In her book Meeting the Universe Halfway: Quantum Physics and the Entanglement of Matter and Meaning Karen Barad asserts that knowledge making is not a mediated activity. Although I am persuaded, a recent conversation about my (ongoing) doctoral research prompted my companion to counter, “But your data suggest otherwise.”
In my study about the emergence of professional knowing in paediatric diabetes, I am finding that digital technologies participate in very important ways. I am researching professional knowing by examining the conditions and practices through which it comes into being. This approach includes focusing on the entangled nature of human knowing and the material arrangements for knowing. In the case of paediatric diabetes, the particular tools and technologies of treatment are part of these arrangements.
Digital technologies, in the form of insulin pumps (also known as Continuous Subcutaneous Insulin Infusion), initiate changed practices of knowing. Software packages replace handwritten notes; lengths of plastic tubing inserted into the abdomen replace injection pens and needles; and calculations of insulin doses rely on the digital technology inside the insulin pump. There are too many other patterns of difference to include them all here.
My companion’s point, I think, is that professional knowing is in fact mediated through these material arrangements: the insulin pump, for example, mediates knowledge-making in very particular ways. This makes sense but Barad makes a different point, and as I said, I am persuaded.
Barad’s argument hinges on the recognition that this is not a case of professional knowing mediated differently. Instead, she claims that the professional knowing is different. Hers is a point of ontology. So for example, the challenge of making theoretical knowledge translate into practical knowledge is reframed by conceptualising the knowings as different. The issue is not how to get the same knowing to work in different spaces and arrangements – the issue is that different knowings are configured by different spaces and arrangements. The professional knowing that is configured by the insulin pump is not the same knowing configured differently by the injection pens. The insulin pump configures a professional knowing that is ontologically different.
In a different study two newly qualified (Foundation Year 1) doctors talking about their first jobs put it like this,
“Yeah, medical school doesn’t really prepare you for being an FY1, it’s completely different you know…I knew what to do, I just didn’t know how to do actually do it; I wasn’t prepared in any practical sense at all.”
“Exactly! Like the bradycardia I saw the other day…I knew as a medical student that I needed to give atropine but I had never actually seen it, never drawn it up, never had to actually give it, so that knowledge isn’t in a form you can use it.” (Tallentire et al, 2011)
The knowings are ontologically different, and it matters. The material arrangements for knowing are reconfigured to include for example not just the diagnosis and the name and dose of the required medication (atropine), but also the fine-grained details of administering the medication. This reconfigured newly qualified professional knowing includes myriad ‘doings’. A small selection of those implied by the doctor in this extract include breaking the glass vial, assembling the needle and syringe, checking and rechecking patient identity, prescription, medication and dose, withdrawing the atropine from the ampoule into the syringe, and expelling air bubbles from the solution.
This way of thinking is a significant shift, because it suggests professional knowing is not just differently mediated through different materials. Instead, the professional knowing itself is materially different. Professional knowing materialises differently as a consequence of the different material arrangements for knowing.
So for now, I think I’m with Karen Barad. Knowledge making is not a mediated activity. Knowing is a specific engagement of the world: a direct material engagement.
About the image: Diabetes Google doodle image by Jen Jacobs (November 2013 post) on her blog Life, Art and Diabetes Jen was diagnosed with type 1 diabetes at age twelve and makes diabetes art as well as writing about diabetes.
Thanks to Dr Michelle Arora (Fellow in Medical Education, University of Edinburgh) for her discussion of atropine administration.
Barad, K. (2007) Meeting the Universe Halfway: Entanglements of Matter and Meaning. Durham, NC: Duke University Press
Tallentire, V.; Smith, S.; Skinner, J. & Cameron, H. (2011) Understanding the Behaviour of Newly Qualified Doctors in Acute Care Contexts. Medical Education. Vol. 45 pp.995-1005
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