Leonardo Chiesi e Silvia Surrenti (eds.), L’ospedale difficile. Lo spazio sociale della salute, Liguori, 2014
10.6092/issn.2038-3460/17400
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2038-3460
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Laura Lucia Parolin
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Tecnoscienza – Italian Journal of Science & Technology Studies
Leonardo Chiesi and Silvia Surrenti (eds.), The difficult hospital. The social space of health, Liguori, 2014
Text.Serial.Journal
https://tecnoscienza.unibo.it/
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Book Reviews
2018-08-06
2023-06-25
2018-08-06
2023-08-28
122-126
TS
Laura Lucia Parolin
2018/08/06
10.6092/issn.2038-3460/17400
122
University of Southern Denmark
2038-3460
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en
126
Leonardo Chiesi and Silvia Surrenti (eds.), The difficult hospital. The social space of health, Liguori, 2014
https://tecnoscienza.unibo.it/article/download/17400/16258
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122                                                            Tecnoscienza – 9 (1)

    Leonardo Chiesi and Silvia Surrenti (eds.)
L’ospedale difficile. Lo spazio sociale della salute [The difficult hospital.
The social space of health], Napoli, Liguori, 2014, pp. 182

Laura Lucia Parolin University of Southern Denmark

    The difficult hospital. The social space of health is a small edited book
that focuses on data from a research project led by an interdisciplinary
team on hospital spaces. The research project, called SPACES, aims to
reflecting on the interplay among architectural spaces, medical practices,
and users’ practices related to health care services. It also investigates the
consequences of this entanglement on the reconfiguration of the meaning
of the right to health. The book deals with the right to health on the ac-
count of its relational dimension. The right to health and health itself are
considered not states, but relationships that connect the individual with
him/herself and his/her physical, architectural, and social environment.
Therefore, the right to health does not only result from an access to ser-
vices (physical, economical, and psychological), but it also entails what is
required to connect seamlessly the health care experience with the en-
joyment of everyday life. This right is defined as the fulfilment of complex
needs, such as care, the feeling of being looked after, and of being considered
as a part of a social network that interacts with healthcare professionals.
    The volume deals with the otherness of a hospital experience, where
primacy is given to the patient-doctor dyadic relationship, underlining
hospital users’ need for co-partnership, for visibility, and, at the same
time, for privacy. It shows how careful attention to the space/time dimen-
sion can offer an interpretative key to succeed in reading the different
hues of the right of co-partnership, visibility and privacy.
    The volume unfolds through a series of chapters with a careful exami-
nation of specific aspects of the organization of the hospital time/space,
based, as it is, on empirical material taken from the SPACES research.
    The volume does not draw from STS literature but leans on the phe-
nomenological reading of the experience in the subject’s relationship with
the hospital and clinical practices. The first chapter by Leonardo Chiesi
develops an interpretative frame to share the coordinates to read both
human and social experience inside the planned space. The outcome
leads to a theorization that promises an account of the dynamic relation-
ship between the plan’s defined inscriptions and the ones emerging from
the practices in use. Chiesi suggests that the planned space, intended as
experience, is the emerging entwining of two different series of “inten-
tions.” On one side the designer’s expectations and intentions inscribed
inside the planned space, on the other side the intentions of the subjects
called to inhabit the spaces, manifested as they are in the social practices
and in their behavior when they use the mentioned space. By Chiesi’s
Book Review                                                              123
conceptualization, the two intentions are symmetrical and specular, but it
is only the understanding of their entwined dynamics that allows us to
read the human and social experience of space.
    The author’s references are phenomenology and the theory of the re-
lationships with the objects as developed by James J. Gibson through the
concept of affordance (Gibson 1979). Chiesi acknowledges that the con-
cept of affordance has the capacity to shift the theorization from the so-
cial effects of the space to the relationship with the subject. If you con-
ceive of space as a container of affordances, or of indications as the au-
thor names them , you shift your attention from the function of space to
the subjects taking part in that relationship. The designed space is thus
conceived in its dual meaning as the “producing product” (Thrift 1983)
of socially organized practices.
    Chiesi proposes different typologies of affordances in his model:
proxemics, of movement, of pause, and of relationship. He means for
proxemics affordances all those opportunities that take place thanks to
the body plasticity. They, then, refer relationships related to spaces’ pene-
trability when in relation with bodies. Movement and pause affordances
refer instead to indications inscribed in the empty space, suggesting its
crossing or pauses within it. The last class of affordances refers instead to
the relationship between space and bodies intended as connected (social)
subjects. We are thus dealing with space opportunities for sociability that
influence the modalities of social interaction when inhabiting spaces.
    The classification proposed seems promising. Unluckily, the volume
does not offer a reading of affordance classes as analytical categories in
order to inform empirical research to investigate the cinematic and social
dwelling of hospital spaces. Chiesi’s very chapter lingers on the categories
of understanding, meaning, and taste, committed, as he is, in introducing
a theory of the dwelling of the architectonic space. In the end, he does
not dedicate enough attention to the development of the different classes
of affordance and, in particular, how they could inform research on hos-
pital spaces. Moreover, the rest of the volume, does not refers to the
Chiesi’s affordance classification in developing the analyses.
    The chapters following Chiesi’s introductory one focus on space di-
mension entwined with time dimension, bound to the time length of ex-
perience. Silvia Surrenti’s work concentrates on the time/space dimen-
sion of the treatment experience by underlining the experience of other-
ness that a hospital awakens in the involved subjects. The author high-
lights how the site is a perceptive field meant as a space open to particular
information flows, by mobilizing interpretative categories taken from
communication sociology (Meyrowitz 1986). The author shows how,
through this reading, the expectation of the performance is characterized
by the experience of the “visibility field.” The author highlights –
through the empirical observation in the waiting rooms of the doctor’s
office – the violations the users enact when the areas preset for waiting
124                                                         Tecnoscienza – 9 (1)

are not in the proximity of the performance sites. While waiting outpa-
tient performances, patients stand in the corridors and in other passage
areas in order to satisfy their own need of being made visible, a need born
from wanting to see and be seen. The patients need to have control on
the information flow regarding the access to the doctor’s office and, at
the same time, they need to be seen by the health providers. Moreover,
the waiting time is never neutral, but charged with waiting concerning the
treatment relationship. “If on one hand you wait for something or some-
one (the waiting), on the other we expect from that someone something
(the expectation). An example could be given by the expectation of being
considered in order to enjoy sufficient relationship time with the profes-
sionals” (Surrenti 2014, p. 67). The attention to the time-space dimension
is thus able to show the mismatch between the experience of the patients’
perceived time and the technical-organizational management of the hos-
pital space. Surrenti’s chapter ends with the indication of a design of
“equipped waiting”, so that articulated rights are satisfied in order to re-
ceive approval from the citizen.
    An explicit focus on the dimension of rights as the product of the in-
teraction between spaces and use practices is at the center of Paolo Cos-
ta’s chapter. He deals with the topic of privacy and confidentiality within
the hospital service. The author analyzes some cases of violation of space
use prescriptions by showing how criticalities bound to confidentiality
rights are often the outcome of complex relationships of the users’ legiti-
mate relationship needs and of space-material elements. The author un-
derlines how some design choices of hospital spaces are not able to satisfy
the relationship needs of accompanying users, who, through forms of vio-
lation of use prescriptions, end up invading the patients’ confidentiality.
A careful design choice should provide consideration for the often-
conflicting interests and use prescriptions of the behavior inscribed in the
space-material elements, according to the author. Although he does not
refer to STS, Costa’s ethnographic interest for the right to confidentiality
for patients leads us to shift our attention to the missing masses (Latour
1992) in the social relationships of health care service.
    Livia Buscaglioni’s chapter introduces a reflection on the organizing
cultures of the treatment space by highlighting a tension between the
co-partnership cultures, and the one more oriented towards the separa-
tion of the spaces between stage and backstage. In this case, too, the
empirical material used to tackle the issue comes from the ethnographic
observation of the waiting areas to access health care. According to the
author, the various cultures have distinct basic assumptions on the same
conception of the treatment relationship. The centrality of the patient-
doctor dyadic relationship implies the design of spaces that neatly sepa-
rate the waiting areas from the performance areas. A culture of co-
partnership would instead foresee the use of open spaces, where also
the accompanying people can access the doctor’s performance.
Book Review                                                               125
     The chapter by Tomas Madonia is dedicated to the same topic of the
opening of the doctor’s relationship to relatives-visitors. It is by focusing
on a process of change in an intensive therapy unit that Madonia notices
how, by extending the visiting times, more opportunities to include those
who support the patient in the treatment relationship can take place. The
presence of the visitor-relative in the unit can, in fact, help the personnel
to contrast the patient’s breakdown process, within the parameters of the
vital functions of the scientific-technical assemblage (Berg 1997). If by
extending the visiting times the health staff is helped in bringing back the
patient to his totality, on the other hand it represents an occasion to in-
clude relatives in the health care trajectory.
     The volume thus introduces an articulated review of the relationships
between time-space dimensions and the right to treatment in the devel-
opment of the chapters. Taken as a whole, the volume is curious, empiri-
cally oriented, and it asks questions on the humanization of the treatment
relationship by paying attention to the dimension of the right as the ele-
ment emerging from the meeting of those we could define complex mate-
rial-social practices. Anyhow, if the book succeeds in showing the im-
portance of the interest in such dimensions by suggesting the need of a
new overall design of spaces, times, and health care practices, the lack of
an integrated theorization limits the value of the volume.
     Several topics treated in the volume are close to STS interests and be-
cause of that, the volume is of interest for an STS readership working in
the domain of healthcare or in the domain of architecture/design. More-
over, some theoretical and or analytical categories here elaborated, meet
some of the categories nowadays elaborated within STS or related fields
as, for example, the proxemics affordance category is analogous to the
way in which interactions among bodies can be seen by Actor Network
Theory (ANT) (Parolin and Mattozzi 2013) or by other approaches deal-
ing with material relationships, as proposed in Ash (2015) or in Ingold
(2007).
     Despite such analogies with STS and STS related approaches, the
phenomenological roots of the reflection provided by the volume, lead to
focus on the human body, by limiting the attention to the perception of
the experience of the space by human actors, without considering in de-
tail how non-humans bodies take part in these relationships.


References

Ash, J. (2015) Technology and Affect: Towards a Theory of Inorganically Organ-
        ised Objects, in “Emotion, Space and Society”, 14 (2), pp. 84–90.
Berg, M., (1997) Rationalizing Medical Work, Cambridge, MA, MIT Press.
Gibson, J.J. (1979) The ecological approach to visual perception, New York,
        Houghton Mifflin.
126                                                              Tecnoscienza – 9 (1)

Ingold, T. (2007) Materials against materiality, in “Archaeological Dialogues”, 14
        (1), pp. 1–16.
Latour, B. (1992) Where Are the Missing Masses? The Sociology of a Few Mun-
        dane Artifacts, in Wiebe E. Bijker and John Law (eds.), Shaping Technol-
        ogy/Building Society: Studies in Sociotechnical Change, Cambridge, MA,
        MIT Press, pp. 225–258.
Meyrowitz, J. (1986) No sense of place: The impact of electronic media on social
        behavior, Oxford, Oxford University Press.
Parolin, L.L. and Mattozzi, A. (2013) Sensible translation. Sensitive dimension
        and knowledge within two craftsmen’s workplaces, in “Scandinavian
        Journal of Management”, 29(4), pp. 353—366.
Thrift, N. (1983) On the determination of social action in space and time, in “En-
        vironment and Planning D: Society and Space”, 1(1), pp. 23-57.


                                        ***

   Manuel De Landa
Assemblage Theory, Edinburgh, Edinburg University Press, 2016, pp.
198

Dario Minervini Università di Napoli “Federico II”

    Assemblage Theory is the most recent effort of Manuel DeLanda. It
accounts his own reframing of Gilles Deleuze and Felix Guattari’s work.
The book was published in 2016 as part of a series put out by Edinburgh
University Press, which has hosted the debate on the “Speculative Real-
ism”, since the seminal conference held in 2007 at Goldsmiths College in
London on the topic.
    Delanda was fully committed with this intellectual challenge against
the post-modern linguistic turn in humanities and for banishing heuris-
tic textualism (Bryant, Srnicek and Harman 2011). An intense intellec-
tual dialogue with the authors of Thousand Plateaus has opened up sig-
nificant insights into sociological thought and for STS scholars, since
the publication of DeLanda’s A Thousand Years of Nonlinear History
(1997).
    “Agencement” is a concept at the core of the argument explored in
the current book. “Assemblage”, as admitted by the author himself, is a
slippery linguistic solution, which was used to substitute the illustrious
French word with an Anglophone one. Indeed, “assemblage” is intended
as both the process and the outcome of a connection, that is to say a mul-
tiplicity of heterogeneous entities interrelated by symbiotic liaisons. As-
semblage is the pattern of a flat ontological plane consistent with a non-
reductionist account of reality and overcoming the conceptualization of
