POSTMODERNITY

POSTMODERNITY/ISM

• Postmodernity – a historical period; current economic climate, structural changes– Implications for medicine & health

• Welfare state (liberalism) to remobilzation of liberal arguments for individual responsibility (neoliberalism)

• Reflected in epidemiology• -ism – a “discourse”

Modern/ity/ism/ization• Modernity -- historical condition, process, a

characteristic period -- a post-traditional order – rupture

• Modernism -- a practice, usage, expression peculiar to modern times– Modernism as cultural project that renew symbolic

practices with an experimental or critical sense• Modernization as a socioeconomic process that tries to

construct modernity; the act of modernizing; the state of being modernized

• reflexivity of modernity– the susceptibility of most aspects of social activity, and

material relations with nature, to chronic revision in the light of new info or knowledge

• Implications for health

The promise of the enlightenment, the promise of the modern

• Unending era of material progress & prosperity

• Abolition of prejudice & superstition• Mastery of the forces of nature based on the

expansion of human knowledge• Laws of development & social sciences• The costs of becoming modern -- the

discontents – alienation; estrangement; anomie; iron cage;

neurotoxic effects of modern, urban life

Postmodernism• Postmodern as incredulity (challenging) toward meta-narratives• contemporary rejection of all overarching or totalizing modes of

thought that tell universalist stories (Marxism, Christianity, ‘scientific progress’).

• Metanarratives operate through strategies of exclusion and inclusion, marshalling and homogenizing heterogeneity into ordered realms – Postmodernists are suspicious of authoritative definitions and singular

narratives of any trajectory of events• the increasing sound of a plurality of voices from the margins, with

an insistence on difference, on cultural diversity and on claims of heterogeneity over homogeneity.– Fragmentation– celebrates the multiple, incompatible, heterogeneous, fragmented,

contradictory nature of postmodern society• No linguistic normality — we can only produce pastiche

(heteroglossia), partial truths

Hasan: The Culture of Postmodernism

Modernism Postmodernism Purpose play Design chance Hierarchy anarchy art object, finished work process, performance, creation, totalization decreation, deconstruction Presence absence Centering dispersal genre, boundary text, intertext Semantics rhetoric lisible (readerly) scriptible (writerly) Narrative anti-narrative grande histoire petite histoire master code idiolect origin, cause difference-difference, trace Determinacy indeterminacy Transcendence immanence

Postmodernity

• Changes in capitlaist society over past 30 years• Decline of industrial sector, working class,

unionization, & occupation as source of identity• Weakening of distinction between public &

private sectors– With associated gender division of labor

• Increased focus on the individual• Reflexivity of social identity – construct our own

biographies

Liberalism, Neoliberalism, Health in Capitalist Society

• Liberalism & welfare state capitalism– Liberalism emphasizes individual rights and equality of opportunity– Different forms of liberalism may propose very different policies– Liberalism rejected many foundational assumptions that dominated most

earlier theories of government, such as the Divine Right of Kings, hereditary status, and established religion

• Liberalism: two major streams of thought which compete over the use of the term "liberal" – Classical liberals: only real freedom is freedom from coercion

• state intervention in the economy as a coercive power that restricts the economic freedom of individuals and favor a laissez-faire economic policy

• oppose the welfare state– Social liberals: governments must take an active role in promoting the

freedom of citizens• real freedom can exist only when citizens are healthy, educated, and free from dire

poverty• Government ensures the right to an education, the right to health care, and the

right to a minimum wage.

Liberalism, Neoliberalism, Health in Capitalist Society

• Structuralist basis of welfare state capitalism undermined by decline of industrial sector & globalization of capitalist investment strategies

• State policy now directed at control over costs (rather than provisions) & quantity of health care

• Medicine caught between state & market• From production to consumption as foundation

of class formation in capitalist society

Liberalism, Neoliberalism, Health in Capitalist Society

• Neoliberalism– move from a bureaucratic welfare-based society

toward a meritocracy acting in the interests of business

– based on individual and economic liberty• Health & health care consequences– Individual centric– Achieved health– Decentralization in the organization/delivery of health

care• Privatization of costs & services

Postmodern health

• Social/economic/political cultural Inequality “increasing”

• Resurgence of patterns of infectious disease• Increasing mortality rates among the poorist• Dying of diseases of affluence in 20th cent.

now dying from poverty• Individual risk and “risk society”

From Modern to Post-/Risk Society

epidemiology• Originally a part of public

health – “people’s health; the study of/the knowledge of the distribution of health in a population

• Used to plan & evaluate strategies to prevent illness

• Guide to the management of patients in whom disease has already developed

Epi- of Risk and Lifestyle• Contemporary focus on “susceptibility”

– Predisposition & risk• Inherited flaw• Aversion by adopting a careful/moderate way of life

• Epi & Risk– Prevalence of disorders & diseases among different sectors of

the population – differentiated by age, gender, ethnicity, family, history, weight, diet, use of alcohol/cigarettes/drugs

– Use of risk scales to assess likelihood of an individual developing a disorder

• The allocations of risk categories• The dream of contemporary diagnostics of susceptibility

– Identifications – way of life; genetics

Type 2 Diabetes – the quintessential postmodern condition

• Idea of susceptibility brings potential futures into the present

• The subject of calculation (biopower)• The object of remedial intervention

(education; reflexivity)• Individual must optimize their life chances• New forms of life taking shape in the age of

susceptibility (risk society)