Key Words: Butler; Post-Structuralism; Queer Theory; Power; Performativity; Ethics

Abstract

Judith Butler is one of the most influential late 20th and early 21st century philosophers in regards to left wing politics, as well as an active campaigner for social justice within the US and worldwide. Her academic work has been foundational to the academic discipline of queer theory and has been extensively critiqued and applied across a hugely wide range of disciplines. In addition, Butler’s work itself is extensive covering topics such as gender, sexuality, race, literary theory and warfare. This article can only serve as a taster for the potential application of her work in relation to nursing, which is in its infancy. This introduction covers three of the potentially most productive themes in Butler’s work, namely: power, performativity and ethics. Each of these themes are critically explored in turn, sometimes in relation to their actual application in nursing literature, but also in relation to their potential for producing novel critiques of nursing practice. Suggestions are made about how Butler’s work can develop nursing research and practice. The article concludes with a short summary of Butler’s key works as well as suggested reading for people interested in examining how her theories have been applied across different academic settings.

Key words: Butler; post-structuralism; queer theory; power; performativity; ethics.

Introduction and context

This paper explores the works and theories of one particular author Judith Butler, and how her theories could be used in nursing research, drawing from examples from the author’s own work on the nurse-patient relationship in palliative and supportive care as well as a sample of other literature where Butler’s work is currently being used productively.

Whilst this paper focuses on Butler’s academic writings, her work extends beyond this and some more general background information is useful in providing context to her theoretical ideas. Butler is currently appointed as the Maxine Elliot Professor in the department of comparative literature and the program of critical theory at the University of California, Berkley. Her work as a corpus is problematic to categorise with one label, partly because it spans around 25 years, but also because it has covered a wide range of different subject areas. However, many people have considered her to have been one of the founding theorists in queer theory, and one of the leading thinkers in post-structural, political and feminist philosophy. She came to prominence in part through her rejection of the distinction between sex as a biological construct and gender as a social construct, arguing instead that “perhaps this construct called ‘sex’ is as culturally constructed as gender; indeed, perhaps it was always already gender, with the consequence that the distinction between sex and gender turns out to be no distinction at all” (Butler, 1990, p.10). This was and still remains a radical shift away from other feminist theories on sex and gender, as to put it simply Butler argues that the physical characteristics of bodies cannot automatically be understood as being in a pre-existing state of either male or female, and that understanding the physical anatomy of bodies as sex is infact a social construction, and therefore sex is and always was gender. This rejection of concepts like sex as pre-existing and natural and instead insisting on examining them as socially constructed concepts remains a key feature throughout Butler’s work.

In more recent years Butler has turned to being concerned with engaging in robust critiques of racism, ethics and warfare with particular reference to the Israel-Palestine conflict and the wars in Iraq and Afghanistan. As Butler’s work is so prolific, reviewing each and every book, paper, interview and commentary would be impossible in a journal article. Therefore, this article will focus on three of Butler’s key theoretical areas that run across the majority of her works and are of particular relevance to nursing: power, knowledge and subjectivity; performativity; and ethics.

Power, knowledge and subjectivity

Butler’s understanding of power is heavily influence by Foucault’s work which posits that knowledge is linked to power by using knowledge to regulate the conduct of others and in a reciprocal way power then regulates what is viable as knowledge. As such, power and knowledge then feed on each other becoming indistinguishable (Foucault, 1980). For example, building on the discussion of gender and sex above, Butler suggests that the knowledge about biological characteristics of sex organs exerts power over the definition of gender and legitimists the male-female binary through reference to medical and social norms. In turn this delegitimises other ways of understanding gender such as transgenderism, inter-sex, and non-binary expressions of gender, this frequently results in individuals being classed as deviating from accepted norms and needing some sort of medical or surgical correction. As such power and knowledge produce certain legitimised ways of expressing one’s gender in relation to one’s body; and in line with Foucault this is conceptualised as something that pervades society and subjects, something which Foucault terms capillary forms of power (Foucault, 1980). However, within Foucault’s work it is never quite clear how subjects come into being, instead within all of his work the subjects and social situations that he examines can generally be characterised as consisting of already-acting adult subjects where no account of their entering into the social word is given.

In her book The Psychic Life of Power (Butler, 1997b) Butler moves away from specific discussion of gender, and instead extends Foucauldian theories of power/knowledge in a more generalised way by exploring how power is not only productive of certain ways of being, but is instead foundational to the formation of subjects themselves. For the purposes of Butler’s theories subjectivity can be thought of as a collection of discourses on areas such as sexuality, race, gender, disability/ability, class etc. Importantly, all these discourses will be suffused by power and knowledge legitimising certain discourses over others. As such one must become subjected to the power and knowledge that various discourses convey in order to be understandable and enter into everyday social relations with others, and to fail to do so risks a variety of actions being taken and sanctions being enforced to make one comply. For example, to return to one of Butler’s key concerns gender, genital ambiguity at birth was and still is subject to knowledge about the gender binary which often results in surgery to achieve normative genital presentation. Equally, later on in life gender ambiguity is frequently met with violence and prejudice, thus again (albeit in a different way) sanctioning non-normative gendered ways of being. Finally, in relation to ways in which power and knowledge suffuse gender there are a multitude of ways in which decisions are enforced in line with a male-female gender binary. For example the clothing one wears, going to the ‘right’ toilet, as well as the purchasing of a wide variety of consumer products aimed at either men or women, or girls and boys. As such, people are not entirely free to exercise their gender, instead there is a frequent and pervasive policing of gender norms in society through a variety of institutions and social means. Therefore Butler argues “when we speak about… my gender, as we do (and as we must), we mean something complicated by it. Neither of these is precisely a possession, but both are to be understood as modes of being dispossessed, ways of being for another, or, indeed, by virtue of another.” (Butler, 2004b, p.19). Within this quote Butler is arguing that one “must” speak about gender because of its foundational nature to being recognised as a valid subject. Speaking however is not limited to verbal communications, but instead must be thought about in the broader sense of its meaning; for example, one’s clothes ‘speak’ about one’s gender. Speaking may even be extended to one’s body and how that speaks to gender as Butler argues that genitalia and physical characteristics rather than being natural are instead inscribed by society to be read as being symbolic of male or female identity (Butler, 1990). As such recognition as a valid subject is rooted (at least in part) to performing a gender that is recognisable by others as valid, and as Butler goes onto develop in her work recognition is not merely limited to discourses on gender but to a whole range of contemporary values (all of which are suffused with power and knowledge) that are key to identities in contemporary Western modernity. Therefore, to be recognised by others as a subject requires subjection to power and knowledge which is not initially internal to the self; i.e. no baby is born with a sense of their gender and one cannot speak of ‘my’ gender as the gendering of oneself is inherently reliant on discourses that precede one’s ability to act in a gendered way. However, this interim conclusion should not be understood as saying that power and knowledge determines subjectivity. Instead power and knowledge animate subjects to be able to engage in the social world, a process which Butler refers to as performativity.

Performativity

Central to Butler’s work is the concept of performativity which Butler uses to understand the dynamism between discourse, the power and knowledge conveyed therein, and subjectivity. Performativity can broadly be understood as a constant ‘doing’, a constant ‘performance’ of discourses which are also constantly being observed and understood by others in reference to discourses that are suffused with power and knowledge (Butler and Salih, 2004). Again, consideration of gender can be helpful in exploring this concept. Gender as a performative endeavour recognises that there is no gender that individuals naturally possess. Instead, individuals must perform their gender by virtue of extant discourses which as discussed cover a wide range of areas all of which are suffused with power and knowledge. However, gendering is not a simple or one off task, instead Butler argues it must constantly be performed. For example, wearing an evening gown would be a performance which is commonly read by others as being feminine (and most likely femininity of a certain class). Equally one’s body can perform gender with various aspects of physical anatomy being read by others as being masculine or feminine; despite what one’s own reading may be. As such performing is a requirement which relies on the subject to perform and others to read, but as the performance is constant it requires repetition which leaves it open to the potential for re/deforming discourses in new and imaginative ways as well as being open to contradictory performances when competing discourses contradict one another. As a result of this performativity reconceptualises all concepts traditionally thought of as nouns (such as gender, sexuality and race) into verbs.

A performative approach can also be expanded and taken towards other specific social identities such as nurses. For example, nurses clearly declare that ‘patient choice’ is an important part of quality care (Griggs, 2010). However, if a Butlerian analysis is taken towards ‘choice’ it becomes more than passively declared by nurses but instead is a discourse that (in part) produces and forms nurses (the subjects) involved in its performative production (re)forming both subjects and the discourse of choice itself. Nurses, patients and all other subjects involved in healthcare become (in part at least) performatively produced by the discourse of choice. Such an approach has analytical implications for nursing research as the focus of a performative analysis is not the construction of choice and establishing a static notion of what choice is, but instead how a discourse of choice is produced by and forms subjects. One example of such work is Nordgren (2010) who provides a robust critique of the concept of ‘choice’ in healthcare. By using a performative analysis, Nordgren demonstrates how patients performatively enact a discourse of consumerism therefore becoming responsible for the choices that they make in the healthcare arena reducing the concept of patients as subjects who are vulnerable and needing professional care. As such, discourses that do not fit the power and knowledge conveyed by consumerist ideas of what a patient should be become unviable performances. Such an approach to analysis can help re-examine previously taken for granted ideas, concepts, identities and ‘realities’ by assuming that they are not de facto but instead continually produced. What is at stake in Nordgren’s analysis is not only what defines a patient but why patients must identify with certain discourses over others and how this is reinforced by wider forms of power and knowledge. As such, when considering social relations from a performative perspective, all discourses that are produced must have social effects by virtue of needing to be repeatable and understandable by others who can therefore go onto repeat them (Butler, 1997a). For example in nursing even cases of abuse can help produce nursing practice as they set the boundaries of what is and isn’t nursing practice; abuse is not (or should not) be repeatable but what constitutes abuse is not easily predefined and instead is a constantly shifting discursive boundary in reference to the power and knowledge that circulates about nursing. Conversely, if a nurse were to give medications as prescribed to a patient this action is intelligible and is therefore repeatable.

However, just as power and knowledge are not deterministic, nor is Butler’s theory of performativity, there remains potential for a blending and merging of different performances to produce novel ways of being with in society at large. For example, recent qualitative work by Nagington et al (2013) took a performative approach to patients and carers views of palliative and supportive district nursing. Nagington et al trace how in recent history discourses of efficiency have become increasingly pervasive in modern healthcare with nurses frequently being described as ‘busy’ or ‘overworked’ in the media. However, on an institutional level busyness is not what is being aimed for, instead there is a broad aim to operate in an ‘efficient’ manner. This then becomes operationalised through various measures such as readmission rates to hospitals and gross number of patients seen per day which must be constantly maintained and improved. However, the policing of these measures to improve means that to be inefficient may result in one’s contract being revoked; effectively making one an unviable nursing subject. Much of this is tied to the neoliberal marketization of healthcare which requires measurements to be produced and efficiency to be strived for. However, the power and knowledge that forms neoliberal discourses of healthcare which claims to improve quality of care when examined in a performative way can be read as having the unexpected effect of doing the opposite because the discourses of efficiency (re)forms the nurses’ identity by patients reading nurses not as efficient, but instead busy. The patient and carer subjectivity therefore then becomes (re)formed in relation to a busy (not an efficient) district nurse, this in turn results in docile patients and carers who do not explore additional or alternative forms of district nursing because nurses were perceived as busy, yet because boundaries of district nursing care were never tested district nurses were perceived as able to do anything. This ultimately resulted in patients and carers not receiving care for needs that they had and disallowed patients to identify as more than just people with physical needs. A more traditional thematic analysis would have often stopped at the level of district nurses being perceived as ‘doing anything’ and thus offering high quality care. However, a performative analysis of the empirical data allows a linking of the broader social discourses tracing the ways in which it enacts and subjugates through the exercising of power. This example therefore serves to show how performances are open to alternative interpretations by others, and meanings are not fixed but instead rely on a complex and constantly maintained set of discourses that produce meaning through extant power and knowledge.