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The Theory and Application of Critical Realist Philosophy and Morphogenetic Methodology

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The Theory and Application of Critical Realist Philosophy and Morphogenetic Methodology THE THEORY AND APPLICATION OF CRITICAL REALIST PHILOSOPHY AND MORPHOGENETIC METHODOLOGY: EMERGENT STRUCTURAL AND AGENTIAL RELATIONS AT A HOSPICE MARTIN LIPSCOMB A thesis submitted in partial fulfilment of the requirements of the University of the West of England, Bristol, for the degree of Doctor of Philosophy Faculty of Health and Life Sciences,University of the West of England, Bristol, March 2009 Abstract The theory and application of critical realist philosophy and morphogenetic methodology: emergent structural and agential relations at a hospice. Critical realist philosophy and realist social theory have much to offer nurse researchers and theorists who investigate or comment on the social dimensions of healthcare and health related behaviour. Critical realists argue that witting or, more often, unwitting ontological presumptions about the nature and powers of society and people are embedded in and influence social explanation. Critical realist theory seeks to make overt the logical ties binding ontology with epistemology and methodology. It proposes emergentist and relational rather than conflationary or epiphenomenal descriptions of structure and agency both of which are granted sui generispowers. Critical realist social theory presents a significant challenge to alternative non-realist perspectives. Potentially, it may even permit more accurate and therefore `better' forms of social explanation to be advanced. The thesis is divided into two sections. Section one describes and critiques the realist theories of Roy Bhaskar and Margaret Archer. The deficiencies inherent in non-realist approaches are exposed and a realist alternative is outlined. Thereafter, section two uses Margaret Archer's realist morphogenetic methodology to configure an illustrative study into aspects of hospice activity at one organisation in central England. The illustrative study described in section two exposes both the benefits and is problems that accompany the application of morphogenetic theory. Beneficially, it suggestedthat the explanation of hospice activity presented in this work would not have been available to non-realist researchers. In particular, structural and agential relations are outlined that alternative approaches might have overlooked or misrepresented. Problematically, researchers cannot apply social realism without maintaining an ongoing philosophic or theoretic interest in their objects of study and it is recognised that this continuing commitment places heavy demands upon practically orientated researchers. Acknowledgements I want to acknowledge the unerring good humour, patience and encouragement provided by my beautiful wife Kath and children Harry and Ella throughout the writing of this thesis. The work would not have been completed without your inspired.I support. With all my love, thank you. PS - the Father'sDay presentwas shall treasureit always. I would like to express my gratitude to Professor Margaret fliers (Director of Studies) and Doctor Theresa Mitchell (Supervisor) for their respective contributions. You repeatedly alerted me to weaknessesthat I would otherwise have missed and you have read and re-read my multiple drafts with stoic doggedness.It is a significantly better product for your input (albeit that the corrected `typos' are now less humorous). Thank you. I must thank the hospice, as an organisation, and the individuals who work within it for agreeing to help me in this study. The contribution made to this thesis by the openness of this organisation and kindness of those who work in it cannot be overstated. I thank my employer the University of the West of England. The generosity of this organisation in providing financial support and study time has been of in immense assistance. In particular I would like to thank everyone involved enabling me to access Higher Education Funding Council for England `buy-out' monies. The thesis would have taken considerably longer to finish without the time away from normal work duties that these monies facilitated. Thank Lipscomb (March 2009) you - Martin Contents Abstract Acknowledgements Contents List - acronyms and abbreviations diagrams, List - tables, models and figures Contents Page Introduction Study outline 1 Personal commentary: three motives for undertaking this study iü Realist theory from hospital hospice iv Clinical experience - to to specialist unit Nursing scholarship vi Prior Publication xii Endnotes - Introductionv Section 1 Introduction to Section 1 Realist theory in this thesis 1 Section 1- Chapter 1 Roy Bhaskar '4 Philosophy's purpose 5 6 Terminology and commentary A Realist Theory of Science 8 Humean experience 9 The epistemic fallacy (transitive knowledge and intransitive reality) 12 Closed and open systems 13 Intransitive reality - mechanisms, tendencies and nomic laws 14 Stratification and emergence 16 Transitive knowledge (Kantian idealism and the significance of theory) 18 Ontology and the human sciences 21 Retroduction and retrodiction 23 Conclusion description PN 24 to of RTS - introduction to The Possibility of Naturalism 25 Hume's legacy for the social sciences 27 Hermeneutics and Hume 28 Winch and the linguistic fallacy 29 Agency 31 - reasons as causes The Transformational Model of Social Activity 33 Agency Structure 38 and - relational concepts Internal and external relations 38 Conclusion to description of PN 39 41 Endnotes - §1 Chapter 1 Section 1- Chapter 2 Margaret Archer 47 48 Morphogenetic-Morphostatic Theory - an overview Methodological Theory and ResearchPractice 51 Epiphenomenalism and Elisionism in social explanation (Hume's ghost) 53 Morphogenetic-Morphostatic Theory 58 Metaphors of relation rather than size 59 Social structure in MM theory 61 Cultural structure in MM theory 63 66 Logical relations and situated logics 72 Agency - ontology and MM theory Synchronous and non-synchronous development 74 Conclusion to §1 Chapter 2 76 Endnotes 77 - §1 Chapter 2 Section 1- Chapter 3 Critique and commentary upon the work of Roy Bhaskar 81 Terminological inexactitude 81 Naturalism 88 Retroduction 95 CR in use 96 Retroduction and language 100 Transcendental argument 101 Scientific emancipation 104 Political emancipation 107 111 Situating CR - internal dialogues 113 Situating CR - within realism(s) 115 Situating CR - non-realist perspectives 117 Endnotes - §1 Chapter 3 Section 1- Chapter 4 Critique and commentary upon the work of Margaret Archer 121 The form and ontological status of CS propositions 123 Hypothesis equivalence and CS expositional clarity 126 Proof by effect and relationalstrength 129 The researcher'sposition or role in MM theory 130 Emergence and structural identification 135 Contexts and mechanisms 136 141 Conclusion to critique and commentary upon MM theory 143 Endnotes- §1 Chapter4 Section 2 Section 2- Chapter 1 Theory and Practice 145 Permission to proceed (gaining formal access) 145 Ethical responsibility 146 Ethical 150 responsibility -a critique Data, evidence and theory 159 Interviews, data collection 166 Interviews, data analysis 169 Template analysis 173 Template analysis,aptness for realist research 180 Situating the researcherin the research 181 185 Endnotes - §2 Chapter 1 Section 2- Chapter 2 Study findings 186 The hospice 186 189 Specifying and critiquing T' - T4 timeframes Structures and institutions 194 The County Palliative Care Directorate 195 Divergent interests 196 Challenges to independence 197 NHS palliative consultant hostility 199 Resources 200 Equity 201 The Department of Health 209 Demographic change 211 Conclusion to `Structures and institutions' 214 217 Relations within the hospice Organisational re-designation 217 229 Agents, actors, persons Increasing medical engagement 238 243 Treatments and interventions 249 Preliminary conclusion to `Relations within the hospice' Spirituality-Religion 253 Study site trends 253 Spirituality-religion and secularisation 257 in 258 Meaning suffering - why the anti-change group resist change Endnotes Chapter 264 - §2 2 Conclusion Conclusion Critical realism 267 Morphogenetic theory 268 Realism applied 269 Summation 272 Endnotes - Conclusion 274 References 275-319 Appendices Appendix A: Degree RD1 - Application To Register For A Research Appendix College B: 1 Enrolment letter - Cheltenham and Gloucester of Higher Education (19`hFebruary 2001) Appendix February 2004) B: 2 Transfer - University of Gloucestershire (25`h Appendix C: 1 Enrolment approval - UWE (17`hMay 2004) Appendix C:2 Research degree (10`hJune 2004) registration - UWE Appendix 3 C: Research student transfer - terms and conditions HSC/04/07/11 Appendix C:4 Ethics application approval (retrospective) - Appendix D Letter of approval from study site to proceed with research Appendix E Participant consent form Appendix F Interview guide Appendix G Pre-coding interview summary A: a Appendix H Pre-coding interview summary B: a Appendix I Interview coding process A: a Appendix :j Interview coding process B: a Appendix K Template A: a Appendix L Template B: a Appendix M Master template (all interviews) Appendix N Hospice links with external organizations and professional groups Papers Lipscomb M (2008) Mixed method nursing studies: a critical realist critique. Nursing Philosophy.9 (1), 32-45. Lipscomb M (2007) Maintaining patient hopefulness: a critique. Nur ing Inquiry. 14(4), 335-342. Lipscomb M (2007) Book Review: Jewell A, ed. (2004) Aging, Spirituality and Wellbeing. Nursing Philosophy.8(1), 68-70. Lipscomb M (2006) Book Review: Groff R (2004) Critical Realism, Post-positivism and the Possibility
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