Orders and Their Others: On the Constitution of Universalities in Medical Work

Attempts to formalize, standardize, and rationalize are ubiquitous in Western worlds. Work practices are made more "efficient," professional practices are supposed to become more "scientific," and technical practices should obey "universal" standards. The disorder of current practices, according to such discourses, should be replaced by scientifically established, rational, and universal modes of working and understanding. Given a certain task, the procedures drawn upon and the knowledge and artifacts used should adhere to scientific criteria, so that the outcomes achieved are optimal--and more predictable. These universal modes are found through diligent scientific reasoning, and their superiority is self-evident--but for those who remain blinded by irrational or biased beliefs. ¹

Within the social studies of science and technology (STS), these discourses and processes have been questioned. Universality, actor-network theorists have argued, is not a transcendent, a priori quality of a body of knowledge or a set of procedures. Rather, it is an acquired quality; it is the effect produced through binding heterogeneous elements together into a tightly coupled, widely extended network. Likewise, "formality" is an effect created by the rendering docile of a network, and by the concurrent production and channeling of a stream of standardized inscriptions that afford easy manipulation. In his elegant study on the creation of universality, Joseph O'Connell discusses the history of electrical units. ² Laboratory scientists, U.S. war planes, and consumers buying new TVs do not simply plug into some pregiven, natural Universal called the Volt. Rather, the volt is a complex historical construct, whose maintenance has required and still requires legions of technicians, Acts of Congress, a Bureau of Standards, cooling devices, precisely designed portable batteries, and so forth. When the U.S. Navy supplied Kuwait with airplanes before the Iraqi invasion, it had to install standards laboratories there first: Kuwait bought not only U.S. Navy airplanes, but the U.S. Navy volt as well. Following Bruno Latour's programmatic analyses, O'Connell demonstrates how "the apparent universality of science is tribute to the power of a collective rendered stable by the pre-circulation of stable objects"; creating universality is "establishing the authority of a particular representative, circulating it, and assuring that comparisons are made to it." ³

Other theoretical traditions within STS likewise question these rhetorics. Social-constructivist analyses, for example, also argue that the universality of technology or knowledge is an emergent property: to them, a fact or a technology becomes universal when the relevant social actors defining it share a common definition. ⁴ Current work practices, according to all these analyses, should not be too easily labeled "irrational" and "disordered": they only seem disordered, most STS researchers would argue, when idealized and impoverished "universal" models are imposed on them as a measuring stick.

These arguments all combat the notion that the ubiquitous utilization of a procedure, a fact, or an artifact is self-explanatory; they undermine the view that universality is a quality inherent in the knowledge or the artifact. Yet in showing the constructed nature of universality, many actor-network theory (ANT) and social-constructivist analyses reproduce some crucial tropes that are part and parcel of the very story they are trying to erode. Universality is depicted as an effect, but then it is often granted some of the qualities that figure as a priori's in the "received" scientistic or technologically determinist tales. In Latour's classic Science in Action, the overall trope is the work and translations involved in the alignment of heterogeneous allies in an expanding network; in the classic studies of Trevor Pinch and Wiebe Bijker, closure is reached through aligning relevant social groups. ⁵ Although these studies stress that closure is always temporary and that a network is never rendered fully docile, the creation of order is argued to depend on consensus, or on rendering equivalent and stabilizing that which was different and untamed.

What remains...