theory calming: you can only get there from here

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Pergamon 1353~8292(95)00025-9 Commentary Theory calming: you can only get there from here John Eyles and Andrea Litva Department of Geography, McMaster University, Hamilton, Ontario LAY 4K1, Canada The Dutch are an inventive people, One of their most brilliant and re- cent ideas to improve the pace of life in cities is traffic calming. In order to reduce the speed of through-traffic, streets are narrowed and turned into culs-de-sac, minor roads become major, and stop signs restrict move- ment. We feel that our initial paper (Litva and Eyles, 1995), upon which Philo (1996) has commented, was to serve the same purpose. We wanted to calm the ‘theoretical traffic’ so one (of many possible) description(s) of how we presently use theory could be elaborated. Let us first under- stand that health geographers are currently attempting to theorize our research in order that we can even- tually merge onto the fast-moving lanes of the theoretical expressway. This has sometimes resulted in ceaseless chatter and lipservice being paid to theorizing. Therefore, some calming is required before a largely atheoretical discipline can join the expressway. In this way, we felt our paper could act as a ramp for greater theoretical discussion in a subdisci- pline where there has been relatively little. We realize that our ‘theory calming’ analogy is another hostage to fortune in that it implies that we see theory exploration and develop- ment as a linear, evolutionary pro- cess. We do not. Really, all we want to do is start at the beginning, pro- ceed cautiously, and really take advantage of the theoretical lessons learned in the ‘already advanced . . . corpus of human geography’ (Philo, 1996, p. 35). Responses to commentaries usual- ly take the form of apology or denial. While this response certainly con- tains elements of both, we also in- tend to be more robust. We are truly delighted that Philo (1996) has pro- duced such a detailed and sympathe- tic account of our work. We feel that he has written the next stage in the process of revealing theory in and for health geography. Just by his com- mentary, our primary purpose is served. However, at times his account does read much as if it addresses the paper he wishes we had written as opposed to one we did. We could not agree more with his last sentence: ‘there are all man- ner of other chapters, sections, plots, sub-plots, footnotes, endnotes and appendices to the story of theory in medical geography which are still very much up for the telling’. Indeed there are and we sincerely hope that this story continues on and that the plot-or congestion-thickens. But let us begin with a little bit of dis- agreement. Philo admits that he is not a spe- cialist in health geography. This is advantageous because it enables him to cast a fresh and different view on issues and helps us to confront them from the unfamiliar point of view. This is also a liability as the history and nature of our subdiscipline is Health & Place, Vol. 2, No. 1, pp. 41-43, 1996 Copyright 0 1996 Elsevier Science Ltd Printed in Great Britain. All rights reserved 1353-8292/% $15.00 + 0.00 somewhat unknown to him. And it is in our reading of the present state of health geography that we feel the need for exposure to (what to others in human geography must appear) the relatively mundane and familiar. However, sometimes we need to re- flect on where we’ve been in order to understand where we are going. So, in our reading, we are struck by the sometimes implicit linkage between health geography and epidemiology and spatial economics in the inves- tigation of disease distributions and diffusion and the location of medical care facilities. In these linkages, we see the relations between health geography and functionalism, and we still argue, positivism. Let us use epidemiology as an illustration. Epidemiology is the study of the distribution and determinants of dis- ease frequently in human popula- tions (MacMahon and Pugh, 1970). It rests on two basic assumptions that human disease does not occur at random and that it has causal (and preventive) factors that can be iden- tified systematically (Hennekens and Buring, 1987). To relate it to a par- ticular philosophy, which can be ex- plained as sets of theories and types of explanation, it is necessary to understand its approach to causa- tion. Hage and Meeker (1988) suggest that there are four recognized kinds of causes, one of which is the effi- cient cause (seen as the source of

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Page 1: Theory calming: you can only get there from here

Pergamon

1353~8292(95)00025-9

Commentary

Theory calming: you can only get there from here

John Eyles and Andrea Litva Department of Geography, McMaster University, Hamilton, Ontario LAY 4K1, Canada

The Dutch are an inventive people, One of their most brilliant and re- cent ideas to improve the pace of life in cities is traffic calming. In order to reduce the speed of through-traffic, streets are narrowed and turned into culs-de-sac, minor roads become major, and stop signs restrict move- ment. We feel that our initial paper (Litva and Eyles, 1995), upon which Philo (1996) has commented, was to serve the same purpose. We wanted to calm the ‘theoretical traffic’ so one (of many possible) description(s) of how we presently use theory could be elaborated. Let us first under- stand that health geographers are currently attempting to theorize our research in order that we can even- tually merge onto the fast-moving lanes of the theoretical expressway. This has sometimes resulted in ceaseless chatter and lipservice being paid to theorizing. Therefore, some calming is required before a largely atheoretical discipline can join the expressway. In this way, we felt our paper could act as a ramp for greater theoretical discussion in a subdisci- pline where there has been relatively little. We realize that our ‘theory calming’ analogy is another hostage to fortune in that it implies that we see theory exploration and develop- ment as a linear, evolutionary pro- cess. We do not. Really, all we want to do is start at the beginning, pro- ceed cautiously, and really take advantage of the theoretical lessons

learned in the ‘already advanced . . . corpus of human geography’ (Philo, 1996, p. 35).

Responses to commentaries usual- ly take the form of apology or denial. While this response certainly con- tains elements of both, we also in- tend to be more robust. We are truly delighted that Philo (1996) has pro- duced such a detailed and sympathe- tic account of our work. We feel that he has written the next stage in the process of revealing theory in and for health geography. Just by his com- mentary, our primary purpose is served. However, at times his account does read much as if it addresses the paper he wishes we had written as opposed to one we did. We could not agree more with his last sentence: ‘there are all man- ner of other chapters, sections, plots, sub-plots, footnotes, endnotes and appendices to the story of theory in medical geography which are still very much up for the telling’. Indeed there are and we sincerely hope that this story continues on and that the plot-or congestion-thickens. But let us begin with a little bit of dis- agreement.

Philo admits that he is not a spe- cialist in health geography. This is advantageous because it enables him to cast a fresh and different view on issues and helps us to confront them from the unfamiliar point of view. This is also a liability as the history and nature of our subdiscipline is

Health & Place, Vol. 2, No. 1, pp. 41-43, 1996 Copyright 0 1996 Elsevier Science Ltd

Printed in Great Britain. All rights reserved 1353-8292/% $15.00 + 0.00

somewhat unknown to him. And it is in our reading of the present state of health geography that we feel the need for exposure to (what to others in human geography must appear) the relatively mundane and familiar. However, sometimes we need to re- flect on where we’ve been in order to understand where we are going. So, in our reading, we are struck by the sometimes implicit linkage between health geography and epidemiology and spatial economics in the inves- tigation of disease distributions and diffusion and the location of medical care facilities. In these linkages, we see the relations between health geography and functionalism, and we still argue, positivism. Let us use epidemiology as an illustration.

Epidemiology is the study of the distribution and determinants of dis- ease frequently in human popula- tions (MacMahon and Pugh, 1970). It rests on two basic assumptions that human disease does not occur at random and that it has causal (and preventive) factors that can be iden- tified systematically (Hennekens and Buring, 1987). To relate it to a par- ticular philosophy, which can be ex- plained as sets of theories and types of explanation, it is necessary to understand its approach to causa- tion.

Hage and Meeker (1988) suggest that there are four recognized kinds of causes, one of which is the effi- cient cause (seen as the source of

Page 2: Theory calming: you can only get there from here

Commentary

motion). They argue that scientists, such as epidemiologists (and spatial economists) use efficient cause as they want to know what makes an event occur or what puts it into motion. Hence, we can see the rationale for the precondition for causality outlined by, amongst others, Jones and Moon (1987), named co-variation (cause and effect being associated over time and space-it not being a unique occur- rence); temporal precedence (if X causally precedes Y, changes in X produce changes in Y); and the lack of spuriousness (the elimination of other possible explanations resulting from extraneous or confounding fac- tors). There are, of course, difficul- ties with theses conditions which are well recognized in both epidemiol- ogy and health geography (see Wal- ter, 1991). But despite its sophistica- tion in recognizing and modelling probabilistic and multicausal situa- tions, the efficient cause remains dominant. And it is elegant in its apparent simplicity. Health outcome is dependent in some way on expo- sure. Or, to put it somewhat dif- ferently, outcome is a consequence of exposure. To tease out these rela- tionships, epidemiologists employ ‘theories’ about the society in very specific and limited ways; usually in the form of working hypotheses in which a priori models are used to develop testable and falsifiable hun- ches about the relationships within and between different variables.

We did not address such ‘theories’ in our paper. We argued that ‘be- neath’ such important science there could be found more implied general theories--not philosophies, although philosophy and theory are closely related-and hence our desire to link health geography to social theory rather than approaches such as posi- tivism, humanism, structuralism as put forth by Johnston (1986). Furth- er, the theories that we advocated, while certainly extremely familiar to particular literatures, were of a par- ticular kind, those which Merton cal- led ‘of the middle range’. These

consist of limited sets of assumptions from which specific hypotheses are logi- cally derived and confirmed by empirical investigation These theories do not

remain separate but are consolidated into wider networks of theory . [they] are sufficiently abstract to deal with differing spheres of social behavior and social structure, so that they transcend sheer description or empirical generalization . . as a result many theories of the middle range are consonant with a variety of systems of sociological thought , The middle-range orientation involves the specification of ignorance . . (Mer- ton, 1968, p. 68).

Such theories have utility. The ulti- mate test of a theory as Stinchcombe (1968, p. 3) notes is ‘to create the capacity to invent explanations’ and to posit a particular form of explana- tion. Note that we write of explana- tions and not of understanding and we do not seek precision in defining the middle range.

Epidemiology does, however, re- main often at the level of working hypothesis. It does, as we have noted, point to an efficient notion of causation. Thus, if the conditions of causality are met, X is seen to cause Y, Y is a consequence of X. It is the nature of causation that enables a linking (or perceived parallelism) be- tween epidemiology and functional analysis. This is not surprising-it seems eminently sensible to examine or determine the consequences of a disease for bodily function or health status. But the use of epidemiologic- al design in health geography carries with it the implicit attachment to functional analysis (and functional- ism) when the unit of analysis is social rather than individual. The tracking from functional analysis to functionalism is subtle, and often unintended. But in functional analy- sis there is an implied model of hol- ism when it is transferred in its ex- tension to examine social matters (see Comte, 1908). Its holism implies harmony, as is restoring the body or the social system. As Radcliffe- Brown (1952, p. 181) puts it:

the function of a particular social usage is the contribution it makes to the total social life as the functioning of the total social system. Such a view implies that a social system (the total social structure of a society together with the totality of social usages in which that structure appears and on which it depends for its continued existence) has a certain kind of unity which we may speak of as a function unity. We may define it as a condition in which all parts of the social system work

together with a sufficient degree of har- mony or internal consistency (i.e. without producing persistent conflicts which can neither be resolved nor regulated).

Of course, the more sophisticated versions of social functional analysis include dysfunctions, conflicts and unanticipated consequences so we have no tried to relate health geo- graphy with a bankrupt straw person.

At one point Philo disputes our statement that ‘[s]tructural func- tionalism uses a postivist approach’ (Litva and Eyles, 1995, p. 8) And this causes him to question our locat- ing much of health geography within this category. In this we follow Dur- kheim (1938), who argues: ‘consider all social facts as things’. Now Dur- kheim did distinguish between things as they are in ‘reality’ and the ideas we have about them, i.e. concepts. Science studies ‘things’, but during the incipient stages of a science’s development it is frequently the case that the human mind not only per- ceives the phenomena under study, but also speculates on their nature and develops crude concepts in order to make sense of them. And this is especially likely to occur with social phenomena. We all have ideas about such things as the nature of humans, the purpose of the family, the func- tion of health, and we govern our behaviour accordingly. But none of these ideas have been scientifically established; they simply reveal our ideas about reality.

Through deductive reasoning, we begin to construct complex theor- etical systems, which are nothing more than logical extrapolations of untested ideas. In Durkheim’s view, we must attempt to avoid dealing with such concepts which have not been established scientifically. So he provided three rules to follow. First, all preconceptions must be eradi- cated and concepts must be free from lay concepts. Second, in order to do science, it is necessary to de- fine at the outset the phenomena under study. Therefore, social facts must be reduced to the most objec- tively verifiable, externally visible characteristics, even if they are not readily obvious. The third rule is that in order to acquire an objective understanding of a phenomenon, it

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Commentary

tivism, Bridges, J. H. (trans.), Harri- son, F. (ed.), London: Routledge.

Durkheim, E. (1938) The Rules of Sociological Method, Chicago: Uni- versity of Chicago Press.

Hage, J. and Meeker, B. (1988) Social Causality, Boston: Unwin Hyman.

Halfpenny, P. (1982) Positivism and Sociology. London: Allen and Unwin.

Hennekens, C. H. and Buring, J. E. (1987) Epidemiology in Medicine, Bos- ton: Little, Brown.

Johnston, R. J. (1986) Philosophy and Human Geography, London: Arnold.

Jones, K. and Moon, G. (1987) Health, Disease and Society, London: RKP.

Lee, D. and Newby, H. (1983) The Prob- lem of Sociology. London: Hutchison.

Litva, A. and Eyles, J. (1995) ‘Coming out: exposing social theory in medical geography’, Health & Place. 1, pp. 5- 14.

MacMahon, B. and Pugh, T. F. (1970) Epidemiology, Boston: Little, Brown.

Merton, R. (1968) Social Theorv and

is necessary to consider it in its general form: or, simply, scientific laws must be universal and general. In insisting that social facts be re- garded as things, Durkheim is not asking us to reduce social phe- nomena to material phenomena but rather to put ourselves in the same frame of mind as the physicist, chem- ist, biologist or epidemiologist when analysing social occurrences. We be- lieve that Durkheim’s view of scien- ce clearly falls into the positivistic tradition. Consequently, functional- ism is rooted in positivism (see Dur- kheim, 1938; Lee and Newby, 1983; Trigg, 1985; Ritzer, 1992) although it is a very complex relation (Halfpen- ny, 1982).

What has all this got to do with health geography? Everything. While our present appears so distant from these ideas, we must recognize the salience of the past. It enables us to see our theories as nested in total systems of thought-philosophical positions or approaches to know- ledge. Actually, the connection be- tween functional analysis and func- tionalism on the one hand and posi- tivism on the other is answered very well by Philo himself in his first endnote. The connection, apparent- ly not noted as a cross-reference in the two dictionaries to which Philo refers in his second footnote, has been debated on several occasions is the social sciences. This is not sur-

prising given the analogies between physical/biological and social worlds employed in functionalism and the conceptual and methodological im- plications of these analogues. For us, positivism provides the ontology and epistemology-the meta-theory-for such health geography.

Despite its recent theoretical de- bates which we reference, the sub- discipline as practised, is still largely functionalist and positivist, seeing efficient cause as its goal rather than understanding. If health geography is to think through what it does, it needs to recognize what this practice implies. This is the reason for our focusing on the familiar in our paper and subsequently our response. In- deed, we know our ‘exposure’ is but one, partial account. We recognize this but perhaps did not state it strongly enough. We provide one reading of the familiar in the hope that we stop at the signs and proceed calmly. Difference in perspectives are enticing and rich but also poten- tially disruptive. We must set our sights-recognizing our beginnings and hence the framing of possibilities-before entering the ex- pressway or else the disruption may result in a traffic jam.

References

Comte, A. (1908) General View of Posi-

Social Strkturel New York:’ Fret Press.

Philo, C. (1996) ‘Staying in? Invited com- ments on “Coming out: exposing social theory in medical geography” ‘. Health & Place, 2, pp. 3S-40.

Radcliffe-Brown, A. R. (1952) Structure and Function in Primitive Society, Lon- don: Cohen and West.

Ritzer, G. (1992) Contemporary Sociolo- gical Theory, New York: McGraw- Hill.

Stinchcombe, A. L. (1968) Constructing Social Theories, New York: Harcourt, Brace and World.

Trigg, R. (1985) Understanding Social Science. Oxford: Blackwell.

Walter, S. (1991) ‘The ecological method in the study of environmental health’, Environmental Health Perspectives, 94, pp. 61-73.

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