The postmodernist war on evidence-based practice

In this paper, we examine the war of words between those who contend that health care practice, including nursing, should primarily be informed by research (the evidence-based practice movement), and those who argue that there should be no restrictions on the sources of knowledge used by practitioners (the postmodernists). We review the postmodernist interventions of Dave Holmes and his colleagues, observing that the postmodernist style to which they adhere, which includes the use of continental philosophy, metaphors, and acerbic delivery, tends to obscure their substantive arguments. The heated nature of some responses to them has tended to have the same effect. However, the substantive arguments are important. Five main postmodernist charges are identified and discussed. The first argument, that the notion of ‘best evidence’ implies a hierarchical and exclusivist approach to knowledge, is persuasive. However, the contention that this hierarchy is maintained by the combined pressures of capitalism and vested interests within academia and the health services, is less well founded. Nevertheless, postmodernist contentions that the hierarchy embraced by the evidence-based practice movement damages health care because it excludes other forms of evidence that are needed to understand the complexity of care, it marginalizes important aspects of clinical knowledge, and it fails to take account of individuals or their experience, are all seen to be of some merit. However, we do not share the postmodernist conclusion that this adds up to a fascist order. Instead, we characterize evidence-based practice as a necessary but not sufficient component of health care knowledge.

“Hegemony Protected by the Armour of Coercion”: Dashiell Hammett’s Red Harvest and the State

This article argues that Dashiell Hammett's 1929 novel Red Harvest is best understood in the context of the consolidation and expansion of the US state following the First World War and the Russian Revolution. It also argues that Hammett's novel constitutes a highly significant articulation of theoretical debates about the nature of political authority and state power in the modern era and speaks about the transition of one state formation to another. Insofar as Red Harvest explores the way in which the state's coercive and ethical character are bound up together, this article argues that Hammett's novel draws upon an understanding of political authority and state power primarily derived from Gramsci, via Marx. Gramsci insists that control cannot be maintained through force alone (and his conception of hegemony, in turn, suggests a power bloc that can become fragmented and disunited in a war of position). In the same way, Red Harvest traces the transformation of the “economic-corporate” state into the expanded or “ethical” State but crucially any ethical dimension, as Gramsci notes, is always beholden to the needs of the capitalist economy. As such, the apparently arbitrary bloodshed in the novel is conceived as a relatively minor realignment in the ranks of the capitalist classes – certainly less serious than the miners' strike that prefigures the novel. What makes this realignment significant is that it calls attention to the state both as repressive and as a site of conflict and compromise. Here, the work performed by the Continental Op and by the crime novel in general – simultaneously buttressing and, to some extent, contesting the power of the state – needs to be understood as part of the process by which the state is consistently enacting hegemony (albeit protected by the armour of coercion). The article concludes by pointing out that while Gramsci is perhaps too willing to dwell upon the state's expanded reach, Red Harvest is more interested in examining possible “cracks and fissures” in the state formation, even if the critique it ultimately offers goes nowhere and yields nothing.

Alasdair MacIntyre and the Hope for a Politics of Virtuous Interdependence

Rebellion, philosophic and political, impels the work of Alasdair MacIntyre. Neither of the left nor the right, he treads a borderline path between conservatism and radicalism in holding to a socialist Thomistic Aristotelianism underpinned by a deliberative ‘ethic of care’ that is implacably opposed to modernity and the advanced capitalist nation-state. The depth of this opposition arouses strong opinions in friend and foe alike. To some he is an eminently dispensable reactionary whose sole consistent feature is an inexplicable ‘hatred of liberal individualism’ (Lessnoff 1999: 4). To others he appears a revolutionary enunciating a departure capable of legitimating the activities of ordinary persons so ‘that previously isolated struggles might be transformed into a new class war of attrition’ (Knight 1996: 896). However, neither interpretation rings true. MacIntyre does develop a cogent critique of the present, but this critique points in directions towards which no politics could hope to move.

The Geography of Revolution: The case of Longford, 1917-1921

Why were some areas of the Ireland more active than others during the War of Independence, and why did the areas of most activity change over the course of the war between 1919 and 1921? In the context of the Irish midlands, County Longford stands out as one of the most violent counties surrounded by areas where there was much less activity by the IRA. Even within the county there was a significant difference in the strength of republican activity between north and south Longford. This article will examine the factors that were responsible for the strength of the IRA campaign in this midland enclave, including socio-economic conditions, administrative decisions and failures, and the contemporary political context.
Much of the evidence upon which the paper is based comes from applications made by Longford Volunteers for military service pensions, granted to veterans of the campaign by the Irish government after 1924. Many of these documents are soon to be released by the Irish government. The paper will also include a discussion of these sources and the way in which they can be used by historians to advance our understanding of Ireland’s revolutionary decade.