Abstract
How might we engage global or transnational practitioners in talking and thinking about policy? This article offers a particular kind of practitioner, already concerned with advocacy, engagement and organizational development, a way of thinking about what they do and, in turn, what policy is and does and how it is made. It presents a research-based, narrative account of a policy officer visiting a country for the first time, as the trip – and the policy work on which the officer has embarked – is reconstructed in conversation with a professional mentor. This dialogue generates a reflexive self-awareness in the protagonist-practitioner, and the reporting of it prompts a similar reflexivity in the reader: The reader-practitioner learns vicariously, by watching a counterpart learn. A supplementary discussion engages with the very different presumed academic readership of this journal, reflecting on the credibility and validity of the story as a mode of academic writing and on its design and form as pedagogy.
A policy story
What is policy? How do we do or make policy? Where and who with? What is it for, anyway, and what difference does it make? Good questions, though you wouldn’t be asking them if you hadn’t already guessed that answering them isn’t easy. You know that some people are called policy makers and others practitioners, though it’s never very clear quite who they are. You’ve heard of something called ‘the policy process’, though it seems very remote. It has to do with government, though it has a lot to do with you and your work, too. So why is it so hard to know what the policy is right now?
I wonder why you’re asking, and want to know more about what you do. All I’ve got is that you work as a Development Officer for an international nongovernmental organization (NGO), and that you hold specific responsibility for its new mental health programme. You have a clear enough sense that you’re supposed to make or find a fit with ‘policy’; you’re just not very clear what that would mean. So tell me where you’re at right now and I’ll do my best to feel my way into the story, interpreting, inferring, sometimes plain guessing, and otherwise leaving gaps where neither of us can fill them. I’m not about to tell you what to do, or how to do it. I don’t want to, and probably couldn’t, anyway. I’m more interested in understanding what you actually do, what you already do, though I might think of it in terms different from yours. I’m not always comfortable with that, because of course you know what you do much better than I do. But you know it tacitly, implicitly. All I’m doing is trying to make it available in a different way, so that we can talk about it.
And then, of course, there are all sorts of ways we might talk about policy. I’ve read some of the academic accounts, and in other parts of my work, find them powerful and useful, though I understand why they don’t make much sense and aren’t much use to you. I’m wondering whether we might build an alternative account of policy based in the kind of work you do, in the tasks and activities which make up your job.
Worried about policy
Anyway, you tell me you’re on the plane and you’re worried. You have a ticket to a capital city you’ve not been to before and you have the aisle seat you prefer. Your hotel is booked, and you have a meeting arranged for the following day. You’re to see Dr Segura who will take you to his office and introduce you to his colleagues. You’ll have lunch, over which he’ll brief you again about the situation. His last mail suggested a site visit to a small town 6 hours’ drive away. You found the region and the river after which it’s named, but the town itself was not marked on your map. You’re expecting to go later this week, though you heard from Jo that the rains have come again.
As you think through the next 3 weeks, you wonder what you need to know to write the assessment report your Board has asked for. You’d talked it through with Deborah, your Program Director, before you left. She’d thought there were ‘policy opportunities’ here and you’d said yes, brightly you thought, though you agonize now about how you could have been so enthusiastic and so uncertain at the same time. She must have noticed, and seemed, now you think about it, to want to push you, test you.
You sit back in your seat, a little self-consciously. You’re not sure where you’re going, you’re not sure what’s going on there, or what you’re going to do. You remember the last mission began like this, though Andrew was with you then (or you with him, as project assistant). So this, in a way, is your first time, your first mission in the job you’ve wanted to do ever since you were an intern. You’re not worried, exactly; apprehensive perhaps, uneasy. You’d usually ask for another of those little bottles of wine, but tonight – or is it already this morning? – you’ve barely touched the first.
As you wonder where you’re going, you think about where you’re from. You always wanted to work abroad. You wanted to make a difference. You wanted to work with people. You wanted, in the end, to do good rather than make money (and what you’re paid now bears that out). You wondered about grad school, you thought about law, you flirted with development studies, you felt suspicious of social science because you couldn’t really see that it was about anything relevant. You volunteered to do advice work, and then took your current job because they encouraged you to do your counselling qualification part-time. You began to see more and more refugees. Their problems have become familiar now. You like working with them, and with the team, which seems to be really going places. You’re happy in the clinic, but you’ve felt for a while you could do more. And now, despite yourself and apparently out of nowhere, you’re worried about policy.
First meeting
In the lobby, that first morning, is a slight young man sitting awkwardly on a couch. You see him glance at the receptionist, who nods. He gets up and comes across to you, introduces himself as Christopher, which seems unlikely until he explains, later, how he was brought up by nuns. He has another name you don’t quite catch. He seems to know who you are. The piece of paper in his hand has your name on it, in capitals and with the vowels in the wrong order.
He drives you across the city in a Land Cruiser, which makes you feel special, though you notice lots of others. He tells you how he began working with Dr Segura when his sister was a patient at the clinic and they needed someone to go to the airport to get boxes of drugs.
Dr Segura stands up from her desk, taking off her glasses and reaching out her hand. You feel a flash of embarrassment. She welcomes you, asks about your trip and where you’re staying, apologizes for her English. The letter from Deborah is on a pile of other papers. The logo on the letterhead is repeated on the badge in your lapel. There’s no time to talk, so you arrange to meet again for lunch. In the meantime, she asks a nurse to show you round. He says little, but smiles a lot.
Later, you stop at a café before going back to the hotel. The waiter comes over to you a bit too quickly, suddenly acting like a waiter rather than simply doing his job. Is he really the waiter, or is he just playing at being a waiter? Is he over-acting, just for you? You remember Sartre’s waiter. You wonder what this one thinks and wants, who he is and where he’s from, and whether he’s heard of Sartre. You ask for that glass of wine you didn’t have on the plane.
What happened back there at the clinic? You talked, feeling your way, sobered by having wrongly assumed Dr Segura was a man. You tried to connect, because you know how much depends on her. You talked in terms you thought would make sense to her, guessing what might appeal to her, trying to get her to guess that you’re the person you’re guessing she wants you to be.
You pieced together what she knew from patients with what you knew from NGO assessments. You listened to what she said about the nurses who had left. You talked about what might be possible for the project in terms of what you knew from Deborah, reframing what had been said in discussion at the staff meeting last week, back in Boston. You watched her slowly make sense of you, understanding Deborah’s letter differently now you were in front of her, rereading the letter in the light of what you were saying, reading you in the light of the letter, still wondering how much to trust.
You kept going, still trying to make sense of the situation. She was gradually more forthcoming about why things hadn’t worked out before. You developed a common story, aligned your work with hers as best you could. ‘What we need to do’, she started then as you left, but trailed off. Your ‘I think I should just go and see’ was a way out of the conversation as much as a decision about what to do next.
Talking to Dr Segura had taken you a long way. ‘Where are you from?’, she had begun innocently, making you jerk inwardly because you thought she should have known. And in fact she did know, but just didn’t know where that was. And then you had struggled together to the point of ‘What we need to do now’. That was worth the glass of wine. Much later, meeting Dr Segura again in another country, at a different table with a different glass of wine, you would agree that this was where it all began.
In the field
You remember the last time you sat in a 4 × 4, on holiday in Scotland, and think how much this landscape is strangely like the Highlands. You frequently go off-road, skirting half-built bridges, reverting then to flat, noisy gravel. You stop in a small town, where the vehicle is quickly surrounded by children. Christopher arranges coffee at what he calls the hotel.
Before the next small town you turn off down a narrow track to a clearing. To one side is a long, low building with a corrugated iron roof and a verandah. The verandah is full of people waiting, some standing, most sitting huddled in white, soft shawls and all of them looking at you. It’s quiet. You walk up the wooden steps; Christopher hangs back.
Inside is a young woman sitting at a table. You ask for Sister Lucia. The woman says, ‘She is not around’. At the back of the room a man in a lab coat sits at a desk. He looks at you through thick glasses and nods, sympathetically but without smiling. He carries on writing, slowly, putting figures in columns. You say your name and that of your organization and he says yes. You say you were to meet Sister Lucia here.
You drive on into town, and find the hotel like the clinic, a low building in a small compound. There’s another white vehicle outside, and the only other guest is Kris. He’s leading a water project for another NGO, and you talk briefly over beer before he leaves. He said that another group had been here, too, but had only had money for 3 months. You asked, rhetorically you thought, why these projects failed. He said it was more than that, that projects fail because policy fails, or perhaps the problem here was that it had never existed. You ask what it would mean for policy to work.
We’d know what we were doing. I mean they’d know what we were doing. Look at those people at your clinic. They’re the same people who walk half a day to the well we’ve put in. I can call that some kind of success, and you’ll probably get something going, too. But in the end we’re probably bidding against the same budget line. And who knows how long that will be there. I can explain what I’m doing in terms that would be good for another proposal, but what are we really doing? Nobody’s talking. We only really know what we’re doing if we have some sense of what everybody else is doing, how it all fits together. And I’m in Cambodia next week. Where does that fit?
Back in the city, you meet Will, the development coordinator at the embassy. He suggests a bid to the regional programme: ‘That should work. Line up a few ducks, get them to buy in’. He suggests a ‘bilateral’ with his contact at the Ministry, and over the next few days you go on to meet people at the city bureau, at three different local NGOs, the medical director at the hospital and the general practitioner who runs the psychiatric ward. You’re received as a visitor, courteously but without much commitment. You feel like a stranger, searching for different ways of telling your story. You come from a world in which almost everybody knows your organization and its Director, where most people you meet already know who you are. They know that your project ‘works with distressed young people in post-conflict situations around the world’. But now you struggle to find the right word for ‘distress’ and wonder quite who, in the end, should count as young. By the end of the week, more people you meet seem already to have heard of you.
Memo to Deborah
Your flight doesn’t leave until late tomorrow. Your plate is taken away, leaving you at an empty table in an empty bar. You take out your notebook, now nearly full of scribbled accounts of meetings and so thickened with receipts and business cards it won’t lie flat. You start to draft a memo to Deborah. Date: 17 October. Subject: Policy Opportunities. You begin by setting out who you’ve seen, and what they said. You describe what you refer to now as the ‘site visit’ and begin to outline what you term a ‘service gap’. You attach a printout of the regional programme.
You start to draw a diagram, which you think might help. It’s difficult to place things on the page: the clinic is at the bottom, but too much of the rest ends up in the top right-hand corner. How should you represent the organizations you’ve dealt with, the people you’ve met, the roles they occupy and the relationships between them? You have some provisional, residual understanding of what is top and what is bottom, but then reflect that it doesn’t really do justice to what you’ve learned. Where is Sister Lucia? Who is Will really working for?
What you know and what you want to propose to Deborah has emerged laterally, not top-down or bottom-up. The health bureau is not ‘above’ the clinic but 150 km south west of it on a barely passable road. The level of practice is not ‘below’ the level of organization but somehow in front of it. Neither is prior to the other: the two are interdependent, mutually constitutive. The nurse is not ‘below’ the clinic, but inside it. The clinic, similarly, is somehow ‘inside’ the columns of figures that end up on Dr Segura’s desk.
You want to say something about the patients and wonder how to translate for Deborah what the nurse had translated for you. You use what the nurse himself had said when you asked about their mental health needs: ‘We can only imagine’. At the same time, there’s a shift in register from talk to writing, from the spoken word to words on paper. It’s partly a move from tacit to explicit, and from a colloquial to technical vocabulary. Much of what you say is borne by your trying to synthesize what different people had said, and much of that, you realize, is based on a few facts and a lot of guesswork. Many of the words are lifted from the regional programme, in effect translating back to Deborah what she had said – or what you now imagined she had said – about policy opportunities.
Now, as you formulate different stages of the project, you begin to identify your interlocutors, defining roles and the ways they might evolve. Your proposal becomes something like a collective script, however much room it leaves for improvisation. You move them round in some new conceptual space which is ‘regional mental health’. You leave the diagram out.
Policy and practice
What happened to that memo? The key thing, you had thought, the ‘principal project outcome’, as you wrote, was to establish a regional mental health network. At the time that felt new but also strangely derivative, taken from what others had told you, from what you had read and from what the funding scheme seemed to require. Nevertheless, getting it agreed was some achievement.
And now, 18 months later, you’re back, sitting in the network’s new office, where Dr James has just come off the phone. ‘Sister Lucia says hi, and thanks for your mail. She’ll come to the seminar’. Dr James is a psychiatrist, written into the project for his interest in outreach and his links with colleagues in the city. And because people think he’s a really good psychiatrist. ‘We’re getting there’, he says, ‘slowly. The district nurses have this idea about pharmaceutical distribution they want me to take to the minister. I said I’d take them instead, which means they’ll have to figure out what to say’. And then, slightly tired, ‘Let alone what to wear’.
As you left, he said he was worried. You smiled. He’d spent a long time with a patient he thought needed specialist care. He had listened to what the young man had told him, trying to understand what the patient himself couldn’t properly understand or express. He’d made some suggestions, though wasn’t sure his patient really took them in. He’d talked to the family, who were also talking to a religious healer, trying to enrol them all in the therapeutic process. He’d written a prescription, and also left a careful case note so that the community nurse could adjust the dose. That had been a couple of weeks ago, and in a village 80 km away. The father was to bring his son to the clinic today, and Dr James wasn’t sure he would.
Making sense of policy
So where does that leave us? Let’s get back to policy. You’ve just talked to me through the process by which you entered this new field as a stranger, and the different means by which you made sense of it and helped others make sense of you. I’ve been trying to draw your attention away from what you think you should be doing and towards what you really do. In essence, I think that’s something like this: you get in touch, you arrange to meet, you talk, you write a minute, a memo, a proposal, you arrange to meet and talk again. Policy making, it seems, consists in meeting, talking and writing, and your story tells how the idea of a project, programme or policy emerges from such everyday activity.
No, it can’t be that simple and I’m not really pretending it is. The simple actions and interactions we take for granted are in fact subtle, sophisticated and complex, predicated on some of the most fundamental aspects of human communication. Yes, in some ways we have to take them for granted, because otherwise we wouldn’t be able to function. But that’s not to say they aren’t worth thinking about sometimes: I think they’re key to thinking and learning about policy, about what it is and does, and how it works.
Meeting, talking, writing
We might begin with who you met, but remember even before we start that this was the reason you went in the first place, to have meetings. Those meetings were variously wary, interesting, confusing, hopeful, shocking, affirming and simply difficult – which, if you think about it, is why you needed to have them.
Moving between meetings is to move between ways of thinking about the world, some of which are complementary, some contradictory, some entirely unrelated. For a while you think you’re looking for a lowest common denominator, but then think that in the end it’s you, your presence there, your meetings. You begin to wonder what might be done at the intersection of all these different conceptions, denials and evasions of the problem, all these different understandings of appropriate action, different kinds of readiness to commit different kinds of resource.
Policy, if that’s what you’re doing, seems in this way truly cosmopolitan. It’s in the city that offices are located and meetings take place. Policy seems to be predicated on a series of spaces in which people meet and talk, and go on and meet and talk with others. Policy is born of the proximity of strangers. They may come to identify and acknowledge shared interests but they don’t necessarily begin with a shared sense of community. For policy becomes necessary in the absence of shared assumptions, when organizations need to make explicit what can no longer be taken for granted. Policy is made in the discussion of problems, in the distribution of roles and responsibilities, in the development of a collective story.
Your talking invariably results in writing of some kind, which is a very special thing. We write to fix the sense of a meeting: the notes we make help us recall who said what; the minutes we take are a way of establishing some provisional agreement as to what we’ve agreed; the memo which results is a way of sharing the discussion with others who weren’t there. And then words on paper are much more mobile than we are, because they can move quickly over large distances and because, remarkably, they can be in several places at once. In this way, they prompt myriad further conversations and writings. As they move, they mobilize: all these notes and memos, statements and reports invite – or perhaps provoke – reciprocal meeting, talking and writing.
As they extend through the world, these chains of discussion and documentation accrete things, bodies, organizations. Conversations develop into proposals, budgets, job descriptions, plane tickets, offices, departments, training manuals, mission statements, secretaries, forms and mailing lists. Projects become programmes and policies, and not necessarily in that order (or any order).
This implies, of course, that there is no real difference of scale or complexity between projects and policies, between micro and macro. At different ‘levels’, the office, the desk and the computer are essentially the same. What happens in the parliamentary chamber is essentially the same as what happens at the cafe table. The difference, perhaps, is only in the number of other offices, desks and computers to which any given office is connected. What we think of as a ‘higher’ level is simply an office predicated on others (and on which those others in turn are predicated).
Policy and power
‘So?’. What do you mean, ‘So?’. ‘Is this policy?’. Yes and no. Yes, it’s policy, in that we now have a collective script or narrative of mental health in the region which helps agents figure out their own and others’ next moves. It’s written up to a degree, partly evident in documents such as email, letters of introduction, minutes of meetings and funding bids, but much more often talked about, traceable in conversation. It’s widely implicit, and sometimes explicit in what people concerned with mental health in the region talk about with each other, and in the terms they use. That doesn’t mean they could always recite something called ‘mental health policy in the region’, but they’d recognize it (and qualify or argue about it) if you told them your version. Individuals, organizations – and networks – develop policies just as governments do, and they’re not in principle much different one from another.
But then no, it doesn’t ‘really exist’. It’s not finished. It has no final, fully articulated form. It couldn’t have: it’s necessarily incomplete, emergent, constantly in motion, always subject to interpretation, modification and extension as it enrols and mobilizes new actors and interests. And it will always be like that, however much it develops and however long it lasts. Any attempt to state it summarily or definitively produces nothing more than an interim artefact, subject to qualification, interpretation and all the vagaries of implementation. ‘Policy’ is contingent at every stage and turn, as Dr James knew and you recognized.
Contingent on what? This is really your other question, ‘Where’s the power?’. It may be there somewhere, but it’s implicit, always there and always implicit, essentially, relentlessly so. The individuals and organizations we’ve talked about hold power to the extent that they share a sense of a problem, a course of action and a set of reciprocal understandings of what each is supposed to do. This ‘shared sense’ holds not simply because it’s shared, but because each actor believes that it’s shared, that the others hold it too. In this way, policy develops by exchanging understandings of order and constructing new ones, new spaces which new actors (the regional network, for example) come to occupy. Now, in the region, not much is going to happen without the network – at least, as long as it can develop and sustain a model of order that serves as a resource for both its members and other relevant actors by which they can define their interests and conceive and coordinate their future actions.
Don’t misunderstand this conception of power as predicated on interrelated systems of belief. It doesn’t mean that power is ‘soft’, or that we can either dream it up or wish it away. In this way of thinking as in others, some people and organizations hold power and others don’t. But this one does help to explain precisely why power is so difficult to shift – think what it would take to change everyone’s understanding of where everyone else understands power to lie – and at the same time why it can seem to evaporate overnight, as people lose confidence in a particular individual, organization or institutional arrangement.
If it is successful, the network will accrete new actors, such as, perhaps, the regional government, the national Association of Psychiatrists and international donors. It will ‘interest interests’, which it will do by constructing disparate interests as consonant, by reconstructing them, rerepresenting and reassociating them, that is by translating them into new terms. It will provide them, as it did you, with ‘policy opportunities’. In this sense, the network is powerful – but see how power is an effect of a collective process of construction, that is, in this instance, what we have called ‘policy making’. Policy produces (and reproduces) power, not the other way round.
But what? You seem hesitant now. Is it right? Is any of this ‘right’? I don’t know, but it’s remarkable how so many of the people you met were somehow hesitant, too. Remember where you began your story, as a stranger entering a new world. The first person you met was Christopher, who seemed something of a stranger in his own world. He’s glad of his job as a driver, but he knows he’s never going to own a car. He’s not very sure what you’re doing, but knows you’ll leave soon. And his sister hasn’t left her room in months. Sister Lucia has an idea where you’re from, because she was on the regional training programme. She won’t make it to the conference, though, not because she can’t find the money (though that would be very difficult), but because she wouldn’t get a visa, because your country simply wouldn’t let her in. Dr James was always somewhat enigmatic, seeming to know much than he would ever say. He wants you around, but you feel he wishes he didn’t.
So what we happily called the ‘cosmopolitan’ was much more cosmopolitan for you than for them. The origins and growth of the city you visited, let alone its current function as a development hub, were always irreducibly colonial as much as or as well as cosmopolitan. That experience is inherent in pretty much everyone you met and everything you saw, and it’s an irreducible aspect of everything you talked about: health, medicine, development, community and, yes, policy.
But that’s the deal. It’s what you’re trying to work against, in some way, but it’s all you have to work
Let’s leave it there. I’m not sure either of us can take much more of this right now, but let’s talk again. Here’s my email address. Meanwhile, thanks for the thanks. It was nice talking to you. I didn’t mean to be counselling you, though, at least not in the way you mean; I don’t think you have a problem. At least, your problem is none other than the universal and existential one of ‘learning what you do’. You can’t help but learn that (though I think you can learn it well or badly), and it rightly makes you both anxious and exhilarated.
You’re the one with the counselling qualification, remember. I’m not, so I have to think of counsel as mere advice, as the ancient and respected function of giving counsel and its various institutional and political expressions. What I like about the idea of giving counsel is the connotations I think it carries of listening first, as well as, perhaps, of the relationship of mutual obligation established by gift-giving. In policy studies, all of this is sometimes described as ‘speaking truth unto power’, though as you’ll have gathered I’m not specially convinced either by truth or power. Speaking matters, though – talking and listening – which psychologists and psychiatrists tend to know better than policy specialists.
Writing for reflexivity
The aim of the first part of this article was to find a way of communicating an understanding of policy to the practitioner who feels somehow obliged to engage with it but who, simply by virtue of an immediate concern with practice, may feel sceptical about its utility. Doing so has entailed writing differently, in the form of a story, while remaining true to an essentially academic and theoretical understanding of both policy and practice. The story turns on the production of reflexivity, first in the story’s protagonist and through them in the reader.
The aim of this second part of the article is now to reflect on this experiment in form, to explain how and why it works not least by making its workings explicit, and to ask whether it works at all. It engages with a very different academic readership, on the understanding that the readership for the article – if published in this form, in this journal – is an academic one. The tone must shift, at least to some extent. It’s this part of the article that reflects on method, engages with theory, has footnotes and references – but it’s worth noting, too, that it’s been produced in practice and through dialogue in much the same way our practitioner experienced in part I. It’s been generated by presenting the story in research and writing groups, in conference workshops and in the discussion which has followed; it’s been questioned and reflected back to me by editors and reviewers who have been likewise generous but demanding, knowledgeable, sympathetic and critical.
The article is led by an interest in a reflexivity which is not just for the academy, which lives in more ways than the postgraduate research proposal allows, which recognizes an element of reflexivity in all teaching and learning, if not in all human interaction. To be sure, the university is one of the sites in which critical self-awareness is produced, often based on difficult thought and writing, especially about the terms and conditions in which knowledge in produced, and often provoked and developed by incursions from outside, by social movements. Yet if reflexivity is to make a difference, it must work in the world, in the wild, in practice. So how should we write about it, and not just
The story
One way to generate reflexivity is by telling a story. ‘Action reveals itself fully only to the storyteller’, (Arendt, 1959: 171). She is thinking of the historian, but we might include all those who register and make sense of an action, either immediately or subsequently. For the actor him- or herself cannot know fully what he or she does: What the storyteller narrates must necessarily be hidden from the actor himself, at least as long as he is in the act or caught in its consequences, because to him the meaningfulness of his act is not in the story that follows. Even though stories are the inevitable results of action, it is not the actor but the storyteller who perceives and ‘makes’ the story.
1
So what story – what kind of story in what form – should the storyteller make? Of all the ways of ‘telling about society’ (Becker, 2007), it is the case study – widely used in academic disciplines concerned with professional training such as law, medicine, business and social work – which is explicitly designed for teaching and learning. 2 Its essential purpose is to create an opportunity for learning inductively, from the specificities of practice (‘real life’), rather than deductively from generic and abstract principle. Cases have varying relations to reality: some are accounts of actual events and experiences, some are invented. Like any other form of representation, each is necessarily partial and selective, isolating or distilling particular social phenomena so as to make them available for interrogation and reflection.
Truth and fiction
What is the status of the story told here? Is it a true story? It has the mood and tone of narrative nonfiction, ‘nonfiction’ indicating that the facts and events described and information conveyed are true, correct, actually happened, and ‘narrative’ meaning that literary devices are used in its telling. 3 What’s interesting about this form is that it is precisely this creative element that enhances the ‘truth’ or verisimilitude of the story, that delivers much of the face-validity or ‘real feel’ it seems to have.
This isn’t, in fact, narrative nonfiction; what happens in the story didn’t actually happen in the way I set out. That said, I need to explain that I haven’t simply made it up, either (as any novelist will say, good fiction is based in extensive research). I’ve worked in Edinburgh since 1994, teaching government and public policy among other things. I have worked comparatively and cross-nationally, and developed a specific interest in mental health policy in the early 2000s.
I met Richard Mollica, Director of the Harvard Program in Refugee Trauma 4 in late 2001 or early 2002, when we both joined a Fulbright research programme. Between 2003 and 2006 I took part in the professional training for global mental health practitioners Richard hosted each year in Orvieto, Italy, and got to know psychiatrists, advocates and others from Africa, Latin America, Eastern Europe and elsewhere. I was later asked to contribute to a teaching manual: the Program wanted to include some element of policy making, which might mean anything from local service development to lobbying and legislation. The piece was to be theoretically sophisticated but also practice-oriented: it needed to be intelligible to practitioner–students across countries, sectors and settings, who may or may not have any background in social science.
I lived in Addis Ababa, Ethiopia for 6 months at the beginning of 2006 and again in 2007, where my wife was working. While there I completed a small project on mental health policy making in Ethiopia, funded by the then Scottish Executive’s Humanitarian Health Fund. This included taking part in meetings organized by Addis Ababa University’s medical school, as well as visits to its principal mental hospital, a regional health administration and a rural clinic. Psychiatrists in Addis had been asked to lead the development of a national mental health policy, and wanted to understand better what ‘policy’ is and does.
All this is by way of establishing my credentials, and the credibility or otherwise of the story. The claim is not that I know or knew the world of mental health policy and practice in any detail, but that I did have the experience of entering that world for the first time and trying to make sense of it. The article is precisely not about policy and practice in the global south, but it is about the process of trying to understand and take part in it.
That said, the story must appeal to and then engage readers with very different biographies and very different intellectual and professional backgrounds. It has a specifically indeterminate geography: there is no distinctively local colour, there are no identifiable foods, no place-names, no words or phrases in any local language. It must break the rules of creative writing and must ‘take you there’ without being very clear where that is: ‘there’ could be anywhere. The reader must do the work (whether consciously or not) of reading into the text the detail she already knows, or half-recognizes, or can imagine.
Of course, some readers will identify more readily with the interlocutors ‘you’ and ‘I’ than will others. The perspective adopted here is meant to engage the young professional in the Global North, and I feel I know ‘you’ and ‘I’ well enough to write about them. Sister Lucia and Dr James would write the story of their relationship with ‘you’ very differently, and would challenge ‘you’ in very different ways. Christopher would be unlikely to write it at all, or to engage with ‘you’ in any other way.
The story proper begins with an air of unease, a sense of discomfort:
‘I’ and ‘you’
What matters is not only the truth status of the story, the utility which derives from its credibility, but the relationship it establishes between speaker and listener, writer and reader. Scientific writing is produced as if from nowhere: it conventionally denies any relationship between author, reader and content. It acquires authority by denying the significance of authorship, other than in the clear identification and sequencing of names and affiliations at the head of a paper; individual identity is lost in a list. Social scientific writing is more personal, in the sense that its value is the product of a particular mind working in a particular way, and claims for it are made on that basis. What matters is the validity of the account of some social phenomenon and the authority of the claim made for or about it. The writer’s concern is with the relationship of what she or he says to the social reality with which she or he is concerned, and much less with his or her relationship to the reader. Writing for teaching is different, concerned principally with the relationship between reader and reality. The relationships between author and content and between writer and reader are made subservient to that.
The first page of my story is concerned with what Goffman would have called the ‘definition of the situation’. It sets up the terms and conditions of the encounter, which is a conversation between a participant on a training programme and a tutor or mentor. In this way, ‘I’ positions ‘you’: the mentor explains what (he) wants each of them to do, how he expects the session to unfold. The idea is that they talk about what the student/participant does when she goes into the field, and how that might be understood as the operation of policy. Together, they produce an account of that work which is both a description and an interpretation of it. 5
Who is this ‘I’? What kind of authorial persona or voice is adopted here? I am impersonating myself, creating (performing) an authorial identity I might want but don’t necessarily have. If I were to sit and talk with ‘you’ in the way this article imagines, my sentences wouldn’t come out fully formed, breaks between paragraphs would be very irregular, and some would seem very long indeed. I would interrupt myself, tell ‘you’ things I thought to say but which ‘you’ didn’t really need to know, repeat some phrase or other in a way ‘you’ would find irritating. Each sentence in the story you read as reader, however, has been crafted, written and rewritten several times.
‘I’ am talking to ‘you’ though I’m very aware I don’t quite know who or where ‘you’ is. And I get ‘your’ trust in part by acknowledging that. I need to get enough of ‘you’ the protagonist right for you the reader to tolerate what I get wrong. A contract has been set up:
In this way, the conversation proceeds in the manner of a therapeutic encounter (a practice familiar to the mental health professionals for whom the article was originally written). Experience is both the object and the medium of communication between counsellor and client; what’s at stake is not what really happened, because what ‘really’ happened remains inaccessible to client, counsellor and everybody else. What matters is the account or representation of what happened, which is to say how that experience is assimilated and how in turn it is described. Experience itself is inaccessible: it’s only the account of it that makes it available for reflection and interrogation. This is the sense of Arendt’s idea of the storyteller.
Writing in dialogue
Dialogue is an ancient pedagogic form. Plato deploys Socrates as the main protagonist of his
The dialogic mode appears to have a particular function in reflecting on practice, as in Kenway and Fahey’s
Academic writing turns to dialogue when authors want to think differently, when they want to show how thinking happens, and when they simply want to engage the reader in a different way, to invite her to join the conversation, however vicariously, rather than simply sit there and be told. Dialogue seems to be a way of getting at our own histories and practices, at things we don’t usually write or necessarily talk much about, a way of articulating them, perhaps for the first time, and so making them visible and available for wider dissemination and critique. What really goes on in the darker reaches of the desktop and the strangely private world of the classroom? What are we thinking when we do what we do? And what is it, in fact, that we’re really trying to do?
Writing, reading, reflexivity
The original aim of this article was to make the concept of policy intelligible and accessible to the practitioner, for whom policy usually appears as alien and abstract if it appears at all. It offers a particular conception of policy not as something ‘out there’, produced and imposed by others, but as something embedded in a set of practices (meeting, talking, writing) in which the protagonist/participant is herself engaged, if not implicated.
And then it is also, of course, an exploration of a form of academic engagement as storytelling, of relating the terms of the self to those of the other. It casts reflexivity as a kind of learning, pursued by researcher and teacher in the role of consultant or counsellor, creating opportunities for others to ‘learn what they do’. This, then, is a reflexive account of an account of reflexivity.
Footnotes
Acknowledgements
The origins of this article lie in conversations with practitioners and policy makers from many different countries, and many of them took place in meetings organized by the Harvard Program in Refugee Trauma. The author owes an enormous debt to Richard Mollica, which is only in small part redeemed here. Gregor Henderson and Pedro Mendoza read an early draft of the article, and the author is very grateful for the comments they made. Members of the ‘materials and practices’ group which used to meet in the Academy of Government at the University of Edinburgh read later drafts, and their mad combination of enthusiasm and scepticism has stayed with the author. He is further indebted to John Berten and Anna Wolkenhauer, editors of this special issue and convenors of the EWIS workshops where its material was first presented, who stayed with this article much longer than they reasonably might have done. He is likewise grateful to Alexandra Kaasch, editor of Global Social Policy and, finally but crucially, to an unusually generous and rightly demanding reviewer. Of course, he remains responsible for the misconceptions and misunderstandings the article may still contain.
Author’s note
No person in the story told here (part I) refers to any actual, living or historical person.
Funding
The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The author’s work in Ethiopia was partly funded by the then Scottish Executive’s Humanitarian Health Fund, as explained in the text, though this paper was conceived and written separately. The author alone remains responsible its content.
