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.