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3 Social constructionism as theoretical foundation

3.3 Discourse and power

Discourse is an important concept for the study of the social construction of reality; in simple terms, it means all social practices of talking and writing that give meaning to something. Discourse is an interrelated set of text, talk, and practice that produces the social reality. We cannot understand and share a social concept in society (think about money, for example) without the discourse that constructs it. Discourses are shared and social by their nature, stemming out of the interactions between social groups and the societal structures in which the discourse is embedded (Phillips & Hardy 2002, 4).

The different interpretations represent the different discourses that give meaning to the event in the previous example about the overflowing river (Jorgensen and Phillips 2002, 9).

An important element of social constructionism is the recognition that different social cultures always exist simultaneously alongside each other.

Of course, the literal languages used in different countries vary, but different language cultures exist around us much more subtly all the time. This

diversity represents the variety of discourse that surrounds us. It explains why, for example, differences in genetic heritance or life history aside, not all Swedish people are culturally alike, since many language cultures exist at once in one place, and those possible cultures enable different kinds of narratives for people. The collection of discourses in any culture is, thus, like a social jigsaw puzzle. This understanding of many levels of discourse operating at once also explains why we talk so differently when we talk to a friend from the way we would talk to a government official: The cultural script for the way we may frame ourselves, and the language we use, differs in these social encounters. We represent ourselves differently, and even view ourselves differently depending on the social context and the language we use to frame our identities and actions (Burr 1995).

Such different language cultures, or different “paths,” exist around us all the time in this way, but some discourse has a heavier weight of meaning.

Continuing the path metaphor, some cultural paths are equal to freeways and some are tiny footpaths crossing through a densely grown forest. This is where the important concepts of hegemony and marginality come into play: some discourse is more mainstream and therefore hegemonic, some discourse is more occasional and, thus, marginal. Mainstream discourse—hegemony—is characteristically hard to resist, and it (artificially) seems invariable and stable due to its long tradition and power. Hegemony can further be understood as the dominance of a particular perspective (Jorgensen and Phillips 2002, 7)—something that is typically so normalized in our cultures that it may seem even strange to think otherwise.

The concept of hegemony brings the idea of power struggle onto the map of social constructionism. As mentioned before, due to their dynamic social nature, discourses cannot be ultimately fixed in stone. However, struggle exists over about what shall be established as the mainstream way of interpreting something in a given time. Hegemony establishes a “taken-for-granted” nature that is seldomly questioned, even though history shows hegemonies to be in constant flux. Laclau and Mouffe’s (1985) theory of hegemony suggests that while there are no fixed structures of meaning, a constant struggle over fixing a meaning exists (see also Jorgensen & Phillips 2002, 24–59). Thus, a discourse is a reduction of other possible meanings that

could have been given to an event. It is this struggle over defining meaning and attempting to establish a hegemony that is interesting to critical discourse analysis as a research method.

Taking the idea of hegemony and power struggle further, discourse can be seen as a constant flux of negotiating identities that bear the weight of power with them. Through the negotiation of meaning, power relations in a society become naturalized, appearing as common sense. This power comes out of the negotiation and historical social struggle; it does not imply essences of things in themselves. The more discursive power a group is able to negotiate for themselves in society, the more influence they gain. Social constructionist thinking holds that there is no essence inside the people that would determine their value or status; it also holds that why we should think a doctor is prestigious but a road sweeper is not is not a reflection of objective facts but of power differences between social positions that have been created and are sustained in cultural discourse.

It is in this way of establishing identities of influence that discourse limits opportunities and keeps important doors open for some people and closed for others. Additionally, the power of discourse is not only the power of the people who use the discourse but the power of discourse in itself, meaning the use of language in itself. For example, taking a position in the euthanasia debate by framing it in medical language, with reference to medical science and text, is likely to have more influence on society than simply framing the argument around one’s own personal concerns about dying. (See Kuipers 1989 about the power of medical discourse.)

This leads us to the acknowledgement that knowledge construction goes together with social action, and as a form of social action, knowledge is also entangled with power. Through the lens of social constructionism, what a given culture represents as the truth is seen as being the currently accepted way of understanding the world and not an objective, all-encompassing fact (again, the previous distinction between the natural world and the social world should be made here, as the natural world does contain objective, unchangeable facts). Power flows into the social process of knowledge construction simply because people in powerful positions are typically in more enabled positions to participate in the kinds of forums in which knowledge

is created, having their voices heard in institutions such as media, science and education. Many of the things we take for granted have been shaped by discourse that has been constructed by people with power and influence;

therefore, many “truths” (the hegemonic discourses of our time) we take for granted have historical power written over them.

Discourse, thus, provides people their words and their talking space, so to speak; discourse enables and restricts the things that people from different backgrounds may or may not know and talk about, respectively. Again, it is important to remember that discourse is not set in stone. However, like the paths in the forest, cultural discourse has a way of silently showing us what kinds of options we find in front of us—the things we may know about and talk about without going against the grain and the kinds of agency we take in our lives. Pushing against the cultural assumptions, the paths provided for us, is possible but arduous and unexpected, like walking through a tightly grown and spiky rose bush hedge.

Nevertheless, there are always power struggles, and a great cultural shift occasionally occurs in which some powerful groups are replaced or are at least accompanied by others. My view is that this kind of social struggle process explains and illuminates the breakout of bioethics in the last decades and the way bioethics has challenged and changed some of the more traditional conceptions of ethics in the medical establishments.

4 Wrapping up the framework: healthcare