Tilley obviously intended the book to represent views of what makes nursing knowledge characteristic according to a number of different institutions (which it does) but also for authors representing those differing views and institutions to enter into some kind of dialogue by reading each others’ chapters and having a series of commentaries. The judgement of some of the non-UK commentators and, I think, Tilley himself, is that that didn’t happen. The book ends with some discussion of why not.
But one theme which does seem to crop up in a number of places is the issue of the unity or not of nursing knowledge and – relatedly – its distinctness from other forms. The Institute of Psychiatry view, according to one chapter, is that there is simply psychiatric knowledge to which nursing can contribute.
The most explicit statement of at least the possibility of a contrary view is expressed by a German commentator Susanne Schoppman who suggests that the various chapters express different but possibly complementary views (of course if they are indeed sources of knowledge, they must be complementary) from:
- natural science,
- social science,
- subjective individual case.
This I think goes to the heart of my worries about the Mad Activism workshop (eg about worries about validating individual experience in a PhD viva) and in general about a too quick ascription of knowledge by experience. There is of course something worrying about small sample sizes. Even Wittgenstein comments:
If I say of myself that it is only from my own case that I know what the word "pain" means—must I not say the same of other people too? And how can I generalize the one case so irresponsibly? [Wittgenstein 1953 §293]
But the worry in the quotation from Schoppman seems instead to be that there is something essentially ungeneralisable from ‘subjective individual cases’ whilst at the same time they do afford a kind of knowledge. What can that knowledge be? I suspect: knowledge of what it is like to have some particular experience. But not even hypothetical Mary’s experience of the what-it-is-like-ness of red when she emerges from her black and white prison since that can be shared by all enjoying a view of the same tomato.
That, I think, pushes the nature of knowledge to the limit. It is acquired automatically and without epistemic effort. (That is not to say that there is no effort involved in living the life that gives rise to it.) Best I think not to call it ‘knowledge’ but ‘experience’ and legislate that it is never correct English to say that such experiences are sharable. They are always tokens, never types. But once we’ve said that, we have, again, left debates about nursing knowledge, or knowledge of rival other forms, behind.