“Negotiating Truth” – Semmelweis and the Role of Emotions in Public Policy

Anna Durnova
Anna Durnova

by Anna P. Durnová, Ph.D., Hertha-Firnberg Assistant Professor, Department of Political Science University of Vienna

Emotions are at the very core of a myriad of scientific and political disputes. Just take this famous, provocative accusation by Viennese gynaecologist Ignaz Philipp Semmelweis about his fellow physician:

“I declare before God that you are a murderer! The history about ‘childbed fever’ would not be too unfair if it remembers you as a medical Nero.”

In 1846, Semmelweis claimed that “childbed fever,” a disease that afflicted many women giving birth in hospitals, may actually result from doctors not disinfecting their hands before assisting in birthing. Since this occurred in the pre-germ theory era, his thesis grew into a vicious dispute over the duty of hand disinfection as a measure against childbed fever, over which he failed to prevail in his lifetime. Today, the story of Semmelweis is a quintessential example of a scientist who was vilified in life because of his controversial and contentious stand but celebrated in later times (as I analyse in Durnova 2015).

What does this have to do with politics?

I analyse Semmelweis’ case as a case for public policy. Although hand washing is today understood as an effective, simple, and rapid measure to reduce the transmission of germs, and has been integrated into public health agendas all over the world, in his day Semmelweis failed to communicate its necessity: he could not explain the link between doctors’ hands and childbed fever, and, moreover, his thesis was at odds with the epidemic and hygienic theories of the period. His failure offers us a unique vantage point from which to explore how issues become defined as matters of public concern with and through emotions and how actors gather, or not, around particular discourses through emotional appeals to values and beliefs.

Public policy research has already shown that truth is a device of power and is used to show the necessity of a change in policy practices. Both poststructuralist political theory (for example David Howarth) and critical approaches to public policy (Fischer and Gottweis 2012) investigate discursive mechanisms through which truth is established and thereby open the analytical door toward an investigation of the ways in which institutions legitimize their agendas. However, both approaches seem to have left emotions behind when describing the process of truth production in public policy and have failed to challenge the leading paradigm in public policy, which claims that emotions destabilize institutional patterns and agenda-setting (e.g. the work of Michael Howlett).

If there have been some sporadic studies on the role of emotions in public policy they have mostly touched upon emotions as surplus phenomena accompanying actual policy making – especially when something runs out of steam or when emotions are related to the specific policy situation (e.g. the work of Marian Barnes for participation and the work of Paul Hogget  for deliberation). Using Semmelweis’ story, and building upon my previous research, I advance a new understanding of public policy through emotions: emotions frame the establishment of “truth” through their relationship with discourse. As such, they enter policy processes not only as discursive parts of compassion, empathy, hope and fear related to respective policy contents – but they refer also to our evaluative judgements of a range of actors that are presented as the entitled ones to speak or handle, whereas the other actors are abandoned as “irrational”.

Semmelweis as a Case for Public Policy

This is how Semmelweis’ story is used in the project: it analyses carefully particular positions in relation to the values and beliefs concerning both hand-washing and childbed fever. The proposed practice of hand washing was ‘uncomfortable’ and ‘time consuming’ in his time, or it was simply considered as not really necessary since there was no proof that it worked, briefly no ‘truth’. This was due to the generally adopted epidemic theory which made it more likely to see the origins of childbed fever within the walls of the hospital, rather than on the hands of the doctors. Another example is the period imagination of the female body and the related accepted causality between childbed fever and female specific sensations: such as ‘shame’ of the female patients of being examined by male doctors or the link of the illness to traumatic experiences during pregnancy or birth.

Yet the most important political moment rises from the logical consequence that accepting Semmelweis’ thesis would mean to accept the doctors’ guilt for the previous deaths of young mothers. In all European clinics of that time, the establishment of gynaecology as a distinguished discipline aimed at improving birth care and, in all of them, childbed fever was a serious threat to this aim. The midwives’ reputation, and maintaining their popularity among the young mothers, became one of the key concerns of the dispute because Semmelweis was automatically placed by his adversaries on the side of accusations of medical birth control as a fundamental danger to mother’s well-being. Thus, we can draw an analogy to public policy: actors must cope with “beliefs” (such as the knowledge of the female body, the then-current epidemic theory) and values (the pride of doctors, the concurrence with midwives, the value of the female body) related to practices they want to change specifically because these novel practices disturb the “values” and “beliefs” that are part of already established practices.

If you enjoyed this blog entry, you may be interested in a similar article: Reflections on contemporary debates in policy studies by Sarah Ayres & Alex Marsh

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