Sunday, February 27, 2005

Lakoff - XIV: public health

[Preamble: This is one of a series of posts about the relevance of the work of George Lakoff for public health. First a disclaimer. My aim here is not an explication of all of Lakoff, or where he stands in cognitive science versus analytic philosophy, or whether there is a "there, there" as Gertrude Stein once wondered about Oakland (where Lakoff is now situated at UC Berkeley). It is rather to take some elements of Lakoff's writings (and I think genuine insights), and see how they might illuminate a central problem in public health, having a Central Problem. Posts will be relatively short, as befits the medium. PF is Lakoff's book, Philosophy in the Flesh (1999). MP is Moral Politics (2002)]

The Strict Father model for politics explains much about what ties the Conservative Agenda and its seemingly contradictory political positions together. It is one solution, but a very plausible one, to the puzzles Lakoff posed earlier (see Lakoff V). You can find his exposition of it in MP or Elephants.

But I admit to not feeling the same way about Lakoff's "liberal" counterpart, The Nurturant Parent. Nurturant Parent Family Morality takes as its foundation the infant's experience
. . . of being cared for and cared about, having one's desires for loving interactions met, living as happily as possible, and deriving meaning from mutual interaction and care.

Children develop best in and through their positive relationships to others, through their contribution to their community, and throgh the ways in which they realize their potential and find joy in life. Children become responsible, self-disciplined, and self-reliant through being cared for and respected and through caring for others.

[ . . . ]

Though this model is very different from the Strict Father model, they both have one very important thing in common. They both assume that the system of child-rearing will be reproduced in the child. (PF, p. 315)
One can recognize in Lakoff's formulation many liberal positions and attitudes, but the "family" model never seemed quite appropriate. Lakoff admits that the family model metaphor for politics is speculation on his part (see Lakoff XII). Because it worked so well for the nuclear family model I am myself speculating that Lakoff was seduced by the symmetry of having a comparable "family model" for liberals. But I don't feel it works as well as "glue" to keep liberal positions together as the Strict Father model does for conservatives. Moreover it imposes a particular social structure, The Family, onto politics that doesn't work for all settings. In particular I don't think it works for public health.

"Families" are local and individual and are imbued with notions of blood relationship. A natural inference (to use Lakoff's fertile idea of embodied reason) of blood relationship, consciously or unconsciously, is tribalism and its various forms: nationalism, religious identification, political sectarianism, etc. Would not a better metaphor for liberal thought be a "community" rather than a family? Communities are unrelated groups of people who recognize a common interest. Admittedly, one can blur the distinction by talking about The Family of Man, as Lakoff does at one point, but the most important feature of The Family of Man is that is not a real family.

I think it bears repeating here that the salient feature of public health, what sets it apart from clinical medicine, say, is that its subject matter is populations. Thus the polarity between populations and individuals is mirrored here as well. The difference between a clinician and a public health practitioner is not that individuals are treated or regarded differently but that in public health we don't treat individuals at all.

What I am suggesting, here, is two things. One, that the Nurturant Parent model makes it difficult for public health to "frame" its arguments adequately. It is a foreign landscape that treads too close to the enemy's own territory and risks confusion with problematic underlying companion metaphors. And two, that using the model of The Community or The Village or The Band makes more sense. In a setting where public health is a global enterprise, the only view that makes sense is the one that recognizes that "we are all in this together." I will try to develop this in subsequent posts, but in the meantime I welcome contrary views. Use the Comments.

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