Twenty years ago, the lines of debate between different versions of critically-oriented social and political theory were a tangled mess of misunderstandings and obfuscations. The critics of historicist metanarratives were often merged under the banner of postmodernism, grouped together in (sometimes surprising) couplings—postmodernism and poststructuralism, poststructuralism and post-Marxism, deconstruction and postmodernism—or strung together in a lazy list of these terms (and others) that usually ended with the customary ‘etc.’. Although this was partly the result of ‘posties’ still figuring out the detail of their respective challenges to and positions within modern critical thought, it was also a way of finding shelter together in a not altogether welcoming intellectual environment.
 
This is because it was not only the proponents of various post-isms who were unsure of what they were defending, it was also that the critics of these post-isms were indiscriminately attacking all the post-isms as one. They would cast their critical responses far and wide seeking to catch all in the nets of performative contradiction, cryptonormativism and quietism. ‘Unravelling the knots’ proposed one way of clarifying one post-ism—poststructuralism—as a small step toward inviting other posties to clarify their own position and critics to take care to avoid bycatch as they trawled the political seas.[1] That was twenty years ago: has anything changed?
 
In many respects, yes; but not always for the better. Within the academy, taking course and module content as a rough indicator, poststructuralism has become domesticated. Once a wild and unruly animal within the house of ideas, it is now a rascally but beloved pet that we all know how to handle.[2] In political studies, this domestication has come in two ways.[3] First, it has become customary to acknowledge one’s embeddedness within regimes of power/knowledge, such that almost everyone of a critical orientation is (apparently) a Foucauldian now. Second, it has become commonplace to study discourses and how they shape identities, adding this to the methodological repertoire of political science. These two simple gestures often merit the titular rubric ‘A Poststructuralist Approach’ and yet they often remain undertheorised in the manner discussed in the original article. Often, there is neither a fully-fledged account of the emergence of structures nor an account of how meaning is constituted through the relations of difference that define linguistic and other structures.
 
Without such in-depth accounts, we are left with empirically rich but ultimately descriptive accounts of how social forces impinge on meaning, which can have its place, or the treatment of language as a data source to be mined in search of attractive word clouds (or equivalents), which can also have its place. Whatever these claims and methods produce, however, it is not helpful to call them ‘poststructuralist’. There is still a need for the exclusive but non-deadening definition of this term, so that it is not confused with the tame house pet with which it is associated today. Part of the problem is that the discussion of how structures of meaning emerge and how they function through processes of differentiation before any dynamics of identification requires, let’s say in a Foucauldian tone, the hard work of genealogy: the patient, gray and meticulous work of the archivist combined with the lively critical work of the engaged activist.[4] But, these days, who has the patience, and the energy, for genealogy?
 
And, in many respects, the difficulties associated with constructing intricate ‘histories of the present’ have led to a tendency to short-circuit the genealogical process (and other poststructuralist methods[5]) under the name of ‘social constructivism’. It is a shorthand, however, that has generated new entanglements, new knots, that have come to define what those of us with a long enough memory can only regret are now frequently labelled the culture wars. On one side, there are the alleged heirs of the posties, awake to the constructed nature of everything and the subtleties of all forms of oppression. On the other side, there are the new defenders of Enlightenment maturity striving to protect science from constructivism and to guard free-speech from the ‘cultural Marxists’.
 
This epithet, of course, is the surest sign that we are in a phoney war—albeit one with real casualties—as it mimics the trawling habits of previous critics but industrialises them on a massive scale. Claims about the deleterious effects of ‘cultural Marxists’ and their social constructivist premisses simply scrape the seabed and leave it barren. But much like the debate twenty years ago, those seeking to defend ‘social constructivism’ cannot swim out of the way unless they specify that this, and other phrases like it, should never be used to end an argument. There is no use in proclaiming a social constructivism if, after all, the social itself is constructed. Shorthand is always helpful but only if we know that it is exactly that and that it will always need careful exposition and explication when critics raise the call.
 
Moreover, what is often forgotten, in the heat of battle, is that the task is not simply to clarify one’s own claims in response to critics but to reflect upon the nature of critical exchange itself. One side of the culture wars take lively spirited debate as the signal of a flourishing marketplace of ideas. Those on the side of social construction appear to agree, simply wanting it to be a regulated marketplace of ideas. What poststructuralism brings to market is succour for neither side. Forms of critical engagement bereft of analyses of the current structures of socially mediated critical practice will always fall short of the poststructuralist project and typically dissolve into the impoverished forms of communicative exchange that never rise above the to-and-fro of opinion. It is incumbent, therefore, on poststructuralists to have a view on the nature of public interaction through social media and how these interlock with different forms of algorithmic governmentality.[6] In this way, the social constructivist shorthand can be given real critical purchase by delving deeply into the nature of public discourse and the technological forms that sustain it, particularly because these make state intervention in the name of ‘the public’ increasingly difficult (even though they can also be used, to a certain extent, for statist purposes).
 
That said, the culture wars obfuscate a deeper misunderstanding about poststructuralism. To grasp this, however, it is important to be reminded of the overarching project of poststructuralism: it is a project aimed at completing the structuralist critique of humanism. It is important to specify this a little further. Humanism can be understood as the project of bringing meaning ‘down to earth’ so that it is in human rather than divine hands. Given this, we can articulate structuralism in a particular way: it was a series of responses to the ways in which humanism tended to treat the human being as a surreptitiously God-like entity and source of all meaning. Structuralism was the project aimed at completing the founding gesture of humanism. Poststructuralism simply recognises that there are tendencies within structuralism that similarly treat structures as analogous to God-like entities that serve as the basis of all meaning.
 
In this respect, poststructuralism is the attempt to complete the project of structuralism, which was itself aimed at completing the project of humanism. When we understand poststructuralism in this manner it is an approach to thinking (and doing) that seeks to remove the last vestiges of enchanted, supernatural, forces, entities and explanations from all theoretical and practical activity, including science but also philosophy and the arts (broadly understood). Given this, there is no room for a pseudo-divine notion of the social that often haunts ‘social constructivism’. Indeed, given this articulation of its project, poststructuralism is hardly anti-science (as some in the culture wars might claim); rather, it is a project of understanding meaning in every respect without reinstating a source of meaning that stands ‘outside’ or ‘above’ or ‘beyond’ the world that we inhabit. In fact, poststructuralists (though not all posties) are rather fond of science and they certainly do not want to undermine the natural sciences in the name of lazy ‘social constructivism’. It is, in fact, a way of seeking better science with help of philosophy, and a way of seeking better philosophy with the help of science (and for the full sense of what’s at stake, this gesture should be triangulated through inclusion of the arts).
 
But how can there be a ‘better’ if the posties, including the poststructuralists, are sceptical of metanarratives? This question brings us to one of the more fruitful aspects that has changed in the last twenty years. The most interesting challenge faced by poststructuralists in recent times has come from the emergence of forms of neo-rationalism looking to reinvigorate critical philosophy through pragmatically oriented forms of Kantianism and non-totalising forms of Hegelianism.[7] From the neo-rationalist perspective, poststructuralism has failed in its attempts to naturalise meaning, to take it away from explanations that rely upon supernatural forces, to the extent that it is reliant upon a transcendent notion of Life that treats the priority of becoming over being as given. This immanent critique of poststructuralism cuts much closer to the bone than the Critical Theory inspired fishing which cast their nets wide but always from the harbour of their own shores.
 
At the heart of this dispute is whether or not what we know about the world and how we know what we know about the world can be articulated within a single theoretical framework. For the neo-rationalist, it is (in principle, at least) possible to work on the assumption that there is an underlying unity between ontology and epistemology founded upon a specific conception of reason-giving. For poststructuralists, exploration of the conditions of experience suggests a dynamic distance between the what and the how, such that the task is to secure the claims of philosophy, art and science as equal routes into our understanding of both. While this reconstitutes a certain return to the pre-critical debates between rationalists and empiricists, it is equally indebted to the critical turn with respect to the shared task of legitimating knowledge claims, but with a pragmatic or practical twist. Both the neo-rationalists and the poststructuralists pragmatically assess the worth of the knowledge produced by virtue of the challenges they proffer to arguments that rely upon a transcendent God-like entity and the dominant form of this today; namely, the sense of self-identity that underpins capitalist endeavours to maximise profit.
 
This critical perspective, perhaps surprisingly, was seeded within the fertile soil of American pragmatism. For the pragmatists—and we might think especially of Pierce, Sellars, and Dewey—it is the practical application of philosophy that engenders standards of truth, rightness and value. Admittedly, in the hands of its founding fathers, this practical application was often guided by the idea of maintaining the status quo. But that is not essential. Neo-rationalists and poststructuralists have found a shared concern with the idea that philosophical practice should be guided by the critique of capitalist forms of thought and life. As such, they share a common ground upon which meaningful discussion can be forged, aside from the culture wars (which are simply a reflex of capitalist identitarian thinking). While deep-seated divisions remain—does the knowledge generated by social practices of reason giving trump the experience of creative learning or are they on the same cognitive footing?—the shared sense of seeking a critical but non-final standard for what counts as better (better than the identity-oriented thinking sustaining capitalism) is driving much of the most productive debate and discussion at the present time. Work of this kind reminds us that poststructuralism is still a wild animal rather than a domesticated house pet, that it is a critical project but also one that has political intent.
 
That said, it is not always easy to convey the political dimension of poststructuralism, especially given the vexed question of its relationship to ideology. As discussed in the original article, part of the initial excitement about poststructuralism was that its major figures distanced themselves from the idea of ideology critique. However, this was only ever the beginning of a complex story about the relationship of poststructuralism to ideology and never the end.[8] While Marxist notions of ideology were critiqued for the ways in which they incorporated notions of the transcendental subject, naïve versions of what counts as real and over-inflated notions of truth, poststructuralists have always endorsed the power of individual subjects to express complex notions of reality and historically sensitive and effective notions of truth, and to do so against dominant social and political formations. These formations are often given unusual names—dispositif, assemblages, discourses, and such like—but the aim of unsettling and ultimately unseating the dogmatic images and frozen practices of social and political life is not too distant from that animating Marxism. Of course, as Deleuze and Guattari expressed it, any revised Marxism needs to be informed by significant doses of Nietzscheanism and Freudianism (just as these need large doses of Marxism if they are to avoid becoming critically quietest and practically relevant for the critique of capitalism).[9]
 
What results, though, is an immanent version of ideology critique rather than a rejection of it tout court: there are many assemblages/ideologies that dominate our thoughts, feelings and behaviour and it is possible to learn how they operate by making a difference to how they function and reproduce themselves. In searching for the natural bases of meaningful worlds it is no surprise that poststructuralists have become adept at diagnoses of how natural processes can lead to systems of meaning that import supernatural fetishes into our everyday lives, and how these are sustained in ways even beyond merely serving the interests of the economically powerful. There appear to be an endless number of these knots that need untying. If we want to untie at least some of them, then unravelling the knots that currently have poststructuralism tangled up in a phoney culture war is another small step on the road to bringing a meaningful life fully down to earth.



[1] I.MacKenzie, ‘Unravelling the knots: post-structuralism and other “post-isms”’, Journal of Political Ideologies, 6 (3), 2001, pp. 331–45.

[2] I. MacKenzie and R. Porter, ‘Drama out of a crisis? Poststructuralism and the Politics of Everyday Life’, Political Studies Review, 15 (4), 2017, pp. 528–38.

[3] One of the interesting features of the recent history of poststructuralism is that it is not the same across disciplines. Of course, this need for disciplinary specificity with respect to how knowledge is disrupted, new forms of knowledge established and then domesticated is part of what poststructuralism offers. That said, much of what follows can be read across various disciplines in the arts, humanities, sciences and social sciences to the extent that the legacies of humanism and historicism traverse these disciplines.

[4] M. Foucault, ‘Nietzsche, Genealogy, History’, in D. Bouchard (ed.) Language, Counter-Memory, Practice: Selected Essays and Interviews by Michel Foucault (New York: Cornell University Press, 1992 [1971]), pp. 139–64.

[5] B. Dillet, I. MacKenzie and R. Porter (eds) The Edinburgh Companion to Poststructuralism (Edinburgh: Edinburgh University Press, 2013).

[6] A. Rouvroy, ‘The End(s) of Critique: data-behaviourism vs due-process’ in M. Hildebrandt and E. De Vries (eds), Privacy, Due Process and the Computational Turn. Philosophers of Law Meet Philosophers of Technology (London: Routledge, 2012), pp. 143–68.

[7] See R. Brassier’s engagment with the work of Wilfrid Sellars, for example: 'Nominalism, Naturalism, and Materialism: Sellars' Critical Ontology' in B. Bashour and H. Muller (eds) Contemporary Philosophical Naturalism and its Implications (Routledge: London, 2013).

[8] R. Porter, Ideology: Contemporary Social, Political and Cultural Theory (Cardiff: Wales University Press, 2006) and S. Malešević and I. MacKenzie (eds), Ideology After Poststructuralism (Oxford: Pluto Press, 2002).

[9] G. Deleuze and F. Guattari, Anti-Oedipus: Capitalism and Schizophrenia (New York: Viking Press, 1977). This triangulation of the philosophers of suspicion, with a view to completing the Kantian project of critique, is one especially insightful way of reading this provocative text: see E. Holland, Deleuze and Guattari’s Anti-Oedipus: Introduction to Schizoanalysis (London: Routledge, 2002).

The concept of ideology seems to have been supplanted in contemporary critical theory by the concept of discourse.[1] Postmodernist scholars, such as Michel Foucault[2] and Gilles Deleuze and Felix Guattari,[3] have criticised the concept of ideology. Nonetheless, the two concepts are potentially compatible.[4] I believe that the concept of ideology is superior to the concept of discourse because, as David Hawkes noted, it mediates between the ideal and the material.[5] The work of the Frankfurt School philosopher, Theodor Adorno, and his conceptualisations of ideology, are particularly useful in examining the relationship between the ideal and the material in modern neoliberal societies.[6] The contemporary relevance of Adorno’s work is evident in the burgeoning literature concerning the philosopher—see, for example, Blackwell’s A Companion to Adorno, published in 2020, which contains the largest collection of essays by Adorno scholars in a single volume.[7] I have utilised Adorno’s conceptualisations of ideology, within my own work, to examine different aspects of the law relating to health and healthcare.
 
Adorno’s distinction between liberal ideology and positivist ideology,[8] and his conceptualisations of reification, informed my analysis of reforms which have marketised and privatised the English National Health Service (NHS).[9]  I also made use of Adorno’s method of ideology critique to demonstrate how many public statements regarding the high-profile Charlie Gard[10] and Alfie Evans[11] cases (which involved disputes between parents and clinicians regarding the treatment of young infants), for example by United States (US) politicians (such as Donald Trump and Ted Cruz), were unjustifiably critical of socialised medicine.[12] The cases led to renewed proposals for the best interests test,[13] which is currently determinative in such cases, to be replaced with a significant harm test. I employed Adorno’s notion of the dialectic of enlightenment (the idea that reason can engender unreason[14]) to undermine the argument that parents would make better decisions in these types of cases.[15] I contended that the clinicians in such cases reflexively acknowledged the limits of medicine, in contrast to the parents, who appear to have suffered from false hope.[16] Adorno’s ideas are also informing my current research projects on vaccine confidence (and the influence of anti-vaccination ideology) and the potential of human rights to address health injustices in states within the Global South. In respect of the former, I have employed the psycho-social dialectic methodology that Adorno developed in his research into anti-Semitism[17] to identify the objective social factors which have influenced the increase in vaccine hesitancy.[18] In respect of the latter, Adorno noted that rights may be tacitly critical of existing conditions[19] and thus I am developing a paper regarding how they may be used to articulate present injustices within the Global South (and elsewhere) with a view to their remedy.
 
In the chapter on the topic of the concept of ideology, published as part of the Frankfurt School’s book Aspects of Sociology, Adorno distinguished between liberal ideology and positivist ideology.[20] In Adorno’s view, positivist ideology, which he thought was becoming more prominent in modern societies, hardly says more than ‘things are the way they are’.[21] By contrast, the emphatic concepts of liberal ideology, such as freedom, equality and rights, are often used, within discourse, to justify certain states of affairs (or changes to them).[22] Such emphatic concepts can also be used to critique existing conditions. There are different modalities of the related concept of reification in Adorno’s work. One modality of reification in Adorno’s work is philosophical reification, which refers to phenomena being treated as fixed.[23] An example of philosophical reification is the exchange principle, which treats unlike things alike.[24] Another modality of reification in Adorno’s work is social reification, which refers to means becoming ends in themselves.[25] Both of these modes are evident in consumerism. Reification may lead to estrangement, whereby people become strangers or enemies to one another.[26] Estrangement is the opposite of solidarity, which Rahel Jaeggi defines as ‘standing up for each other because one recognises one’s own fate in the fate of the other’.[27] Reification may undermine the solidarity which has been pivotal in the creation and continuation of the NHS.
 
I have analysed the emphatic concepts of freedom and equality and how they have been used within the discourse of successive governments regarding the English NHS. I have also considered the potential reifying effects of the market reforms that successive governments have implemented within the English NHS. When the NHS was established, in 1948, it was to be publicly answerable via ministerial accountability to Parliament. However, this was deemed to be a constitutional fiction.[28] Since the 1970s, there have been efforts to enhance patient and public involvement within the NHS via two types of mechanisms, identified by Albert Hirschman: voice and choice.[29] In the neoliberal era, the preference has been for choice mechanisms (although attenuated voice mechanisms have persisted). This preference is evident in the use of indicators and market mechanisms to facilitate competition among NHS providers. The internal market introduced by the Conservatives, in the 1990s,[30] was justified on the basis of enhancing patient choice,[31] although evidence indicates that it reduced the choices available to patients.[32] The mimic-market established in the English NHS by the New Labour governments, in the 2000s, afforded private healthcare companies increasing opportunities to deliver NHS services and gradually extended patient choice to any willing provider.[33] New Labour sought to naturalise the relationship between patients and the NHS as a consumerist one.[34] However, studies indicate that many patients were recalcitrant in this regard[35] and often did not utilise the opportunity to exercise choice when it was available to them.[36]
 
The latest English NHS market was introduced by the Health and Social Care (HSC) Act 2012. This statute places duties on commissioners to act with a view to enabling patients to make choices.[37] Such commissioners are also required to comply with regulations passed pursuant to S.75 of the statute,[38] and, prior to Brexit, with European Union (EU) public procurement law,[39] in tendering services. Such laws have coaxed many commissioners into tendering services in circumstances where they did not think that it was best for patients, [40] which is symptomatic of social reification, as the market has become an end in itself. New methods for enabling patients to compare providers, such as friend and family test (FFT) scores, have also been introduced. These are symptomatic of philosophical reification, as the process of reducing quality (patient experiences) into quantity (a number) is one of abstraction,[41] which is unlikely to capture the complexity of patient experiences. In any event, patient choice, which was used to justify the coalition’s reforms, has taken a backseat,[42] and the market created by the HSC Act 2012 has primarily involved providers competing for tenders. The intention of many of the policymakers who designed the market reforms to the English NHS thus seems to have been to get private providers into the NHS, rather than to extend patient choice. I contend that voice mechanisms are a preferable method of empowering patients by allowing them to convey the complexity of their experiences and to influence clinical practices.
 
Adorno was critical of the concept of equality, on the basis that it could obscure important differences.[43] Nonetheless, equality of access to the NHS (based on need) and the reduction of health inequalities are principles which, I contend, are compatible with an Adornian perspective. The Welsh Marxist theorist, Raymond Williams, helpfully distinguished between dominant, residual, and emergent norms within his work. [44]  I have conceptualised neoliberal norms (such as competition and choice) as dominant norms, the founding principles of the NHS (such as equality of access, comprehensiveness, and universality) as residual norms (as they are remnants from the era of the social democratic consensus, which preceded the neoliberal era) and the reduction of health inequalities as an emergent norm.[45] In the neoliberal era, different UK governments have all articulated their support for the residual norm of equality of access. However, this has been undermined, for example, by the ability of foundation trusts to earn 49% of their income from private patients.[46] The other residual norms, such as comprehensiveness, have also been undermined by successive governments, within the neoliberal era, thereby extending the exchange principle (as patients are now required to pay for some health services). The issue of health inequalities was not a priority of the Conservative governments between 1979 and 1997, which sought to bury the Black Report[47] and which rebranded such inequalities, in a positivistic manner, as health variations.[48] In contrast, both the New Labour governments between 1997 and 2010 and the Conservative-led governments since 2010 have adopted the goal of reducing health inequalities. The HSC Act 2012 created statutory duties for different actors to have regard to the need to reduce such inequalities.[49] However, the impact of the main economic policy (austerity) pursued by governments since 2010, has increased such inequalities.[50] Austerity negatively affected NHS capacity and resources, as well as population health, rendering the NHS less resilient to the current Covid-19 pandemic.[51] The reduction of health inequalities requires alternative economic policies to austerity.
 
Ultimately, I have identified both liberal and positivistic elements in the discourse of successive governments, in the neoliberal era, in relation to the English NHS. Consequently, government discourse pertaining to the English NHS has not become completely positivistic. Rather, there are liberal elements which provide members of the public and scholars with a basis for critique. The statements of successive governments that they were desirous of empowering patients, respecting the NHS’ founding principles and reducing health inequalities can be used to critique their policies (which have not empowered patients, have undermined the NHS’ founding principles and are likely to exacerbate health inequalities) and to conceive alternative policies. The development of sustainability and transformation plans (STPs), integrated care systems (ICSs) and integrated care providers (ICPs), and the increased emphasis on integration in the discourse of the government and NHS England (a non-departmental body which oversees the day-to-day operation of the NHS in England and commissions primary care and specialist services) has been interpreted by many as a move away from the competition that has dominated the English NHS in the neoliberal era.[52] A recent Kings Fund report found that there has been a move away from procurement to collaboration within the English NHS (with the former being used as a method of last resort).[53] However, some fear that the new structures being established within the English NHS may undermine its founding principles and afford new opportunities for private companies.[54]
 
I have argued elsewhere that the policies of successive governments pertaining to the English NHS were indicative of market fetishism.[55] The recent award of many contracts to private companies under special powers that circumvent normal tendering rules, during the Covid-19 pandemic,[56] suggests a fetishism for private companies and not necessarily with competitive processes. I have identified the corporate influence on the reforms to the English NHS of successive governments.[57] Such corporate influence has ostensibly also affected the current government’s response to the pandemic.[58] Although I have identified several potential reifying effects of government reforms to the NHS, which could undermine the solidarity which led to its creation and continuation, the adherence of the public to unprecedented rules, such as national lockdowns, during the Covid-19 pandemic, to ‘Protect the NHS’ (as government slogans state), is a palpable contemporary manifestation of such solidarity. The pandemic has also exposed the impact of persistent health inequalities.[59] If efforts to undermine the founding principles of the NHS continue, the slogan ‘Protect the NHS’ will persist as a powerful means of providing an immanent critique of government policies. Additionally, growing awareness of health inequalities may lead to increased clamour for more action than government promises and statutory duties.



[1] Rahel Jaeggi, ‘Rethinking Ideology’, in Boudewijn de Bruin and Christopher F. Zurn (eds.), New Waves in Political Philosophy (Basingstoke: Palgrave Macmillan, 2009), 63.

[2] Michel Foucault, Power/Knowledge: Selected Interviews and Other Writings, 1972–1977 (Brighton: Harvester Press, 1980), 118.

[3] Gilles Deleuze and Felix Guattari, A Thousand Plateaus (London: Continuum, 1987), 76.

[4] Trevor Purvis and Alan Hunt, ‘Discourse, Ideology, Discourse, Ideology, Discourse, Ideology...’, The British Journal of Sociology, 44(3) (1993), 498.                                                                  

[5] David Hawkes, Ideology: 2nd Edition (London: Routledge, 2003), 156.

[6] See, for example, Charles A. Prusik, Adorno and Neoliberalism: The Critique of Exchange Society (London: Bloomsbury Academic, 2020); Deborah Cook, Adorno, Foucault and the Critique of the West (London: Verso, 2018).

[7] Peter E. Gordon, Espen Hammer, and Max Pensky (eds.), A Companion to Adorno (Hoboken, NJ: Wiley, 2020).

[8] See Theodor Adorno, ‘Ideology’, in Frankfurt Institute of Social Research (ed.), Aspects of Sociology, (London: Heinemann, 1973), 202.

[9] David Benbow, ‘An Adornian Ideology Critique of Neo-liberal Reforms to the English NHS’, Journal of Political Ideologies 26(1) (2021), 59–80.

[10] Great Ormond Street Hospital v Constance Yates, Chris Gard and Charles Gard (A Child by his Guardian Ad Litem) [2017] EWHC 972 (Fam) [20].

[11] Alder Hey Children’s NHS Foundation Trust v Mr Thomas Evans, Ms Kate James, Alfie Evans (A Child by his Guardian CAFCASS Legal) [2018] EWHC 308 (Fam) [6].

[12] David Benbow, ‘An Analysis of Charlie’s Law and Alfie’s Law’, Medical Law Review 28(2) (2020), 227.

[13] Children Act 1989, S.1(1).

[14] See Theodor Adorno, and Max Horkheimer, Dialectic of Enlightenment (Stanford: Stanford University Press, 2010), xvi.

[15] Benbow, ‘An Analysis’, 237–8.

[16] Ibid.

[17] Theodor Adorno, The Psychological Technique of Martin Luther Thomas' Radio Addresses (Stanford, CA: Stanford University Press, 2010).

[18] The World Health Organisation (WHO) declared this to be a global health threat in 2019. See WHO, ‘Ten threats to global health in 2019’, available at https://www.who.int/news-room/feature-stories/ten-threats-to-global-health-in-2019 (accessed 29 October 2020).

[19] Adorno and Horkheimer, Dialectic of Enlightenment, 141.

[20] Adorno, ‘Ideology’, 202.

[21] Ibid.

[22] Deborah Cook, ‘Adorno, Ideology and Ideology Critique’, Philosophy & Social Criticism 27(1) (2001), 10.

[23] Anita Chari, A Political Economy of the Senses: Neoliberalism, Reification, Critique (New York, NY: Columbia University Press, 2015), 144.

[24] David Held, Introduction to Critical Theory: Horkheimer to Habermas (Cambridge: Polity, 2004), 220.

[25] Chari, Political Economy of the Senses, 144.

[26] John Torrance, Estrangement, Alienation and Exploitation: A Sociological Approach to Historical Materialism (Basingstoke: Macmillan, 1977), 315.

[27] Rahel Jaeggi, ‘Solidarity and Indifference’, in Ruud ter Meulen et al (eds.), Solidarity and Health Care in Europe (London: Kluwer, 2001), 291.

[28] Alec Merrison, Report of the Royal Commission on the National Health Service, Cmnd 7615. (London: HMSO, 1979), 298.

[29] Albert O. Hirschman, Exit, Voice and Loyalty: Responses to Decline in Firms, Organisations and States (Cambridge, MA: Harvard University Press, 1970).

[30] Via the National Health Service and Community Care Act 1990.

[31] Department of Health, Working for Patients (London: Stationery Office, 1989), 3–6.

[32] Marianna Fotaki, ‘The Impact of Market-Oriented Reforms on Choice and Information: A Case Study of Cataract Surgery in Outer London and Stockholm’, Social Science & Medicine 48(100 (1999), 1430.

[33] Department of Health (DOH), Principles and Rules for Co-operation and Competition (London: DOH, 2007), 10.

[34] For example, the word consumer appeared more in Labour’s health policy documents than in its policy documents for other policy areas. See Catherine Needham, The Reform of Public Services under New Labour: Narratives of Consumerism (Basingstoke: Palgrave, 2007), 115.

[35] John Clarke, Janet Newman, and Louise Westmarland, ‘Creating Citizen-Consumers? Public Service Reform and (Un)willing Selves’ in Sabine Maasen and Barbara Sutter (eds.), On Willing Selves: Neoliberal Politics vis-à-vis the Neuroscientific Challenge (Basingstoke: Palgrave, 2007), 136.

[36] Anna Dixon, Patient Choice: How Patient’s Choose and How Providers Respond (London: Kings Fund, 2010), 20.

[37] NHS Act (2006), S.13I and S.14V as amended by HSC Act (2012), S.23 and S.25.

[38] National Health Service (Procurement, Patient Choice and Competition) Regulations (No.2) (S.75 Regulations), SI 2013/500.

[39] Directive 2014(24) EU of the European Parliament and of the Council of 26 February 2014 on Public Procurement and repealing directive 2004/18/EC, OJ L. 94, 28 March 2014. This was implemented in the UK via the Public Contracts Regulations, SI 2015/102. Such regulations are still in force.

[40] D. West, ‘CCGs open services to competition out of fear of rules’, Health Services Journal, 4 April 2014.

[41] Theodor Adorno, Lectures on Negative Dialectics: Fragments of a Lecture Course 1965–1966 (Cambridge: Polity, 2008), 127.

[42] Chris Ham et al., The NHS under the Coalition government part one: NHS Reform (London: Kings Fund, 2015), 18.

[43] Theodor Adorno, Negative Dialectics (New York: Continuum, 1973), 309.

[44] Raymond Williams, Marxism and Literature (Oxford: Oxford University Press, 1977), 122.

[45] David Benbow, ‘The sociology of health and the NHS’, The Sociological Review 65(2) (2017), 416.

[46] NHS Act (2006), S.43(2A) as amended by Health and Social Care (HSC) Act (2012), S.164(1).

[47] Department of Health and Social Service (DHSS), Inequalities in Health: Report of a Research Working Group (London: DHSS, 1980).

[48] Clare Bambra, Health Divides (Bristol: Policy Press, 2016), 185.

[49] For example, the Secretary of State for Health is required to have regard to the need to reduce health inequalities in exercising their functions (NHS Act (2006), S.1C as amended by the HSC Act (2012), S.4.) and NHS England and CCGs are required to have regard to the need to reduce inequalities in respect of access (NHS Act (2006), S.13G(A) and S.14T(A) as amended by HSC Act (2012), S.23 and S.25) and outcomes (NHS Act (2006), S.13G(B) and S.14T(B) as amended by HSC Act (2012), S.23 and S.25).

[50] Clare Bambra, ‘Conclusion: Health in Hard Times’ in Clare Bambra (ed.), Health in Hard Times: Austerity and Health Inequalities (Bristol: Policy Press, 2019), 244.

[51] Chris Thomas, Resilient Health and Care: Learning the Lessons of Covid-19 in the English NHS (London: Institute for Public Policy Research, 2020), 3.

[52] Hugh Alderwick et al., Sustainability and Transformation Plans in the NHS: How are they being developed in practice? (London: Kings Fund, 2016), 7.

[53] Ruth Robertson and Leo Ewbank, Thinking Differently about Commissioning (London: Kings Fund, 2020).

[54] Allyson M. Pollock and Peter Roderick, ‘Why we should be concerned about Accountable Care Organisations in England’s NHS’. British Medical Journal 360 (2018).

[55] Benbow, ‘The sociology of health and the NHS’, 420.

[56] British Medical Association (BMA), The role of private outsourcing in the Covid-19 response (London: BMA, 2020), 4.

[57] Benbow, ‘An Adornian Ideology Critique’, 66, 68.

[58] Peter Geoghegan, ‘Cronyism and Clientelism’, London Review of Books 42 (2020).

[59] Abi Rimmer, ‘Covid-19: Tackling health inequalities is more urgent than ever, says new alliance’. British Medical Journal 371 (2020). 

Marius Ostrowski: Perhaps to start with a retrospective view, and a simple question. What first prompted the idea to found the Journal of Political Ideologies?

Michael Freeden: The main reason was the pronounced gap within the field of political theory between political philosophy and the history of political thought and the absence of a journal that could fill some of that gap. More importantly, one that could stimulate researchers to turn their minds, efforts and creativity towards a highly promising, patently relevant,  rich, and astoundingly underexplored area of the political thinking that is happening around us, day by day, country by country, emanating from every section of society.  Given that the interrogation of political actions and practices is so central to political studies, it seemed remarkable that so little research effort had been devoted to exploring the political thought-practices produced by, and circulating in, societies, beyond rudimentary left-right distinctions and historical accounts.

Despite the growing interest in the study of ideologies, there was no dedicated outlet that could distinguish itself by specialising not in the normative improvement of political arguments or the pursuit of ethical truths, and not in the narratives—however disrupted—about the changing nature of political thought, but in the actual patterns of thinking about politics prevalent in societies and communities. That important genre for anyone interested in how people in concert conceptualise, defend, criticise, or change their political arrangements simply had far too little purchase as a focus of political studies and university courses.

The secondary reason—important to me—was that I felt that I would enjoy the experience of being an editor and ushering a new venture, and sub-field, into greater academic prominence. It was a challenge that emerged directly from my immersion in preparing my 1996 book, Ideologies and Political Theory, and from the questions and interest displayed by the many students who took my courses and seminars on ideology over the years. To my mind, the JPI was not just another journal but had the potential to serve as pioneer in an important and somewhat underrepresented and underpopulated area. My father had been a journalist and newspaper editor and as a child I had often watched him prepare an issue—so the craft of assembling, selecting and bringing together material, and getting the balance right, was familiar to me. Of course, the practice was rather less romantic than I had imagined, but nonetheless very rewarding—give or take the Sisyphean search for assessors to evaluate submissions.
 
MO: How would you characterise what has happened to ideology studies since the JPI started—not least in terms of the journal's content? What have been the most significant areas of scholarly innovation and growth?

MF: There was indeed an astounding and gratifying change. In the first few years, hardly any submission latched on to the distinction between straightforward political theory as an advocacy endeavour and ideology studies as the interpretation and contextualisation of such arguments and views, whether those were intentional or not. In an extreme case, one author submitted, without comment, twenty letters he had sent to Brezhnev and Reagan, except that (unsurprisingly) there were no replies. But then the sophistication and range of articles started to increase exponentially, as the academic public began to realise what the deep analysis of ideologies entailed. The geographical range of the JPI began to expand; related schools of thought, such as the Essex school of discourse studies, or critical discourse analysts, saw the JPI as a kindred spirit (although occasionally just as an outlet for their own agenda!); the intellectual scope of ideology studies increased throughout its pages; and the concrete concerns and flavours of the year reflected shifting emphases within this or that ideological family or grouping.

The JPI welcomed that diversity, but also tried, in a very modest way, to persuade some practitioners of these genres to think about the differences as well as the similarities between their interpretations of the role of ideology theory and ours. Crucially important, we believed, was to build methodological bridges, or at least start a conversation, in order to relax some of the fixed assumptions that siloed the various sub-disciplinary approaches and aims and resulted in their talking past one another. Not least, we always appealed to contributors to eschew the 'semi-private' 'in-language' of some genres and to write in a way that could be understood and appreciated by all JPI readers. Although too many academics—and that includes university administrators—may think that the point of a journal is to add to one's tally of research publications as a means to career advancement, the dignified rationale of a journal is to speak to a broad readership  and convince them that new and exciting ideas are worth considering.

We also strove to reflect the political and cultural issues that preoccupied the world around us in the shape of specific ideological families or segments as they emerged, persisted, or declined. Environmentalism, globalism, feminism, anarchism/post-anarchism, and political Islam appeared alongside the stalwarts of liberalism, conservatism, socialism, nationalism, and fascism. Neoliberalism, the alt-right, and of course the now ubiquitous populism—highly pertinent to contemporary politics, although experiencing a nigh-uncontainable surge in current academic fashion—have been more recent players on the JPI stage.

In sum, the recognition of ideological fragmentation, of how some of the weightiest and most intriguing features of ideologies mutate and adapt, and of the location of ideological expression in hitherto unexplored areas of social thinking, have all brought about a recalibration of the field. Significantly, too, the geographical range of contributions to the JPI has grown considerably—it is no longer a Eurocentric journal as it was at its inception. Moreover, we have always encouraged younger scholars and those at the beginning of their academic career. A journal not set in its ways, not simply replicating the historical conventions of its subject-matter, offers a fresh outlet for new thinking and imaginative research.

MO: It strikes me that the study of ideology or ideologies is on the cusp of moving from being a thematic focus within several separate subfields to evolving into a discrete subfield in its own right. Would you agree? And if so, what is the current 'lay of the land' of the main traditions of ideology theory?
 
MF: That is an acute observation. But the intertwined nature of many disciplines and sub-disciplines suggests that one can recombine fields of scholarship in multiple ways. By juggling with Venn diagrams, different disciplines and subdisciplines can rank similar material differently according to their criteria of what matters most, or which of many paths through a body of knowledge and understanding reaps the most insight for diverse scholars. The same texts and practices can be read in very distinct ways. An example I have given in the past is to draw attention to a triple reading of John Rawls as a moral philosopher, an exponent of a curious and rather idiosyncratic variant of contemporary North American liberal ideology, or a very indifferent—perhaps abstruse—stylist and communicator. That said, ideology scholars are now confident enough to place their specialisation at centre-stage, or at least as co-equal, with other branches of political theory. They can rightly claim, for instance, that when we access political thinking—in whatever shape—it is immediately, first and foremost, decodable as an ideological statement or manifestation.

As for the traditions of ideology theory, while some reinforce one another, others inhabit separate circles. Our view of ideology theory has consequently been heterodox, pluralistic, and layered. I turn to a passage from a JPI editorial I wrote a few years back: Ideology as fantasmatic veil-drawing, ideology as the articulation of social identities, ideology as distorted belief, ideology through the lens of discourse analysis, ideology as conceptual morphology, ideology as rhetorical language, ideology as aggregated attitudes, the visual representations of ideology, ideology as anchored in emotions, ideology as party programmes, ideologies as bifurcated or multiple psychological tendencies, ideology as performativity, ideology as ritual, ideology as consensus formation, ideology as the management or mismanagement of agonism and dissent, ideology as rupture—all these, and more, have been given a fair platform in the JPI and most of them are accumulating an impressive body of knowledge.

But it still remains a challenge to draw cross-cutting links among some of them. There is also a notable decline in regarding the state as a source of ideology and a shift to non-institutional foci of ideological debate. The one problem amongst that embarras de richesse is the legacy of unease and negativity that has accumulated around the concept of ideology in certain swathes of Continentally-inspired approaches, to which I refer in response to your final question.

MO: One of the most intriguing developments seems to be the explosive rise of 'thin' ideologies (e.g., populism, nationalism, Euroscepticism, etc.), which compete for ever more central positions within their 'thick' host ideologies (e.g., conservatism, liberalism, socialism), to use your distinction from Ideologies and Political Theory. At times, the thin ideologies now seem to threaten to entirely devour the thick ones from the inside. What do you think lies behind this phenomenon? Is it merely the latest form of decontestation in action?
 
MF: There has been a massive change in the culture surrounding the production and the reception of ideologies. The conventional ideologies were durable and complex systems of ideas and arguments that required education and intellectual sophistication to understand and appreciate them, even in simplified form, particularly those on the liberal, socialist, or radical side of the ideational spectrum. They were interwoven with philosophical texts and traditions, supported, bolstered by, and embedded in political institutions, and linked to defining events and transitions in human history: foundational moments, revolutions, power shifts among social groups, wars, ideals of social reform.

The grand ideas of human association have diminished since the Second World War and, later, since the fall of communism, and they lack new bedrocks, motivation or rationale. People talk of globalisation, but in the world of political ideas there is little evidence for that—bitty and disjointed scraps are circulated by economic conglomerates and would-be petty Napoleons. And the players and cultures on our planet are far more visible and vocal than in the past, an uncoordinated diversity that multiplies and jumbles messages that come and go at great speed and cannot put down ideologically sustainable roots.

The populisms of today are not ideologies in any meaningful sense; they are not movements, either. Communities don’t march under banners proclaiming, or hoping for, them—the proselytising, inspiring or at least conserving levelheadedness of the old ideologies is entirely absent here. Serious tomes may be written against them, but few aiming at recruiting public opinion for them. Even ideologies such as fascism and Nazism were peddlers of social visions, albeit loathsome ones. And the various neoliberalisms are catch-all repositories for distinct economic, neo-colonial, or just trite conservative positions.

The steam seems to have run out of earnest political thinking that can distil the 'spirit of an age' or oppose it intelligently. Even where positive social ideals make headway. such as environmentalism and the perils of climate change, or 'black lives matter', their dissemination is irregular, competing for cyberspace, too decentralised to have cohesive momentum, too sporadic to constitute a body of ideas and, so far, too indeterminate outside their specialised objectives to offer comprehensive social agenda with actual mass appeal, rather than dream of it. The written word—the means of ideological dissemination—has given way to film, pictures, bland repetition ('enemies of the people'), or banally channelling the energy of catastrophes.

More than anything, ideological segments—that is to say, elements that would normally have been lodged in broader frameworks—are popularised and vernacularised, ostensibly easy to understand and reproduce. They possess a superficial resemblance to the propaganda machinery and memes of the 20th century, but whereas those were top-down and regime-led, they now originate from anywhere and are circulated with consummate ease and carelessness. Above all, we now know that they no longer need to be articulated or even consciously developed. Ideologies, and their lesser manifestations, may be unintentionally produced and consumed, which makes them difficult to counteract.
​
MO: You suggest that what makes ideologies political is, among other things, their capacity to mobilise support, form collective priorities, and project plans and visions for society. In the context of growing social complexity and the proliferation of newly-salient identities, is that task becoming harder? Are the criteria of success for political ideologies becoming increasingly demanding?
 
MF: Unfortunately, the reverse is true. Given the transformation in the languages and presentation of ideologies discussed above, it is relatively easy to launch and muster support for clarion calls to mobilise, to adopt quarter-baked segments of what at other times would have been incorporated into properly worked-out ideologies. Ideologies are necessarily simplifiers, but the technological and stylistic changes relating to social media, digital platforms, and demands for immediate comments and responses have produced parallel ideological worlds: slow cooking versus fast food.

On the one hand, you have the older, argumentative, far-reaching, detailed and often sophisticated competing maps of the political world that engage in interpretation, prescription, and criticism of forms of common life. On the other, we are increasingly witness to the impatient, from-the-hip, cavalier, and opinionated snatches of private opinion dressed up as vox populi that either are highly fragmented or depressingly shallow. To complicate matters further, some of those—right-wing populism is one instance—take on the semblance of spectral ideolonoids that offer a pat 'comprehensiveness' that turns out to be posturing, even hollow. When you poke them, they evaporate into smoke without mirrors. That said, they all are grist to the mill of the student of ideologies.

But then we have to ask ourselves: what are the criteria of ideological success? Not necessarily guiding us to a political promised land, defeating ideological rivals, or making us better citizens. The success of an ideology should be ascertained through different standards of evaluation, based on what ideologies are designed to accomplish: the mobilisation of support; effective communication to their prospective audiences; the display of imaginative and feasible plans for political action; the intelligible mapping of the ways and means to fashion or interpret the conscious and unconscious political practices and thought-practices of the societies and grouping with which they engage.

It is not so much the criteria that become more demanding, but rather the onus on the ideology scholar to scan the field, know how and where to extract relevant evidence and information, and acquaint her- or himself with the increasing nuances of interpretation and decoding. The questions we should ask ourselves are, have we extracted as much as we can out of a particular, given nugget of information; do we know how to find and identify it when it hits us in the face; and what do we need to do to transform that process into knowledge—into Weberian Verstehen or Ricœurian surplus of meaning. All that should lay to rest the facile characterisation of ideology studies as descriptive, when even at the best of times we can never adequately describe anything without passing it through the filter of interpretation.

MO: One of the recurring themes in your work is the contrast between neat and untidy political thinking, as well as the failure of academic political theory to adequately take the latter into account. At the same time, we are living through a time where denialism, conspiracism, 'fake news', and 'alternative facts' play a prominent role in political argument. What can be done to square that circle? Can a 'political theory of political thinking' as you describe it bridge the gulf between the accepted standards of political reasoning, in the academy versus among the public?
 
MF: A major role of ideology studies is to examine and analyse the normal expressions of action-oriented political thinking at every level of articulation. Here political theory falls in line with the empirical bent of other genres of political science. Studying ideologies, as the JPI understands it, differs from its subject-matter, and from much political philosophy, in not being an advocacy-led practice but one that satisfies our curiosity about societies—even if that satiated curiosity is always provisional, awaiting contrary interpretation. This makes that perspective very different from the position adopted by many political philosophers, for the latter do not distinguish between the arguments and approaches they scrutinise in their subject matter and the methods they themselves employ as scholars—regarding the two as part of a seamless enterprise. Yet inasmuch as human beings are not automatons, ethical perfectionists, or logic machines, they think in disorganised, disjointed and often messy ways.

That is the scholarly challenge of ideology scholars: to make sense of and interpret the commonplace as well as the exceptional, the incomplete as well as the polished, the mistaken as well as the reasonable. If we are to have a finger on the pulse of what makes societies tick, if we want to take ideologies seriously, we need to craft theories and approaches that do normal political thinking adequate justice, that account for the reasons and forms of diverse conceptual decontestation, deliberate and unconscious, that link together and separate different cultural environments. That does not mean bridging a gap: If the ‘general public’ wishes to read studies on ideology they are of course warmly invited to do so, but ideology studies are not deliberately educational in the sense of making us all better reasoners. The hard sciences and philosophy are geared to that, but the kind of ideology studies reflected in the JPI are not on a mission to improve but on a mission—if that is the mot juste—to understand as best we can and to offer that understanding to other branches of knowledge if they wish to avail themselves of it.

The most worrying thing about failing to reflect the new world of ideology is the lamentably lagging state of undergraduate ideology courses in so many universities. Far too many still follow the tired old classifications and assumptions about ideology that should have been abandoned 20 years ago. The damage is substantial, for while innovative courses in other branches of political theory have admirably marched on with the times, the topic of ideology is made to seem unsophisticated, as if it had stood still. The allure of this field of political theory is thus unjustifiably and negligently made to pale against its lively partners, based on a lack of curiosity about what's happening in the neighbouring garden. The responsibility lies squarely with those political theorists and political scientists who, sadly for all concerned, do not want to educate themselves—and others—in getting to know the changing terrain and the budding plants. If they did, a far more productive conversation of equals would benefit all sides and enrich all facets of theorising about political thought.

I'm afraid that fake news and alternative facts are part of the raw material that scholars of ideology need to confront. At best, ideologies aren't 'true'—I leave the ascertaining of truth to philosophers—but networks of established facts and conventions of understanding interspersed and stapled together with conjecture, speculation, and wishful thinking. Denialism and fabrication offer their own fascinating windows into the ideologies of their disseminators. Even falsehoods are worth studying because their patterns of deceit are themselves revealing of ways of ideological thinking. As responsible citizens we may well be disturbed and depressed by them. But as ideology scholars our job is to explain why this, rather than that, deceit or deliberate misinterpretation prevails? What patterns of 'fake news' work well in which societies and what patterns fail?

MO: Finally, the concept of ideology and ideological thinking still tends to be given a pretty bad rap in common parlance. (Marx, it seems, is casting a long shadow in this respect too.) What do you think needs to be done to turn this around?
 
MF: The Press has been the worst culprit in this, with endless callings out of plans or ideas as pejoratively 'ideological', including newspapers, such as the Guardian, that should know better than to fall into that rhetorical and often propagandist trap. In my 2003 book, Ideology: A Very Short Introduction I recount the story of a gentleman who took umbrage at a talk I had given and confronted me in affronted tones: 'Are you suggesting, Sir, that I have an ideology?' 'I very much hope you do!,' was my response. As sentient members of society, how could anyone not?

Sadly, you sometimes get equally ignorant, or haughty, responses from within the academic profession. An Oxford philosophy colleague said to me many years ago: 'Those who work on inferior thinking can only produce inferior work'. That writes off many eminent historians, as well as raising questions about the criteria of 'superior' thinking in the realm of politics. What gets a bad reputation are only certain senses of 'ideology', but the fact is that they have frequently colonised the entire field of meaning the word covers. Put differently, the rhetorical, combative, obfuscating, and colloquial senses of ideology—as so often is the case in political language—have overshadowed its more nuanced and analytically perspicacious interpretations, even among political theorists.

All that is hardly improved by poststructuralists and post-Marxists assuming that ideologies always are the product of, and reflect, conflict and antagonism, sidestepping the many ideological features that are based on identifying and building overlapping areas of broad agreement or, for that matter, a vague indeterminacy. Nor is it helped by those who subscribe to the kind of critical theory--Ideologiekritik—for whom ideologies are invariably dissimulative distortions of a so-called reality, or just blatant and manipulative lies. Of course, those variants do exist, but that is not typical ideological thinking. To suggest they are does the entire field a great disservice. If I may be so bold, what might turn this around is the flourishing and persistence of vehicles such as the Journal of Political Ideologies.