Empowerment and dilemmas of expertise

Consider, for example, a person with a back problem. What should she do to seek treatment? If she were in Britain, she might go to see a general practitioner under the auspices of the National Health Service. The general practitioner might refer her to a specialist, who may perhaps offer recommendations or provide services which satisfy her. But it could easily happen that she finds that nothing the specialist is able to do offers much help in alleviating the condition. The diagnosis of problems to do with the back is notoriously problematic, and most of the forms of treatment available are controversial both within the medical profession and outside. Some medical specialists, for example, recommend operating on disc ruptures. Yet there are studies indicating that patients with the disc problem concerned are almost as likely to recover without surgery as they are with it. There are large differences between different countries in respect of this issue. Thus the number of patients per thousand for whom operations are recommended for disc troubles in the United States is ten times as high as in Britain, this difference representing,

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among other things, a variation in generic philosophies of how best to treat back problems between the two countries. If she chooses to inquire further, our patient will discover that within orthodox medical circles there are major differences of opinion about operating techniques, even when an invasive treatment has been agreed on as the best strategy. For instance, some surgeons favour microsurgery over more established spinal surgical procedures.

Investigating a little more deeply, the patient would discover that a variety of other modes of back therapy, held by their proponents to cover ruptured discs as well as many other transitory and more chronic back conditions, are available. These therapies differ not only in the forms of treatment they offer, but in respect of the interpretations they provide of the causal origins of back pains and pathologies. Osteopathy is based on rather different principles from those followed by chiropractors. Each of these orientations also contains competing schools. Other available forms of back treatment include physiotherapy, massage, acupuncture, exercise therapy, reflexology, systems of postural adjustment like the Alexander Method, drug therapies, diet therapies, hands-on healing -- and no doubt other therapeutic methods also. One school of thought holds that the vast majority of back problems, including many of a quite serious nature, have their origins in psychosomatic stress, and should therefore be treated by remedying the sources of stress, rather than concentrating directly on the back itself. According to such schools of thought, psychotherapy, meditation, yoga, bio-feedback techniques and other modes of relaxation, or a combination of these, provide the best means of treatment.

At this point the patient might quite reasonably decide that enough is enough and resolve to inform herself about the nature of her complaint and the vying remedies for it. Many non-technical books about the back are available on the popular market. Most give an interpretation of the general state of medical knowledge about the spine and try to provide an informed guide to the competing therapies available. There is, of course, considerable agreement among otherwise differing authorities about the structural anatomy of the body. It would not take long for the sufferer to master a basic understanding of the structural problems which may affect the back. Reskilling/

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appropriation would be possible fairly readily in that she could learn about at least the outlines of the different treatments available and how they compare with those suggested by the original specialist. Deciding which to opt for, if any, would be more difficult because she would need to balance off the various claims made by the different approaches. There is no overarching authority to whom she might turn -- a characteristic dilemma of many situations in conditions of high modernity.

Yet if such a person takes the trouble to reskill appropriately, a reasonably informed choice can in fact be made. All such choices are not simply behavioural options: they tend to refract back upon, and be mobilised to develop, the narrative of self-identity. A decision to go along with conventional or high-tech medicine, for example, is likely to be only partly a matter of informed choice: ordinarily it also `says something' about a person's lifestyle. It may mean that an individual is following a fairly pre-established pattern of behaviour, perhaps coupled to certain forms of deference. This might be the case if a person goes to see the general practitioner and then the specialist recommended, and simply follows whatever that specialist suggests, in deference to them both as authoritative members of the medical profession. To opt for a form of alternative medicine, particularly of one of the more esoteric varieties, might signal something about, and actually contribute to, certain lifestyle decisions which a person then enacts.

In most such decisions, conceptions of fortuna, fatalism, pragmatism and conscious risk-taking are likely to be mingled together. Since experts so frequently disagree, even professionals at the core of a given field of expertise may very well find themselves in much the same position as a layperson confronting a similar decision. In a system without final authorities, even the most cherished beliefs underlining expert systems are open to revision, and quite commonly they are regularly altered. Empowerment is routinely available to laypeople as part of the reflexivity of modernity, but there are often problems about how such empowerment becomes translated into convictions and into action. A certain element of fortuna, or of fatalism, thus allows a person to `ride along with' a decision which can only be partially warranted in the light of whatever local and expert information is to hand.

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Date: 2016-04-22; view: 662