Experiences and expertise of codependency: Repetition,claim-coupling,and enthusiasm

1. Introduction

This article explores the Swedish U-FOLD network (Forum for research on addiction to medical products and illegal drugs) as an arena for coproduction and communication of new addiction knowledge. The forum describes itself as a unique venue for collaboration and production of new, interdisciplinary knowledge, and involves a range of actors (researchers, practitioners, clinicians, politicians, journalists, non-governmental organizations (NGOs), and the publics). Previous studies have investigated coproduction in, for example, patient organizations’ participation in research processes, science museums, and, as in this study, semi-scientific events (public information symposia, dialogue events, etc.). Such events are especially interesting if we are to understand dissemination of expert knowledge, for they enable different actors to interact “beyond disciplinary boundaries” (Cassidy, 2006: 178) and invite actors inside and outside of the scientific community to participate (cf. Jasanoff, 2004). While some initiatives have been criticized for only gaining public trust without increasing the agency of publics, previous studies typically hold that the inclusion of publics in scientific processes has had a positive effect on democracy and equality (Fischer, 2000; Jasanoff, 2003; Wynne, 2001). For example, Davies et al. (2009) argue that public/scientific interaction could lead to more democratic and symmetrical learning. More participation is not necessarily better, however. Actors can monopolize discussions and regulate the empowering of other actors (Davies et al., 2009). Such critique is often aimed at protecting the publics, as scientific actors in general possess more status and power. This study however suggests a symmetrical approach to explore the production of knowledge, publics, and experts. The aim is to expand on the dichotomized approach to publics and experts as two stable categories and on inclusion of publics as either leading to positive change or futile grandstanding.

I will explore what and how knowledge is produced within U-FOLD’s interdisciplinary semi-scientific collaboration and how this production affects the boundaries between publics and experts. Three questions guide the analysis: What and whose knowledge claims are made, how are they made (what activities are involved), and how do they affect the relationships of publics and experts?

I will next present the theoretical framework and some methodological considerations. This is followed by an analysis of how repetition in knowledge production brings with it claim-coupling, enthusiasm, inclusion, and exclusion. A summarizing discussion of the results concludes the article.

2. Coproduction of knowledge and boundary concepts

Science outreach is a central academic task. This “third mission” used to rely on the deficit model of passive and misinformed publics, and has since the 1990s been replaced by the dialogue approach to some extent (cf. Bucchi, 2014). While some scholars argue that news of “the death of the “deficit model” have been greatly exaggerated” (Wilsdon et al., 2005: 34), the focus has shifted from a one-way relation—the publics, politicians, and patients as passive recipients—to a two-way (even three-way) relation of science and society acknowledging the active role of such actors (cf. Bucchi, 2014).

The coproduction framework is useful to explore such two-way (or more) relationships of science and society. There exist various applications of coproduction (see for example the contributions in Jasanoff, 2004). This study relies on a general understanding of coproduction and acknowledges two broad premises: a non-linear and co-constitutive relationship between different domains of science and society and their knowledge objects, and an understanding of the actors existing within these relations as active and their positions as potentially flexible.

Several studies have argued the active role of publics in the making of agendas, decisions, policies, and science (Bucchi and Neresini, 2008; Callon, 1999; Frewer and Rowe, 2005; Rowe and Frewer, 2000, 2004). Although experts and publics are often conceptualized as stable and dichotomized categories, many studies have also criticized such a simple division, and embraced the heterogeneity and complexity of publics, experts, and blurring of the two (cf. Allgaier, 2012; Einsiedel, 2000; Felt, 2000; Irwin and Michael, 2003; Jasanoff, 2000; Stilgoe, 2007). Scholars have applied different concepts and typologies to explore this relation. For example, Irwin and Michael (2003) argue that we can study how both expert and lay identities are fluid, and how knowledge is produced, through conflicting ethno-epistemic assemblages—coalitions involving both experts and laypersons—rather than separate groups of either publics or experts. Collins and Evans (2002), and later Carolan (2006) differentiate between no expertise, contributory expertise, and interactional expertise. Carolan (2006) argues that contributory expertise—for example, farmers’ local or practical knowledge—is increasingly important, but interactional expertise—scientists’ ability to understand the importance of farmers’ contributory knowledge, or, farmers’ ability to speak about their knowledge in a successful way—is necessary for this contribution to enable useful exchange of knowledge. Moreover, Rabeharisoa and Callon (2004: 145) show how patient groups and scientific actors’ mutual learning “transforms both patients’ identities and the status of their diseases” and how laboratory research and patients’ experiences coproduce neuromuscular diseases. Another example is Epstein’s (1995) study of negotiation of credibility: AIDS activists as lay experts illustrate the transformation of medical practice and knowledge as a result of coproduction: in applying the medical vocabulary, AIDS activists have been able to affect research processes as partners. Furthermore, Myers (2004: 168ff) shows how expertise is multifaceted through an analysis of how participants in focus groups reach entitlement to speak, as they provide different representations of themselves and experts through the use of voices of other positions in their activities and that this challenges the identities the participants were ascribed in the research methodology.

These problematizations of the lay/expert divide are reflected in this study. The “public” in this case is indeed multiple, as it is represented by victim identities, specific actors/spokespersons “on stage,” the audience, and Swedish citizens at large. The actors representing the public on stage are well-known journalists and (social) media faces, at the same time they are invited to speak for the people. I will refer to them as actors of lived experience and/or lived expertise although they aspire on other identities as well. Consequently, the “expert” is also multiple, as it is represented by actors of both lived and professional expertise, as well as disqualified or excluded authorities. All expertise rely on some kind of experience. “Lived” grasps the contributory knowledge that no authorities can have, unless they have lived a life of codependency and shared their experiences about it.

Different domains are surrounded by multiple boundaries of knowledge, methodologies, and practices (Gieryn, 1983). When domains interact, boundaries are blurred (Allen, 2009; Löwy, 1992; Star and Griesemer, 1989). To enable cooperation and to strengthen one’s position, actors communicate, interact, and gather around loosely defined boundary objects (Star and Griesemer, 1989) or (even more flexible) concepts (Löwy, 1992), here referred to as BO/Cs. The BO/Cs are open-ended and allow interpretive flexibility but are coherent enough not to fall apart. Their vague and simultaneously cohesive character facilitates interaction of various domains and actors and bridges their social worlds. Previous studies have investigated the immunological self (Löwy, 1992), the big bang (Bucchi, 2000), the “pillars of creation” (Greenberg, 2004), parameterizations (Sundberg, 2007), care pathways (Allen, 2009), the transition between scientists and policy makers (Kemp and Rotmans, 2009), the American Journal of Sociology in relation to publics (Evans, 2009), artistic–scientific collaborations (Halpern, 2012), food labels (Eden, 2011), autism (Feinstein, 2014), the El Nino Southern Oscillation (ENSO) (Leith and Vanclay, 2015), and music (Huang and Allgaier, 2015) as BO/Cs bridging social worlds blurred by natural, cultural, technological, or other systems of meaning.

I will use BO/Cs to explore how different actors from different domains form a coalition. Previous studies argue that the function of BO/Cs leaves the actors and differences intact and benefits all participants (Cash et al., 2006; Carolan, 2006; Cassidy, 2006; Kemp and Rotmans, 2009). Still, Evans’s (2009) study of how the public is defined shows that strategic reformulations of BOs do not bridge social words of actors. “Boundary” refers both to what links the different actors and bridges their social worlds and what unlinks and “unbridges” them. An important but overlooked dimension of these processes is the act of repetition. Although repetition is often present in boundary work (see, for example, Greenberg, 2004; Halpern, 2012; Leith and Vanclay, 2015), it is seldom seen as crucial.

Calls have been made for forums that suit the needs and thoughts of scientists and publics alike, and for more critical studies of the relation between them (cf. Einsiedel, 2000; Felt, 2000; Jasanoff, 2000). This study heeds these calls with a symmetrical approach on coproduction that explores how repetition produces cooperation and conflict, inclusion and exclusion, and bridges and unbridges social worlds.

3. Material and method

It is in the meeting between different researchers of different scientific disciplines and practices that we will find new questions and methods for our work together. Our interdisciplinary structure and short distance to practical implementation will with no doubt increase our possibilities to develop misuse care. (U-FOLD, 2011)

This article draws on material from the U-FOLD network in Sweden. The arena is described as a unique research forum in which leading researchers and experts come together as a “unified force against addiction” (U-FOLD, 2014b) to solve problems of addiction through means and production of interdisciplinary science, collaboration, and knowledge. Through such definitions, U-FOLD sets up itself as a practice of coproduction. U-FOLD arranges public meetings, with invited national and international experts as well as actors outside academia (County Administrative Boards, the Police, Church of Sweden, and Medical Products Agency). U-FOLD provides education to social work and health-care practitioners and represents Uppsala University in conferences, media, and political events. The coordinator of the network holds a chair at the Department of Pharmaceutical Biosciences at Uppsala University and is nationally and internationally renowned for his work.

In addition to several meetings, events, and courses annually, the network arranges around two larger public meetings every year. Within these meetings, researchers, experts, and other relevant societal actors join to communicate their knowledge and produce solutions for problems of addiction. The meetings are opportunities to explore the practice of what the network preaches—coproduction of knowledge and problem-solving action—but also to study how the inclusion of public actors affects such processes. The meetings are thematic and focus on potential problem areas, such as “codependency,” “unaccompanied children seeking asylum,” and “the environmental effect of drugs.”

This study examines the meeting on codependency ¹ (7 October 2014), a typical example of how the network picks up phenomena underpinning recent public debate in Sweden. The same year, the Swedish Public Service Television produced a popular series on the topic. The two well-known TV hosts identifying themselves as “codependent” were invited as speakers at the meeting. The meeting was moderated by a representative from the pharmaceutical student union, and other invitees were the coordinator; the president of the university; a clinician; a professor in child and youth studies; another journalist identifying as codependent; a practitioner; the secretary general of a Swedish anti-bullying organization (NGO 1); a secretary general at an organization supporting children with parents who have problems with alcohol, other drugs, or mental health (NGO 2); and two politicians from the county council and the municipality.

The observation took place at the University Hall at Uppsala University (approx. 450 persons in the audience). The meeting lasted for 5 h with two breaks; it was recorded and subsequently published on the network website (U-FOLD, 2014a); and field notes were taken openly during the event. The study is based on website material (summaries from meetings, video recording, and advertising video) and observational data (field notes and photographs) of nine presentations and one panel debate involving 12 actors. The data were either copied or transcribed verbatim and exported to the program Nvivo for coding. I coded the content of the actors’ discussions as well as their actions, such as challenging or emphasizing knowledge claims. Repetition was an evident theme, and from this theme followed claim-coupling and enthusiasm as sub-activities of repetition. I also tried to catch the contradictions (Swedberg, 2017): what was not repeated, coupled, or enthused over?

4. Repetition as claim-coupling and enthusiasm, inclusion, and exclusion

The following sections discuss how different actors and claims gave rise to potential conflicts and engagement with the arena’s initially promised interdisciplinary science, new knowledge, and collaboration. The focus was on how actors’ repetition of, claim-coupling with and enthusiasm for three dominating BO/Cs —“the children,” “to dare,” and “disease”—locked these concepts into “boundary beliefs” involving inclusion and exclusion of actors and claims: (1) the victimized codependent children and their spokespersons failed by an impaired society; (2) the act of daring and sharing as the solution; and (3) the (brain) disease model of (co)dependence. These beliefs produced a community that altered and challenged a dichotomized relation between publics and experts, as the experienced actors became the spokespersons and protagonists of victims of codependence and the future collaborators of new knowledge. Moreover, this reproduced the disease model as the scientific knowledge, excluding existing social interventions, and critique. The following sections explore the processes of repetition: claim-coupling, enthusiasm, inclusion, and exclusion.

Inclusion, exclusion, and resistance

The narratives of societal deficits solved by lived expertise were confirmed and enthused over by other actors in the meeting, often in the name of calls for future collaboration. There were limited possibilities of actual interdisciplinary scientific knowledge making: there were only two scientific actors, ² and they did not ally with each other. As the original focus on new, mainly interdisciplinary scientific knowledge waned, one might ask if scientific narratives were represented at all. One scientific claim—the disease model—was however repeated and coupled to the actors’ shared claims and personal stories. The notion of addiction as a brain disease, referred to in the introductory speech by the coordinator, recurred in almost all actors’ discussions. Experience-based explanations of codependence concurred rather than conflicted with the scientific claim. Below is an example from the coordinators presentation (Picture 1).

OPEN IN VIEWER

Picture 1.

Photograph of U-FOLD PowerPoint slide involving pictures from NIDA (National Institute on Drug Abuse), Uppsala University Hall, 7 October 2014.

The slide’s headline says that “The love for the drug will hurt eventually …,” accompanied by an image of the brain (recurring on all slides). On the left is a sitting person, head down and elbows leaning against the knees. To the right, two brains scans show the difference between a “healthy subject” with “High dopamine levels—Normal pleasure and interests” and “drug abusers” with “Low dopamine levels—Lack of pleasure.” Below is a list of characteristics: “Dependence is a brain disease characterized by losing oneself in the drug, compulsive behavior, continued misuse despite harmful effects, and permanent changes in brain structure and function.” The coordinator continued,

But there is something else that also hurts very much. And that is what characterizes codependency. To get lost in the addicted partner. To fatally conform so that you suffer extremely badly. That you suffer from a compulsive behavior, although this to you is the only thing you can do. Continued commitment despite harmful effects, there are similar situations that exist with the codependent as with the dependent person. (Coordinator)

After a presentation of what dependence was—“a disease within the brain”—the coordinator coupled codependency to the brain disease through this analogy: love for the partner is “something that hurts” like the partner’s love for the drug; “getting lost in the addicted partner” is like the partner getting lost in the drug; “to fatally conform” is like the partner giving in to the drug; suffering from “compulsive behavior” just like the partner; and maintaining “continued commitment despite harmful effects.” The professional expertise represented by the coordinator was not conflicting with, but rather easily coupled to lived expertise. This can be further explained by recent studies within the field of biomedicalization. The scientific knowledge of his presentation was the product of brain scan technology, which is usually ascribed high status and explanatory potential in contemporary addiction discourse (cf. Campbell, 2012; Fraser et al., 2014; Hickman, 2013). The correlation between brain scans and human behavior is however filled with complexity: translation of brain activity to human activity is highly controversial and debated by scientists themselves (Dumit, 2004; Hickman, 2013). Nevertheless, the brain scan images are also understood as “literally the brain on drugs” (Hickman, 2013: 216; cf. National Institute on Drug Abuse (NIDA), 2007) in public discourse. The images are realized through colorful representations of healthy versus unhealthy brains available through the influential NIDA, with publications and presentations available free of charge and containing both illustrative brain scans and metaphors such as “the hijacked brain” (Hickman, 2013). Accordingly, the coordinator’s images and texts largely relied on information from NIDA (2007, cf. Leshner, 1997; Volkow et al., 2001). Moreover, the correlation gap between brain scans and human behavior were bridged over by his analogy of brain disease and codependency and by other actors who repeated, claim-coupled, and enthused over claims of the (brain) disease model. By talking about denial, the actors argued that dependence was a disease; they referred to the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria in the coordinator’s presentation; spoke allegorically of diseases like cancer, allergy, disabilities, or mental disorders. They maintained that “our society triggers our dopamine system” and that “[children] should get the right kind of help to take care of their bodies and their brains.” Other actors talked about “demons in his [her partner’s] heart and brain” or “my codependent/hijacked brain,” and one of the presentations was entitled as “A hijacked life.” NIDA has successfully disseminated the model of brain disease and the hijacked brain, and the U-FOLD actors illustrated how such messages were not only repeated and expanded but also embodied when introduced to new arenas and actors within the addiction field. Thus, while certain actors own claims were repeated and met with enthusiasm and agency, they also (as they coupled their knowledge with his) reproduced (repeated) the claims of the coordinator, who in turn repeated claims from NIDA.

Except from the coordinator, the professor in child and youth studies was the only invited scientific actor. He raised several challenging and alternative knowledge claims; he deconstructed codependency as a historical and social construct, and argued that children should not be the target group of knowledge and information. He thus questioned both the basic premises of the meeting—that codependency is a fact—and the claims of children as active and responsible knowledge providers. Given the claims of knowledge deficits and calls for new, interdisciplinary knowledge during the meeting, it was surprising that his objections were left untouched, neither repeated nor defeated, despite his professional expertise (professor in child and youth studies), merits (academic publications about codependency), and his use of the same concepts (e.g. children and denial). A way to understand this is that his argument lacked the underlying syllogism for him to participate as a full member of the community: the collective focus on codependency as an objective truth, the repeated stories, claim-coupling of victimized children with own arguments, and the enthusiasm. Repetitions were a way to credibility, but only if other actors’ engaged in your claims. In this way, narratives (as well as their supporters) that victimized children appeared as the naturally virtuous position while criticism of victimization and allotting responsibility could instead appear as critique against the children themselves. This applied to the child and youth studies professor in particular, but to some extent also to the audience. Overall, the audience performed in line with the rest of the group and confirmed the community through enthusiastic screaming and applause during the meeting. At the end of the meeting the collective focus was nevertheless disturbed by several audience members. For instance, one audience member argued the possibility of a reversed victim/perpetrator relationship: “We haven’t heard a single word about parents to misusers. We’re also codependent throughout our whole lives.” This illustrates the exclusion of alternative narratives but also the potential resistance within the audience’s means of repetition and enthusiasm—applauses and cheering. The audience had hitherto endorsed the presentations by collective applause and cheering. The extensive applause following this alternative narrative made evident that applauding could also be an act of resistance against the consensus, for example, regarding who the victims of codependency were. Another audience member stressed the importance of an existing municipal support center for children, which challenged the collective repetitions of knowledge deficits. Many claims of deficits made in the meeting (societal deficits, knowledge deficits, lack of interventions, no place to go, no help, and no relationship between schools and victims) could not have been made if this actor had been “on stage,” because the support center represented just such interventions. The problem according to the practitioner was rather lack of financial resources than a lack of knowledge. The last audience question however put an end to talk about financial resources:

I was born codependent. […] We who have had this with us our whole lives. Why don’t you use us senior citizens, we are serious, willing, and able! [audience applauds]. And one more thing, you only talk about resources and money, but what about us? We are resources! For free! [the audience screams, cheers, and applauds]

This quote, too, was praised by the audience and panel members and effectively led the panel debate back to the theme of this meeting: lived expertise.

5. Discussion

This article has investigated an initiative for coproduction of knowledge, a “forum for research” which seeks to disseminate expert knowledge to society and to solve problems related to addiction through interdisciplinary science, collaboration, and knowledge. The question was how inclusion of public actors affects the coproduction of knowledge, and how actors’ repetitions of knowledge claims include and exclude other actors and claims. Interaction in the meeting was largely constituted by repetitions and claim-coupling often followed by great enthusiasm. Analysis of repetitions illuminates the practice of coproduction: which and whose knowledge claims are resilient, and how. In their interaction, the actors directed a collective focus toward certain objects or actors. They negotiated the key BO/Cs of the network (interdisciplinary science, knowledge, and collaboration) as they were open, allowed different meanings, and bridged the processes of understanding, interpretation, and coproduction. Moreover, they introduced new objects—children, daring, and disease—that solidified into three boundary beliefs: (1) victimized codependent children and their spokespersons failed by an impaired society; (2) the act of daring and sharing as the future change; and (3) the (brain) disease model as the scientific representative and explanatory model for (co)dependence.

Membership of the community was tied to an obligatory passage of what could be read as interactional expertise (Collins and Evans, 2002), necessary enthusiastic beliefs in the power of certain victims, and certain lived and professional expertise. This excluded (through lack of repetition, claim-coupling, or enthusiasm) existing interventions and alternative knowledge claims. The act of repetition created boundaries around what claims could contain and were both inclusive and exclusive. BO/Cs not only bridged social worlds (cf. Star and Griesemer, 1989), they also disrupted or transformed them. Repetition (and lack of it) was thus transformative by creating a community of belief and enthusiasm contrasted to the lonely and sad narratives witnessed on stage, and it produced new (lived) expertise, reproduced (the disease model and children as victims), and deproduced (social scientific critique, existing interventions and knowledge, and reversed victim narratives). Interactional expertise was thus not only brought into a knowledge process but also a product of the very same process.

The aim of the meeting—creating better lives for victims of addiction—is honorable and difficult to criticize. Such an aim nevertheless has potentially numerous contradictory premises. Three were featured here: that children and female partners were the only victims; that society had failed them because of knowledge deficits; and that their spokespersons’ expertise was the answer to the problems. The production of codependency as a public health (brain) disease affecting innocent children validated codependency as a material, real phenomenon affecting many citizens’ lives. Considering the potential suffering, some of which was witnessed in the meeting, this has a value as such. However, the suffering is also constitutive. When actors narrate children in this way—the one single relation of victim and perpetrator, one possible hero, and the limited access to alternative narratives, especially about children themselves—they reproduce one order and exclude others such as the victimized parents of perpetrating children, existing work, interventions, and expertise, or critical perspectives on the object of codependency or responsibility.

Earlier studies of coproduction often describe the positive effects on democracy and equality of including the publics in scientific or policy processes (Fischer, 2000; Jasanoff, 2003; Wynne, 2001). The inclusion of the lived expertise actors in the meeting clearly dissolved the role of the publics, as these persons simultaneously represented the publics, the children, and the new knowledge providers, while other actors and societal institutions were positioned as knowledge recipients. This reflected both a replacement of roles and status, and a reversed deficit model in contrast to the deficit model discussed earlier (cf. Bucchi, 2014). The publics as a unit were further disrupted through the performance of the audience, first acting in line with the community of enthusiasm, and then to some extent challenging the claims of the “publics on stage.” Previous studies have emphasized the necessity of validation of experiential knowledge and the simultaneous risks that validation introduces in terms of essentialized experiences as either individual or universal, and protected from critical scrutiny (cf. Voronka, 2016). As this study shows, the potential essentialization is tied to certain types of experiences at the cost of others. Experiences and expertise then, are just like the actors performing them: hybrid, plural, and multifaceted phenomena, particularly when used as the publics’ “voice” within collaborative semi-scientific arenas.

Rabeharisoa and Callon (2004) report that the actors in their study did not resign into the patient role after diagnosis, thus letting the expert continue future work. Instead, several new meeting spaces—hybrid forums—were organized. The journalists in the U-FOLD meeting have not only continued their work on codependency but also spread their wings in forums beyond this setting, for example, as discussants of drug policy and as speakers in other meeting points for researchers in the addiction field (e.g. The Swedish Association for Alcohol and Drug Research; Politicians’ week in Almedalen 2015–2018). Although I do not wish to exaggerate the results of this study or the power of the actors or their claims outside the U-FOLD arena, the agency produced for these new experts is pronounced. Moreover, one of the “mantras” in this meeting—dare (to ask)—has also traveled to or from other contexts in which the daring to ask is projected as the solution to problems, for example, regarding children in foster care, (Barnombudsmannen, 2014); mental illness among the elderly, (Kunskapsguiden, 2017); suicide (Suicide Zero, n.d.); and domestic violence (Socialstyrelsen, 2014). This both confirms and questions the power in this “new” expertise of daring and sharing.

Although the constellation of actors in the meeting would not fully pass as producers of interdisciplinary scientific knowledge, the setting for the meeting is still a research forum associated with Uppsala University (ufold.uu.se, 2017-10-31). What are the consequences of inclusion and exclusion within the U-FOLD network as regards its aims of dissemination of and collaboration in scientific and expert knowledge? The brain disease model fitted quite well with the lived expertise and vice versa. An investigation of the ongoing discussion of codependency as a potential diagnosis could increase our understanding of this relationship between certain actors with experiences of codependency and medical professional expertise.

This article has not analyzed the invitation process of speakers to the meetings, so we cannot know why NGOs, journalists with experiences of codependence, and their repeated claims of non-existent support for children were prioritized as speakers instead of actors working with such support. Neither can we know the constellations of speakers in other meetings. Instead, this study has shown that it is crucial that features of coproduction initiatives are scrutinized and made transparent: what is the agenda, which actors are invited and why, and which positions do they speak from?