It would seem that Tilley and Ryan and I agree on at least one thing – that work on spirituality could benefit from a new perspective. They argue, however, that my paper does not deliver this. They seem to suggest that it could have done so had I but followed Foucault's lead on the matter. I will argue below firstly that their criticism in part rests on a misinterpretation of Foucault as cited in the original article and on a failure to recognize the central concern of discourse analysis with social practices. I will then briefly reiterate the contribution the article makes to the field.
Tilley and Ryan tell us that I have not read Foucault closely enough when he writes, ‘The unity of discourses on madness would not be based on the object “madness”, or the constitution of a single horizon of objectivity: it would be the interplay of the rules that make possible the appearance of objects during a given period of time…’ (Foucault 1972, pp. 32–33). Tilley and Ryan take from this that Foucault wishes to leave ‘madness itself’ to one side while he focuses instead on ‘other domains…from which originated the rules which generated social constructions of madness altering over time.’ This distinction between ‘the thing itself’ and ‘social constructions of it’ is Tilley and Ryan's and not Foucault's. In this quote Foucault is saying there is no unchanging essence of madness (or spirituality), no irreducible core that can guarantee the truth of our statements about it. Madness itself (or spirituality itself, for that matter) does not direct our discourses upon it to this or that shape, to this or that unity. Discourse produces the objects of which it speaks. When Foucault mentions ‘the rules that make possible the appearance of objects during a given period of time’ he really means ‘make possible’.
Tilley and Ryan go on to evaluate my article as if it were a conventional literature review. Here their distinction between ‘the thing itself’ and ‘social constructions of it’ leads to an elision of the terms ‘discourse’, ‘social constructions’ and ‘theories’. They end up concluding that I have not fully reviewed the nursing theories on spirituality.
Secondly, and related to the first point, Tilley and Ryan appear to miss the concern in discourse analysis with social practices. To produce an object of discourse is simultaneously to produce a cluster of social practices. How madness is produced as an object of discourse is simultaneously a study of power relations – how mad people were identified, how they were treated, etc. All discourse bears the traces of a particular disposition of power even when it seems to speak neutrally, as if merely noting the truth about ‘the thing itself’. The distinctive contribution of discourse analysis is the way it allows us to see language and social practices, knowledge and power together– not to help us appreciate links between social constructions of some sorts of things (e.g. madness) and social constructions of different sorts of things (e.g. religious piety).
Discourse analysis is therefore more than the study of old theories about madness or new ones about spirituality. Discourse makes some things possible to do legitimately and others not. My article allows us to see some of what is at stake for nurses and patients when constructing spirituality by means of scientific and religious discourses, respectively. The first strategy treats spirituality as an object contained in the patient to be assessed and treated. The second deploys the term within religious discourse to provoke and assuage existential anxiety. Some implications of each for nursing as a social practice are set out in the article.
Perhaps another thing that Tilley and Ryan and I would agree on is that there are important issues at stake in current debates on spirituality. Contemporary concern with spirituality can be linked to ‘the return of religions’ and the particular questions this poses to our understanding of modernity. In this state of affairs there is not just one spirituality sitting serenely to one side of our attempts to theorize it, but many. My article provides some analytical tools to help us think through the implications of two contrasting constructions of spirituality for patients and nurses.
Discourse analysis can be exhilarating and disconcerting in turns but provokes a reaction and encourages debate. It is hardly an approach ‘premised on regarding nursing practitioners as choiceless followers of unreflexive writings’. On the contrary it provokes questions and choices that might otherwise remain unspoken and unmade. I am glad that Tilley and Ryan have engaged with this perspective and look forward to further fruitful debate.