I am affiliated as a visiting scholar at the Harvard T.H. Chan School of Public Health 2018-2019. In this post I write about the reason for this and the work I have conducted during my visiting scholar stay here in Cambridge, MA.
In the summer of 2017 I had started to draft an idea of a social theoretical contribution regarding how the notion of agency (in its sociological connotation) stratifies people in policies of health. I realized that I would not be able to rest until I had this “theory” figured out.
I visited Boston for a work meeting in July 2017 and immediately saw that this was an environment for me to get away from my daily work and start focusing on the writing. I met people from BU and Harvard and other places, but when I came home I started to Google Boston area-based sociologists with an interested in health policy questions from an institutional perspective.
Jason Beckfield’s work caught my eye due to his articulated engagement in health-related stratification and institutional dimensions of health and, importantly, the fact that he had cooperated with Sigrun Olafsdottir. Olafsdottir’s work on the cultural and societal systemic seating of medicalization was familiar from before and it closely relates to my focus. Beckfield was likely to appreciate my epistemic adherence and scope. In the end of the year 2017 Beckfield recommended some visiting programs to apply to and since he was the Associate Director at the Harvard Center for Population and Development Studies (the Pop Center) I thought this would be the one that suited me best.
The main aim for my visit was to proceed in the book project on the Agency-based structuring principles in governance of addictions and lifestyles. Another, just as important aim was to develop new contacts and possible new cooperation. As a third aim I had to just proceed in the existing projects that I lead in Helsinki. I decided to take my leadership tasks with me since it proved difficult to get a substitution for such a short time.
The book project proceeds
The idea for the book was to draw upon the research that I have conducted over the years and by discussing it in a dialogue with social and cultural theory trying to formulate a social theory on how agency has become a compass construct for policies in the fields of health, lifestyles, addictions and such.
The project has proceeded steadily, and except for a 2 week break in October, rather rapidly. Towards the end of November (at the time of writing this report) the manuscript is starting to take the shape that it is likely to have, or at least resemble, in its final version.
Initially I structured the book in three parts. I began by presenting the theory, and after that I adhered it to the existing work by myself and others, and in the third part I suggested some new approaches for doing the research. In the beginning of October I restructured the outline completely: the book now follows three parts of the theoretical discussion with three bundles of adherent hypotheses. These are: the stratifying function of agency constructs; the illusion of a biological and/ or knowledge-based disentanglement of agency, and, a new political representation view on agency as capacity.
The change in the structure makes it a more difficult project that will demand more time and energy from me, but it will become a better book. An important push in this direction might have come from a trip that I did to Yale in New Haven in late September. I met with Gideon Yaffe, whose work on agency and addiction was familiar to me from before. I presented to him my thoughts and it encouraged me to acknowledge to myself that I might be on the right path in my thinking. After this trip I felt a bit more bold and credible in my reasoning.
From the start, I knew that I just had to go through the existing social theory and empirical work that was of relevance to the discussion I was taking on. Important basics that we have used in our previous research are for example Ian Hacking’s work on interactive constructs, and the cultural seating of health questions (e.g. such as Olafsdottir’s work). I thought that I could not take my usual Foucauldianish perspective, as Foucault has been seen as quite firm in rejecting agency and autonomy. This was a great dilemma, since the knowledge/power concepts are so important for my work. This started to bother me also as a scholarly identity-question. What am I really doing? What is my contribution to the deliberation that is supposedly taking social sciences and societies further and evolving our understanding of what is happening in the world?
I like to think that my scope as a researcher is something like: “The study of developments of societal and cultural understandings of people and problems across time and space”. I ask: In what ways do cultural constructs, power and knowledge push questions [regards lifestyles, mental health and addictions] in different directions? How does this change over time and how does it differ between societies? What does it mean for societies on a systemic and principle level?
How was this even possible by not drawing on Foucault? A great breakthrough came when I realized that (a) agency in my agency theory is approached as a construct, not as something that I study in “real life”. An important circumstance was also (b) the re-reading of Mark Bevir’s text on agency in Foucault (Foucault and Critique. Developing Agency against Autonomy, 1999). The governmentality theory was already permeating the whole book manuscript and it was just for me to integrate Bevir’s understanding of a “moderate” Foucault reading that would scaffold it enough to keep it all together.
To summarize: there is a lot of thinking and writing left before the book is finalized, but it feels better now when I know that I am somewhat on the right path and that I will be able to finalize it (whenever this will happen, I hope, in the near future.)
Networking and establishing cooperation
The new contacts and cooperation at the Pop center have unfolded naturally due to the fact that I sit here every day. At the Center I am a bit of an odd bird being qualitatively focused and working on a theoretical project. It seems I have no natural point of reference for plugging into to the project work conducted here (someone said it is hard also for those who have this!).
A thematic area in the Pop center research environment at the moment that I felt I could relate to in the sense of wandering into new landscapes of understandings and new thought patterns were the work on Machine Learning presented by fellow Nordic researchers Adel Daoud and Fredrik Johansson (MIT). Their presentations served as an impetus for imagining the uses for ML in future societies. Especially considering the great transformations that all European health and welfare systems are undergoing, and an enhanced interest in AI, this area should be discussed from a principle level: What sort of knowledge in democratic institutions, stakeholder interests and professional practice is needed for getting the most valuable parts out of ML techniques in the field of health and welfare?
Another cooperation initiative that I took all too late during my stay was to discuss with faculty member Mary Waters about an article on qualitative coding and Grounded Theory that I saw that she had co-authored. I would like to initiate some sort of network of methodological discussion regarding how qualitative methods are used in health studies. Qualitative research is a difficult craftsmanship that is often conducted quite poorly. A great deal of the qualitative public health research is too descriptive and crucial argumentation and writing do not live up to the standard needed. At their best, qualitative projects and articles resemble nothing that has been conducted before. This is the complete opposite to traditions in which empirical and theoretical contributions are reproduced, added, and copied, building on existing knowledge aiming to construct stronger and stronger platforms of evidence, drilling further and further into a phenomenon.
It was not until I visited the Yale Law School (amidst the crazy Kavanaugh hearings-time!!) that I understood that my epistemic and scope-based focus is in the US ordered somewhere in the crossing point between ethics, law, philosophy, history and health policy. In Finland, as in most European countries, the court system is non-partisan and does not play a big concrete role in political life and executive power. Instead we have a very autonomous executive power (I do not mean the authorian Trump-variant). This means that ministries and departments play real “political” roles in the welfare state, but without a particularly articulated party-adherence (there are partisan department posts, but not comparable to the US system). This can work and be accomplished due to the consensus striving policy culture and a general belief in centralized collective solutions (which is now being de-emphasized due to neolib-trends). Anyway: in America my material for studying the systemic and principle aspects of policy-making and institutions of the welfare state would have to be more concerned with law and courts and principles in this area (cf. drug courts!! A good example!).
A valuable contact in Boston was the Boston University School of Public Health (BUSPH) and Richard Saitz, who is a medical addiction scholar, and a close colleague in the International Society for Addiction Journal Editors (ISAJE). The SPH arranges on a regular basis so called Dean’s seminars of which there were two really interesting ones during fall 2018: One was on vested interest (with my brilliant colleague Sally Casswell from New Zealand) and industry conflicts of interest, and the other one was on cannabis policy more generally and specifically in Massachusetts. The latter seminar really helped me understand how valuable and generalizable the Nordic research on alcohol and gambling policies is also for cannabis policies.
I had hoped that I was going to be able to study more closely (and with better material) the opioid crisis during my stay in the US. However, for my book, the most important input was suggested to me by Pop center colleague Onur Altindag concerning the increased mortality and ill health trends in white less-educated Americans (the now classic work by Case & Deaton 2015; 2017). This work also supported my agency theory: towards the end of the 2017-paper the authors speculate about the reasons to the trends that they are witnessing, and they take up some circumstances not only regards substance use and lifestyles, but concerning self-identity on a group level. This is interesting for me to read, as it confirms that there is a need for an understanding of the concept of agency as orienting us in policies and also concretely in our actual health-related behaviors.
In November I attended the Starr Forum seminar arranged by the MIT Center for International Studies. The seminar discussed populist trends in Brazil, Turkey, India and the USA. This event also served as an important impetus and inspiration for my work in that leading populist researcher Pippa Norris confirmed that political division lines are no longer built around classic left-right wing divisions, and that constructs and views on matters by certain age groups and generations are really what we should focus our attention on in case we want to understand where our political developments / societies are heading.
In the middle of November I guest-lectured at Uconn Health in Hartford about some research that I have been leading in the field on alcohol and gambling marketing. The lecture went really well. During my stay I started discussions with Helen Wu and my host and close colleague and friend Thomas Babor regarding a potential online course in addiction studies that I could import and adjust to the Nordics. Babor also had great ideas on a new dissertation project that I am supervising, and on the cannabis policy project that I am initiating.
The last week of my stay I visited the Center for Mental Health and Addiciton (CAMH) in Toronto (20-21.11.2018) to consult on a protocol that we are developing for a focus group study that is part of the international A-BRAIN consortium. The material is being gathered in early 2019.
Ongoing projects
In my ongoing research projects that I brought with me it has been “business as usual”. Some are in the protocol developing stage and some are in the reporting stage. Three achievements that are worth mentioning from my Harvard stay as they were, I think, innovative or “smart” in some way or another: I came up with a semiotic analyses model for an analysis on how so called native marketing on gambling through “journalistic” winner stories serve the gambling industry. I think this is valuable proof (or at least a first step) for understanding this cultural phenomenon’s impact on gambling’s societal position (and its anchorage in people’s fantasies and dreams!). Second, I came up with a way to use Luhmann’s concept of autopoiesis for understanding how the Ministerial bodies concerned with channeling funding to Civil Society are really just reproducing their own existence. This might be valuable insight from a democracy perspective: What is the state-governed Nordic Civi Society really all about, and what will be its role in the future? During my stay, I also re-submitted an article in which I had used applied ontology as an analytical approach. I think that this can maybe be an approach valuable for my future work on how knowledge/power push and orient our understandings of questions.
Last but not least: The Pop center administration and help with practicalities, direct daily support and work atmosphere has been really fantastic in every way. I cannot stress enough how grateful I am for my stay here, how fond I have become of everybody and how sad I am to leave. I have used the Widener Library as a crazy person who has no boundaries whatsoever. I have borrowed around 40 books and had lengthy visits in the catacombs. I will miss this library so much.
Signing off and heading home!
Cambridge, Massachusetts, 24 Nov 2018
Matilda Hellman
