T R A N S D I S C I P L I N A R Y S T U D I E S T R A N S D I S C I P L I N A R Y S T U D I E S

Ontologies for Developing Things

Ontologies for Developing Things

Making Health Care Futures Through Technology
Ontologies for
Casper Bruun Jensen Developing Things
IT University of Copenhagen, Denmark

Ontologies for Developing Things offers a series of conceptually inventive analyses of

the future-making processes put in motion in contemporary health care systems with
Making Health Care Futures Through
the introduction of electronic patient records and other communication technologies.
The book shows how such technological development and implementation processes are
Technology
bound up with multiple other issues: professional, social, economic and political. Through
such processes health care ontologies gradually change, often with unanticipated effects.
In analyzing these effects, Jensen offers a highly innovative interpretation of where
science and technology studies could be headed - towards performative, non- humanist
Casper Bruun Jensen
modes of inquiry.

Casper Bruun Jensen is one of the most intellectually accomplished and creative theorists
of second-generation Science and Technology Studies (STS) as well as one of the most
active and productive researchers in the field. In Ontologies for Developing Things, he offers
a series of highly original delineations and vigorous defenses of recent developments--or,
as he calls them dispositions--in STS (ontological, performative, pragmatist, and so
forth) through a series of parallel narrations of his own onsite studies of the introduction
of new medical-information technologies in Denmark and Canada.
Ontologies for Developing Things is a work of unflagging intelligence and intellectual
energy, spilling over with new ideas, surprising angles, sharp perceptions and interesting
juxtapositions, and written with correspondingly attractive punch and force. Readers
interested in information technologies, contemporary developments in social studies of
science, and related cultural and political theory will find the book immensely engaging
and endlessly useful. - Barbara Herrnstein Smith, Duke University and Brown University
[author of Scandalous Knowledge: Science Truth and the Human and Natural Reflections:
Casper Bruun Jensen
Human Cognition at the Nexus of Science and Religion]

This superb book is all of empirically rich, politically engaged, ontologically profound
and lucid. Any three of the four makes a very good book; all four makes an outstanding
one. - Geoffrey C. Bowker, Professor in Cyberscholarship, University of Pittsburg (Author
of Sorting Things Out: Classification and Its Consequences (With Susan Leigh Star) and
Memory Practices in the Sciences).

SensePublishers
SensePublishers TDSS 03
Ontologies for Developing Things
TRANSDISCIPLINARY STUDIES
Volume 03

Series editor
Jeremy Hunsinger, University of Illinois, Chicago
Jason Nolan, Ryerson University, Toronto, Canada

Editorial board
Megan Boler, University of Toronto, Canada
Geoffrey C. Bowker, Pittsburgh University, USA
Timothy W. Luke, Virginia Polytechnic Institute and State University
Wendy Martin, Claremont Graduate School, USA
Helga Nowotny, Wissenschaftszentrum Wien (Science Center Vienna), Austria
Joel Weiss, University of Toronto

Scope
Transdisciplinary Studies is an internationally oriented book series created to generate
new theories and practices to extricate transdisciplinary learning and research from
the confining discourses of traditional disciplinarities. Within transdisciplinary
domains, this series publishes empirically grounded, theoretically sound work that
seeks to identify and solve global problems that conventional disciplinary perspectives
cannot capture. Transdisciplinary Studies seeks to accentuate those aspects of
scholarly research which cut across todays learned disciplines in an effort to define
the new axiologies and forms of praxis that are transforming contemporary learning.
This series intends to promote a new appreciation for transdisciplinary research to
audiences that are seeking ways of understanding complex, global problems that
many now realize disciplinary perspectives cannot fully address. Teachers, scholars,
policy makers, educators and researchers working to address issues in technology
studies, education, public finance, discourse studies, professional ethics, political
analysis, learning, ecological systems, modern medicine, and other fields clearly
are ready to begin investing in transdisciplinary models of research. It is for those
many different audiences in these diverse fields that we hope to reach, not merely
with topical research, but also through considering new epistemic and ontological
foundations for of transdisciplinary research. We hope this series will exemplify
the global transformations of education and learning across the disciplines for years
to come.
Ontologies for Developing Things

Making Health Care Futures Through Technology

Casper Bruun Jensen

IT University of Copenhagen, Denmark

SENSE PUBLISHERS
ROTTERDAM/BOSTON/TAIPEI
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 TABLE OF CONTENTS

Acknowledgments and Reading Guide .................................................................. vii

Preface..................................................................................................................... xi

1. An Amodern Disposition: On Performativity, Practical Ontology,

and Intervention................................................................................................... 1

2. Researching Partially Existing Objects: Ontologies for Developing Things ..... 19

3. The Birth of a Future-Generating Device: On Electronic Patient Records

and Expectations................................................................................................ 31

4. Traveling Standards ........................................................................................... 51

5. Citizen Projects and Consensus Building at the Danish Board of

Technology: On Experiments in Democracy..................................................... 69

6. Infrastructural Fractals: Re-Visiting the Micro-Macro Distinction in

Social Theory..................................................................................................... 85

7. Sorting Attachments and the Multiplicity of Usefulness ................................. 101

8. Power, Technology and Medical Sociology: An Infrastructural Inversion ..... 119

9. Established Sentiments, Alternative Agendas, and Politics of

Concretization.................................................................................................. 137

Bibliography......................................................................................................... 157

Index .................................................................................................................... 169

v
 ACKNOWLEDGMENTS AND READING GUIDE

This book is the result of research that began while I was a Ph.D.-student at the
Department of Information-and Media Studies at the University of Aarhus, Denmark
between 20012004. Originally, Finn Olesen and Randi Markussen introduced me
to science and technology studies and they, as well as, Andrew Pickering inspired
me to start these studies. And engagement with members of the emerging now
flourishing STS environment in Denmark, especially Peter Lauritsen, Christopher
Gad, Brit Ross Winthereik and Signe Vikkels, continued to provide inspiration.
My philosophical interests were nourished as a visiting researcher at Don Ihdes
Technoscience Research Seminar, at the State University of New York, Stony Brook,
and in ongoing conversations with Evan M. Selinger. Later, my constructivist
tendencies (and capabilities, such as they may be) were strengthened as a research
fellow at the Center for Interdisciplinary Studies in Science and Cultural Theory at
Duke University, under the supervision of Barbara Herrnstein Smith and through
discussions with Geoffrey C. Bowker, Steven D. Brown and Isabelle Stengers.
One of the recurrent themes of the book is the normativity and politics of
constructivist STS. This topic was the focus of two workshops, one in Amsterdam,
one in Aarhus, and a special issue of Science as Culture that I organized and edited
with Teun Zuiderent-Jerak. Id like to thank him, as well as the participants in the
workshops and Nina Boulus for their inputs and thoughts.
Finally, I would like to thank Jeremy Hunsinger for his encouragement and the
staff at Sense Publishers for their assistance.
Many chapters have been presented in different formats and to different audiences.
Chapter one An Amodern Disposition: On Performativity, Practical Ontology,
and Intervention was originally published as A Non-Humanist Disposition: On
Performativity, Practical Ontology, and Intervention in Configurations vol. 12.
22961, 2004. Reprinted by permission of The Johns Hopkins University Press.
Chapter two, Researching Partially Existing Objects: Ontology for Developing
Things was first published in the Center for STS-studies at the University of
Aarhus working paper series no. 4. Reprinted by permission of the Center for STS-
Studies at the University of Aarhus.
Chapter three The Birth of a Future-Generating Device was first presented as
An Experiment in Performative History: The Electronic Patient Record as a Future-
Generating Device, at the Public Proofs: Science, Technology and Democracy,
4S/EASST 2004, Ecole des Mines de Paris, August 2004. It was published in
a significantly different form as An Experiment in Performative History: The Danish
Electronic Patient Record as a Future-Generating Device. Social Studies of Science.
Vol. 35 No. 2, 24167. 2005. Copyright Sage Publications 2005, by Permission of
Sage Publications Ltd. The current version draws additionally on presentations made
at the conference for the Danish Association of Science and Technology Studies,
rhus, June 2008 and at the 4S/EASST conference Acting with Science, Technology
and Medicine, Rotterdam, The Netherlands, August 2008.

vii
ACKNOWLEDGMENTS AND READING GUIDE

Chapter four Traveling Standards was presented as The Standardisation

Debates on Danish Electronic Patient Records: Handling a Differend in Practice,
at the EASST 2002 conference Responsibility Under Uncertainty, University
of York, UK, July 2002 and at the Infrastructures for Digital Communication
graduate conference, University of California, San Diego, January 2003. It was
first published in the Center for STS-studies at the University of Aarhus working
paper series no. 8. It is reprinted by permission of the Center for STS-Studies at the
University of Aarhus.
Chapter five on Citizen Projects and Consensus-Building was presented at the
workshop at Science Studies and Sociology, University of Madison, Wisconsin,
February 2003 and at the workshop on Technologies of Nature-Politics, held at
the Center for Technology, Innovation and Culture, University of Oslo, February
2006. It has been published as part of the EU-frame program STAGE in
R. Hagendijk, P. Healey, M. Horst and A. Irwin (eds) Science, Technology and
Governance in Europe: Challenges of Public Engagement. Stage (EU FP5: contract
HPSE-CT2001-50003) Final Report, February 2005 and in Acta Sociologica.
Special issue on Science, Power, and Democracy.Vol. 48 No. 3. 22135. 2005.
Copyright Sage Publications 2005, by Permission of Sage Publications Ltd.
Chapter six Infrastructural Fractals was first published Infrastructural Fractals:
Re-visiting the Micro-Macro Distinction in Social Theory. Environment and
Planning D: Society and Space. Vol. 25 No. 5. 83250. 2007. Reprinted by per-
mission of Pion Ltd, London.
Chapter seven Sorting Attachments and the Multiplicity of Usefulness
integrates discussion from the paper Sorting Attachments: On Interventions and
Usefulness in STS and Health Policy, Practices of Assessment and Intervention in
Action-Oriented Science and Technology Studies, Amsterdam, April 2005 and
published as Sorting Attachments: Usefulness of STS in Health Care Practice and
Policy. Science as Culture Vol. 16 No. 3 (Special issue: Unpacking Intervention
in Science and Technology Studies. 23753. 2007, reprinted by permission of
Routledge, and the paper Description as Inquiry and Experimentation: On the
Multiplicity of Usefulness in/of Ethnographic Practice. prepared for the What is
the point of description panel convened by Marilyn Strathern for the Description
and creativity: Approaches to collaboration and value from anthropology, art,
science, and technology conference, Kings College, Cambridge, U.K., July 35,
2005.
Chapter eight, Power, Technology and Social Studies of Health Care: An
Infrastructural Inversion was originally published in Health Care Analysis Vol. 16
No. 4. 15574, 2008. It is reprinted with kind permission from Springer Science+
Business Media.
Finally, chapter nine, Established Sentiments, Alternative Agendas and Politics
of Concretization was presented at the Department for the History of Conscious-
ness, University of California, Santa Cruz. It was published in Configurations
Vol. 14 No. 3. 21744. 2006. Reprinted by permission of the John Hopkins
University Press.

viii
 ACKNOWLEDGMENTS AND READING GUIDE

The book is organized as follows: Chapter one provides an analytical background

and introduces several key concepts relating to amodern, nonhumanist studies
of science and technology. Chapter two offers a brief (anti-)methodological
discussion of how to study ontologies for developing things. Chapters three to six
are empirically oriented towards processes and controversies relating to the
development of electronic patient records (EPRs) in Denmark. Chapter three gives
a brief historical account of the EPR and analyzes the emergence of this technology
as a future-generating device. Chapter four considers questions of standardization
and their entwinement with social, political and economic issues. Chapter five
follows the EPR as it became an object of democratic debate and inquiry at the
Danish Board of Technology. Chapter six revisits some of the previously encountered
empirical scenes and offers an argument that the researcher might make better
sense of them by avoiding the loaded categories of micro- and macro-studies, instead
tracing infrastructural fractals. Chapter seven and eight are based on empirical
work conducted at a Canadian hospital. In chapter seven I make use of experiences
as action-oriented researcher in order to articulate the job of the contemporary
social researchers as one of sorting attachments. This chapter critically engages
the question of how STS (and other social sciences) might be useful and relevant.
Chapter eight uses material from a technology implementation project to consider
the role of power and its relation to technology in social studies of health care.
Finally, chapter nine, offers a kind of incomplete synthesis of the main analytical
themes that have run through the book. Rather than becoming useful or relevant, but
also instead of criticizing the powerful, or giving voice, the chapter argues that
studies of ontologies for developing things, should be conducted in a way so as
not to hinder becoming.

ix
 PREFACE

There is a certain genre of books that issue an invitation to the reader to a particular
field or area of study. These Invitation to X books promise to open up a hitherto
unexplored vista of learning. The author acts as a guide, or better yet as an insider,
welcoming the reader into their inner circle: stick with me kid, Ill show you
around. Invitations come, of course, with strings attached. To accept such an
invitation is to agree to the assumption that the author has a privileged perspective,
that they can provide an overview of matters as they actually are from the
perspective of those who are able to see them properly. Backstage: exclusive.
This book offers no such invitations. One of its central tenets is instead no
promises. This is to say that whilst this is certainly an inviting text, which
welcomes the reader into a habitable world, rich in possibilities, there is no
pretence that this is a neutral guidebook for the perplexed. In part this is because
the field which the author describes Science and Technology Studies (STS)
does not really lend itself to rapid survey. Emerging from the ashes of the Sociology
of Scientific Knowledge, a discipline that now only exists in the kaleidoscopic
afterlife given to it by Malcolm Ashmores The Reflexive Thesis, STS is the point
where philosophy, anthropology and sociology meet together in the shadow cast by
the exact sciences. As such, writing in the STS is typically a prime candidate for
what Marilyn Strathern refers to as blurred genres. Her contrast case, which the
text approvingly cites, is with complex trajectories. It is one of the many
accomplishments of this book to exemplify this elusive distinction.
What STS lacks in terms of clear disciplinary foundations is more than made up
for by a certain kind of modishness. This is clearly evident in the work of the best
known representative of STS, Bruno Latour, who is also one of the most renowned
stylists in contemporary social science, and with whom a significant proportion of
this book is both explicitly and implicitly in dialogue. Casper Bruun Jensen, too,
demonstrates impeccably good taste and discernment in his choice and use of
theory. Readers in search of discussion around concepts-de-jour like performativity,
the turn to ontology, assemblages, cyborgs will find immediate gratification in
what follows. But at the same time, the text is marked by a kind of classicism.
Longstanding debates around the micro-macro distinction, the practicality of
social science as a vocation and the nature of power are revisited. This is done
not because the author promises finally! to offer a neat resolution, but because
these debates take on a new tenor and importance in the course of following the
particular objects and relations which form the bulk of the research in this text. The
text is a sort of key change where the melodies of social scientific enquiry are
intensified and refreshed.
It is traditional in social science to operate in a mode of last person standing.
One obliterates ones potential rivals and interlocutors as part of the ritual of
laying out the groundwork. This tendency towards total critique makes for a good
spectacle, but perhaps not for a very satisfying resolution. There is very little
blunderbuss critique on offer here. In fact, the text for the most part follows

xi
PREFACE

Isabelle Stengers call to respect established sentiments. This much misunderstood

phrase makes it sound as though analysis ought to confine itself to commentary or
elaboration in this case of current technological advances in public medicine. But
as Casper Bruun Jensen shows it is best understood as recognition that any critical
engagement with an object of study cannot begin with a questioning of its right to
exist. Whatever our views might be of the viability or the ethics of an Electronic
Patient Record and with the rapidly advancing field of medical informatics, it
already is, it has a concrete existence and set of capacities which are not negated
by any supposedly critical discourse. The question is rather what can be connected
to (and indeed disconnected from) the mass of relations and actors for which the
term electronic patient record is shorthand.
A rejection of total critique does not, however, mean a refusal to judge. There
are incisive discussions of contemporary work and strong positions taken on what
it is to do STS in a performative mode. Judgement and evaluation are not idle
reflective matters but central to how this texts lives, how it breathes. If, as Latour
declaims, existence is action, then for a text to exist it must endeavour to persist
through selecting, connecting and acting in concert with the scholarly, professional
and public worlds into which it is cast. From a performative perspective, no text,
no body, no actant can survive on its own. Its merits are to be judged on the basis
of the particular kind of existence which means a web of relations it can
fashion for itself.
Performativity is central to what Casper Bruun Jensen occasionally refers to as
non-humanist STS. The choice of prefix is interesting. Anti-humanism, for
example, defines a critical attitude to the supposed legacy of the European
humanist tradition. Whilst many of the writers discussed in the text have a
relationship to this critical move, it does not figure as a substantive issue here.
Similarly, post-humanism, concerns itself with the decidedly unnatural state of
the human brought about by technological change. Again, despite strong affinities
with the general shape of the argument, the text does not dwell on this often
hackneyed debate. So why non-humanism? The term recognises that the human
subject no longer occupies what Foucault by way of Velasquez described as the
place of the king. It also takes for granted the interdependency between people
and things. The difference concerns instead what follows from this recognition of
complexity. Questions of social justice, of creating and fostering liveable lives
remain despite the lack of sovereign subject to whom these questions might
typically be referred. Non-humanism then promotes the ethical and the evaluative,
it asks which kinds of assemblies of relations between people and things we wish
to support, what kinds of lives are worth living (where the category of life is not
reserved for humans alone). In this sense non-humanism might also be called
alternate humanism insofar as it carries forward the experiential and emancipatory
dynamic of humanism beyond its established confines.
Non-humanism is a practical matter. Drawing on the work of Isabelle Stengers,
Casper Bruun Jensen uses the term experiment to refer to the making and
breaking of connections. In this sense any newly proposed arrangement of relations
such as that between patients, doctors, nurses and medical technologies is an

xii
 PREFACE

experiment, an attempt to explore what these actors can jointly do to and with one
another when they are brought together. Make one further step: what the analyst
does is not so much describe an experiment, but add a further element to that
weave of relations. Description becomes part of the experiment, it opens it out in
a further direction and expands further its capacity to connect. If this is so then the
bar is raised for what counts as adequate description.
Gilbert Ryle famously demonstrated that in order to capture what is at stake in
the simple gesture of a winking eye a thick description of the myriad social
relations that might potentially be enacted in that moment was necessary. Ryles
example is properly philosophical in the sense that is concerns no-one in particular
in a space outside of any definite cultural or historical location. When thick
description is applied to actual empirical cases as demonstrated by Clifford
Geertz the practical difficulties of this philosophical parlour game become
rapidly apparent. Just how thick should the description be? Where does one start?
When can one stop? The task that STS scholars such as Casper Bruun Jensen set
themselves makes the questions even more urgent, since the field they enter is no
longer clearly bounded by geography or by social relations. The electronic patient
record is an actor (or rather endless strings of actors) that displays a kind of
topological complexity in terms of social relations. Social topologies, complex
trajectories, technological realities and imaginaries: this is the stuff of STS.
Amongst this shifting array of actors and actions one is hard pressed to locate the
winking eye that can serve as cornerstone for analysis. What is done instead is to
propose a variety of starting points. These are not chosen at random, but rather
carefully selected, or, we might say, invented, on the basis of sorts of connections
and vectors they afford. The method is to always multiply and expand the
empirical object, to treat it as a crystal which reproduces, but also complexifies its
structure as it grows at its edges. In so doing analysis becomes one of those edges.
The empirical object acts through the analysis, which becomes part of its existence.
In this book Casper Bruun Jensen does not just describe, he winks back at the
technologies engaged. He conducts analysis as though it were a process of
invention, repeated over and again on the field until it grows connections on every
side. We might call this a work of thick invention. It is a set of experiments
which thinks with and through its object, which seek to create a form of life with it.
The book does not it cannot promise what the outcome will be. That is in our
hands as readers and fellow experimenters who can take and tinker with this fine
text as we see fit.

Professor Steven D. Brown, University of Leicester, UK

xiii
 CHAPTER 1

AN AMODERN DISPOSITION
On Performativity, Practical Ontology, and Intervention

How to turn an opposition into a possible matter of contrast? Obviously, this

is not only a question of goodwill. My guess is that we may do so through
the experimental extension of the specific risks that singularize each position.
Giving a chance for contrasts to be created where oppositions rule implies
producing a middle ground but not a medium or average mitigating differ-
ences. It should be a middle ground for testing, in order that the contrasts
evolve not from tamed differences but from creatively redefined ones. (Stengers,
2002: 2367)
Science and technology studies (STS) today can be viewed as a relatively stable
enterprise, with its own conferences, journals, professional organizations, and
graduate programs. With Bruno Latour, one could talk about the black-boxing1
of STS. Yet, characterising a study as in STS, does not determine its features
very predictably because the field of inquiry, is heterogeneous as regards the
assumptions, theories, institutional affiliations, methods, approaches, goals, and
interests of its practitioners. For this reason Michael Lynch and Kathleen Jordans
term translucent box is probably more fitting (Jordan and Lynch, 1992: 207; also
Ramsey, 1992: 284).
Undoubtedly, this diversity and differentiation makes any one description of STS
problematic. As has been argued, disciplinary looseness is often an asset, rather
than a weakness for developing disciplines and practices (e.g. Clarke and Fujimura,
1992) that are inevitably shaped in the historically contingent interactions between
multiple kinds of actors with different agendas and aspirations. The gesture of
presenting the chapters that follow as a strong case of STS, by emphasising the
coherent theoretical basis on which it is built thus reproduces an idea with which
STS itself has regularly taken issue; that the unified position of a scientific
community is necessarily a measure of the epistemological merit of that community,
and therefore conveys, or at least ought to convey, additional credibility to the
statements of its members.2
Rather than unification, several debates that may be observed within and around
STS bears resemblance to what Barbara Herrnstein Smith has called microdynamics
of incommensurability. Their familiar frustrations are exemplified as follows: You
cant argue with these people, says one. They dont play by the rules; they
challenge every word you say. Its like talking to a brick wall, says the other.
They dont hear a word you say; they keep repeating the same arguments
(Smith, 1997: xii). Smith proposes that such stalemates are often not due to simple

1
CHAPTER 1

misunderstanding or to differences in vocabulary, but are rather symptomatic of

systematically interrelated divergences of conceptualization, that emerge at every
level and operate across an entire intellectual domain. (Smith, 1997: 131).
Within and around STS, such divergences display themselves with especial
vigor in relation to recently emerging agendas revolving around such notions as
performativity and practical ontology, the activation of objects as nonhuman
actors, and questions relating to the politics, normativity, interventionism, activism
and usefulness of the field. Put together, the performative and ontological re-
orientation in the understanding of the content and stakes of STS can be seen as
characterizing a amodern and non-humanist disposition (rather than an theory,
for performative reasons, to which I will return); one which has been particularly
(but not exclusively) inspired by post-structuralism and pragmatism.
Criticisms of various aspects of such a disposition have been expressed particularly
in terms of normative worries, and accusations of political abdication (e.g. Radder
1998, Winner 1993, Woodhouse et al 2002). In view of such criticism, I believe an
important task lies in articulating the considerable potentials, in terms of both
alternative conceptualizations and interventions that amodern, nonhumanists STS may
hold for understanding the role of technology in contemporary health care organi-
zations and in social life more broadly. This is a key issue in the following chapters.
The aspiration to analyze these relations is captured in the book title Ontologies for
Developing Things, for reasons that will hopefully become clear. The analytical
disposition underpinning this venture, and some of its theoretical implications, are
outlined in this chapter., which draws upon a range of ideas from writers such as
Donna Haraway, Andrew Pickering, and Bruno Latour, which have various affinities
with poststructuralists such as Gilles Deleuze, Michel Foucault and Michel Serres.
All of these people are not talking about precisely the same issues and they are not
saying exactly the same things; it is not, therefore, my interest to try to integrate all of
them in a common, eclectic framework. Instead, I take my cue from philosopher of
science Isabelle Stengers who, in the introductory citation, wonders about how to turn
differences or, indeed, antagonistic oppositions into productive intellectual contrasts.
And she suggests that a solution could be found in experimentally processing sets of
positions through each other. Productivity would be created at the middle-ground,
where no position would be able to silence any other, and where differences would
therefore have to be respected, rather than made to disappear (either by force or by
consensus; which is often a more invidious force since it is rarely recognized as such).
The latter qualification is important, because it emphasizes that tolerance of
alternative perspectives is not necessarily, certainly not always, the ideal. Speci-
fically, it means that in the following I am not prevented from noting and, indeed,
going some lengths to stress amodern disagreements with a number of positions
within STS and more broadly. This is due to the assumption that it is only by
painstakingly working to clarify differences, rather than glossing them in the name of
a pluralistic good-will that a serious evaluation of the possibilities, limits, and
implications of amodern STS-studies can be attempted.
In what follows, I concentrate in particular on the shift from a representational
to a performative idiom for analyzing scientific and technological processes, and

2
 AN AMODERN DISPOSITION

the closely related switch from an interest in epistemology to a concern with

understanding how ontologies are shaped through practical action. I present an
analysis of what such changes entail in terms of theory, but this question imme-
diately leads to a consideration of what they imply in terms of practice, politics,
and intervention for, of course, the performative argument is that such distinctions
cannot in general be upheld. I sum up by considering what one may and may not
hope for from amodern STS-studies in practical terms.
What follows may thus be seen as an experiment in the expansion of relevant
resources for STS-theorising. The set of ideas outlined here are put to the test in
subsequent chapters. Of course, whether they survive that test is for the reader to
decide. In any case, rather than presenting a history of increasing theoretical
sophistication, for example from Mannheim (1952) and Merton (1968) to Latour
(1987) and Haraway (1989), via Kuhn (1970) and Feyerabend (1993), Bloor (1976),
Collins (1985) and numerous other important figures, I offer here a kind of theoretical
assemblage, drawing selectively on multiple figures without, I hope, unnecessarily
disfiguring them in the process.

THE PRACTICE-TURN IN SCIENCE AND TECHNOLOGY STUDIES

As indicated by the name science and technology studies, researchers in this field
have been interested in closely investigating differing aspects and relationships in
the extremely broad sphere of contemporary life which has to do with science and
technology (e.g. Bowker and Star, 1999; Pickering, 1995) They have done so from
numerous perspectives and with numerous approaches (e.g. Traweek 1993). One
fairly generally acknowledged change that has occurred in these studies over the
last decades, is from focusing exclusively on the content3 of science to focusing on
the intertwining of content with multiple practical and material aspects of
laboratory life (e.g. Pickering, 1992; Schatzki, Knorr Cetina et al 2001).
Obviously, the practical and material effects of scientific knowledge, the
technologies whose invention it has enabled, and the many applications it has made
possible, have been regularly taken as establishing the superiority of Western science
over all other systems of inquiry. However, the practice-turn in recent socio-cultural
inquiries into science and technology refers to a quite different phenomenon, which
is in an important sense corrective to the received view: that if it works it must be
true. For it has focused not only on material effects as they are enabled by scientific
ideas, but also on the material, practical, and institutional aspects as they participate
in the construction of scientific content. This change of emphasis, which has been
driven by empirical inquiries into the way science is practically carried out, has been
of consequence for discussions about epistemology and ontology.

CHALLENGING EPISTEMOLOGY

Epistemology is usually seen to concern itself with investigating the foundations of

certain knowledge. This inquiry has been very generally premised on the idea of a
split between the ideal and the concrete, and prioritized the abstract capabilities of
the mind over the inadequacies of the body. It has also been recognized that scientific

3
CHAPTER 1

ideas are generated in the interaction with obdurate materials with unknown qualities,
and for this reason a prominent concern of epistemology has been with purifying
science from the many biases that could potentially invalidate its knowledge in this
interaction. Epistemology thus tries to establish an ideal relationship between the
level of scientific ideas and the level of their practical validation and application, and
in this project it has consistently prioritized theory over practice. In contemporary
epistemology this purification has been typically managed by invocation of the
scientific method, which, if properly applied, has been seen as the guarantee of
knowledge claims. In recent years claims pertaining to the absoluteness or univer-
sality of such claims have been toned down somewhat, and often the emphasis is now
on securing the least fallible knowledge. Yet, the claim to be able to (unequivocally)
determine what is least fallible continues to rely on an idea of an external standard,
which allows one to measure and determine which kinds of knowledge are more and
less secure.
The classical epistemological ambition is regularly presented as a defence against
the contamination of knowledge claims, for instance by the partisanship or local
provincialism of their producers. The analytic philosopher Paul Boghossian, in a recent
polemic against constructivism in general and Barbara Herrnstein Smith in
particular (one, which, incidentally, vividly illustrates Smiths analysis of micro-
dynamics of incommensurability), offers the following description:
What matters to epistemology are three things: first, the claim that only some
considerations can genuinely justify a belief, namely, those that bear on its
truth, second, a substantive conception of the sorts of considerations that
quality for this normative statusobservational evidence and logic, for
example, but not a persons political commitments; and finally, the claim that
we do sometimes believe something because there are considerations that
justify it and not as a result of some other cause, such as because it would
serve our interests to do so (Boghossian, 2002: 218)
Another example is afforded by John Searles The Construction of Social Reality,
which has less interest in defending epistemology per se, yet leaves no doubt about
the undiminished importance of such classical notions as evidence, objectivity,
reality, and truth:
Having knowledge consists in having true representations for which we can
give certain sorts of justification or evidence. Knowledge is thus by definition
objective in the epistemic sense, because the criteria for knowledge are not
arbitrary, and they are impersonal (Searle, 1995: 151).
Undoubtedly the understanding of what exactly counts as proper evidence, objectivity
and truth varies between analytic philosophers, including Boghossian and Searle, as
does, therefore, interpretations of what the scientific method would consist in, and
how to properly make use of it. Certainly, analytic philosophers would also contend
that the differences between the positions of Boghossian and Searle are substantial.
However, what remains in the background of these debates is the assumption
that traditional notions of evidence, objectivity, reality, and truth cannot be done
without; not, at least, without inviting epistemological catastrophe. The challenge

4
 AN AMODERN DISPOSITION

posed to classical epistemology by STS-research has therefore been much more

severe than internal epistemological quarrels. For in insisting on the participation
of practical and material effects in the production of knowledge, these studies have
problematized many of the key-distinctions and relations in epistemology; notably
between knowledge and power and between (scientific) ideas and their (technical)
concretizations. By doing so they have ineluctably challenged the central episte-
mological ambition to guarantee the possibility of formulating true, in the sense of
reliably decontextualized, statements about the world. This challenge of construc-
tivism is of wide-ranging ramifications for the conceptualization of science,
technology, society and their interrelationships and, in this context, for articulating
ontologies for developing things.

PRINCIPLES OF SYMMETRY

These ramifications are themselves variably reviewed depending upon the strand
of STS-studies of ones adherence (such as, for instance, standpoint feminism,
sociology of scientific knowledge, social epistemology, symbolic interactionism,
cultural anthropological studies of science or actor-network theory). Many of these
studies would in principle agree with the famous symmetry doctrine, formulated by
sociologist of science David Bloor, which proposes that statements that we take to
be true and statements that we take to be false should be accounted for with the
same set of explanatory devices (Bloor, 1976: 243). But what is viewed as following
from this doctrine is highly variable.
Michel Callon and Bruno Latour accepted the general outline of Bloorian
symmetry but extended, or generalized it (Callon, 1986; Callon and Latour 1992).
Their suggestion was that, as well as symmetry between the truth or falsehood of
statements, analysts need to be symmetrical with respect to the question of who
acts in shaping the world. Famously, their suggestion was that not only humans
act. It is as often the case that humans are acted on by other nonhuman actors.
If this is the case the aspiration to offer a sociological analysis of science and
technology is limiting, since society can offer no stable explanatory framework for
scientific and technological development. Instead, generalized symmetry posits a
situation in which society and nature is constructed in the same process. Contrary
to what is sometimes imputed this has nothing to do with arguing that humans and
technologies are somehow the same. Instead, generalized symmetry can be viewed
as a methodical insurance policy against taking for granted any preconceived notion
of who has the power to act. It thus multiplies the potentially relevant actors and
force attention on their differences and relations. The aspiration is to thereby facilitate
more nuanced analyses of how humans and things (broadly construed) together
create, stabilized and change worlds. Analyses, in other words, that are sensitive to
human and nonhuman activities as practical ontology: efforts to concretely shape
and interrelate the components that make up the worlds they inhabit.
Of course, general symmetry and its implied turn to ontology has not gone
unchallenged. In the famous chicken debate between sociologists of science
Harry Collins and Steven Yearley, reflexivist Steve Woolgar, and actor-network
theorists Bruno Latour and Michel Callon, the former formulated one important

5
CHAPTER 1

version of the consequences of adopting a constructivist stance in the exploration

of science. Collins and Yearley suggested a dualistic model, referred to as meta-
alternation, in order to account for how one could take seriously both the realist
findings of scientific research and the constructivist findings of science studies
research. The idea was that the sociologist (promiscuously) develops the ability
to switch between different frames of reference, viewing each setting as displaying
but one set of beliefs among many. (Collins and Yearley 1992: 301). Yet, according
to Collins and Yearley, this was a merely analytical stance, for one cannot,
presumably, be a constructivist in everyday life:
In spite of this achievement, all of us, however sophisticated, can switch to
modes of knowing that allow us to catch buses and hold mortgages. We all
engage as a matter of fact in which we might call meta-alternation (302)
According to Collins and Yearley one necessarily ceases to be a social constructivist
the moment one enters the bus or pays mortgages, because one cannot doubt that it
will safely carry one home from work. While social constructivism as intellectual
endeavour is aligned with doubt and illusion (its job being to pull the veil from
science) one must be a realist in everyday life, and especially so with respect to
objects of scientific inquiry.
The stance of meta-alternation was defined in part to discredit the actor-network
idea that non-human things such as scallops should be granted agency. It enabled
Collins and Yearley to query how one could really acquire knowledge of non-
human capacities, and it suggested that one could not, except by becoming a
scientist:
In any case, the complicity of the scallops (or whatever), if it is to play a part
in accounts of this sort, ought to be properly recorded. How is the complicity
of scallops to be measured? There is only one way we know of measuring the
complicity of scallops, and that is by appropriate scientific research. If we are
really to enter scallop behavior into our explanatory equations, then Callon
must demonstrate his scientific credentials. He must show that he has a firm
grip on the nature of scallops. There is not the slightest reason for us to
accept his opinions on the nature of scallops if he is any less than a scallop
expert than the researchers he describes. In fact, we readers would prefer him
to be more of a scallop expert than the others if he is to speak authoritatively
on the subject (316)
In matters scientific, we have no better bet than taking at face value the pronounce-
ments of experts since they, but not we, are the specialists in their respective areas.
All this sounds quite humble. However, when it comes to explaining the means of
achieving agreement on scientific matters, authority should be deferred to the
sociologist of science, since this is his area of expertise. This model thus gives to
the scientist with the one hand the epistemic authority (realism about non-humans),
which it seeks to remove with the other (constructivism about scientists realism
about non-humans). On the one hand the epistemological realist position of science
is granted, but it is then doubled by the position of the sociologist, who is able to

6
 AN AMODERN DISPOSITION

show how realism is really the result of the open and negotiable work of scientists
(but not of the open and negotiable work of natural entities). Although Collins and
Yearley conclude that Of course we cannot claim epistemological authority
either.We can only compete on even terms for our share of the world with all the
usual weapons, (324) this share takes on significant proportions, as the final say in
epistemic matters is conferred back to the sociologist who really knows how
science works.
Similar double-movements of endorsing radical (anti-)epistemological principles
while refraining to acknowledge their implications at the time when they would
apply to one-self, a strategy which Barbara Herrnstein Smith has referred to as
cutting-edge equivocation, (Smith, 2002) are found in a number of STS-studies
that claim to offer specific kinds of political leverage in their engagements with
technological practices, such as the ability to criticize or resist the status quo. It is
thus worthwhile considering in more detail what are the critical or political
implications of general symmetry. To do so it is necessary to take a closer look at
the relation between performativity and practical ontology.

FROM EPISTEMOLOGY AND REPRESENTATION TO PRACTICAL ONTOLOGY

AND PERFORMATIVITY

In the view here presented and worked with in subsequent chapters it will be
suggested that the challenge of generalized symmetry is intimately bound up with
a move from an epistemological approach to one focusing on practical ontology, and
from a representational to a performative idiom in the understanding of science. The
gist of this change can be nicely summarized in a formulation of Bruno Latour,
Essence is Existence and Existence is Action, (Latour, 1999: 179) but its philo-
sophical history can be traced, at least in some of their interpretations, to Greek
philosophers such as Heraclitus and Lucretius, to Leibniz and Spinoza, to Friedrich
Nietzsche and A. N. Whitehead and, unsurprisingly, to different radical thinkers in
recent French philosophy who, in effect, have worked to re-interpret several of the
above-mentioned; I think here in particular of Gilles Deleuze (1983, 1990, 1993),
Michel Foucault (1984, 1984a), and Michel Serres (1982, 2000).
Essence is Existence. This is a claim which denies the purity of the ideal and
refers all there is, in the first instance, to the material world. Existence is Action.
But what exists? We do not know, at least not comprehensively, or not yet. But what
this formulation suggests is that we can try to find out; for, often enough, action and
activity is empirically observable. Not, however, as something simply out there. For
as scientists well know it is only through an organized and co-ordinated effort, using
multiple machines and other things as mediators, that different entities become able
to reliably express themselves. The enabling by humans of such expressive
displays can be characterized as events because of their unforeseeable character.4
The implication of this view is that novel aspects of the world (in the shape, for
instance, of new effects, particles, or phenomena) can be articulated in the laboratory
only because of the constellation of the particular forces that constitute the given
experiment by which they are shaped and through which they emerge. As such

7
CHAPTER 1

articulation takes place at the intersection of the (sets of ) forces, which we regularly
categorize as observers, instruments, and the natural world, the distinctions
among these forces and the properties that go with them themselves become
problematic and are turned into topics for investigation, rather than taken for
granted as resources in the investigation of science and technology.
We have returned to the issue of generalized symmetry, for the implication of
the discussion above is that STS needs to develop models and concepts to account
for the fact that there are large differences between the effects of beliefs. In Callon
and Latours original formulations, the stabilization (legitimation, institutionalisation)
of some set of beliefs and practices rather than others is crucially dependent on the
successful delegation of actions and responsibilities to non-human actors, and their
consequent practical re-definitions or translations. This move is related to Andrew
Pickerings suggested emphasis on the performative dimension of science. As he
explains, the representational idiom casts science as, above all, an activity that
maps, mirrors, or corresponds to how the world really is (Pickering, 1995: 5). But,
Pickering continues, there is quite another way of thinking about science; one,
which starts from the idea that the world is doing things, and is therefore, first of
all, full of agency. This idea is the starting point for a performative analysis of
scientific practice, in which science is regarded a field of powers, capacities, and
performances, situated in machinic captures of material agency. (7).
For some time researchers in cultural studies, social anthropology, and qualitative
sociology have told sophisticated stories about the artful work needed to successfully
integrate the many different and sometimes contradictory exigencies of stabilizing
social identities in multiple technologically mediated formations. In recent years
these stories have been extended to also cover the social formations involved in
techno-scientific production, and this has been one important strand in the depurifica-
tion of contemporary understandings of science. But what happens when non-humans
are added to the collectives to be described?
Perhaps a first experience is one of increased complexity. Indeed, in some
research in cultural studies and STS the delight in making visible complexity seems
to overshadow the question of what productive differences such re-description could
render pertinent. Another perspective would view the notion of complexity as a
lure for feeling, with the capability of generating new, different and, perhaps,
harder questions for us to answer about sciences and society. This is the proposal
of Isabelle Stengers:
As for the notion of complexity, it sets out problems we dont know a priori
what sum of parts means and this problem implies that we cannot treat,
under the pretext that they have the same parts, all the sums according to
the same general method (Stengers, 1997: 123)
In her suggestion, noticing complexity is the mere beginning of the process of
understanding and transforming relations between the sciences and society. It is
a necessary beginning, however, because relevant questions regarding a given
situation can only be formulated if the situation has first been de-composed into
enough divergent elements to prevent its simple evaluation.

8
 AN AMODERN DISPOSITION

POWER AND COALITIONS

Today, most technological-social innovations affect things in much more

varied modes than those anticipated by our questions, and thus create a gap
between things, as they are implicated in it, and their scientific representation
(Stengers, 2000: 158)
Surely a lesson that has been well learned in the past century is that scientific
innovations are effective in a multiplicity of ways, only a small number of which
are anticipated (Fortun, 2001; Mackenzie, 1990; Perrow, 1999). Stengers is not the
first, or only, scholar to point to the fact. In the domain of the human sciences,
for instance, Michel Foucault, analyzed and described the multiple socio-political
effects, for better and worse, of the invention of modern medicine, psychiatry, and
criminology (e.g. Foucault, 1973, 1991). In this work he has pre-figured, as well as
functioned as a tremendous inspiration for, research in STS and numerous other
disciplines. In order to take up the challenge of Isabelle Stengers; how to respond
inventively to the fact that non-human actors are increasingly brought to bear on
our lives in ways we not only do not, but probably cannot anticipate, some of
Foucaults sociopolitical ideas could prove useful.
Foucaults political thinking was concerned, among other things, with how to
cut off the kings head, (Foucault, 2001: 121) by which he meant constructing
a mode of political analysis, which would not primarily be organized about the
classical themes of sovereignty and law, and which would consequently not have to
imagine that power comes from above.5 Instead he would be interested in the
play of power as instantiated in myriad microprocesses throughout the social
field. In different analyses Foucault showed how sets of practices were slowly and
painstakingly composed, not least through the stabilization of specific discourses,
even though no common interests between their constituents existed prior to their
engagements. Power (as efficacy of action) seemed thus not to be inherent in some
actors (and not others), but rather to be always in the making. By considering
socio-politics from this transformative viewpoint; as having to do with the
composition of coalitions out of heterogeneous elements, rather than as having to
do with stable formations with specific pre-defined interests and powers, Foucault
could view the construction of disciplinary and institutional matrices as intentional
but non-subjective, rather than enforced by the presumptively powerful (Foucault,
1990, esp. chapter two).
This conclusion, based in historical analysis, also functioned as a practical
heuristics in Foucaults own political engagements. Since, in Foucaults phrase
power is everywhere, but inherently unstable and transformative (as it is shaped
in the ongoing interactions between practices, discourses, institutions etc.) to resist
specific functions of power, one must become as flexible as it is. In this case, what
could be termed roughly as a coalition-based approach to political action makes
sense, precisely because it is based on constellations of people, which temporarily
take shape around a cause of concern.6 As no overall political programme needs to
be constructed for there to be resistance, no heavy bureaucratic apparatus mimicking
power would be needed to oppose it.7

9
CHAPTER 1

The Foucaultian (and Nietzschean) conception of power and the conditions for
political efficacy has been theoretically developed in political theory by scholars
such as Ernesto Laclau and Chantal Mouffes influential work (1985), Wendy
Brown (1995, 2001) and by Judith Butler (1997). It has also been investigated in
STS through studies such as Steven Epsteins (1996) on gay activism that shaped
and redefined AIDS-research, Andrew Barrys work on ecological activism (e.g.
2001), and Brian Wynnes (1996) writing on controversies between sheep farmers
and scientists.

CO-ORDINATING SCIENCE, TECHNOLOGY AND SOCIETY

In the above examples I have focused on coalitions seemingly external to normal

science which took shape through efforts to resist specific kinds of development,
but this should not be viewed simply as a matter of outside forces trying to
influence what is (or ought to be) internal to science. For one point in re-
describing scientific controversies in the language of shaping and transforming
coalitions is precisely to point to the fact that society is never external to science
and technology. On the contrary the success of activists in challenging and
redefining, for example, AIDS research can be seen as one more bridge being built
between the presumed insides and outsides of science. If this is a (partial) success
story it is for the double reason that the articulation of parts of the AIDS research
community with the agenda of activists simultaneously improved the situation of
both communities: it enabled the scientists to do better science and improved on the
lives and the chances of surviving for people with AIDS.8
However, successfully linking these outsides and insides is a difficult task,
because the sets of practices, relevancies, and interests of those who would need
to co-operate are often vastly divergent. As the articulation of a novel entity in
a laboratory can be described as an event, so can the (partial) success of the AIDS-
coalition in re-defining the relationship between science and the public, and for the
same reason; that it required a unique constellation of forces, which, far from being
given, had to be painstakingly constructed in order to express itself effectively.
Such technoscientific events can be characterized as experiments in democracy
when they succeed in conferring on all interested parties the capacity of expressing
a viewpoint, without trying to predetermine what it is, or what the consequences of
it should be (see chapter five).
STS-studies in various instantiations have been interested in analyzing how the
creative potential of scientific practices is opened up precisely to the extent that
ideas, programmes, or techniques have had to be shared among what proto-STS
scholar Ludwik Fleck referred to as different thought collectives with different
thought styles (Fleck, 1979; Smith, 1999). Scholars such as Leigh Star and James
Griesemer (1989) have shown how the co-ordination of complicated scientific
efforts is not only not dependent on homogeneous interests among participants, but
that actors disparate goals may actually enable scientific success. In their work,
they show how material entities can function as boundary objects that give just
enough structure to the interactions between members from heterogeneous social

10
 AN AMODERN DISPOSITION

worlds (or thought collectives) to enable the successful co-ordination of their

efforts, but does not try to impose on members the same definition of the work they
are trying to accomplish. It is the mediation of non-human actors that allow
members of different social worlds to productively articulate their similarities and
dissimilarities.

THE COLLAPSE OF EPISTEMOLOGY INTO ONTOLOGY

Stressing the intertwinement of human and non-human actors in science challenges

traditional epistemology because activities such as observing or representing
are not seen as distinct from intervening or constructing; rather they are viewed
as specific ways of intervening and constructing (e.g. Hacking, 1983). In this
view epistemology collapses into ontology and the sciences are reformulated as
practical activities aimed at (re-)building the world by adding new elements with
new capabilities and new relationships to it. Knowing (and thinking about
knowing) is turned into particular styles and methods for connecting and co-
operating with specific actors (human and otherwise), thus shaping reality, or
doing practical ontology. Scholars such as Annemarie Mol (2002), Hans-Jrg
Rheinberger (1997), Charis Thompson (2005), and Helen Verran (2002) have
detailed this occurrence in various settings, and Latour has formulated the important
implication: There is no primary quality, no scientist can be reductionist,
disciplines can only add to the world and almost never subtract from it. (Latour,
2004: 226).
This idea is almost as foreign to social constructivism as it is to epistemology
because its focus is on the eventful reconfiguration of reality, taking place in
laboratories and elsewhere, rather than on the replacement of naturalist explanations
of science with social or cultural ones.
The move, suggested in the Callon and Latours notion of generalized symmetry,
of treating the sociality and the naturalness of the sciences as equally troublesome,
thus opens up a space for viewing the sciences as vehicles for the construction of
many different socionatural entities; for a multinaturalism replacing both (traditional,
realist) mononaturalism and multiculturalism (Viveiros de Castro, 2004; Latour,
2004a). This position clearly leaves no room for the epistemological aspiration to
define a method for the generation of objective knowledge within a discipline,
much less in general, because knowledge is constructed precisely at the intersection
of the many different agencies concretely interacting in the world. This condition
of specificity, of course, does not prevent technoscientific constructions from
becoming consequential in different places or on quite different scales in the
hands of later users.

THE NORTH-WEST PASSAGE: ORDERS, AND THEIR OTHERS

Michel Serres has provided a nice analogy for knowledge-production by comparing

it to the famous navigational problem posed by the Northwest passage (Serres
and Latour, 1995: 104, 152).9 Travelling the Northwest passage has many hazards

11
CHAPTER 1

such as wild tempests and drifting ice-floes but if these perilous conditions can be
successfully navigated, novelty awaits at the end of the journey in the shape of a novel
(and usually unexpected) environment.
In spite of the connotations of scientific heroism that this image may evoke, I do
not think glorification is the main point Serres is trying to make. It is possible
instead to make some different observations. First, Serres, as Whitehead before
him, presents a view of science as an adventurous journey in which curiosity and
jouissance figure as important components. But it is a journey with specific risks
and dangers. This is not a very esoteric observation, but one to which people as
diverse as Cumbrian sheep-farmers, ACT-Up AIDS-Activists and Danish health
care workers can testify. Since we really do not know how the landscape we
encounter at the end of our journeys will look, this poses to scientists the important
challenge of learning how to become responsible for all the entities of our making,
which, nevertheless, we are not mastering. (Stengers, 2000a). Likewise, it poses
to our societies and institution the challenge of learning how to respond
innovatively to the world-building activities of scientists, technologists and
others. This is the point at which politics, or critique, in another key, might be
brought back into non-humanist, amodern analysis (see chapters 5, 6, 8 and 9).
Two additional points can be made. Throughout the Serresian sea-journey disorder
and uncertainty reigns, and multiple contingencies must be handled to prevent the ship
from perishing. Only at the end of the trip does it make sense to credit the traveller
with the courage and rationality necessary for its completion.10 But the ordering thus
achieved also comes with a price, which is often forgotten; that the traveller is still
somewhere particular (albeit somewhere new) and for that reason not everywhere
else. As a metaphor for scientific work, this indicates that, contrary to common
views, the scientific journey does not finally remove one from earth, providing access
to a non-situated and objective truth (Haraways view from nowhere). Instead
science provides situated ways of knowing, which are always relying on specific,
practical, institutional and conceptual orderings, which always come packaged with
their own disorders; for example, their forgotten questions, perceived irrelevancies,
impracticalities and other invisibilities that sociologists Marc Berg and Stefan
Timmermans (2000) have referred to as orders and their others, and that philosopher
Adrian Cussins (1992) has pointed to in his theory of cognitive trails. This view thus
returns technoscientific endeavours to earth. It does not do so, however, with primary
ambition of critiquing or denouncing. Rather it rather aims to reorient the normative
potentials of STS as resolutely relational and symmetrical.

INTERVENTIONS AND INCOMMENSURABILITIES

Can one be unhappy with aspects of the world and seriously want to change it,
while at the same time denying the (received) grounds for critique? This, of
course, has been strenuously denied by the vast majority of philosophers and
other scholars over the last two thousand years, and is currently signalled by the
impotence and vague (or blatant) heresy ascribed to researchers that can be
termed relativist. As Barbara Herrnstein Smith documents, even fairly radical
such scholars regularly feel the need to defend themselves against these accusations,

12
 AN AMODERN DISPOSITION

usually by claiming to steer between the dangers of some nave orthodoxy and
an extreme relativism, often characterized as Scylla and Charybdis (Smith, 2002
and see discussion in chapther nine).
Actor-network theory and generalized symmetry has often been viewed as
particularly lacking in normativity. Even sophisticated and friendly-minded scholars
as Malcolm Ashmore find the Latourian strategy difficult to understand:
For infrareflexive [one of Latours term for his non-critical style of conducting
science studies] writing, on the other hand, you just offer the lived world and
write (1988: 70). The necessary reflexivity is achieved by applying principles
of analysis which are self-exemplifying (1988: 171), by multiplying genres,
by getting on the side of the known (1988: 173), by gaining explanatory
equality with those we study, and by refusing to build a metalanguage
(1988: 174). It would really be very simple if it wasnt quite impossible. As
a story, just another story (1988: 171) Latours tale of infrareflexivity is
a romance; and Ive seldom read a better one. (Ashmore, 1989: 60)
Many other criticisms have been considerably less benign (e.g. Cohen, 1999).
Critically minded scholars have repeatedly, and repetitiously, pointed to the
presumed complicity of amodern thinking, with its Machiavellian bent, to its seeming
lack of concern for properly emancipatory projects, such as feminism or Marxism.
The move is double. On the one hand amodern, nonhumanist studies are criticized
for being too critical of established categories, in their insistence on using a flattened
ontology where things and people, social and natural entities, institutions and
microbes are treated as analytically symmetrical. When such agnosticism perplexes
or infuriates critics it is in part because it works to deprive them of the conceptual
tools with which they achieve their critical effects. But if Latour and his colleagues
are viewed as too critical in their denunciation of modern categories, this is seen as
making them too uncritical in not drawing the usual (foregone) critical conclusions.
For the focus on the specificity of situations (throw-away explanations) and on the
transformative capacities of all involved actors prevents these researchers from
pronouncing at the end of their stories on who were really the bad guys. Why and
how is this a problem?
I would suggest that the stance of general symmetry remains impossible to
understand precisely to the extent that one situates oneself as (or akin to) a critical
epistemologist, trying to adequately represent the situation under investigation.
With this disposition it will seem seems obvious that Latours presentations are
selective, and to the extent that they do not match the preferences of the reader,
criticism will be easily enabled (as, indeed, criticism is always easily enabled from
such a vantage point). In a performative understanding, however, the situation is
quite different, as the researcher is, first and foremost, a participant, with all the
problems this involves. For the critical stance, the first of these is that it becomes
impossible to claim for oneself a moral high ground. Or, rather, in a flattened
landscape it is possible to exactly the same extent as it is to everyone else. To the
same extent, however, is not good enough if one wants ones critical perspective to
get an edge over other positions.11

13
CHAPTER 1

This is where the idea of strategic essentialism (or differently named relatives of
this idea) is often invoked;12 that is, the theoretically informed decision that at
certain points one should cling to ideas otherwise acknowledged as analytically
crude, or even fictive, because it is viewed strategically as offering better
opportunities for practically engaging in the real world than sticking to ones
more subtle actual beliefs.13
It can be questioned, however, whether the adoption of various essentialized
concepts provides for adequate intellectual, political or practical responses and
solutions to the multitude of challenges facing the world today. It might even be
argued that this strategy is politically irresponsible in its own way. In The Differend
Jean-Franois Lyotard showed in detail that a universal rule of judgment between
heterogeneous genres is lacking in general. (Lyotard, 1988: xi). Eduardo Viveiros
de Castro has extended and redefined the challenge posed by this statement, by
locating it at the level of ontology involving the mutual existence of potentially
incompatible natures, rather than at the level of representation and discourse. The
crucial point of the differend is to emphasize how discursive genres may function
in resolutely divergent ways, providing no position from which to formulate an
external evaluative measure. Hence, the possibility of discursive as well as
ontological incommensurability remains the background for intellectual and
political work. In Barbara Herrnstein Smiths words the implication is that:
The resounding reaffirmation of an absolute distinction between truth and
rhetoric, fact and fiction, science and superstition, will not in itself do the
crucial substantive, technical and often arduous work of effectively differen-
tiating among specific competing, conflicting claims of truth or between
mutual charges of falsehood. Nor will a general affirmation of the inestimable
value, irrefutable possibility, and transcendent ideality of genuine objectivity
identify where, in any particular instance, objectivity lies or (the pun is apt
enough) lies. (Smith, 1997: 2930)

PARTICIPATIONS

In view of everything said above it should be clear that I do not believe any general
method for solving the political and practical problems posed by reconceiving
intellectual activity in the mode of performative nonhumanism. Nor, I think, would
my affirmation of such a method solve the issue; since, indeed, many other people
have already proposed many analyses, methods, criticisms, rebuttals, rules and
guidelines without much luck. But, of course, this does not prevent me from taking
a position on the matter and offering what I think is adequate reasons for
maintaining it. I do, however, believe that the performative approaches outlined
above offer better tools for making sense of the multitude of complex issues that
contemporary STS researchers are likely to get involved in, than presently
available alternatives. In my estimation this is one way of achieving what Latour
referred to as getting explanatory equality, both with other researchers and with
those under study.

14
 AN AMODERN DISPOSITION

In fact, I think the dictum of explanatory equality is liberating. It liberates the

researcher from the belief that there is a specific set of ways by which one can
properly engage in research, and a determinable set of proper outcomes of such enga-
gements (Jensen and Lauritsen, 2005). Both of these assumptions are, in my experi-
ence, continually falsified in practice. The suspension of explanatory categories along
with the urge to critique enables different research strategies, and modes of inter-
action to be tested with our research subjects, those about whom we talk as scholars.
In particular it forces us to learn to respond more keenly to what is going on in the
field, because we know that our explanations and interventions have to be renewed in
each instance. Our research agendas are therefore invariably, and perhaps increa-
singly, shaped in ongoing engagements with the field. I think a similar idea is implied
by Annemarie Mols phrase empirical philosophy, which she describes as follows:
It is possible to refrain from understanding objects as the central points of
focus of different peoples perspectives. It is possible to understand them
instead as things manipulated in practices. If we do this if instead of
bracketing the practices in which objects are handled we foreground them
this has far-reaching effects. Reality multiplies Attending to the multiplicity
of reality opens up the possibility of studying this remarkable achievement
(Mol, 2002: 45)
Being able to follow this remarkable achievement does not give the researcher
any critical edge in the classical sense of being able to tell what is wrong, and what
consequently ought to be done about it. But, arguably, this becomes less important,
because amodern analyses bring with them an automatic unsettling effect, which
may have numerous practical ramifications (see also chapter seven). Under such
re-description, practices and materialities, their inhabitants and their relationships
start to look different. Good examples include the work of both Marilyn Strathern
and Michel Callon and Bruno Latour to re-figure the classical micro-macro
distinction in social theory (Callon and Latour, 1981; Strathern, 1991, and chapter
six) The former accomplishes such a shift by understanding social relationships as
fractal, the latter by viewing the presumed macro-actors as micro-actors situated
on top of many (leaky) black-boxes, (Callon and Latour, 1981: 286) containing
more or less stabilized associations between human and non-human actors.
Providing such alternative descriptions to people, both in and outside science and
technology studies, can be seen in itself as an intervention, possibly (although, of
course, not certainly) enabling these people to respond differently to their various
environments (see e.g. chapter five and seven). Although the specifics of this response
cannot be controlled by (and in) theory, I think this is already quite an achievement.
The effect of nonhumanist a-critical STS-studies, like everything else, would
then be in the hands of later users. These might be scholars or researchers, or they
might be informants, the old term for the co-producers of the research object.
Both of these groups are audiences whose responses to our texts, as they were
conceived, produced, and, finally, presented, will have also shaped the way these
texts ended up looking. Assuredly, they are also audiences whose engagements
with our texts are highly variable.

15
CHAPTER 1

The continual and dynamic relationship between our own interests and those we
encounter, as exemplified by the above-mentioned readers/co-producers of our
texts, is very nicely captured, I think, with Gilles Deleuzes term, the powers of the
false. Deleuze says:
A new status of narration follows from this: narration ceases to be truthful,
that is, to claim to be true, and becomes fundamentally falsifying. This is not
at all a case of each has its own truth, a variability of content. It is a power
of the false, which replaces and supersedes the form of the true, because it
poses the problem of incompossible presents, or the co-existence of not-
necessarily true pasts (Deleuze, 1989: 131)
The falsity here mentioned is not opposed to truth, as in the classical opposition;
for as in other theories I have discussed at length above, to Deleuze this notion of
truth (as universal, de-contextual, etc.) is exceedingly dubious. His playful invocation
of falsity therefore at most suggests that if the standard of evaluation is classical
truth then we would all be falsifiers. However, since a standard theory of truth is,
in fact, not invoked, the powers of the false signals rather an opening up towards
collective explorations of situations that are both important and complex, since
no-one can claim immediate access to their solution (situations, therefore, of
explanatory equality) (see chapter five for further discussion on this).
I think the image of our work and texts as participating in the powers of the false
is a good one, but not a simple or gratuitous one. It is not simple and gratuitous
because no one has promised us anything.14 First, no one has promised us that
anyone will indeed become interested in our ideas, plans, or articulations; that we
will be able to make them resonate with those with whom we would like to
interact. Second, no one has promised us a successful outcome of our endeavours,
even if we manage to interest others and collectively produce a new response to
the problems with which we are dealing. But perhaps the biggest cognitive and
practical challenge relates to the fact that even when disappointments occur, as
they inevitably do, due to the non-cooperativeness of those with whom we would
like to co-operate, or to the non-effectiveness of the interventions we have
struggled for, the grounds for making classical criticism are still gone; having no
means of scapegoating all there is to do is to start a constructive effort over again.
In my own estimation, this way of thinking about the concretizations, both as
failures and successes, of ones hopes, ideas, and aspirations, is far away from
many contemporary intellectual engagements continuing to struggle for episte-
mological supremacy rather than ontological symmetry. Whether successful or
not, this idea is a guiding inspiration for subsequent chapters. First, however, chapter
two draws some (anti-)methodological implications for engaging ontologies for
developing things.

NOTES
1
Classic actor-network analyses explored how and why networks of actors become stable (e.g. Latour,
1987). If patterns of actions are stabilized to an extent where the actors take them for granted, they

16
 AN AMODERN DISPOSITION

are said to be black-boxed. Black-boxed relations are naturalized and therefore difficult to investigate
and change, not least because it has become hard to see that there is even something to change.
2
It can be argued, for instance, that unification indicates merely that the discipline is in a stable state
of normal science, as in (Kuhn, 1970).
3
The sociological focus on the content of science was initiated, not least, by the Edinburgh sociologists
David Bloor and Barry Barnes, and had two targets. Against classical sociology of knowledge, as
represented by Mannheim or Merton, SSK aimed to show that the content of scientific knowledge
was, indeed, amenable to sociological analysis, and that the classical distinction between external
factors (which sociologists couldstudy) and internal factors (which they could not) did not hold.
Against classical epistemology, they aimed to show that what was regularly characterized as internal
to science was in fact influenced by the putatively external, and that the classical distinction between
the context of discovery (which might be messy) and the context of justification (in which the mess
was removed and the logical core of discovery was elucidated) could not be upheld.
4
This makes events literally just happen, when understood in a real-time, rather than retrospectively
(Pickering, 1995). It also introduces another vantage point from which to pinpoint the difference
between nonhumanist and epistemological understandings of science, as Stengers indicates: If we
take seriously the description of stories belonging as much to the history of the science as to
contemporary practices, and particularly the controversies aroused by any new proposition, we are
obliged to conclude that the criteria of scientificity or objectivity that should allow these
controversies to be settled did not preexist them, but are on the contrary a major issue in discussions
between scientists. And this situation has not been changed at all by philosophers of science and the
criteria that they propose, (Stengers, 1997: 81).
5
A very similar move is made in Latour (1986) that distinguishes between power understood as
transmission of a substance (the diffusion model) and power understood as an effect of the successful
work to stabilize associations among a set of actors (the translation model).
6
For example, Foucault temporarily participated in organizations such as Mouvement pour la Libert
de lAvortement (Movement for Freedom of Abortion) and the Groupe dInformation sur les Prisons,
which worked for reforms of the penal system (Foucault, 2001: 41823).
7
In a related move Isabelle Stengers has discussed issues of power in science. She contrasts minority
and majority science: I mean by minority not a part of the population which is not, but could and
tries to become, the majority, but active minorities who do not dream of obtaining for themselves the
power of a majority. Like Flix Guattari, I dream about multiple connections among minorities, so
that each of them would become able to work out its own singularity through the creation of
alliances, not in isolation, and so that each individual would be simultaneously part of many
minorities. Science, as I love it, is also a minority movement in a way (Stengers, 1994: 41). Whereas
minority science is seen by her as in league with power: the invention of the power to confer on
things the power of conferring on the experimenter the power of speaking in their name (Stengers,
1997: 165) emphasis in original), majority science merely mimes this inventive capacity with the
systematic production of beings constrained to obey the apparatus that will allow them to be
quantified (such as the all-too-famous rats and pigeons of the experimental psychology laboratories).
In the name of science, innumerable animals have been vivisected, decerebrated, and tortured in
order to produce objective data. (Stengers, 2000: 2223).
8
This links up with Isabelle Stengers suggestion that there is an inherent link between science and
democracy, In fact, as soon as one puts aside the classical division of responsibilities, which gives the
sciences and their experts the task of informing politics, of telling it what it is and deciding what it
must be, one comes face to face with the inseparability of principle between the democratic quality
of the process of political decision and the rational quality of the expert controversy . . .This double
quality depends on the way in which the production of expertise will be provoked on the part of all
those, scientific or not, who are or could be interested in a decision (Stengers, 2000: 160).
9
The Northwest passage refers to the much sought for polar passage, which would connect the
Atlantic Ocean with the Pacific. Michel Serres uses the term as an analogy for the construction of
connections between seemingly non-related cultural and scientific ideas and events.

17
CHAPTER 1

10
The point is emphasized to provocative effect by Latour (1987) but has a long history. Louis
Menand describes the following as a key tenet of classical American pragmatism: In the end, you
will do what you believe is right, but rightness will be, in effect, the compliment you give to the
outcome of your deliberations. Though it is always in view while you are thinking, what is right is
something that appears in its complete form at the end, not the beginning, of your deliberation,
(Menand, 2001: 352).
11
This is precisely the problem analysed in Latour (1988).
12
The term is from Gayatri Chakravorty Spivak, who defines it in the following way, A strategic use
of positivist essentialism in a scrupulously visible political interest, (Landry and Maclean, 1996:
214).
13
Strategic essentialism is thus obviously a majority concept in Stengerss sense: Furthermore, I do
not know which kind of power would define what it is to be anti-racist, anti-classist, anti-sexist, and
anti-culturally-coercive. All I know is that if it is in a position to select and direct it will be a
majority power, and thus it will demand submission and refuse putting at risk the majority
formulation of their values. (Stengers, 1994: 45).
14
Isabelle Stengers suggests that: In most cases, scientists and epistemologists have been in a great
hurry to explain this history, to show that the access was deserved and legitimate, the consequence
of an ultimate rational method or interrogation. They have made the method, which ensued from the
event, responsible for it, and have, as a result, obscured what is essential: no one has promised us
anything, and in particular, no one has promised us that, in all the fields of knowledge, the same type
of event will be reproduced, (Stengers, 1997: 88).

18
 CHAPTER 2

RESEARCHING PARTIALLY EXISTING OBJECTS

Ontologies for Developing Things

INTRODUCTION

The previous chapter introduced some key concepts and areas of concern for
amodern, nonhumanist analysis. Following on, this chapter asks the question of
what methodology looks like with an amodern disposition. To be precise, it is about
how to study developing technologies, things not yet stable, or black boxed. As in
several subsequent chapters the illustrative case has to do with the specific kind of
health care technologies called electronic patient records (EPRs). In the Danish
context as abroad, EPRs have been imagined as crucial future components of the
Danish health care system for at least fifteen years, and they continue to hold the
attention of many different groups of people, such as nurses, physicians, engineers,
medical informaticians, and politicians, as well as numerous STS researchers
(e.g. Jensen (2006), Jensen & Winthereik (2002), Olesen & Markussen (2003),
Svenningsen (2003), Winthereik and Vikkels (2005)). Such actors have had
partially overlapping yet markedly different reasons for engaging in EPR develop-
ment and analysis and they have brought with them variable expectations, for
example with respect to how the EPR might change and improve working processes
in hospitals.
This variability of interpretation and multiplicity of activities among the involved
actors is the starting point for the following analysis. Multiple actors have tried to
shape electronic patient records, but for different reasons, with different means and
to significantly different effect. Thus as my research began the electronic patient
record was precisely not yet a firmly stabilized actor in health care practices.
Instead it was a developing technology, or perhaps several ones.
Multiple actors participated in attempts to make (various) kinds of new health
care futures by means of new technologies. Meanwhile these technologies were
themselves under continuous transformation in order to respond to the varied
expectations made on their behalf. And, slowly and contingently, they started to
change health care practices and actors in return.
This chapter as well as several following ones (chapters 36) is based on a three-
year study of the development of EPRs and their implementation in the Danish
health care system. My initial research questions were quite general: What are
these technologies? Where do they come from? Why do they come? and How
are they developing? In a truncated explanation, I studied visions for the EPR, the
development of these technologies, and their implementation. It would be fair to
characterize these guiding questions as relatively diffuse. They were also rather

19
CHAPTER 2

nave in the sense that when I started research much had been said about each of
them. Yet, I would like to argue that such deliberate simple-mindedness in fact
turns into an analytical strength when the object of study is a not-yet-quite-existing
technology; a thing whose existence is still only partial. The reason is that such
peculiar objects of study require a kind of theoretical and methodological
flexibility and attentiveness, which is all too easily diminished if one is certain
about how to approach the object because one already knows what it is and does.
I explored the development of electronic patient records primarily in relation to
a large and ambitious project in the Aarhus region. The qualification primarily
seems innocuous enough, but in fact it is crucial for the following considerations.
The reason is that it turned out in practice to be impossible to stay within the
geographical, organizational and political parameters of the Aarhus Region, if one
wanted to understand its development project.
Even though I started with the ambition of simply investigating the project in
the Aarhus region, I was quickly led elsewhere: for instance, to the European
standardization organization and to sites of political contestation, regionally and
nationally. The EPR, presumably made in Aarhus, seemed to be both there and
elsewhere. It quickly became necessary to put the idea of studying the EPR in a single
context under scrutiny, since the technology seemed neither singular not singularly
attached to any one site. Rather, it seemed to be distributed, and located in what
I came to think of as a fractal landscape (see chapter six). In this landscape, the
contours of the EPR was (and is) subject to ongoing negotiation and revision as it
got (and gets) into contact with differently located and interested actors. The chapter
analyzes this uncertain ontological status and considers its methodological
ramifications by characterizing the EPR as a partially existing object (following
Latour (1999)). Several insights gained from viewing the EPR as a partially
existing object are not specific to this particular case but, rather, would be replicable
in many other projects where ontologies for developing things are gradually
articulated.

STUDYING WHAT?

As noted I studied the visions, development, and implementation of the Danish

EPR. What then did I study, exactly? In fact, I continued for a long time to be
haunted by my inability to specify and explain my research. Probably such unclarity
of purpose is a rather well known phenomenon in early phases of research, yet it
still indicates a peculiar and awkward problem: how could it possibly be so
confounding to specify a set of coherent problems around EPR development?
Especially in academic terms there is something evidently troubling about this,
since clear problem definitions and questions are usually viewed as a sine qua non
for conducting proper research. After all, if you dont know what you are studying,
or precisely why, you can hardly investigate it. (Consider what you would usually
tell first year students on this issue). There were thus obvious reasons for
contemplating this problem. Yet, I do not return to the issue because of a parti-
cular interest in reflexivity. Instead of turning the problem inwards towards a

20
 RESEARCHING PARTIALLY EXISTING OBJECTS

consideration of epistemology, problem delimitation, classification and typology,

I would like to turn it outwards. The argument is that my problem with speci-
fying the object of study had to do with the technology itself: it responded, so to
say, to the refusal of the EPR to behave as a technological object is expected to do.
Hence, the problem was neither conceptual, reflexive, discursive or communicative.
Instead it had to do with the multivalent states of being of the EPR; that is, with its
seemingly paradoxical ontology.
The paradoxical quality stems from the common notion that a technology is a
coherent object and objects are static, homogenous and consistent. Yet, this
assumption quickly proved to be empirically unworkable. In practice the EPR
seemed more like a multiple object, which formed a whole only sometimes, in
some places, for some actors and for some purposes. When I refer to this as only a
seeming paradox this is because the suspension of modern categories advocated in
amodern STS dispenses with the idea that objects are static and homogeneous.
Instead they take as their task to explore how the ontologies of things develop and
change in practice. That means: such research investigates the sociotechnical
processes whereby unstable, weak, almost non-existing things gradually become
attached to diverse networks and practices and thereby attain a multiple and
distributed, yet partial existence. As noted much modern philosophy and social
discourse assumes a stand-alone and static object. This is why discussions so often
have to do with how humans project their perspectives and ideologies onto passive
things or, alternatively, have their actions determined by things (in which case
humans are passive). Yet, free-floating, stand-alone things are are hard to come by
empirically. When technologies are effective in so many different contexts and
circumstances it is rather because they are active participants in the ongoing
transformation of practices. This observation, also, provides the rationale for the
actor-network requirement of symmetricizing analyses in order to simultaneously
get into view how humans create things and vice versa.
Bringing an amodern and symmetrical disposition to the problem posed by
open-ended and ill-defined research questions obviously does not mean the
disappearance of all conceptual, political and practical issues. Instead it entails
a change in the field of concrete problems and analytical and methodical options.
With this approach it cannot be a requirement to be able to define a precise area of
investigation (say, a technological object or a social context) prior to investigation.
Rather it is crucial to empirically track down how technologies are constructed
and transformed in multiple situations and networks and to analyze the specific
consequences such constructions have for different practices and actors. This
interest in active construction extends to the researcher of partially existing objects,
who is also involved in defining and constructing the object through his or her work.
He or she is therefore a part of the same field as the one investigated and for that
reason denied access to an external standpoint. For this reason it cannot be an
analytical ambition to provide general explanations or external rationalizations.
Rather, one participates with other actors (but of course with different means and
aims) in what might be called experiments to articulate and specify the existence of
things, and to engage and articulate the consequences of specific reality constructions.

21
CHAPTER 2

With this in mind, the next part of the chapter will aim to clarify why it is so
hard to state succinctly what one is studying when one is studying developing
technologies such as the EPR, and what one is, actually, studying. This will make
available for exploration a number of possibilities, which come into view when
one redefines the EPR, as I will continue to do, from a technological object, to
a partially existing object operating in more or less fluid practices, in a more or less
coordinated set of and networks.

WHAT IS AN EPR? THE PARADOXICAL ONTOLOGY OF

A DEVELOPING ARTEFACT

Let me ask first what is an EPR commonly taken to be? It is easy enough to find
suggestions. For instance, the Danish National Board of Health, in their National
Strategy for IT in the Health Care Sector 20002, offers the following:
An EPR is a clinical information system, which directly supports process-
oriented examination, treatment, and care of the individual patient Process-
oriented means a patient record, which directly supports coherence and
quality in the clinical treatment (15)
In this definition the EPR is centrally about supporting existing clinical practices,
but offering a coherent technological framework for doing so. In other documents
this challenge is specified as conceptual and terminological clarification and standar-
disation is just what the National Board of Health have aimed to provide. However,
the National Board of Health holds no monopoly on determining what EPRs are.
Thus it is also easy to find alternative definitions. The EPR development project
in the Aarhus Region of Denmark, for instance, adopted the definition from the
National Board of Health, but stressed that several additional operational require-
ments were important. For example, the EPR should be integrated with other
hospital information systems and the record should be available as an efficient
work tool for all kinds of health care workers. The Aarhus development group
therefore emphasized that: we are talking about long-term development projects,
with an emphasis on organizational change and learning.1
Now the fact that it is not difficult, but rather too easy to find competing
definitions also indicates a potential problem. The problem is that as incompatible
definitions appear to multiply it becomes correspondingly difficult to sort and
evaluate which ones are better and which worse, which ones are more correct and
which ones more faulty. This, of course, is a problem insofar as one is interested in
finding out what the EPR really is and does.
For example: even though the description of what the EPR is about provided by
the Aarhus development group begang with a citation from the National Board of
Health, it drew quite different conclusions about how this technology ought to
become part of Danish health care practice. For, what mattered to the group in
Aarhus, was not primarily conceptual standardisation but organizational change.
The group, however, had no principled opinion about whether the terminological
standardization promoted by the Board of Health was the only or best solution to
achieve this goal.

22
 RESEARCHING PARTIALLY EXISTING OBJECTS

Further, the report from the Aarhus group was no more authoritative than the
one from the National Board of Health; not even within the frame of the Aarhus
project. For example, nurses, secretaries and doctors provided quite different view-
points on this matter when they were placed in working groups in 2001, in order to
formulate responses to questions such as How they would work on 01/0404?
How it would be possible to plan a good implementation process to make all
groups of personnel feel safe about the new system? How to de-mystify the EPR?
and How to prepare the personnel in IT-terms? (Secretaries report: 34, Nurses
report: 4).
The secretaries focused primarily on the need for education and interdisciplinary
interaction, since they saw these dimensions as crucial for the successful organi-
zational transformation, which they expected would be brought about by the new
technologies. They also reserved critical commentaries for the monodisciplinary set-
up of the working groups, because it prevented what they viewed as necessary
interchanges between the different groups about these organizational consequences.
The nurses group concurred and said that: the lack of contact between the
groups has necessitated an array of assumptions concerning the routines and work
flows of other professional groups (5). Even as they said so, however, they excluded
secretaries from their concerns, and concentrated on the hoped-for changing relation-
ships between doctor and nurses. This led them to suggest that workflow analyses
should be carried out at each ward, so that the EPR could be used to create
beneficial changes in working arrangements. They also discussed the implications
of various arrangements of hardware, such as EPR work spaces are located in an
office adjacent to the ward, a portable computer is placed on a moving table,
transported to the patient, or doctors and nurses each have a pocket PC (7) with
this issue in mind.
Meanwhile the main concern of doctors was precisely whether they would be
protected against unwanted new tasks (which to a significant extent overlapped
with what the nurses considered beneficial changes in working arrangements):
Will the implementation of the EPR entail task slippage, so that the group of
doctors will be expected to take care of more routine tasks, such as writing in the
record, booking of examinations etc since it is so easy? (Doctors report: 4,
original emphasis). To avoid considering this unpleasant possibility they decided
to view the EPR with visionary doctors eyes (3) and proposed that: it is important
that specific groups retain the possibility of emphasising/justifying the specific
interests and problems in relation to their own tasks (5). In their analysis it was
assumed that everything concerning security and backup is, of course, solved, such
that the system is up 99,9% of the time, and the remaining 0,1% is taken care of .
And the report offered suggestions such as that the table top of the moving table for
the ward round, by the way, is a computer with finger touch screen, capable of
showing x-rays and when you have dictated a note to the EPR (secretary or voice
recognition) it immediately appears as a draft on the screen (9).
In this short presentation of the analyses of secretaries, doctors and nurses, we
see the articulation of different versions of the EPR. For nurses and secretaries the
existence of the EPR was associated with changing working relations although in

23
CHAPTER 2

different ways. Doctors, meanwhile, decided to view the EPR as a neutral techno-
logical tool, which might stabilize and render more efficient current organizational
and disciplinary divisions of labour. We can also note how the EPR moves from
a purely terminological-conceptual entity at the National Board of Health to an
organizational technology in the Aarhus project, which once again splits into many
versions in the hands of different health professionals.
Because understandings of what kind of entity the EPR is and what kind of
implications it has are proliferating and variable, the researcher may feel an almost
irresistible urge to decide whose definition to believe in, whose agenda to prefer. If
one expects the object of inquiry to be static and homogenous this is even required,
since the research task will then precisely have to do with figuring out who is right
in their descriptions of the technologies and their estimations of implications, for
example for organizational arrangements. But although this is a venerable approach
in social science, there is another option; one can follow Michel Foucault and be
nominalist.
What is a nominalist? According to literary theorist Barbara Herrnstein Smith,
a nominalist answers the question What is X?, for example: what is truth?, what
is knowledge?, what is value?, or, in this more mundane case, what is an electronic
patient record?, by insisting that X is, in the first instance, a word, with a history of
variable and still changing usage. Such insistence certainly adds interpretive
flexibility to an investigation. It leads one to expect variable answers to any
number of questions regarding the object: What is the EPR? Does it even exist?
What does it do? Where is it found? What are its benefits, risks and costs? And for
whom? According to nominalism all the different answers given to such question
must be taken as reasonable contextual responses to the given question. In contrast,
if one starts out assuming that the EPR is a specific bounded something (which as
a researcher one has special mental capacities for recognizing or methodological
tools for unravelling) then alternative suggestions encountered in practice might
well be viewed as deviant, benighted and, perhaps, to be corrected. (If only they
really knew what the technology can do for them, then they would not resist
implementation). This preliminary observation can be read as a re-statement of the
anthropological commonplace that the interpretations of all involved actors should
be treated equally, or symmetrically, to ensure that official or institutionally
sanctioned perspectives are not simply replicated in analysis.
Yet one thing is obvious so far: the analysis offered seems quite distinctly
discursive or social constructivist. In fact, we have so far not encountered
the thing itself , the electronic patient record that, qua nonhuman thing, I have
begun to intimate plays such a central role in generating future networks of health
care practices. To grasp how technological actors such as the EPR do enter the
analysis it is crucial to understand that although nominalism is the analytical
starting point of amodern analyses, enumeration of perspectives need not be the
end-point of investigation. This is where insights from actor-network theory and
related nonhumanist approaches become pertinent, due to their emphasis that
objects should not be understood simply as the passive receptacles or stable centres
to which human actors interpretational work attach and relate.

24
 RESEARCHING PARTIALLY EXISTING OBJECTS

Instead, Annemarie Mol proposes, one ought to look closer at the practices in
which objects are manipulated:
If practices are foregrounded there is no longer a single passive object in the
middle, waiting to be seen from the point of view of seemingly endless series
of perspectives. Instead, objects come into being and disappear with the
practices in which they are manipulated. And since the object of manipulation
tends to differ from one practice to another, reality multipliesAttending to
the multiplicity of reality opens up the possibility of studying this remarkable
achievement (Mol, 2002: 5)
Mol calls this approach empirical philosophy. It is philosophical in its interest in
understanding knowledge and knowledge production. But it insists that this can
best be grasped through detailed studies of how people and things become
associated in practice. And this connects Mols philosophy with the study of
partially existing objects:
A new set of questions emerges. The objects handled in practice are not the
same from one site to another: so how does the coordination between such
objects proceed? And how do different objects that go under a single name
avoid clashes and explosive confrontations? And might it be that even if there
are tensions between them, various versions of an object sometimes depend
on one another? (Mol, 2002: 56)
I previously wrote that the EPR, in the first instance, has to be viewed as a word.
How is this connected with Mols argument that urges us to attend to materiality,
practices and objects? It is crucial to understand that this is not a performative
contradiction. Instead, the point is that such shifting frames of reference are
necessitated by the ongoing transformation and variable ontologies of the techno-
logies we study. And the EPR precisely illustrates this point.
Traced in practice, it traverses modern dichotomies such as object/subject and
materiality/discourse. As one encounters it empirically, the EPR is sometimes
a word, a text, a vision, a procedure, a prototype, an interface and a database. One
cannot decide in advance whether the referent is linguistic and rhetorical to be used
for political bargaining, or a piece of software used by nurses for medication
purposes, or quite possibly both at once as well as other things.
Prior to empirical scrutiny, one simply cannot be sure whether the EPR is
something envisioned or something concrete. In some places the EPR seems to
exist, but others will argue that what one can encounter at current hospitals is at
most vaguely related pre-cursors to the real thing. In some places it is being built,
but as it exists only in beta-versions, and remains untested in practical situations
pronouncements on its reality are marred by uncertainties.
Furthermore, the EPR is variably understood in local terms: developed as
a solution to very specific medication procedures and problems, or in national
terms: as an initiative carried out by the National Board of Health to rescue the
Danish Health Sector from a babel of varied practices and uncoordinated efforts,
compromising patient safety as well as health care economy. One simply cannot
know once and for all whether the EPR is discursive or material, local or

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national, a good idea or a large problem, technical or political, or if it is all of

these things to varying degrees at various times and in various places. If it is
presumed that entities have fixed and stable properties this is a paradoxical
claim, but the paradox diminishes if one begins to think in terms of variable
practical ontologies; that is, if one starts imagining that the properties of objects
are precisely not essential, but that existence builds and transforms gradually, as
properties are loaded into and conferred upon technological things through
relations with new practices.
If one studies technological projects and development ontology for deve-
loping things one has to be nominalist, no doubt as Michel Foucault (1990: 93)
expressed it. Methodically, this entails that one takes serious the assumption
that any entity is a word in the first instance. In the first instance but not
necessarily in the last instance, since the point of following the processes
whereby objects garner partial existence is precisely to learn how it is possible
for actors to undergo ontological phase-shifting, from being mere words to
becoming properly technical objects with well-known and reliable capacities and
functions.
There is thus a double suspension at play here. For just as empirical philosophy
has no investment in pre-determining what an actor must be it (in the first instance it
is simply a word) does not need to insist that, in the end, all is discourse (in the
last instance it may have become a technical object). And, of course, words and
visions sometimes, if not always, do materialise as technological reality,
although they invariable transform in this process. The argument is thus that by
letting go of both a priori conceptions of what technologies really are and
deterministic understandings of what they must turn into, facilitates the study of
partially existing objects as the study of practical ontology for developing
things.

WHERE IS THE EPR? LOCATING PARTIALLY EXISTING OBJECTS

Since the mid-nineties anthropologists and sociologists have discussed the methodo-
logical problems that emerge when social research turns to empirical study of
information technologies (e.g. Newman, 1998; Star, 1995). The well-known idea
that the researcher steps into a clearly defined field site runs into constant trouble
in relation to the study of IT in which the object almost per definition is distributed
(see e.g. Cooper et al, 1995). But while this has posed challenges for the classical
ethnographic ambition of surveying ones entire field, it has also enabled the
emergence of a new set of opportunities and insights. Not least, it has facilitated
new analyses of how the supposedly very large, or even global, is interrelated
with the supposedly very small and local. What connects the insignificant micro-
actor and the powerful macro-actor? Materiality does. Research into the ontological
processes through which technologies gain and lose existence produces knowledge
about such relations. In potentia the EPR associates multiple sites that were
previously unconnected, thus producing a change in scale, from the micro towards
the meso or even macro.

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 RESEARCHING PARTIALLY EXISTING OBJECTS

If one explores a technology that appears sometimes to be local, sometimes

global, it will thus be with an interest in understanding how the object becomes
linked with other actors in ways, which make them mutually stronger, add to their
existence and therefore make them more global in reach (or vice versa). The
national or global technology in this view is simply the one that has been most
thoroughly and intensively socialized, has gained most in reality, and therefore has
become most capable in tying together and fitting into multiple disparate practices.
As we will see in more detail in the following chapters, these processes are
vividly illustrated in the case of the EPR. Here, multiple actors from multiple sites,
such as the Danish government, the regions, the National Board of Health, the
health professional and patient organizations, individual hospitals, the medical
informatics community, the Board of Technology, as well as software companies,
standardisation organizations, and medical jurists are all engaged in trying to define
and influence technological development and predict its consequences. And, of
course, these actors do not only speak and write, they participate in multiple other
activities as well. At the time of my research this was most visible in the attempts by
different Danish regions to develop a well-functioning EPR model. To be able to
demonstrate a successful system to politicians, other hospitals, and the public, was
presumed to be a much stronger argument for the adoption of that particular system as
the national standard than any amount of analysis and argumentation.
All this adds up to an argument that it is, in fact, quite complicated to study
technological development in distributed and politicized environments, although for
some other reasons than one might have imagined. What one investigates in such
instances seems not to be a technology, which happens to be multiple and distributed.
Rather, the EPR is a vivid, even dramatic illustration of the partial existence charac-
terizing technologies under development; ontologies that vary and emerge in practice
as multiple material and discursive resources are woven together or fall apart.
This makes explicit the possibility that the EPR might exist in a diversity of
modes. Or is it rather: it makes visible the fact that different varieties of EPRs
exist? The first expression suggests that the EPR is really one technology that
happens to be realized differently in different contexts. The second proposes
that there is no single unambiguous EPR because the many different technologies
posing under that name are not common enough to share existence. The question
about ontological cohesiveness and commonality is not nearly as esoteric as it
sounds because it has immediate consequences for involved actors. For example it
mattered deeply for the relation between the Danish Board of Health and the
various regions, since regions were threatened with sanctions should they fail to
demonstrate that their EPR models were similar enough to the one promoted by the
board. But it holds central significance for the researcher interested in practical
ontology as well. For the activities engaged in by diverse actors in order to
demonstrate similarity provides additional knowledge about the generation and
transformation of technological futures; their ontology and relations. It facilitates
the asking of questions such as: How are technologies, procedures and practices
built in order to facilitate comparison? Indeed, how are these scales of comparison
built, challenged and changed, and by whom? If actors engage in an ongoing

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reshaping of existence both of the EPR and themselves through such work, then
documenting and analyzing such processes are crucial for understanding how
health care futures are generated.
To sum up it is in principle impossible to know whether we are dealing with
one or several EPRs. In practice, however, it can be established by empirically
following the ontological work, which actors put into adding existence to one or
another version of the EPR; a work which gradually transforms organizational
structures and health care professional relations, as well as technological infra-
structures. This situation also makes clear why the distributed and partial existence
of the EPR has been both an asset and a liability for the many actors who have
been involved in its development. The strength has been that it has ensured a very
broad support of such development, since almost everyone has agreed that the
EPRs would be beneficial for the health care system. Yet, the weakness has been
that the EPR has remained difficult to control, classify and specify, precisely
because the multifarious interests with which the technology has been invested, has
continuously threatened to fragment the object; turning it from one to many.

ONTOLOGIES FOR DEVELOPING THINGS

In this chapter I have developed some (anti-)methodological implications of amodern

approaches to the study of technological change. I have focused especially on the
variable and changing ontologies of technical objects, and pointed to the diverse
forms of heterogeneity and variability of the object usually called the EPR. By now
the reader will be excused if he or she thinks the point is to show that the EPR is
a quite fickle empirical object; one which it is rather hard to freeze analytically.
This, of course, it is, in a sense, and it is important to recognize as much. Yet, the
point has not been to argue for the complete randomness of the technology or the
development process. Rather the argument to be substantiated in the following
chapters is that it pays off to make an effort to distance oneself from the most
common clichs about technological development. One particular merit of amodern
approaches is that they offer a mode of analysis that can handle that technologies
do not behave as stand-alone, homogenous, static objects. This makes it possible to
closely follow the multiple associations created between things, humans, discourses
and organizations, as numerous actors attempt to shape new and as yet only weak
technologies and associate them with their specific practices, adding to their partial
existence in particular ways.
As I aim to show in the following chapters, bringing an amodern disposition to
the question of technological change, makes it possible to ask questions about why
the existence gained by the EPR sometimes seems to be paid for by other human or
technological actors, whose existence it threatens, whereas other versions of the
EPR seem able to co-exist with many other actors, and yet others appear able to
lead indifferent and parallel infrastructural lives. And it enables the study of
ontology for developing things; that is, the exploration of why and how a thing
becomes a coherent object, or, alternatively, why and how a thing is turned into
multiple, fragmented, things, or, sometimes, is turned into nothing at all. These are

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questions that the next chapter continues to explore, as it focuses on how the
electronic patient record emerged, gradually gained existence, and began to
generate new futures in the Danish health care context.

NOTES
1
Visited at: http://epj.aaa.dk, 15/4-2002 (no longer accessible).

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