About Bullshit Nursing

This text is an analysis of a very peculiar form of language that I will call nursing bullshit. The title as well as the initial inspiration comes from André Spicer brilliant essay Business Bullshit. My core message is that a significant proportion of academic nursing is bullshit. Yes, the choice of the term is deliberately catchy and offensive, and I’ll get back later to the justification of this choice. But before, what is academic bullshit?

The first characteristic of bullshit is that, contrarily to other forms of language it has no obvious connections with empirical reality. The object of bullshit isn’t to describe reality nor to communicate about it. Bullshit is thus highly abstract. Neither the speaker nor the listener would be able to translate the bullshit into a set of simple, practical sentences related to mundane daily experiences of the world.

But then, is language always meant to be simple, precise and objective? Obviously not. The line that distinguishes the normal use of language and what we call bullshit might be a thin one. In Philosophical Investigations Wittgenstein brilliantly highlights the complexity of the link between language and any objective reality. At the same time, and somewhat paradoxically, in that text Wittgenstein uses language in a very careful way to systematically and clearly make his point on the complexity of language games. He does also raise the possibility that, sometimes, language can be crafted specifically to not convey a meaning.

When we say: “Every word in language signifies something” we have so far said nothing whatever; unless we have explained exactly what distinction we wish to make. (It might be, of course, that we wanted to distinguish the words of language (8) from words ‘without meaning’ such as occur in Lewis Carroll’s poems, or words like “Lilliburlero” in songs.)

Wittgenstein, L. (1998). Philosophical Investigations. Blackwell Publishers (para. 13)

Bullshit is, in the same way, an atypical use of language in the sense that it is not meant to convey a specific meaning. To take an analogy, bullshit is to meaningful language what cubism is to realistic visual representation. Saying this does not imply that cubism, as a visual expression, is meaningless. On the contrary, the painter’s ambition is definitely to convey something. But that something is for one part in the realm of subjective feelings and for another part a dialogical episode in the evolution of visual arts. In the same way, bullshit is language carefully crafted to evade any specific and precise meaning while being effective in ongoing social games.

The second characteristic of bullshit is that it has no practical conceptual value. Academic language is full of complex and sophisticated concepts summarized as one simple word (power, culture, democracy, etc.). To make sense of specialized academic discourses one thus needs to gain a sufficient mastery of those underlying concepts (which is a huge endeavour). But, as those concepts are often captured by words also used in daily lay language, specialized academic discourses actual sophistication might not be obvious at first sight. Therefore, such discourses outside of one’s area of expertise can read like a meaningless string of semi-random words and logical articulations.

Because of the external similitude between conceptual sophistication and academic bullshit, some academics have shown an unhealthy enthusiasm to explore the boundaries between the two. One of the clearest demonstration of the prevalence of bullshit in academia was provided by Alan Sokal who deliberately wrote of full paper of total bullshit and got it peer-reviewed and published (see Sokal Affair). However, I do contend that specialized academic discourse isn’t usually bullshit – or, at least, a lot of it isn’t. But making the distinction between a conceptually sound but complex academic concept (Bourdieu’s habitus would be one I like and use) and academic bullshit requires specialized expertise.

Actually, it requires both expertise and self-confidence. There are many good reasons one can be reluctant to call bullshit on a colleague (seniority, politeness, diplomacy, etc.) but there is also a whole lot of pluralistic ignorance going on. When a speaker utters bullshit, listeners are often left silently pondering if they are the only ones perplexed. What if what sounded like a meaningless garble to you was in fact a robust scientific debate that everyone else understood? So, not only can bullshit be hard to distinguish from legitimate complex academic discourse but raising the question can be intimidating. Nevertheless, we stick to our second characteristic of bullshit as deliberately hard to grasp discourses that have no conceptual value –– actually impossible to grasp discourses, as they have no meaning.

But the best way to define academic nursing bullshit might be to provide what Wittgenstein would have called an ostensive definition. So here are some – well-cited and peer-reviewed – samples randomly identified from a few minutes spent online:

The principles of integrative nursing and caring science align with the unitary paradigm in a way that can inform and shape nursing knowledge, patient care delivery across populations and settings, and new healthcare policy. The proposed policies may transform the healthcare system in a way that supports nursing praxis and honors the discipline’s unitary paradigm.

Koithan, M.S. Kreitzer M.J. & Watson J. (2017) Linking the Unitary Paradigm to Policy through a Synthesis of Caring Science and Integrative Nursing. Nursing Science Quarterly. 30(3) p.262

By transposing Ricouer’s [SIC… for real, I’m not making this up] (1992) ontology of the self onto a nursing ontology, nurse theorists’ articulations become individual attestations about nursing practice. Attesting and being suspicious, according to Ricoeur, are both indispensable sensibilities for understanding the self and, by analogy, they are both indispensable for exploring the nature of nursing practice.

Flaming, D. (2004) Nursing theories as nursing ontologies. Nursing Philosophy, 5 p. 227

The creative leap necessary for formulating the motion lens of nursing inquiry may be to address the rhythmic processes of complexity and integration that enhance well-being across these health experiences.

Reed, P.G. (1997) Nursing: The Ontology of the Discipline. Nursing Science Quarterly 10(2) p.78

And unfortunately, such examples are terribly easy to source. I would even suggest that a significant proportion of what is produced within academic nursing is actually bullshit. Clearly, academic bullshit isn’t specific to nursing. But, in my mind there is a lot of bullshit going on in academic nursing and this isn’t desirable for, at least, three reasons. First, it is useless to the scientific endeavour. Having no connection to reality nor conceptual value, bullshit is the exact opposite of what the language of science should be.

Not only is it useless but it impedes the understanding of the world. As bullshit becomes a commonplace occurrence in a field, it will prompt the growth of a significant capacity in bullshit exegesis. Academic bullshit being deliberately cryptic a lot of individual and collective efforts will be put into offering various – equally cryptic and useless – applications and explanations about the meaning and implications of given pieces of bullshit. This will in turn prompt a feedback process where large layered constructions of bullshit will be produced and circulated. This uses-up time and resources that could instead be used to actually do something useful.

Finally, bullshit disempowers those who use or are exposed to it. By being both useless and ambiguous bullshit weakens the connection between participants, language and reality. As said earlier I don’t posit a simple connection here, but I conceive language as the main human tool to build a shared understanding of reality. When language is used for the opposite, it makes it all the much harder, not only to understand the world, but also to share its understandings. And, ultimately, shared understandings are the basic political tools needed to change the world. Conversely, language emptied of any meaningful connection with people’s experience is a tool to foster obedience. For example, last year a Pocosa blog entry brilliantly discussed how Nurspeak was used to disempower nurses. And the fact that bullshit, as a specific form of language, was first described in political and business discourses is no accident. In those fields, bullshit is used with a purpose. It is a social tool used to foster obedience and stability (Adam Curtis 2016 documentary HyperNormalisation provides some frightening insights on the scale of it).

In my opinion, most academic bullshit isn’t used with such a purpose nor such a level of Machiavellianism. It is mostly the product of individual opportunism, pluralistic ignorance and gullibility. Some academics will discover on their own that they can successfully get away with bullshit instead of proper academic analysis. Something that will be easier in new disciplinary fields (academic nursing being an example) or during periods of paradigmatic change (postmodernism in social sciences).

Nursing has all two traits of a vulnerable field. First, as a university-based autonomous discipline, nursing’s existence rests on its capacity to distance itself from a purely technical field of practice. Going for a high level of abstraction is an obvious way to achieve this. And bullshit – being disconnected from any reality – can be seen as the absolute level in abstraction. Second, as a new discipline, nursing is – very legitimately – borrowing heavily from other fields. And this creates an opportunity to, sometimes, take too much liberty in interpretation and adaptation, thus trespassing from the complex to the meaningless. And by saying this I am in no way suggesting that all academic nursing is bullshit. I’m convinced that nursing is a proper discipline. I’m barely saying that academic bullshit exists within nursing and that there are reasons to believe that this discipline might be more vulnerable to it than others.

Once trainees and students enter in a field where bullshit is widely regarded as a valid intellectual currency then social reproduction processes will facilitate its growth. Mastering nursing bullshit takes time and, as such, is an investment. As any investment, those who capitalized on it will want it to be fruitful (which somehow intersect to some extent with David Graeber’s thesis about the economic importance of bullshit jobs). The only way to reap the benefits from one’s investment in mastering a strand of academic bullshit is to foster its use in academia. In practice this will take the form of a systematic effort to push any debate or academic discussion toward the realm of bullshit-based discourses. When successful, this grants the speaker a distinct advantage in controlling the discussion.

The points I wanted to make here are threefold. First, I believe that what I have described as nursing bullshit exists and is quite widely used. Second, once bullshit takes hold somewhere it creates a feedback process fostering its own growth. Third, academic bullshit isn’t only ridiculous, but it is actually dangerous for the scientific endeavour. This brings me to my conclusion. I could have written this text using a term less offensive than bullshit (The Sokal hoax is often discussed using the term fashionable nonsense). But in my opinion, the nursing discipline needs a good shakeout. Bullshit has reached the point where I sometimes feel more energy is spent in bullshit exegesis and hermeneutics than in improving the understanding of the world or improving practice. This needs to change and here is my advice:

Nursing bullshit:

Spot it. Name it. Sidestep it.

Don’t use it. Don’t ignore it. Don’t debate it.

And more than anything DON’T TEACH IT

*L’image à partir d’un photogramme tiré de la pièce de John Baldessari I Will Not Make Any More Boring Art (1971)