Nursing moves into the 21st century exposed to timely and important sensibilities about the constitutive functions of language. However, there is a wide gap between verbal acknowledgment of postmodern positions on language and their practice in undergraduate and graduate nursing education. The main thesis of this article is that postmodern understandings of language can function as revolutionary critical thinking tools and enable multicultural education in a way yet to be resolutely embraced by the discipline.
Multicultural is understood broadly throughout this article to indicate multiple, complex, similar, and different cultural understandings based in wide ranging culturai diversity. This includes cultural understandings that are shaped by age, gender, race, ethnicity, socioeconomic class, regional identities, sexual orientation, education, history, and many other factors. They come together in similar and different ways to shape subjectivity, or self-understandings, and one's understandings of health, illness, and other aspects of the world. To support the thesis, postmodern positions on language are reviewed and explicated through examples relevant to nursing education. Working through these positions on language produces important questions and offers nursing provocative ways of thinking about education and radically different approaches to critical thinking and cultural competence.
The approach to critical thinking presented here broadens the understandings of what counts as evidence in making decisions. It takes up critical thinking conversations in nursing that call for nonpassivity and risktaking through regular practices of questioning and evaluating information, challenging assumptions, and consideration of historical and social context (Adams, 1999; Eisenhauer, 1998; Morin, 1997; Tanner, 1996, 1997a, 1997b, 1999). It pushes the boundaries of creativity in the service of nursing's mission to care for diverse clients ethically and responsibly. This approach to critical thinking works against the notion of standardized care and standardized patients, where standardization has the effect of producing or encouraging a unitary, fixed, and linear approach to professional practice.
POSTMODERN POSITIONS ON LANGUAGE
When postmodernism is described, it is usually against the implicit or explicit ideals of modernity. Belief in the existence of natural truths that transcend history, culture, and language is important to modern education and science. In this philosophical paradigm, objective knowledge is often assumed to be independent of time, place, and the knower (i.e., educator, practitioner, or researcher). The position that the only true knowledge is knowledge that is objective and universal, however, has limited both ways of knowing and what is known in modern Western societies (Denzin, 1997; Harding, 1998).
Postmodern philosophies are a diverse group with as many similarities as differences. Poststructuralism, feminist and critical theories, Lacanian psychoanalysis, and the deconstructionism of Derrida and Foucault, are some of the philosophies included within the postmodern rubric. Each of these perspectives on the nature of knowledge (epistemology) contains antifoundational elements that unsettle stable knowledge by showing the asymmetry, complexity, and contradictions obscured by the illusion of stability (Denzin, 1997). Poststructuralism, for example, can be understood as a philosophy that focuses on the instability of language. That is, language has no fixed structure. The relationship between words and meanings is contingent on things like context, history, the speaker or writer, and the audience. Poststructuralism overlaps with postmodernism, and for the purposes of this article, is practiced under the umbrella of postmodern philosophies. Also included under this umbrella are other postmodern theoretical positions such as critical and feminist theories that foreground the importance of factors like race, class, and gender in language.
Postmodern philosophical positions have been filtering into nursing education over the last 15 years (Allen, 1986, 1995; Allman, 1992; Diekelmann, 1995, 1997; Doering, 1992; Mitchell, 1996; Tanner, 1995a, 1995b; Thompson, 1990; Traynor, 1996, 1997; Weyenberg, 1998). These positions work from the central assumptions that language precedes thought, experience, and theory; participation in cultural conversations from birth shapes the realities and truths that ones perceives; and, therefore, understandings are contingent and truths are context dependent. Allen (1995), drawing on the works of Foucault (1972, 1980) and Gadamer (Hekman, 1986), provides a careful introductory reading of central postmodern positions on language. He emphasizes their importance in critical hermeneutics, and to the possibilities of nursing scholarship that is not dependent upon unchanging theoretical foundations. Listing principal positions as "the role of language in creating human subjects, the role of history in understanding language, meaning as interaction, and the social production and reproduction of language . . . ,"Allen recommends shifting to a critical hermeneutic perspective and to the centrality of language as socially produced (Allen, 1995, p. 176). Enabling attention to sociopolitical environmental effects, this shift encourages a focus on the unacknowledged conditions and unintended consequences of the production and reproduction of discourse. As examples throughout this article show, postmodern positions on language are helpful in bringing unacknowledged conditions and unintended consequences to the foreground.
The gap between acknowledging postmodern positions and practicing these positions may be explained, in part, by the fact that enacting postmodern views on language profoundly challenges conventional notions of education and practice. Significant tensions exist between traditional goals of western education and science, and the realities of a complex and continuously changing multicultural society. Postmodern views can often feel quite risky because they question much of the ground we stand on. These sometimes uncomfortable views, however, are crucial in beginning to unsettle received truths that may be tightly held by students, faculty, and clients. These tightly held "truths" can act as barriers that prevent critical thinking and multicultural (defined earlier) education.
Culturally competent education and practice are enabled by regularly calling into question visible discourses within which we are embedded, and by surfacing multiple perspectives that are similarly complex and contingent. Questioning the status quo loosens the hold of a unitary approach to truths (and facts), and creates openness to alternative understandings produced by alternative discourses. In addition, these positions give birth to the expectation that clients, students, and faculty from diverse backgrounds will be participating in nonfamiliar and familiar discourses.
The notion of language as much more than neutral representation of pre-existing (and pre-discursive) objects or phenomena is a central postmodern premise. In the past and according to modern positions, the primary function of language was thought to be objective representation of a discovered truth. It has been assumed that discovered truths transcended history, culture, and language, and existed independent of the educator, practitioner, theorist, or researcher, and the conversations within which they were participating. From this philosophical perspective, words refer to a meaning that corresponds to a realm (of objects and phenomena) that is free of human interpretation. The task of knowledge was to build an adequate representation of those things that exist, unaltered by the language used (Benhabib, 1990) or by the discursive context of reception (history and context of the audience).
Language as constitutive is different from language as representational. Benhabib (1990) describes the centrality of language in postmodern philosophies as a paradigm shift from language as a reflection of private content of human consciousness to language that is shared and public, and from language that labels or names to language that is constitutive. From this perspective, truths and understandings are constituted through historical, heterogeneous, and changing written and spoken conversations within which someone is participating. They are not assumed to be guaranteed by or representative of something metaphysical or "divine" outside of a particular context and historical moment, or that can be "known" untouched by language.
Written and spoken conversations about nursing, clients, behavioral norms, science, or research findings, for example, are not based on knowledge that originates in the individual. Individuals are born into language and conversations that structure meaning. How an individual comes to understand and interpret these discursive objects is through language (Rorty, 1989). Similarly, there is no place to stand outside of language. Words and sentences are available and familiar to nurses through participation in particular cultural conversations or discourses. When nurses speak and write, their words are not labels of things that exist outside of language, but are constitutive (creating a particular reality). Moreover, any relationship between something, the word that represents it in language, and the content that it refers to, is not natural, but is constructed in language that is contingent upon current and historical conversations (Benhabib, 1990; Rorty, 1989). Nurses, students, or clients cannot transcend their history in language or their current familiar language to interpret, understand, or theorize.
A consequence of this view in practice is a subsequent loosening of the hold of assumed singular true meanings connected to a "god given" or metaphysical realm, and an opening up of receptivity to alternative and multiple understandings of a particular phenomenon. What traditionally may have appeared as fixed and true can be approached more tentatively and contingently as one possible understanding among many. These positions call for a multicultural education that is open to and teaches complexity, alternative understandings, contradictions, and uncertainty. Nurses inhabit a complicated culture constituted by many more cultural conversations than historical and contemporary metanarratives make evident. Recognizing the power of all conversations to constitute different, similar, and contradictory understandings of health, illness, and other aspects of living and dying is an essential philosophical position crucial to contemporary nursing education.
Cultural Discourses, Conversations, and Narratives
Discourses, cultural conversations, and narratives are used interchangeably in this article to describe the multiple written, verbal, and nonverbal conversations within society at the individual, group, and societal level that constitute a particular understanding of an object or phenomenon. Constituting sets up and reproduces meanings (or understandings) that have been heretofore assumed to be neutral "facts" that are referred to by a name. Foucault (1972) describes this as the ability of groups of signs or discourses to act as practices that systematically construct the objects of which they write or speak.
Müller and Dzurec (1993) head in a postmodern direction when they describe the power of naming maternal infant attachment, but they stop short of the provocative and critical position that language is constitutive. For example, their work implies that the act of naming is attaching a label to a pre-existing phenomenon rather than a constitutive practice. They describe effects of the naming of maternal-infant attachment, such as privileging of selected essences referred to by the name and excluding others from knowledge development, directing researchers to place less emphasis on alternative theories, and leading to one knowledge perspective. While these are key considerations and they overlap with positions on the power of language to constitute a particular reality, the above list implies that essences and a phenomenon (maternal-infant attachment) exist independent of historical cultural narratives. This understanding (language) leads down the modern path to words as neutral representations of prediscursive phenomena and away from the postmodern positions that words are meanings and language is constitutive. Finding the best name to represent the phenomenon or suggesting that alternative names may further knowledge development leaves the phenomenon in place as a natural fact. These positions do not unsettle the concept or loosen the implied notion that a singular truth exists about a universal phenomenon between mothers and infants that can be recognized when it is present.
Questioning the discursive ground upon which concepts like maternal infant attachment are produced and making this ground visible are two key aspects of postmodern approaches to critical thinking. Unsettling knowledge that appears universal in order to increase receptivity to alternative knowledges, while decreasing the oppressive consequences of unitary knowledge is imperative to cultural competence and social responsibility. The name maternal-fetal attachment did not originate in a researcher's mind, nor does it exist as a phenomenon as such outside of language. Nurse educators, researchers, and practitioners, like all people, come to understand things through their participation in multiple historical and contemporary narratives. In this case, historical, overlapping, and influential scientific and cultural conversations that presupposed or came before maternal-infant attachment most likely included particular ways of understanding women, mothers, maternal and nonmaternal behaviors, motherhood, infants, infant needs, men, fathers, and fatherhood, to list a few.
For example, in the 1800s an influential French bourgeoisie discourse on mothers wove its way into the dominant cultural fabric of the U.S. (Kaplan, 1992). The vital importance of the child, and in particular the White male child, was seen as central to the survival of the human race. According to this discourse, middle and upper socioeconomic class White women as mothers were depended upon to care for children through their natural skills in emotions and relationships, as well as through their total attention to the child from an early age. Bold traces of this discourse can be found in western cultures today. As Kaplan notes, this "early-modern-mother paradigm" is difficult to dislodge because of its close links to religious ideologies and authoritarian discourses such as Darwinian, Marxist, and Freudian discourses (p. 20).
As a dominant professional and popular cultural narrative, maternal-infant attachment is a meaning or understanding that is commonly taken-for-granted as representing universal truths about mothers and infants. No person, however, stood outside of language or historical cultural conversations to identify, and then name it. Rather than a truth, maternal-infant attachment as a phenomenon was produced by loud and visible historical conversations. Moreover, these conversations were and are nondemocratic. They have unintended consequences depending on how a particular person (like a woman or mother) is positioned in relation to the maternal-infant attachment discourse.
Equally as important as awareness of the production of maternal-infant attachment as a phenomenon, is awareness of possible effects of participating in the contemporary discourses reproducing it. Many educators, practitioners, and clients come to understand mothers and infants through this discursive lens. Women and mothers are positioned as normal and abnormal through this discourse. Public policies and child-rearing practices are underpinned by these unspoken, yet very influential discourses. In addition, fathers and their abilities to attach are constituted by these same conversations, in comparison to the mother-infant attachment phenomenon that is believed to exist. What a nurse "sees" when the nurse assesses mothers and infants, depends on the particular nurse's history in language (cultural conversations). If the nurse is participating in the dominant maternal infant attachment narrative, she or he may "see" maternalinfant attachment, or its binary opposition, nonmaternal-infant attachment.
Diverse and changing cultural groups may be very different in their understandings of women, men, and infants. An educator, practitioner, or mother from a nonwestern country may not be participating in western conversations constituting women and infants as attached or not attached. They may be familiar with discourses constituting mothers and infants in ways that are quite dissimilar from western discourses. Although western conversations have no more privileged relation to reality than do other discourses within which western or nonwestern nurses and mothers may be participating, western discourses constituting maternal-infant attachment are markedly visible in professional and popular culture conversations and, thereby, are likely to constrain multicultural understandings and practices.
What is critically important, in order to move the discipline more deeply into multicultural education, is the position that the maternal-infant attachment lens, like all discursive lenses, is partial and limited, and has important unintended effects. It is constituted and reproduced by relatively few historical, cultural, and overlapping discourses, albeit loud and visible discourses, like nursing, medicine, and psychology that act as practices systematically constructing the objects of which they write or speak. Unless the nondemocratic constructing process is excavated (i.e., through critical thinking exercises in multicultural education), maternal-infant attachment appears as the norm and as naturally suited to being the ethical standard against which all mothers are measured equally.
Postmodern psychodynamic positions help to explain that how one comes to understand an object, experience, or situation in a particular taken-for-granted way is not an entirely conscious process (Flax, 1990; Hollway, 1989, 1995). Interpretation and understanding occur through participation in a discursive world of everyday meaning, constituting and reproducing conversations. Subjectivity and one's understandings are informed by individual histories located within discourses and power relations with meanings achieved consciously and unconsciously in relation to others (Hollway, 1989). If one is not participating in a particular discourse constituting a particular object or experience as such, one will not recognize it as such, but will have understandings constituted by the discourses within which that person is participating.
Another example, relevant to HIV multicultural education, may help to further clarify this position. Some heterosexual Latina women are at risk for HTV because their male partners having sex with other men. Yet many Latina women have no understanding of this sexual practice because they participate in conversations that constitute sexuality as a strict sexual dichotomy between heterosexual and homosexual (Romero, Lourdes, & Rivero, 1993). According to Romero et al., for many Latina women, male homosexuals are understood as "feminine" and only "feminine" males, not "heterosexual" males, can be sexually involved with other males (p. 346). Bisexual and "heterosexual" men having sex with men are meanings within the western conversations that establish and reproduce them, but may have no meaning to some Latina women not participating in those particular conversations. HFV prevention education that presupposes western understandings of bisexuality and heterosexual men having sex with men can have serious consequences for heterosexual Latina women who understand sexuality as either homosexual or heterosexual.
Multicultural education informed by postmodern positions on language aims to reflect upon unstated assumptions, to offer opportunities to participate in alternative discourses, and to regularly demonstrate that understanding a phenomenon is much more complicated than it appears. Using multiple educational sources from insider perspectives can go a long way toward unsettling a dominant Eurocentric perspective, especially if they are used in concert with reflective journals and regular discussions about the effects of racism, sexism, heterosexism, and White privilege.
KNOWLEDGE: PRODUCTION AND EFFECTS
As evidenced by the explication of the maternal-infant attachment discourse and the HIV sexuality education discourse, postmodern positions can reveal the power language and the production of knowledge through expert discourses, which subsequently structure and limit the field of possibility for nonexperts (Cheek & Rudge, 1994). Foucault's work describes power and knowledge as "mutually generative, that is, knowledge initiates power and power initiates knowledge" (Dickson, 1990, p. 22). As noted in the above examples, nursing discourses are constituted as expert discourses, and can have an unintended effect of limiting possibilities and reproducing universal truths constituting one particular reality that is constraining for people participating in alternative discourses.
In general, definitions are an example of this constructing process that has both enabling and limiting effects. Knowledge, in the form of definitions, is often used as a way to mark off reality. Young notes that "any identifiable something presupposes a something else against which it stands as background, from which it is differentiated" (Young, 1990, p. 98). Subsequently, definitions purposely are not open-ended, in flux, ambivalent, or facultative of multiple possibilities. They do, however, privilege particular discourses that constitute the definition.
Example: Defining Health
Postmodern positions maintain that health is a discursive object constituted by multiple discourses and understood differently in different discursive contexts. Good health, for example, may be defined as stable or normal vital signs in a western hospital, and as the ability to reproduce and keep children alive in an impoverished country. How particular words come to have meaning is contingent on the particular discourses within which a person or group of persons are participating. Self-esteem, for instance, is constituted within visible western cultural narratives as an aspect of health, but may not exist as a discursive object or aspect of health within less visible cultural discourses, nonwestern discourses, or both.
Participation in discourses is understood here as consciously or unconsciously taking up of discourse, enacting it or using it, and, thereupon, reproducing it. Participation in discourse can take many forms. A subtle but powerful form of participation occurs through unstated assumptions. Unstated assumptions are discursive understandings that are implied, relied upon, and reproduced, usually without notice as the more visible discourse supports or constructs a main thesis. The assumptions and main thesis are imbricated in one another. Participation in the thesis discourse reproduces the unstated assumptions discourse upon which the thesis is constituted.
An example of a more visible form of knowledge production and reproduction through participation in discourse is when a researcher goes into a community with standardized assessment instruments, like ones measuring the presence of self-esteem and quality of life (QOL). A common assumption of researchers and participants, and one implied by the notion standardized assessment instrument, is that it represents objective and neutral facts about self-esteem and QOL. With the history of the instrument's development obscured, it is commonly taken for granted that something called selfesteem and QOL exists beyond language and context. Research participants and nurses participating in professional and popular discourses constituting selfesteem and QOL as aspects of health, may assume these qualities were discovered through examination of individuals' experiences as reflections or representations of a truth about persons.
This perspective relies on the assumption that objects and phenomena transcend language. Obscured by this view is the connection to the discourses that produced the experiences or constituted their meanings. There may be little recognition of the discursive context of the instrument's production, or that the client's account, as demonstrated by answers on the instrument, can fit only into the conversations that produced the knowledge about self-esteem and QOL and that shaped the research in the first place. In addition, an "either/or" is constructed, where the participant is either normal or deviated from normal. In this process, the participant and the researcher come to interpret the participant's experience within the categories of the research instrument. Tensions exist between science as value neutral, both in its constitution and its effects, and the notion that value neutral, and thereby, innocent science is a discourse that has been taken up and reproduced to the point of obscuring its own historical constitution as value free and neutral.
Postmodern positions unsettle health research and unearth seemingly innocent scientific practices that ask participants to reproduce or further establish socially constructed categories, criteria, and taxonomies that define health (or health parameters like self-esteem and QOL). Recognition of complex cultural diversity requires reconsideration of taken-for-gr anted, natural facts, and a more contingent and tenuous hold on acknowledged constructed truths. In this example, if the research instrument included categories such as race and gender, it could further reinforce discursively produced connections between self-esteem, QOL, race, and gender that may be theoretically (and implicitly) presupposed by the instrument. Regularly questioning the salient overlapping conversations that establish definitions, interpretations, research, and in this case, knowledge about self-esteem and QOL that refer or imply that self-esteem and QOL exist outside of the historical overlapping discourses that constitute them, is a radical notion crucial to loosening the hold of singular truths discovered through science and to multicultural education guiding practice, and research.
Definitions, concept clarification, and standardized tools underpin and are underpinned by positions on language as delineating and representing realities that exist outside language and are represented by words. Paley (1996) critiques the modernist position that concepts are building blocks of theory. He contrasts this position by explaining that concepts are "niches created by theory." They do not exist in language, prior to the construction of the theory (p. 572). One cannot, for example, define health without first having an understanding or theory about health. Concepts and definitions are presupposed by the theoretical conversations that produce them.
Example: Defining Person
The domain of person continues to be central to nursing and implied definitions abound. Although often unstated, an effect of implied definitions is a false sense of unity that serves to enable those persons privileged by the definition and to constrain the "others." By creating an illusion of unity, definitions reduce the flux and heterogeneity of experience into binary, and supposedly, natural (or essentialist) "either/or" oppositions (Flax, 1990). The creation of binaries or oppositions (vs. heterogeneity or multiplicity) through reliance on assumed essences, privileges the part of the binary against which the "other," less privileged part is defined. In other words, if a human body with particular characteristics is a person, then a human body without these characteristics is, implicitly, not a person.
For example, from 1932 to 1972 the United States Public Health Service (USPHS) seems to have implicitly used racial categories to determine personhood in its 40year study of the effects of untreated syphilis on Black men (Jones, 1981; Reverby, 1999). Medical treatment for syphilis (neoarsephenamime, bismuth, and in the 1940s, penicillin) was available during this time period, but was intentionally withheld from Black men in the medical experiment. No similar harmful experiment was conducted on White men with syphilis. Prominent cultural conversations constituting race as a Black and White binary were tacit discourses that formed the warp of dominant culture fabric earlier in the 20th century enabling this inhumane experiment on Black men. Seen as evidence of an implicit cultural definition of person, the analytic frame employed in this article proposes that a consequence of being naturally excluded from the definition of person resulted in tragedy and death for many Black men and grave loss for their partners and families.
The fact that definitions change over time and are contingent on the discourses available historically and currently is often obscured by erasure of the history of the definitions' construction and by the assumption of fixed, unitary facts. For example, 10 or 20 years ago, hospital, medical, and insurance company conversations constituted a myocardial infarction (MI) patient differently than the hospital, medical, and insurance company discourses constitute them today. A person experiencing an MI in the 1980s was considered a critical cardiac care unit patient, needing intensive care and relatively long hospital stays. Today, this same person may be considered stable enough to be in need of significantly less intensive care and to be sent home after only a few days. Did the MI patient 10 or 20 years ago have a more serious MI than MI patients today? No, but the discourses constituting MI patients have changed, the hospital, medical, and insurance company discursive context within which to interpret the meanings has changed; and physical location of the person in the hospital has changed.
Lupton (1992), describing discourses as groups of ideas or patterned ways of thinking, which can be identified in textual and verbal conversations, also notes that discourses are located in wider social structures, like relationships and institutional practices. Discourses may overlap, produce similar accounts of reality, or be contradictory, offering contrasting accounts of reality. When discourses overlap, the overlap is often taken for granted as the dominant discourse, or understood more traditionally as the "master" narrative, metanarrative, or universal understanding. Dominant narratives or conversations persist because they are held in place by complex webs of institutionalized social relationships and practices.
For example, the most common and visible western conversations (i.e., media images such as news, television, and movies) constitute Arab women as either "the 'Faceless Veiled Woman', silent, passive, helpless, in need of rescue by the West, or as the exotic and seductive 'Belly Dancer'" (Fayad, 1992, p. 170). Inadvertently holding these dominant narratives in place are social relationships, such as nursing, that may expect Arab women to be silent, passive, helpless, exotic, or seductive.
Usually, discourses that are contradictory to the most visible cultural conversations are marginalized and often invisible to those participating in primarily dominant conversations. Fayad (1992) writes that the "two- in- one" construction of Arab women above is completely intractable: "Her voice drowns mine" (p. 170). Emphasizing the power of constitutive linguistic practices, Fayad notes that western dominant discourses resist her contradictory discourse as she attempts to point out to American students that Arab school girls wear khaki uniforms, are required for school credit to work on urban improvement projects, and that Syrian television runs ads for women to join the army.
The authority of metanarratives is challenged through openness to and participation in marginalized written and spoken conversations, like Fayad's discourse above. Openness to and participation in alternative conversations (e.g., reading fiction and nonfiction written by insiders of marginalized groups) leads to contesting the dominant narrative and to altering consequences, such as social relationships, produced by dominant conversations. When we think and talk differently about a particular person or group of persons or about health, illness, or nursing, we, ultimately, do education and practice differently. An appreciation of the power of language to constitute and to bring new and different things to the forefront through participation in alternative conversations becomes possible when "one's aim is an expanding repertoire of alternative descriptions rather than The One Right Description [sic]" (Rorty, 1989, p. 40).
Although there seems to be verbal acceptance of the fact that conversations are historical, cultural, and changing, and the meanings they produce are likewise, historical, cultural, and changing, there is a gap between verbal acknowledgment and verbal acceptance as practiced (praxis). Science and practices that, inadvertently perhaps, aspire to discover and apply fixed, singular truths is not adequate or appropriate to multicultural education, and multicultural education should not be about such science and practice.
A final example examines defining person in light of categories such as gender and race. Postmodern positions consider gender and race symbolic, imaginary, and binary social constructs established through historical cultural conversations. However, both are often taken-for-granted to exist, and to represent a reality, beyond language. For example, women and men are constituted as biologically distinct. This may seem obvious, but how one comes to understand men's and women's biological bodies as distinct is through language. Had dominant historical discourses been different, they could have constituted prominent body distinctions as hair color or foot size, or bodies possibly could have been constituted with multiple distinctions, without any particular distinction privileged over another distinction.
Similarly, there is not a "real" way to be female or male since male and female do not exist outside language. Postmodern education, practice, and research are more interested in how people have come to understand themselves as gendered, raced, classed, intelligent, or in other ways, and in the effects of gendered, raced, classed, and other discourses in people's lives. How a particular person understands his or her gender is dependent upon the sociohistorical narratives available to a particular person and within which that person has participated.
For example, a young child growing up participates in multiple conversations regarding gender that may be similar, overlapping, or contradictory. These conversations may include the family verbal conversations and nonverbal practices regarding gender roles and expectations, which may be similar to or different from the discourses available to the child in her or his school, with that child's peers, and in the culture via the media. Subjectivity, or the growing child's sense of self as a gendered person, is constituted through the discourses available to a particular child. Postmodern positions on language acknowledge this process and assume multiple possibilities in persons' lives. Critical, feminist, and antiracist postmodern positions call attention to the uneven, unjust, and, at times, dangerous effects of cultural discourses on subjectivity (Phillips, 2000; Phillips & Henderson, 1999).
Although there is not an ahistoric, nonculturally constructed real person, woman or man, at the end of the rainbow to discover, to be, or be compared to, this critical point gets lost in the societal context of reception where the overriding discourses function to create normals and abnormals. For example, adolescent boys are able to clearly describe normal adolescent male behavior including how to dress, how to talk, whom to be seen with, the unacceptability of feeling scared at violent movies, and the importance of verbal and physical violence in attaining and maintaining identity as a normal male (Phillips, 2000). When these same boys describe how they spend their time, the majority describe a history of frequent and regular participation in cultural discourses, like media (primarily R-rated violent movies and violent TV shows), violent video, and computer games that require increasing violence to progress and win, and the enactment of practices of masculinity, like perpetrating, witnessing verbal and physical harassment of other boys, or both. On the other hand, alternative discourses complicate this discursive picture. Cultural conversations taken up less frequently are ones describing nonviolent male behaviors, the importance of good grades in school, the acceptability of crying and of stopping verbal and physical harassment of others, and media discourses such as TV shows and movies focused on teenage friendships, romantic comedies, and fantasies. Adolescent boys do not stand outside cultural conversations, but come to understand themselves and others through these conversations. Moving beyond the individual level, critical tliinking in multicultural education interrogates complex social conditions and institutionalized practices like discourses of masculinity to ask its important questions about health and illness.
For nursing, the implications of postmodern positions on language are being asserted through qualitative research that explicitly aims to surface complexity and contradictions, and by the growing tradition of critical, feminist, and postmodern educators, practitioners, and scholars who directly address the invisibility of alternative discourses and the consequences of universale in a multicultural society (Allen, 1995, 1996; Allman, 1992; Baldwin, 1999; Boutain, 1999; Cheek & Rudge, 1994; Diekelmann, 1995, 1997; Drevdahl, 1998; St. Clair & McKenry, 1999; Tanner, 1997c; Taylor, 1999; Thorne, 1997). Recognizing the value of multiple conversations and accepting alternative interpretations as legitimate is profoundly important as nursing moves into the increasingly visible and explicit multicultural complexities of the 21st century. Rorty (1989) asserts that the shift in aim from one understanding or truth to multiple understandings and truths is possible when the "world and the self have been de-divinized" (p. 40). That is, when nurses no longer understand the world or the self as speaking to us in our own private language that nursing happens to recognize, but as one of many conversations constituting a particular version of the world and its inhabitants.
As the examples throughout the article demonstrate, enacting postmodern positions on language is critical thinking and a particular way of practicing cultural competency, two basic ingrethents of (postmodern) de-divined multicultural education. Capitalizing on postmodern sensibilities about language in order to create multicultural education and practice will take persistent self-reflective educational practices that question the ground that we stand on, as well as good intentions regarding a deep and broad embrace of complexly understood cultural competence.
This work was supported in part by an NIH/NINR Women's Health Research Training Grant Pre-doctoral Fellowship, an NIH/NINR Pre-doctoral NRSA, and by an award from the Nurses Educational Fund. The author gratefully acknowledges Drs. David Allen, Doris Boutain, Denise Drevdahl, and Carole Schroeder for their contributions to earlier drafts of this manuscript.
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