Departures:
The optical metaphor of ”reflexivity” or critical reflection is held centric in most conventional cultural humility frameworks as an essential approach to knowing about the social and researchers/practitioners’ own embeddedness and the social embeddedness of their patients in social-health worlds5. As an approach to knowing, reflexivity suggests the inquiring subject’s capacity to mirror back to themselves the social or physical realities of a context, bodies or objects under consideration. Reflexivity, in other words is ultimately concerned with an analysis that has a fidelity to, or searches for a more authentic engagement with the truth about natural or social phenomena, such as social determinants of health impacting the differential health experiences of patients who hold marginalised social identities28. In this sense, conventional models of cultural humility engage the use of the critically reflexive professional self as a powerful tool for both diagnosing the social-physical truths about the patient’s body and assessing structural expressions of power manifesting in the clinical encounter5. Specifically, critical reflexivity, in this calculous, permits a certain epistemological window into the materiality of the patient’s body and embodied experiences of health/illness as social artifacts produced in and through cultural and social forces, or as natural entities over-layed with cultural, psychical and social interpretation. In both of these senses, reflexivity tends to assume an a priori fixity of the observed phenomena under examination in relation to the socially situated reflexive self29.
Several other ontological - epistemological assumptions about the bodies, subjects and objects encountered in clinical space ground critical reflexivity’s logics: There is an objective status ascribed to the patient’s body and to other non-human material objects. As example, medical instruments, viruses, diagnosing technologies, pharmacological treatments, and various relevant social/cultural factors are understood to be determining of - and thus ontologically separable from - the socio-materiality of the patient’s body and presenting health issues. As consequence, each of these elements are treated analytically and in practice, as knowable (or to be known), stable objects. Epistemologically stabilising the heterogeneous, constitutive elements in a patient’s embodied and psychical life-worlds into recognisable social identity/morphological categories (eg virus, social determinants of health, social categories of race, gender, sexual preference, age, etc), allows for an ease of translation of the differentiated body - scaled at the level of the individual patient - into an evidence based medical knowledge calculus, formulated at the scale of the population. It is in the wake of translation across two different ontological expressions of health subjects/bodies where intervention and treatment plans are articulated with technologically driven governance models of care9.
Critical reflexivity is at the crux of this epistemological operation. And yet, as we have explored, reflexivity as a culturally humble standpoint - because of its human-centricity and its predisposition to invoke binaristic separations between human and non-human elements - isn’t nimble enough to inquire into and assess the emerging problematics of technologised practices of care. The possibility that patient’s knowledges, together with the epidemiological-social categories of risk upon which diagnoses and treatment plans hinge are constituted materially and discursively through the techno-scientific practices of contemporary biomedicine29 is unthinkable in this model of clinical assessment and evaluation. In other words, reflexivity in a cultural humility framework lacks an epistemological interest in looking otherwise at differences. There is a contemporary need to evaluate differences not as ”homologies and analogies between separate entities”29 but as the effects of complex entanglements of discursive and material elements brought into play in the clinical encounter. In addition, a reliance on reflexivity analytically keeps manifestations of technologised health-care knowledge and decision making at a distance from its object of study. Methodologically foreclosed in this analytic is the possibility of considering in what ways practices of reflexivity might themselves be productive of the health phenomenon being observed and evaluated29.