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The walls within: working with defenses against otherness

Online Conference 5-11 July 2021

The libidinal economy of healthcare

This paper explores how the libidinal economy (the relationship between affects, desire and their identifications) shapes, limits and organizes healthcare delivery. The paper reveals two ideological phases which have determined how healthcare is organized in the NHS. These ideologies are bound together around point-de-capiton's (Lacan's term for a quilting points that bind the symbolic together). The first ideology that dominated the NHS is bound together by the binary, Caring-Dependency, which whilst delivering advances also created the serious problems that occur when autonomy is limited and power is concentrated in top-down omnipotent forms leaving patients and staff silent and impotent. The second ideological phase is bound together by binary Market-Efficiency, which harnesses the ideas of modernity, the market and managerialism to create a clean, modern and efficient healthcare service. Sadly the ideology has de-humanising implications, and its inability to address holistic and complex healthcare issues, and to re-think the idea-of-healthcare itself. The paper deconstructs these ideologies, identifying the affective investments and attachments that produce the libidinal economies that are a product of, and sustain the ideology. It concludes by identifying a new point-de-capiton binary; Mutual-Networked care, that binds together a new libidinal economy based on re-thinking healthcare and removing the 'factory-hospital' idea of healthcare, that dominates contemporary thinking today.