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Working the 'wise’ in speech and language therapy: Evidence-based practice, biopolitics and ‘pastoral labour’

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  • Butler, Clare

Abstract

This paper examines how power and knowledge are involved in the workings of speech and language therapy and in the work of speech and language therapists (SLTs). The paper draws on Foucault for its conceptual frame, with reference to his exposition of governmentality, biopolitics and pastoral power. Based on interviews with thirty-three SLTs in the UK, the findings show that evidence-based practice (EBP) is ever-present in speech and language therapy, despite its apparent absence; and that its power circulates in a multitude of ways. EBP as a process, and not an outcome, was workable. When competent practice was at risk, however, the SLTs challenged the dominance of EBP by saying it needed to ‘get real’ but then were troubled when it did. Working the 'wise’ - those people involved with the client, including the SLTs themselves - was key to speech and language therapy; as was the making of subjects into biopolitical objects. At its most rewarding, but also most personally challenging, the work of SLTs involves mediating between different ways of being in the world and reimagining life, personhood and citizenship; to capture this complex labour process, the paper introduces the term ‘pastoral labour’.

Suggested Citation

  • Butler, Clare, 2019. "Working the 'wise’ in speech and language therapy: Evidence-based practice, biopolitics and ‘pastoral labour’," Social Science & Medicine, Elsevier, vol. 230(C), pages 1-8.
    • Handle: RePEc:eee:socmed:v:230:y:2019:i:c:p:1-8
    DOI: 10.1016/j.socscimed.2019.03.038
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    References listed on IDEAS

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    1. Crawshaw, Paul, 2012. "Governing at a distance: Social marketing and the (bio) politics of responsibility," Social Science & Medicine, Elsevier, vol. 75(1), pages 200-207.
    2. Shih, P. & Worth, H. & Travaglia, J. & Kelly-Hanku, A., 2017. "Pastoral power in HIV prevention: Converging rationalities of care in Christian and medical practices in Papua New Guinea," Social Science & Medicine, Elsevier, vol. 193(C), pages 51-58.
    3. Waring, Justin & Latif, Asam & Boyd, Matthew & Barber, Nick & Elliott, Rachel, 2016. "Pastoral power in the community pharmacy: A Foucauldian analysis of services to promote patient adherence to new medicine use," Social Science & Medicine, Elsevier, vol. 148(C), pages 123-130.
    4. Brosnan, Caragh, 2017. "Alternative futures: Fields, boundaries, and divergent professionalisation strategies within the Chiropractic profession," Social Science & Medicine, Elsevier, vol. 190(C), pages 83-91.
    5. Clare Butler, 2015. "Making interview transcripts real: the reader’s response," Work, Employment & Society, British Sociological Association, vol. 29(1), pages 166-176, February.
    6. Martin, Graham P., 2008. "Representativeness, legitimacy and power in public involvement in health-service management," Social Science & Medicine, Elsevier, vol. 67(11), pages 1757-1765, December.
    7. Lancaster, K. & Seear, K. & Treloar, C. & Ritter, A., 2017. "The productive techniques and constitutive effects of ‘evidence-based policy’ and ‘consumer participation’ discourses in health policy processes," Social Science & Medicine, Elsevier, vol. 176(C), pages 60-68.
    8. Pilgrim, David, 2007. "The survival of psychiatric diagnosis," Social Science & Medicine, Elsevier, vol. 65(3), pages 536-547, August.
    9. Wahlberg, Ayo, 2007. "A quackery with a difference--New medical pluralism and the problem of 'dangerous practitioners' in the United Kingdom," Social Science & Medicine, Elsevier, vol. 65(11), pages 2307-2316, December.
    10. Baeza, Juan I. & Boaz, Annette & Fraser, Alec, 2016. "The roles of specialisation and evidence-based practice in inter-professional jurisdictions: A qualitative study of stroke services in England, Sweden and Poland," Social Science & Medicine, Elsevier, vol. 155(C), pages 15-23.
    11. Greenhalgh, Joanne & Flynn, Rob & Long, Andrew F. & Tyson, Sarah, 2008. "Tacit and encoded knowledge in the use of standardised outcome measures in multidisciplinary team decision making: A case study of in-patient neurorehabilitation," Social Science & Medicine, Elsevier, vol. 67(1), pages 183-194, July.
    12. Broom, Alex & Adams, Jon & Tovey, Philip, 2009. "Evidence-based healthcare in practice: A study of clinician resistance, professional de-skilling, and inter-specialty differentiation in oncology," Social Science & Medicine, Elsevier, vol. 68(1), pages 192-200, January.
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