What is a problem drug user?

What is a problem drug user?
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   Addiction Research and Theory , August 2011; 19(4): 334–343Copyright ß 2011 Informa UK Ltd.ISSN: 1606-6359 print/1476-7392 onlineDOI: 10.3109/16066359.2010.512109 What is a problem drug user? Toby Seddon School of Law, University of Manchester, Oxford Road, Manchester, M13 9PL, UK  (Received 9 June 2010; revised 20 July 2010; accepted 21 July 2010) The term ‘problem drug user’ (PDU) has risen toprominence in policy and research discourse overthe past 25 years or so, particularly in the UK andEurope, largely at the expense of the older‘addiction’ and ‘dependence’ concepts. How shouldwe understand this shift? Is it merely a change interminological fashion or does it signify somethingmore significant? In exploring this question, thework of the philosopher Ian Hacking is drawn on, inparticular his related ideas of ‘making up people’and ‘looping effects’. Although it first emerged inthe early 1980s, it is shown how the idea of the‘PDU’ in fact has a long and mixed genealogy whichcan be traced back at least as far as the 1930s,a heritage which continues to exert influence today.Following Hacking, it is argued that the invention just over 25 years ago of the ‘PDU’ constituted thecreation of a new kind of person which did not existbefore and which has shaped how those so labelledare governed and controlled. Keywords: Problem drug user, history, Ian Hacking INTRODUCTION The term ‘problem drug user’ (PDU) has become astaple of the drugs research and policy industries in therecent years, displacing to some extent earlier labelslike ‘drug addict’. It is now common terminology in thefield in the UK, as well as across the rest of theEuropean Union and some places beyond. One obviousquestion to ask is: when did this happen? These thingsare always difficult to pinpoint exactly but we canperhaps date this shift in terminology to the year 1982,although, as we will see, its roots can be traced back much earlier than this. But has this just been are-labelling of an old idea, a re-badging of somethingthat remains essentially the same? Or by this shift inlanguage has something more significant taken place?I want to explore this by posing what might seem tosome readers a rather curious question: were there anyPDUs before 1982? Obviously, before 1982 there werepeople taking drugs who both suffered from problemsof various sorts and caused them for other people.That is not my point. But, as I shall argue, in a certainand quite important sense the answer to this questionmay be ‘no’.The idea that I will be exploring in this article is atheart a philosophical one, but one that I believe alsohas implications of a more practically edged kind.Indeed, as Gootenberg (2009) has recently argued in aninsightful piece, a focus on discourse and language isan essential component for any critical analysis of drugcontrol. Ian Hacking calls the idea that I will be lookingat ‘dynamic nominalism’ but it is perhaps better knownthrough the title of one of his most influential essays,‘making up people’ (Hacking, 1986; see also Hacking,1995, 2007). I will begin the main section of this articleby outlining briefly what Hacking means by this. I willthen go on to consider how the idea might be applied tothe term PDU. In conclusion, some implications of myargument will be discussed.A couple of points of clarification are perhapsneeded here. First, I want to emphasise that I am notarguing that the language of addiction has entirelydisappeared and been replaced by problem drug use.Even a cursory glance at policy documents andscholarly journals in the field tells us that that ismanifestly not the case. What I am claiming, though,is that addiction has been knocked off its perch as thedominant concept and that problem drug use hasrapidly risen to prominence since its (relatively) recentemergence. Second, I also want to make clear that I amnot attempting to make a universal or global case.The PDU label has been more popular in some parts of the world than others. Australia is a good example of  Correspondence: T. Seddon, School of Law, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.Tel: þ 44(0)1613066549. Fax: þ 44(0)1612754724. E-mail:  334    A   d   d   i  c   t   R  e  s   T   h  e  o  r  y   D  o  w  n   l  o  a   d  e   d   f  r  o  m   i  n   f  o  r  m  a   h  e  a   l   t   h  c  a  r  e .  c  o  m   b  y   T   h  e   U  n   i  v  e  r  s   i   t  y  o   f   M  a  n  c   h  e  s   t  e  r   (   A   C   T   I   V   E   )  o  n   0   7   /   0   5   /   1   1   F  o  r  p  e  r  s  o  n  a   l  u  s  e  o  n   l  y .  somewhere where it has had much less traction; indeed,the term is scarcely used there at all. This reminds usthat there is a powerful cultural and political dimensionhere. I write primarily from a British perspective,although the ‘rise of the PDU’ has extended muchwider than that, across the rest of Europe and to someplaces further afield. MAKING UP PEOPLE Ian Hacking’s essay on ‘making up people’ has becomea classic – one of those groundbreaking contributionsthat manages to combine great novelty and srcinalitywith a crossover appeal that seems to resonate acrossdiverse fields and disciplines. This is not to say that itis entirely new. Its lineage can be traced back in partto some of Wittgenstein’s work in the 1950s(Wittgenstein, 1953) and it also shares some commonground with the symbolic interactionists and radicallabelling theorists of the 1950s and 1960s, notablyBecker (1963) and Goffman (Hacking, 2004). Perhapsmost obviously and explicitly, it is strongly influencedby Foucault’s dazzling contributions to questionsconcerning classification and categorisation withinthe human sciences (Foucault, 1970, 1972).In common with many classics in the social andhuman sciences, Hacking’s argument has been subjectto some wildly varying interpretations and for thisreason I want to set out here my own understanding of his thesis. He begins from a seemingly banal observa-tion: at different times in history and in differentplaces, human beings have created different systemsfor categorising their fellow humans. At any givenmoment in time, societies tend to think of their owncategories or classes as denoting definite properties of people. So when we describe a person today as, forexample, a homosexual or a high-functioning autisticperson, we believe we are referring to an essentialaspect or part of their nature, that is, to what we mightthink of as a real kind of person. Yet, the ways in whichthese classification systems change over time shouldmake us wary about this. How can they refer to realkinds or classes of people if the categories themselveskeep changing? This is historical nominalism.But by itself, this is still a relatively uninterestingobservation. We could view it, for example, asindicative simply of scientific progress in a veryconventional sense: as our understanding about our-selves improves, so we refine over time our scientificclassification systems. But one of Hacking’s greatinsights is that this type of historical nominalism isonly half the story; nominalism is also dynamic . Labelsor names are not simply applied to people in a staticway; rather, there is an interactive and dynamic processinvolved. He helpfully summarises: I have long been interested in classifications of people, in howthey affect the people classified, and how the effects on thepeople in turn change the classifications [ . . . ] I coinedtwo slogans. The first one, ‘making up people’, referred to theways in which a new scientific classification may bring intobeing a new kind of person, conceived of and experienced asa way to be a person. The second, the ‘looping effect’,referred to the way in which a classification may interact withthe people classified. (Hacking, 2007, pp. 285–286) A good example he uses to illustrate this is thecategory of ‘homosexual’. As I have already men-tioned, many people today might view this as atimeless or universal kind of person. After all, can wenot trace homosexuality back to the ancient world(Dover, 1978)? Hacking quotes an illuminating passagefrom a newspaper review by Foucault of KennethDover’s well-known book on homosexuality in AncientGreece: You still find pleasant people who think that, all in all,homosexuality has always existed. They cite in evidenceCambace´re`s, the Duke of Crequi, Michelangelo orTimarchus. Dover offers such naı¨fs an excellent lesson inhistorical nominalism. Relations between two persons of thesame sex are one thing. But to love someone of the same sexfor himself, to take pleasure with him, is something else,a whole other experience, with its own objects and theirvalues, together with the way of being a subject and theawareness that he has of himself. (Foucault, quoted inHacking, 2007, p. 295) In other words, whilst same-sex acts clearly existedin Ancient Greece, the homosexual as a kind of person,as a way to be a person, did not. But this is not the endof the story for a dynamic nominalist like Hacking. Theinvention of the homosexual has profoundly influencedthe ways in which many of the people so categorisedhave lived their lives and this, in turn, has refinedand reshaped what is meant by the term homosexual.And these dynamic interactions continue – when weinvestigate kinds of people, the target is always moving(Hacking, 2007, p. 293).The significance of these processes is much widerthan it might appear at first sight. When a new kindof person is invented, there is an impact that is notrestricted just to those groups directly coming withinthe new classification. It alters the space within whichwe shape ourselves, as Hacking (1986, p. 229)explains: How might a dynamic nominalism affect the concept of theindividual person? One answer has to do with possibility.Who we are is not only what we did, do and will do but alsowhat we might have done and may do. Making up peoplechanges the space of possibilities for personhood. In this sense, we are all ‘made up’ by the range of possibilities that exist in our own time. As Hacking(1986, p. 233) puts it, ‘we are not only what we are butwhat we might have been, and the possibilities for whatwe might have been are transformed’ by the inventionof new ‘kinds’ of people. This potentially places thestudy of ‘making up people’ and ‘looping effects’ at thecentre of intellectual enquiry into human behaviour andrelations. WHAT IS A PROBLEM DRUG USER? 335    A   d   d   i  c   t   R  e  s   T   h  e  o  r  y   D  o  w  n   l  o  a   d  e   d   f  r  o  m   i  n   f  o  r  m  a   h  e  a   l   t   h  c  a  r  e .  c  o  m   b  y   T   h  e   U  n   i  v  e  r  s   i   t  y  o   f   M  a  n  c   h  e  s   t  e  r   (   A   C   T   I   V   E   )  o  n   0   7   /   0   5   /   1   1   F  o  r  p  e  r  s  o  n  a   l  u  s  e  o  n   l  y .  This is a very condensed summary of Hacking’sthesis. I will flesh it out somewhat in the rest of thisarticle, as I start to apply it to the PDU concept. I willbegin in the following section by exploring where theconcept has come from and setting out an outline of itsgenealogy, before turning directly to the matter of themaking up of the PDU. A GENEALOGY OF THE PDU New classes or categories of people, new ways to labelother human beings, do not simply materialise out of thin air. They have antecedents which can be traced.As Foucault (1984) argues, this type of tracing exerciseis seldom simply a matter of identifying or excavatinga clear linear development from the past to the present.Rather, what he calls genealogy, a term he borrowsfrom Nietzsche, seeks to piece together the sometimesdispersed and disparate events out of which history isformed and, along the way, to abandon the notion thatthe ‘srcin’ is the place where the ultimate essence ortruth of an object is revealed: If the genealogist [ . . . ] listens to history, he finds that thereis ‘‘something altogether different’’ behind things: not atimeless and essential secret, but the secret that they have noessence or that their essence was fabricated in a piecemealfashion from alien sources. (Foucault, 1984, p. 78) The emphasis for genealogy, in other words, is onrecovering the creative work involved in inventing newideas or concepts or classifications. They are humaninventions rather than things that already exist, justlying there waiting to be found. Indeed, Hacking’scentral slogan, ‘making up people’ captures this pointvery nicely.The genealogy of the PDU concept is certainlydisparate and we can trace several lines of develop-ment. Part of the difficulty here is knowing where tobegin. I have no doubt that a fuller and morecomprehensive genealogy remains to be written butfor the purposes of my brief sketch in this article,I want to start in the final decades of the nineteenthcentury. It was in this period that fears about nationaldegeneracy became widespread across Europe(Pick, 1989), providing the basis for the emergingeugenics movement (Garland, 1985, pp. 142–152).Central to these anxieties was the idea that a degenerate‘residuum’ was expanding at a faster rate than the restof the population, leading to a decline in the quality of the national stock, and this concept of the ‘residuum’was highly influential at the turn of the century onsocial reformers like Charles Booth (Stedman Jones,1971). Concern about the ‘residuum’ abated a littleafter the outbreak of the Great War but returned againin the 1920s when mass unemployment revived thespectre of degenerate ‘unemployables’ weakeningthe population. In Britain, it was against this backdropthat the influential Wood Committee on mental defi-ciency conducted its work, leading to an extremelysignificant report published in 1929 (Macnicol, 1983).This report promoted the idea of the ‘social problemgroup’, essentially a revival of the residuum concept,which was to become prominent in the 1930s(Welshman, 1996). Here, then, we can see onebeginning for the notion of ‘problem groups’.The Wood Report described the social problemgroup as comprising the ‘lowest 10% in the socialscale’. It included the insane, paupers, unemployables,criminal recidivists, epileptics, inebriates and othersdeemed to be ‘socially inefficient’. It recommended astrategy of segregation and sterilisation – a decimationstrategy, in the most precise sense of the term – and theconcept was keenly taken up by the Eugenics Societyin the 1930s (Welshman, 1996, p. 449). Articlesappeared in the Eugenics Review discussing the idea(e.g. Mallet, 1931; Lidbetter, 1932) and two bookswere also produced by prominent Society members(Blacker, 1937; Lidbetter, 1933).The connections with what was then still called theinebriety 1 field are interesting to note. Certainly,inebriates were seen as mainstays of the social problemgroup. But, more than this, there were strong linksbetween the two fields of knowledge. In 1932,a member of the Council of the influential Societyfor the Study of Inebriety (SSI), Dr C. Brasher,produced a note for a Eugenics Society symposiumon ‘Inebriety and the Social Problem Group’ (Berridge,1990, p. 1031). This was later published in 1937 asa chapter in the book  A Social Problem Group? editedby Blacker. Blacker was a key figure in all this duringthis period. Not only was he General Secretary of theEugenics Society throughout the 1930s, but he was alsoa member of the SSI Council and this no doubt aidedthe crossover of the concept. So this idea of ‘problemgroups’ was significant in the field of inebriety some80 years ago.We might think that this branch of the genealogy wassawn off long ago, as the eugenics programme has cometo be seen as a particularly disreputable and discreditedpart of our history that has no bearing on the contem-poraryworld.Butechoesofthislineofdevelopmentcanstill be dimly heard in the drug field today, occasionallysounding above the background. In 2004, for example,a distinguished Professor of Drug Misuse ResearchproposedpayingfemalePDUstotakecontraception, 2 anidea that might well have appealed to the WoodCommittee in the 1920s had that particular technologyexisted then. Along similar lines, in 2006, a Scottishpolitician suggested putting oral contraceptives infemale heroin users’ prescribed methadone. 3 Mostrecently, ‘Project Prevention’ has become a centre of controversy for offering cash incentives to women drugusers to use long-term or permanent birth control. 4 A decade after the flourishing of the concept of thesocial problem group, another line of developmentemerged in the 1940s, initially in the US. Researchersclose to the alcohol industry began to put forward theidea of the ‘problem drinker’ as a more palatable336 T. SEDDON    A   d   d   i  c   t   R  e  s   T   h  e  o  r  y   D  o  w  n   l  o  a   d  e   d   f  r  o  m   i  n   f  o  r  m  a   h  e  a   l   t   h  c  a  r  e .  c  o  m   b  y   T   h  e   U  n   i  v  e  r  s   i   t  y  o   f   M  a  n  c   h  e  s   t  e  r   (   A   C   T   I   V   E   )  o  n   0   7   /   0   5   /   1   1   F  o  r  p  e  r  s  o  n  a   l  u  s  e  o  n   l  y .  alternative to the term ‘alcoholic’ (Room, 1983,p. 74). 5 Joseph Hirsch’s book, The Problem Drinker  ,published in 1949, was one of the more prominentefforts (see also Duryea, 1947; Duryea & Hirsch,1948). Hirsch (1949), at the time, was ExecutiveDirector of the Research Council on Problems of Alcohol, which had been formed in 1937 by a group of doctors and scientists, and his promotion of the termcarried a considerable degree of scientific respectabil-ity as a result of his position. It also appeared in anumber of sociological studies published during thesame period (Riley, 1949; Riley & Marden, 1947;Straus & Bacon, 1953). But it was in the 1960s that theproblem drinker concept really began to take off amongst alcohol researchers in the US, in a series of papers that sought to disaggregate the various compo-nents of alcohol-related difficulties (e.g. Clark, 1966;Knupfer, 1967), prising apart what had previously beenassumed to be describable as a single entity. Cahalan’s(1970) book  Problem Drinkers was a classic exampleof this new body of work.This development was not exclusive to the US. In aninsightful report, Taipale (1979) documents the use of the problem drinker concept in Finland going back tothe 1950s. He identifies six different usages of the termand suggests, interestingly, that its srcinal sense inFinland was a person who drinks on account of theirproblems (see also Room, 1987, p. 1065). Taipale’sanalysis is important as it highlights the malleability of the concept, that is, its potential to sustain or supportmultiple meanings. I will return to this point later.In Britain, as late as the 1970s, the term alcoholicwas still dominant in policy and research documents.This began to shift in the latter half of the decade. TheAdvisory Committee on Alcoholism, set up in 1975and widely known as the Kessel Committee, illustratedthis nicely, as Betsy Thom (1999, p. 122) observes: It is indicative of changing perspectives on the nature of theproblem [ . . . ] that the committee’s terms of reference andearly discussions spoke of ‘alcoholism’ and ‘alcoholics’ whilethe final reports used the terms ‘problem drinking’ and‘problem drinkers’. As we will see, the Kessel Committee’s terminologywas explicitly referred to in the report by the AdvisoryCouncil on the Misuse of Drugs (ACMD) in which wefind what seems to be the first use in Britain of thisproblem language in relation to illegal drugs (ACMD,1982, p. 34). I will return to this report in the followingsection.So, another branch in our genealogy of the PDUdescribesseepageortransferfromthealcoholfield.Thisis a familiar story, of course. As Levine (1978, p. 144)showed over 30 years ago in his classic article ‘TheDiscovery of Addiction’, the addiction concept wasitself first worked out for alcohol, before being appliedto other substances like opium. In case, we are seducedinto thinking that this represents some type of generalsequence or pattern, an example of a concept thattravelled in the opposite direction is that of dependence.This was first coined by the World Health Organisation(WHO) in the 1960s to apply to illegal drugs (WHO,1964),butwas thenborrowed adecadelaterbyEdwardsand Gross(1976) intheir well-known paper setting outanew ‘alcohol dependence syndrome’.Another influence on the shift to a problem-orientedconcept was the emergence in the 1970s of whatbecame known as the new public health. This newapproach was characterised by a focus on populationhealth, the development of preventive approaches andthe targeting of high-risk groups with the poorest healthoutcomes as part of strategies to reduce healthinequalities (Ashton & Seymour, 1988). It was drivenin part by technical developments in epidemiologyduring this period which had been kick-started by Dolland Hill’s famous work on smoking and cancer in the1950s and had then developed rapidly in the 1960s(Mold, 2007).In a useful review article, Room (1984) expertlycharts how the influence of this new direction in publichealth began to be felt in the mid-1970s in the alcoholfield. An early example was the landmark 1975 report  Alcohol Control Policies in Public Health Perspective which became widely known as the ‘Purple Book’(Bruun et al., 1975). In the context of alcohol, theimplications of the new public health for alcohol policywere extremely challenging, as Room (1984) discusses,sitting particularly awkwardly alongside the economicinterests of the alcohol industry, as they pointedtowards the public health benefits of reducing theoverall level of alcohol consumed in society.With its focus on distributions of health outcomes,there was an obvious affinity or ‘fit’ between the newpublic health and notions of problem drinkers or PDUs(Seddon, 2010, pp. 83–87; Stimson & Lart, 1991,p. 1273). Setting this in a wider context, the connectionbetween a problem-oriented perspective and the moregeneral rise of risk-based forms of governance in thelate twentieth century – in shorthand, the emergence of the ‘risk society’ (Beck, 1992) – is equally evident(Mugford, 1993; Seddon, 2010, p. 85). In this sense,we might view the concept of the PDU as havinga particular resonance in late-modern society, although,in keeping with the Foucauldian spirit of genealogy,I would resist arguing that the concept is an inevitableproduct of our times, just a possible one.So what does this potted genealogy tell us? Firstly,it shows that what at first sight might appear to be arelatively new concept, can in fact be traced back to atleast the 1930s and the idea of the social problemgroup, a notion itself linked to the even earlier termresiduum. Secondly, we can see that the concept has adistinctly mixed heritage, being fabricated from quite‘alien sources’ (Foucault, 1984, p. 78), ranging fromnineteenth-century discourses of degeneration andeugenics to contemporary neo-liberal discourses of risk and risk management. This is significant: conceptsretain traces of their past and, as I hope to show, this WHAT IS A PROBLEM DRUG USER? 337    A   d   d   i  c   t   R  e  s   T   h  e  o  r  y   D  o  w  n   l  o  a   d  e   d   f  r  o  m   i  n   f  o  r  m  a   h  e  a   l   t   h  c  a  r  e .  c  o  m   b  y   T   h  e   U  n   i  v  e  r  s   i   t  y  o   f   M  a  n  c   h  e  s   t  e  r   (   A   C   T   I   V   E   )  o  n   0   7   /   0   5   /   1   1   F  o  r  p  e  r  s  o  n  a   l  u  s  e  o  n   l  y .  history can sometimes illuminate otherwise perplexingfeatures of the present (Hacking, 1991, p. 184). MAKING UP THE PDU It is against the background of this genealogy, thismixed heritage, that we should view the invention of the concept of the PDU in 1982 by the ACMD. Theirreport on Treatment and Rehabilitation has come to beseen as significant in many respects and historians havestarted to explore its srcins and development (Mars,2005; Mold, 2008, pp. 73–78). In the report, theACMD set out their rationale for the new term: The individuals with whom the treatment/rehabilitationsystem is concerned may have various problems arisingfrom the misuse of drugs or from drug dependency or both.These are not solely physical or psychological problems, butalso social and environmental problems. A multiple drugmisuser may have a range of problems, being concurrentlypsychologically dependent on some drugs and physiologicallydependent on others, and at the same time having financial orlegal problems or difficulties over housing. The response tothe needs of the drug misuser therefore requires a fullymulti-disciplinary approach.This approach should be problem oriented rather thanspecifically client or substance labelled. It would be similar tothat in the field of alcohol where the term problem drinker hasbeen defined by the Advisory Committee on Alcoholism.Thus, a problem drug taker would be any person whoexperiences social, psychological, physical or legal problemsrelated to intoxication and/or regular excessive consumptionand/or dependence as a consequence of his own use of drugsor other chemical substances (excluding alcohol and tobacco).(ACMD, 1982, p. 34) This newly minted term was expressly and explicitlybroad in its coverage. In the ACMD’s formulation,a problem drug taker could encompass not only astereotypical heroin addict but also a teenage first-timeglue sniffer getting stopped by the police whenintoxicated. The purpose of this broadening of scopeis made evident in the rest of their report which makesa case for a transformation of service provision, awayfrom a narrow medical model of treatment towardsa more multi-disciplinary approach.The novelty and distinctiveness of the concept isnicely shown by comparing it with the influentialWHO definition of drug dependence from a dozenyears earlier: A state, psychic and sometimes also physical, resultingfrom the interaction between a living organism and a drug,characterised by behavioural and other responses that alwaysinclude a compulsion to take the drug on a continuous orperiodic basis in order to experience its psychic effects, andsometimes to avoid the discomfort of its absence. (WHO,1969, p. 6) At the heart of the WHO definition is the idea of compulsionandthisisabsolutelycentraltothelanguageof dependence: it refers to the loss of control over drugconsumption. Indeed, the notion of loss of control runsdeep through the history of the addiction concept, fromJellinek half a century ago all the way back to BenjaminRush and Thomas Trotter at the beginning of thenineteenth century (Levine, 1978). The language of problems, on the other hand, is altogether different.It refers to consequences of drug-taking irrespective of whether consumption is controlled or compulsive.Conceptually, this marks a fundamental shift.For my purposes, the key question is this: did theproblem drug taker represent a new kind of person?I do not intend to get embroiled in philosophers’arguments about the idea of ‘human kinds’ (Cooper,2004; Hacking, 2002, 2007). Hacking himself haschanged his mind on this over the past 25 years. Morefruitful, in my view, is to look at two types of statementthat he invites us to consider (Hacking, 2007, pp. 299,303–304):(A) There were no problem drug takers in 1975; therewere many in 1985.(B) In 1975, this was not a way to be a person, peopledid not experience themselves this way, they didnot interact with their friends, their families, theiremployers, their counsellors, in this way; but in1985 this was a way to be a person, to experienceoneself, to live in society.Statement (A) is, in many ways, patently false.Of course, in 1975 there were users of drugs like heroinwho experienced a range of difficulties connected withtheir drug use, some of whom also caused problems forothers, including through their criminality. ReadingStimson and Oppenheimer’s (1982) classic accountof heroin use in the 1970s provides a vivid reminder of this. Nevertheless, at the same time, it is equally true tosay that the construct ‘problem drug taker’ did not existin 1975 but did in 1985. In stating this, I am in effectsimply making the relatively uninteresting and familiardistinction between ideas and the ‘real’ objects towhich they may refer (Hacking, 1999, pp. 28–30).But, following Hacking’s lead, it is the interaction between ideas and objects that I am really interested in.This leads us to statement B.On the face of it, statement (B) may also look false.But I suggest that it merits closer attention. As aresearcher, I have interviewed many people who wouldbe described as PDUs, and I have read the transcripts of even more interviews conducted by collaboratingcolleagues – I have never tried to count all these upbut it probably runs to several hundreds of people. Yet,I cannot recall any of these interviewees using the PDUlabel to describe themselves. And so the idea of thisbeing a new way ‘to be a person’ or ‘to experienceoneself’ or ‘to live in society’ seems rather misplaced.How can we talk of interactions between a classifica-tion and the people to which it refers if those peopleappear not to recognise the classification?But clearly this type of classification does have animpact. As Hacking (1999, p. 31) observes, ‘classifi-cations do not exist only in the empty space of 338 T. SEDDON    A   d   d   i  c   t   R  e  s   T   h  e  o  r  y   D  o  w  n   l  o  a   d  e   d   f  r  o  m   i  n   f  o  r  m  a   h  e  a   l   t   h  c  a  r  e .  c  o  m   b  y   T   h  e   U  n   i  v  e  r  s   i   t  y  o   f   M  a  n  c   h  e  s   t  e  r   (   A   C   T   I   V   E   )  o  n   0   7   /   0   5   /   1   1   F  o  r  p  e  r  s  o  n  a   l  u  s  e  o  n   l  y .
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