Monday 23 November 2009

Melancholy, books, and Lobster Risotto

One of my sad duties this week has been to try to make sense of some my books. I'm very old fashioned, I suppose, and believe that the life of a university professor is one that involves books – not as ornaments or signs – but as integral to the work of scholarship. The wonderful new building that is being built for the Institute that I belong to, however, has no space for my books or anyone else's. Indeed, I will have neither bookshelves or private spaces for scholarship. Instead, it is formed through large open plan office spaces - an 'environment' - where I will be able to entertain dynamic relationships with others, sparking off their ideas, find new ways to collaborate, and enjoy the electric excitement of constant collaborative interactions with teams. Sharing an office with 30 other people will bring its own challenges of course, and I'll probably experience these mainly in the business of grant writing and drafting papers and book chapters. These are challenges that, to be frank, cause me a certain amount of anxiety. I've always felt that my modest successes as a researcher – both in generating research income for my own work, and contributing to the generation of income to support others (£17.2 million, to date), and writing (about 180 articles and book chapters) – have stemmed, in great part, from having a private space in which I could read, research, write, and talk to my colleagues without being disturbed or disturbing others. We must embrace change, of course, and there are plenty of reasons why my current accommodation is unsuitable for its present purposes. However, I do envy my colleagues who will get to keep their offices in other parts of the University, and a deep nostalgic regret at the prospect of not having my books at hand to read, and lend, and think about – and of the loss of a private, quiet space in which to talk and work without being disturbed or disturbing others.

So, between now and moving-in day next March, I have to sort through my books and dispose of about 600. Not all can come home. There isn't room in my house. There is, however, an up-side to this which is the process of sorting out in itself. For reasons that I cannot explain, I own a pile of books about Freudian theory. I can't explain this, since I have never taught, written, or even talked about psychoanalysis. They mystify me. And, like about six hundred of their fellows, they are off to universities in the developing world. With them go a number of tomes of Gramscian political philosophy; rigorous interrogations of Heidegger and Foucault; political economies of health, morals, and industry. I feel ashamed about palming off a load of books about the discredited science of Oedipal nonsense, but I can't bear to throw away even books about Freud. Amongst the books I am keeping, I have come across many gems. One example is Leon Eisenberg and Arthur Kleinman's edited collection on The Relevance of Social Science for Medicine (D Reidel: Boston, 1981). This is one of those books that presents in chapters many of the concepts which are now the commonplace and taken-for-granted elements of my discipline. (Rediscovering Andrew Twaddle's chapter on sickness careers in this book, last summer, gave an impetus to the way that I began to try to retheorise the business of illness through the lens of Normalization Process Theory, and so to my contribution to the notion of minimally disruptive medicine.) I saw in last week's BMJ that Leon Eisenberg died the other day. By all accounts he was a 'proper gent' and he was certainly a pioneer spirit in integrating sociology into the medical curriculum. Some years ago I wrote a short paper about the 'invention' of shell shock as a psychiatric condition between 1914-1919, which when it was published in the Journal of the Royal Society of Medicine led to a brief note from Eisenberg. In it he offered some recollections of his clinical work with US army veterans after World War II. They were interesting, but it was the fact that he wrote at all that I enjoyed.

Amongst the other books that I have been looking at are some rather forbidding volumes about sociological Rational Choice Theory. Not the least of these is James Coleman's Foundations of Social Theory (Cambridge: Harvard, 1994). This is a genuinely alarming book, and contains on pp 454-455, the only sociological interpretation that I have come across of CP Snow novel (The Masters, as it happens). These, and some books about economic sociology, exchange theory, and the so-called Micro-Macro problem in sociological theory and analysis, were all drifting towards each other, finally ending up on the same shelf. This was because my Director and colleague Cam Donaldson and I had planned to do some work together to look at the ways in which ideas in medical sociology and health economics might be worked out in ways that would lead to integrated theoretical models. I was rather looking forward to that, because it promised the kinds of theoretical innovation that drive empirical research forwards. However, Cam has announced that he is to leave Newcastle and move to a post at Glasgow Caledonian. Which is another source of the mild melancholy that has overtaken me this evening.

I'm not melancholy about my talk at King's College London last Wednesday, though. I had a terrific time with a very interesting Q&A afterwards. Interestingly, participants at that meeting included NHS managers as well as academics, and they had perceptive and useful questions about our telecare studies and about the application of Normalization Process Theory. In particular, they were interesting in NPT's role as a management tool for thinking through implementation problems. Later, I was taken to dinner at a very nice neighbourhood restaurant in Coin Street, where I had an excellent Lobster Risotto. I recommend RSJ if you venture south of the river. The whole evening was excellent fun, but the night (at the Charing Cross Hotel) was largely spent listening to grim noises from ancient plumbing. Also, someone phoned my room at 04.00 and asked, 'Is that you, gorgeous?' To which I could only say, 'no'.

Sunday 8 November 2009

Time spent with friends



I've been really fortunate to have spent a good deal of time in the company of old friends lately. Last week, in particular, I visited Edinburgh for the second meeting of our NIHR Peer Learning Set for Normalization Process Theory. Last year we met to discuss how we were going to progress the theory, and one of the objectives that we set ourselves was that we would begin to develop an on-line 'users manual' for NPT. Day one of the meeting involved us in reviewing two studies that have pushed the bounds of the theory - work on the experience of depression, led by Chris Dowrick, and Cathy Pope's study of the implementation of NHS Pathways systems for telephone triage. These were important presentations, in part because they suggested how NPT could be a launching point for new conceptual models of processes that are supposed to be well understood, but which are actually much more opaque than we would like to believe. What united these two very different presentations was the way that they touched on the practices - the work - of social construction. This is one of the interesting features of NPT, and it's also one of the problems. Keeping the enterprise within reasonable bounds is a problem for theories of change - in part because change itself raises questions about levels and units of analysis. This is becoming an important focus for the final chapter of the book, Normalizing Health Technologies, that Tracy Finch and I are co-writing. Day one also included a detailed discussion of draft chapters for the NPT on-line users' manual, which is being supported by the ESRC as part of its 'follow-on' funding programme. Shaun Treweek, Tim Rapley, and Frances Mair presented their drafts on clinical trials, qualitative research and systematic reviews, respectively. This was a really congenial day, followed by a good dinner. Day two involved a detailed presentation by Tracy Finch on the operationalization of NPT's constructs, and the development of survey items to measure them. The discussion that followed was important, and our collective work has begun to open up new ways in which NPT can be usefully applied.

As we were having our Edinburgh meeting, the NPM/NPT papers published on-line in BMC Journals passed 20,000 accesses. This is interesting in itself, and I wonder how academic publishing is going to respond to the development of Web 2.0 technologies for dissemination. Or whether it can. One important feature of this is that impact will come to be measured in more than citation counts. These are a really narrow way of assessing engagement with an article or presentation. It also assumes that it is the article that actually matters, when down the line it might be the blog of the article, or the embedded video, or embedded powerpoint, of the article, that are actually the important routes by which research ideas and results are disseminated. Ac

Speaking of dissemination, on 18 November I am giving a seminar at King's College, London. I shall be speaking about problems of implementation and integration of new health technologies, and probably trying out some ideas from the forthcoming book. It's a while since I was last in London, so I'm looking forward to it.