Subject to empowerment: the constitution of power in an educational program for health professionals
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Empowerment and user participation represents an ideal of power with a strong position in the health sector. In this article we use text analysis to investigate notions of power in a program plan for health workers focusing on empowerment. Issues addressed include: How are relationships of power between users and helpers described in the program plan? Which notions of user participation are embedded in the plan? The analysis is based on Foucault’s idea that power which is made subject to attempts of redistribution will re-emerge in other forms. How this happens, and with what consequences, is our analytical concern. The analysis is contrasted with ‘snapshots’ from everyday life in a nursing home. The program plan communicates empowerment as a democracy-building instrument that the users need. It is a tool for providing expert assistance to the user’s self-help. User participation is made into a tool which is external to the user him-/herself. Furthermore, the analysis shows that the plan’s image of empowerment presupposes an ‘élite user’ able to articulate personal needs and desires. This is not very applicable to the most vulnerable user groups, who thereby may end up in an even weaker position. By way of conclusion, we argue that an exchange of undesirable dominating paternalism for a desirable empowerment will not abolish power, but may result in more covert and subtle forms of power that are less open to criticism. The paper offers insights that will facilitate reflections on the premises for practising empowerment-oriented health care.
KeywordsDeconstruction Elderly Empowerment Foucault Governmentality Linguistic power User participation
This project has been financially supported by the Norwegian ExtraFoundation for Health and Rehabilitation through EXTRA funds.
- Adams, R. 1996. Social work and empowerment, 2nd ed. London: Macmillan.Google Scholar
- Cruikshank, B. 1999. The will to empower. Democratic citizens and other subjects. Ithaca, NY: Cornell University Press.Google Scholar
- Dean, M. 2010. Governmentality. Power and rule in modern society, 2nd ed. London: Sage.Google Scholar
- Derrida, J. 1997. Of grammatology. Baltimore: Johns Hopkins University Press.Google Scholar
- Donzelot, J. 1979. The poverty of political culture. Ideology and Consciousness. 5: 73–86.Google Scholar
- Engebretsen, E. 2006. Barnevernet som tekst. Nærlesning av 15 utvalgte journaler fra 1950- og 1980-tallet. Faculty of Humanities, Univerisity of Oslo, Oslo, Norway.Google Scholar
- Etterutdanning i brukermedvirkning (EiB). 2005. N.K.S. Kløverinstitusjoner as, http://www.klover.org/aktuelt/klovernytt/doc_download/6-etterutdanningen-i-brukermedvirkning Accessed 5 April 2011.
- Fairclough, N. 1995. Critical discourse analysis. Boston: Addison Wesley.Google Scholar
- Fleming, J., and D. Ward. 1999. Research as empowerment: the social action approach, empowerment practice: developing richer conceptual foundations. In Empowerment practice in social work: developing richer conceptual foundations, ed. L.M. Wells, and W. Shera. Toronto: Canadian Scholars’ Press. Inc.Google Scholar
- Foucault, M. 1980. Power/knowledge. Selected interviews & other writings 1972–1977. New York: Pantheon Books.Google Scholar
- Foucault, M., and L.D. Kritzman (eds.). 1988. Politics, philosophy, culture interviews and other writings, 1977–1984. XXV, 330 s vols. New York: Routledge.Google Scholar
- Foucault, M. 1990. The history of sexuality. An introduction Volume I. New York: Vintage Books, Random House, Inc.Google Scholar
- Foucault, M. 2002a. Questions of method. In Power. Essential works of foucault 1954–1984 Vol. 3, ed. J.D. Faubion, 223–238, 3rd ed. London: Penguin books.Google Scholar
- Foucault, M. 2002b. Omnes et singulatim. In Power. Essential works of Foucault 1954–1984 Vol. 3, ed. J.D. Faubion, 298–325, 3rd ed. London: Penguin books.Google Scholar
- Foucault, M., F. Ewald, M. Senellart, and A. Fontana. 2008. The birth of biopolitics. Lectures at the Collège de France, 1978–1979. Basingstoke: Palgrave Macmillan.Google Scholar
- Freire, P. 1972. Pedagogy of the oppressed. London: Penguin.Google Scholar
- Kristeva, J. 1984. Revolution in poetic language. New York: Columbia University Press.Google Scholar
- Laclau, E., and C. Mouffe. 1985. Hegemony and socialist strategy. Towards a radical democratic politics. Verso: London and New York.Google Scholar
- Lorentzen, P. 2003. Fra tilskuer til deltaker. Samhandling og kommunikasjon med voksne utviklingshemmede. Oslo: Universitetsforlaget.Google Scholar
- Mcfadden, D.L., and E.P. Burke. 1991. Developmental-disabilities and the new paradigm—directions for the 1990’s. Mental Retardation 29(1): R3–R6.Google Scholar
- Miller, P., and N. Rose. 2008. Governing the present. Cambridge: Polity Press.Google Scholar
- Norwegian Ministry of Health and Care Services. 1999. LOV 1999-07-02 nr 63: Lov om pasientrettigheter (pasientrettighetsloven). http://www.lovdata.no/all/hl-19990702-063.html. Accessed 16 March 2011.
- Norwegian Ministry of Health and Care Services. 2009. St.meld.nr. 47. Samhandlingsreformen. Rett behandling—på rett sted—til rett tid. http://www.regjeringen.no/nb/dep/hod/dok/regpubl/stmeld/2008-2009/stmeld-nr-47-2008-2009-.html?id=567201. Acessed 16 March 2011.
- Seattle 2000 Decleration. 2000. Seattle 2000 Declaration on Self-Determination and Individualized Founding. http://members.shaw.ca/individualizedfunding/Declaration.htm. Accessed 14 Dec 2010.
- Selbaek, G., O. Kirkevold, and K. Engedal. 2008. The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes—a 12-month follow-up study. American Journal of Geriatric Psychiatry 16(7): 528–536.PubMedCrossRefGoogle Scholar
- Solomon, B.B. 1976. Black empowerment social work in oppressed communities. New York: Columbia University Press.Google Scholar
- Starrin, B., C. Heyerdahl, and O.P. Askheim. 2007. Empowerment i teori og praksis. Oslo: Gyldendal akademisk.Google Scholar