Annemarie Mol's Keynote address at the 11th annual qualitative research conference provides the basis for this blog.
Instead of the random control trial (rct) being the gold std to prove that care practices studied are good, we would do better to develop research methods that work to improve care practices. She argues against foregrounding effectiveness but instead that we investigate the various effects of interventions. The effects on the bodily parameters and on the intricacies of daily life should not be separated out but studied in connection.
Now here lies a good idea because the faults in studying effectiveness are numerous. Through reading several horrible articles i have learned how to survive 'best practice.' The following articles should come with warning that they may be damaging to your health:
'Best Practice' for restraining people
(Evidence Based Practice Information Sheets for Health Professionals. Volume 6, Issue 3, 2002 ISSN 1329 - 1874 Physical Restraint -Part 1:
Use in Acute and Residential Care Facilities)
'Best Practice' in wound care demonstrating potable water is good enough for wound care
(Evidence Based Practice Information Sheets for Health Professionals. Volume 7, Issue 1, 2003 ISSN 1329 - 1874 Solutions, Techniques and Pressure for
These articles, widely disseminated, fail to take into account
1. the purpose of care
2. not doing harm (saline doesn't hurt, water does).
Mol discusses this because what is 'for the better' is often not known.
This reading -in combination with it being Christmas and my having a pine tree in my lounge- reminds me of other reading, of E.M. Rogers, and of how the repercussions of change are oftentimes unexpected. p440 a story of Lapps and loss of reindeer and establishing a culture of dependence and poverty following the introduction of snowmobiles.
The effects of adopting innovations are oftentimes not known in advance, and maybe shouldn't wait for full implementation and formal evaluation before being revisited.
Effective and good practice are not unequivocal- Mol draws on examples from arteriosclerosis treatments and of type 1. diabetes.
She demonstrates how control needs to be social and material.
I remember a friend who killed herself. She too had type 1 diabetes, but she also had genital herpes. The diabetes would go out of control whenever the herpes flared up. Living between metabolic wards and gynae wards and the mental health unit for most of a year, she decided if this is life it sucks. Such control needed in her life made life unlivable. She killed herself.
Mol questions the notion of the good, 'what is good care?' Is the management so tight it risks hypoglycamia? This risks relationships as it tends to make people aggressive. There is a concurrent risk to brain cells; hypoglycaemia kills brain cells. The body and the social are implicated throughout. She concludes we cannot tell what good health care is, not simply, not in general. And so argues that it has to be established closer to home: in practice- in day to day life.
If what is good care cannot be answered in effectiveness measures, an urgency still remains in providing an evidence base for practice. It is not a case that one treatment is better than another, as they come with different 'goods' and 'bads', qualitatively. How then to handle these? If there is trade off long term vs short term, what is more important? What is it you- as client- need /want to achieve...?
Clinical trials have a tendency to evaluate what is, what exists, what is known and market conditions support this. She argues though, that the market alone is not enough to improve health care. Treatments do not suddenly materialize of themselves. and treatment options are not linear. Goals+treatment+evaluation is not the only care trajectory that can or does unfold. The devil may be in all the details, but people are not automatons, almost every variable in a person's life is subject to change. Professional care involves tinkering, negotiating, and 'doctoring' to fit.
She further argues that this becomes obvious over time and not in snapshots or vignettes. The rct evidence to convince of best options, of funding, of external persons, of outsiders, of the quality of existing care, would do better to focus on insider issues. In tinkering and adapting, in calibrating. Such research is not in prooving rightness or wrongness but adaptability, of improving practices. Such unravelling of the tensions involved.
I wish i had written this myself. She's clever.
To further paraphrase:
A lot goes on without being sharply articulated, this then is our job as researchers: to unravel and to articulate, casting practice into words that allows them to travel, so that they might be more widely reflected on. Reality becomes foregrounded, and the intricacies of hopes and fears negotiated alongside the material technologies involved. The sociotechnical comes as a package, so it is better to study them together. In doing so we may come to discover how one form of practice differs from another, how practice is shaped 'for good.'
I am in awe.
I am not studying effectiveness of counselling in its various forms, but i am studying practice; practice as it unfolds and is un/told.
Thursday, December 20, 2007
Annemarie Mol's Keynote address at the 11th annual qualitative research conference provides the basis for this blog.
Tuesday, December 18, 2007
The joys of being a PhD student! Just as I find my voice on an issue, I find I am not alone, my fumbled thoughts have found their way into words eloquently writ elsewhere.
‘Anyone can have big ideas”, said Concepcion. “I have had some big ideas, and most of them I thought of for myself, and then I found out that others have thought the same, and then I found out that other people have big ideas that are exactly the opposite, and when I think about it even more, I decide that only small ideas can be true, and the big ideas are too big to fit inside anybody’s mind, so there is no point in trying to have them. You know what my mother used to say when I asked her a question like “why does God let babies die?” She said “Pregunta a las mariposas”. Go and ask the butterflies, because they don’t know any better than anyone else.’ Whether to prove or improve practices in health care research is well discussed by Annemarie Mol. I discovered this article while clearing a backlog of reading:
(de Bernieres, 1993, p 278)
As it is, clinical trials are the gold standard of health care research, employed to prove that the care practices they study are good. Here, the author suggests that we would do better to develop research methods that work toward another goal: to improve care practices. This requires that we no longer foreground the effectiveness but, instead, investigate the various effects of interventions. If undesirable, they might then be tinkered with. As a part of this, the effects on bodily parameters and on the intricacies of daily lives should not be separated out but studied in connection. With examples drawn from studies into care practices for patients with diabetes or atherosclerosis, the author argues that instead of trying to turn the clinic into a laboratory, we should strive to support and strengthen clinical ways of working.
Annemarie Mol (2006),
Proving or Improving: On Health Care Research as a Form of Self-Reflection
This approach also encompasses the issues raised by cj:
... in new ways of doing things (aka technology)... for the most part, the original intent of the gizmo is rarely the use that is taken up....this points to an interesting habit where we tend to assume that gizmo X was actually designed to do what it is now being used for, i.e. the myth of design, make and appraise of technology as it is often taught in schools.
We also know that the making life easier line plays out interestingly when you, for example, have say two online information sources, one which is has richer resources but devilishly difficult to use, the other much poorer resources but dead simple to use. The easier to use resource wins. Then there is the small initial advantage a particular technology may develop, perhaps randomly, which is then amplified quickly over time. The Beta vs. UHS video format comes to mind. There are others.
For me, all of this underlines that we are always considering the sociotechnical, not just the technical that somehow gets taken up or adopted as diffusion theory suggests. It's all about negotiation between people and things. Delegation of work to a thing which is never a simple matter as Latour elegantly demonstrated a long time ago.
There is richness to be had in investigating the practices as they unfold, rather than attempting an evaluation of goodness, badness, rightness or wrongness.
It seems i need to take several steps forward to find myself standing in the same place and I am finding an essential ingredient for a Phd student is the ability to laugh at myself ;)
I don't know, and will never know, how come the funding application fell over.
However, it may have been the answer to the question on whether txt counselling is a good thing.
In some way i said that it was a difficult question to address in this way as the variables could not be controlled for and therefore a qualitative analysis on the perspectives of those involved would be important in informing future practice. (Reminds me of a poem, I will include at foot of this posting)
I didn't get the funding so maybe the answer didnt work.
And i don't know, but suspect risk aversive funding people just like sure things.
I also suspect the gold standard of randomized control trials was the only way to go for one panel member.
But the older i get, the less sure i am of rightness and wrongness.
When i was younger, i saw decisiveness as a good thing, and fence sitting as an inability to draw a conclusion.
In psychotherapy from an Assagioli tradition, it was about collapsing the point of tension too quickly. I personally found it uncomfortable to the point of distressing, to hold a point of tension.
I think about this differently now.
I have mellowed.
Applying a concept from Annemarie Mol's 'The body multiple' - reality is different for different players. I see this reflected in a review of elearning by Graham Attwell (2006).
Approaches re evaluation differ fundamentally with purpose, underpinning philosophy and ideological base. Different evaluations theories will be based on different assumptions about the way the world works and so models and practices based on those theories will be different as well. Despite this, the client base and majority of evaluation consumers, particularly in education are still wedded to the idea of objective evaluation and "finding the facts".
Attwell expands on this in several ways, one is about how the evaluator role is perceived, eg if seen as a judge or critical friend; how they conduct any evaluation and the conclusions drawn will vary.
In using ANT, my role is different again, I get to tell the stories, the performances witnessed.
"Evaluation theory also develops in a social context and practitioners work in different ways in different cultures, different sectors with different target groups, and different audiences. Consequently different approaches and models have tended to emerge based on these factors. For example, educational evaluation has developed along a different trajectory than for example health services. Theory in practice is a powerful determinant of evaluation approach and stakeholder perceptions and expectations of the evaluation process." (Attwell, 2006, p.19)
Here too, the performative turn is evident.
She asked me
She asked me if she took one pill for her heart
and one pill for her hips and one pill for her chest
and one pill for her blood
how come they would all know
which part of her body
they should go to?
I explained to her
That active metabolites in each pharmaceutical
would adopt spatial configuration
leading to an exact interface with receptor molecules
on the cellular surfaces of the target structures involved.
She told me not to bullshit her.
I told her that each pill had a different shape
And that her pills
could only work when both these shapes fit together.
She said I had no right
to talk about the shape of her body.
I said that each pill was a key
and that her body was ten thousand locks.
She said she was not going to swallow that!
I told her they worked by magic.
She asked me why I didn't say that in the first place.
Glenn Colquhoun (2002)
Thursday, December 13, 2007
In reading Sherry Turkle's (2007) book, Evocative objects. Things we think with. I am provoked; the essay on cell phones has yet to be written. In its absence i write the chapter myself. Fanfiction for the Fanfact world?
Objects speak in ways that destroy the simple stories of relating. This theme is enlarged upon in the writing of Bruno Latour (1996). In my own story, i too find complexity; a not so simple story of relating. In Turkle's book, each narrative is paired with a short excerpt drawn from theory, talking philosophy down to earth. The excerpt I have chosen is taken from Annmarie Mol's, "The body multiple."
...a philosophical narrative. If we focus on foregrounding the practices inside of which objects are handled, the far reaching effect is reality multiplies. If practices are foreground there is no longer a single passive object, instead objects come into being, and disappear, with the practices in which they are manipulated. This begs the question of how they are related. For even if objects differ from one practice to another, there are relations between these practices. Far from being fragments, these objects hang together, somehow. The question rather than uncovering some truth, is how are objects handled in practice. The objects handled in practice are not the same from one site to another; so how does the coordination between such objects proceed? And how do different objects that go under a single name avoid clashes and explosive confrontations? And might it be if there are tensions between them, various versions of an object sometimes depend on one another.
"If it is not removed from the reality that sustains it, reality is multiple."
Paraphrasing Ann Marie Mol, The body multiple. Ontology in medical practice.
My cell (mobile phone) is a bridge crossing distance, time, relationships and is integral in my transition.
She helps me manage my life, my engagements and disengagements.
The first cell (phone) was a present, then the present got a present, dressed up and personalised both on the inside (with her own directory of contacts, ringtones to differentiate mine from others...and also on the outside. A pretty cover to shelter her from an inclement environment such as being dropped, or the tortures of being stuffed in a pocket,a handbag or chucked in the car. Personalisation also decreased the risk of mistaken ownership; accidental or by theft.
I found she extended my reach; no more waiting by a phone for a call. Such a quaintness associated with memories of aged love.
Though the expectations of being forever available to the reach of others became a source of contention. "I tried to call you, turn your phone on." I wanted to throw her off the harbour bridge. I liked the convenience of calling out, I resented the intrusive beck and call nature it placed on my relationship. "Leave me messages that would make me want to hear you, i would reply. But I kept her; the ph. that is. And the relationship :)
She evolved, I still use prepay, and so there are reasonably frequent times when she's not topped up and i cant call or txt. Her charge holds fairly well- a few days at least, and her reception is considerably better than earlier incarnations. She's evolved, newer renditions have made her smaller, though her functionality is considerably enhanced. My functionality too has increased. I am more intune with her, I keep her on, she's almost always with me: keys, money, cell phone.
I am dependent; I have handed over part of my brain to her, she is now part of my external memory: for phone numbers, addresses, hairdressing appointments.... She is my surrogate timekeeper, alarm, clock, mini sized torch, camera... And security blanket.
I had a miscarriage while away on a writing retreat, and my cell became my best friend. Supported, she enabled me. I could stay in contact with the people i cared about, and who cared for me, as i got myself home the 200km needed. She contributed to my safety but also bridged love and belonging.
For my daughter, her cell too provides a sense of belonging, enhancing what it is to be human. Always tethered Turkle says, but there is also a knowing; a comfort that others are there. Anytime, always. She has friends, many of them, affirmed by a contact list. Security comes in a slim purple chic package of sophistication and aesthetic beauty. I feel safer in trusting the cell connection that our daughter can go further; do more. Tethered risk enhancement.
My cell has taught me a new language, txt. 160 characters or less shapes each message. I use even fewer:
c u soon.
Am at *bucks
Each txt demonstrating variations on a theme:
I don't want to speak to you but will leave you a message.
I don't want to speak to you; either you or this message is of less financial value, than the pittance a call would cost.
I don't want to speak to you, but i need you to get it right- i txt what i want you to remember: there's the shopping list, the address, the time, there is no room for denial.
I want to know what you're doing, I remind you of my 'presence'. Do you respond? Do i still matter? i want you to know that i matter, im here, i care, i want you to care, notice me!
4 me 2 txt takes 2 hands, and reading glasses. I know im old when I txt. A default grammatical correction corrects me now in the use of my first language; i becomes I, but she does not know what to do with im. I choose to ignore the niceties of language construction. My sentences get shorter. My words shorten, was ok not short enough? K. My punctuation worsens and predictive txt brings a whole new level of confused relating.
"Dad has alot me rain"
Half a world away an answer, huh?
My cell is moody, she can be quiet in meetings, if I engage with her according to her rules. There is need to demonstrate the correct etiquette to make this happen. Neglected, she has a life of her own. She can at inopportune times draw attention to herself; our initial appointment with the school principal was interrupted by the attention seeking chirruping incoming txt message. At other times she spontaneously elects not to function. I nurture her, feed her with prepay, charge her up. In an act reminiscent of open heart surgery I open her up investigate her internal workings, take the battery out, remove her sim card, put her back together, watch for life to spring forth. She needs my care. And I am careful of her (one of her relatives was killed in a horrible washing machine incident). Smallness paradoxically increases some vulnerabilities but decreases others. She has learned to manage me better.
Our symbiotic relationship works. I am/We are technically co-dependent. Technologically enhanced, I am provocatively cyborg Donna Haraway (1991) expands on this shifting quality of the human species. A hybrid of machine and organism; we are shaped in relation to each other.
Having fun in the funhouse, with mirrors reflecting on mirrors on mirrors, I thought I had a cell phone, but now she has me.
"You think you have an organizer, but in time, your organizer has you" (Turkle, 2007, p. 310).
And you, reader...you thought you were reading a blog?
Has it taken you?
Reality is multiple.
Latour, B. (1996). Aramis: or the love of technology (C. Porter, Trans.). Cambridge: Harvard University Press.
Haraway, D. (1991). "A Cyborg Manifesto: Science, Technology, and Socialist-Feminism in the Late Twentieth Century" in Simians, Cyborgs and Women: The Reinvention of Nature New York; Routledge.
Mol, A. (2002). The body multiple: ontology in medical practice. London: Duke University Press.
Turkle, S. (2007). Evocative objects. Things we think with. London; MIT Press.
Sunday, December 09, 2007
We find it familiar to consider objects as useful or aesthetic, as necessities or vain indulgences. We are on less familiar ground when we consider objects as companions to our emotional lives or as provocations to thought. The notion of evocative objects brings together these two less familiar ideas, underscoring the inseparability of thought and feeling in our relationship to things. we think with the objects we love; we love the objects we think with.(Turkle, 2007, p.5)
In the selection of essays edited by Sherry Turkle, each object brings together intellect and emotion, in each case, the author focuses not on the instrumental power or purpose but on the object as companion in life experiences. Turkle points to how a train is connecting emotional worlds and the mental space between computer keyboard and screen as creating erotic possibility.
I look at my daughter as her face lights up when she sees Finnish band HIM playing in NZ in March and secs later the mobile phone too is lit up, the appointment calandar loaded and txts sent. Its 11.00 at night in real time but for txt this doesn't matter. No family will be distrurbed, just the recipient- and if they did not want to receive txt they could have this component turned off, or on silent...we have discussed this before. (The teenager that lurks in her has 'all the answers.')
"We live our lives in the middle of things" says Turkle.
Turkle, with a psychoanalytic background emphasizes the emotional component. She makes links to Freud saying : the shadow of the object fell upon the ego.
And i think to myself, yes. The ego of young people seems held or contained in txting, a vulnerability less fragile. This is what my first interviews with a telephone/txt counsellor seems to endorse. When someone txt counselling sends an SMS txt that says I cant talk, there is the possibility that it is too hard emotionally.
Latour describes the sociotechnical involvement but not of such drives as ego. I recall cj's reminder that I should eschew structures, and I am back to following the actors on this one (I cant see them naming their practice as shaped by ego defence mechanisms and stories told need no imposed meanings ...)
She also cites Walt Whitman who said "a child went forth everyday/ and the first object he look'd upon, that object he became."
With my daughter I see the object and she have already morphed; extended as cyborg.
With foresight cj reminded me of Latour and the 'delegation of work to things not being simple'.
Saturday, December 08, 2007
The network of relations are not all pulling together, sometimes they pull apart. The pushing and pulling on the strings that bind make for a precarious existence.
For txt messaging at Youthline, how useful is it that a sibling organisation, lifeline also uses txt, email and Internet postings? In part Lifeline's use provides credibility as a larger and more conservative organisation takes on practice that was innovative. Concurrently, this has been made possible through winning the contested funding. Its amazing that charitable organisations can work cooperatively when the processes shaping them encourage competition.
The Gods seem to be smiling on Youthline today; it is the Coca-Cola Christmas in the park tonight and it is not raining. This pulls on all the resources (people) Youthline can muster as its largest fundraising event. That the rain holds off contributes significantly to Youthline's wellbeing. The ability to raise charitable donations is to a large extent subject to the benevolence of God/s and/or the fickleness of Auckland's early summer weather.
There is the huge goodwill of volunteers, and also of paid employees (well beyond financial remuneration). What is it that creates the circumstances of giving the gift of time? (Titmuss wrote of this regarding the gift relationship; from human blood to social policy. What creates such philanthropy? What creates such philanthropy in NZ today? A whole new chapter to consider. A whole new thesis I suspect!).
There is also a funding war keeping the cost of txting down.
People dont use what doesnt work.
"People will use technology if it helps them, if it makes their lives better"
Stephen Downes said this regarding the 45-page guide to the evaluation of e-learning. The same might well be said of the use of txt, Internet postings, and email for counselling.
The philosopher in me struggles with such pragmatism, but here it is:
There is no pleasing everyone. Whats used, is used, to the extent that it is useful.
Might need to revisit this when the Oyster Bay wears off....
Circular arguments, and the profanity associated with such pragmatism, might not look so good in the morning :)
Pragmatism and fragility. hmmm.
Friday, December 07, 2007
I was prompted today to consider the purpose of blogging while reading Biella's healthhacker blog triggered by a google alert on a particular writer, Anne Marie Mol. (I have her as an alert because she uses ant, shares a health focus, writes well of 'the performative turn' and utilised a creative writing style of a split screen between her own thinking and how this is informed by literature- a performance in its own 'write'.)
The reasons i blog; here they are, the unexpurgated version, Dec 2007:
1. my thoroughly modern supervisor suggested it
2. it helps me think! (writing creates my thinking, its not an after the fact activity)
3. being in the public domain forces me to be consider carefully; accuracy, acknowledgments, palatability- the approachability of what I write to a wider audience.
4. it links me to others who share similar methodology, or processes of study, or content; whether they know it or not.
5. provides for dialogue; real or imagined. Included here are my supervisor, other students (local and international, some I meet, most I never will), with colleagues, family, with myself.
6. provides a chronology of my own thinking and doing. (My methodology informed by ant follows Latour; he suggests 4 notebooks, one of which i have substituted with this blog- a chronology to keep track on the research process)
7. provides me a medium that hyperlinks to relevant resources; del.icio.us clouds that link me to other people's delicious use. And the bubbl.us software-
8. I am not limited to text or prose. i hyperlink, mindmap, use visual, auditary. The blog provides both actual and potential space for trials of creative writing.
9. its a playful forum, in many ways a forgiving forum, as i put it in take it off, move it around, wordsmith for impact.
10. Blogging allows for a work in progress to be shared, commented upon, revisited, reworked.
11. I stay writing, not as much by volume as i read, but time spent writing about what i read, or what i think, or can apply, to my areas of study, could be close to 50:50.
12. I 'perform' differently in this medium. The writing is less formal, less starchy.
13. I am shaped in doing this, and in this there is overlap with what i am studying- in (re)shaping practice, what is practice doing back. The exploring of how i am shaped in doing this provides for insights into how the medium shapes the message in counselling through use of txt, email and Internet postings. There is a walk the talk type quality. Havent started txting the PhD, yet ;)
So Whats different about doing this by blog rather than doing it in a notebook, using paper or a word doc?
a. Its still as public as i choose to let it be.
b. There is no doodling here, the medium and my artistic ability dont gel in the satisfying way of strokes on a page being pleasing aesthetically or soothing or whatever else my doodling suggests.
c. i dont have the satisfaction of crossing out, pushing the pen into a page, screwing up the page as a cathartic exercise. Moving to the delete bin doesnt quite do this.
d. I dont/didnt share as much in written hard copy formats. What i would have shared is so much more formal; i would feel compelled to have it at least halfway right, to be substantive, to look like chapters, essays. To look like a promising academic. The hard copy written format i find/found a slower more pensive engagement.
If you are visiting my site because of this posting linking to your own research purposes, or interest in blogging for academic purposes, please do leave me a post to let me know. Do you have similar reasons? what would you add? I will turn off the antispam number recognition thingy for a week (or as long as i can bear it) to make it easier (dont tell the spammers).
Wednesday, December 05, 2007
"Strength does not come from concentration, purity and unity, but (Latour, 1997).
from dissemination, heterogeneity and the careful plaiting of weak ties."
Plaiting the weak ties is the metaphor used in making a more durable entity: "...resistance, obduracy and sturdiness is more easily achieved through netting, lacing, weaving, twisting, of ties that are weak by themselves, and that each tie, no matter how strong, is itself woven out of still weaker threads..."
In applications of communications and computer technologies for counselling, there appears to be some strengthening of the weak ties; another actor is enrolled. Lifeline has launched txt messaging, and using an Internet based website for postings through a web page targeting young people with depression. This seems to add a little more substance to a 'novel' practice, the larger and arguably more conservative organisation seems to add a veneer of respectability to a method of counselling considered suspect by others.
I really want to follow this lead... it is a new endeavour for lifeline, being launched 3/12/07. Youthline's text service began December 2004 and Internet postings much earlier with the launch of the Urge website. One aspect argued by the CEO OF Youthline in an October 2007 press release was about not reinventing the texting wheel. The competitive funding model to my mind, continues to put services up against each other. The potential is that threads unravel.
A further musing installment on the question: what is occurring as counselors (re)shape their practice; and what is practice doing back?
Monday, December 03, 2007
I am just waiting for the newspaper competition of fill in the thought bubble: Tell me again why I should spend less time with the people I love and more time with strangers?
etiquette involved in martyrdom and suffering seems superfluous to many. The use of phone booths could be subject to an ant informed analysis, predating Dr Who and the TARDIS, the need to have a booth compensated for the vulnerability of the technology and the quality of the connection. Arguably such factors helped to create the expectation that calls occur privately. Current advances in audibility and portability may be aiding and abetting the publicly displayed intimacies that others find surprizing if not offensive.
Saturday, December 01, 2007
The worlds population reached 6,634,294,193 yesterday (at least according to International Programs Center of the US Census Bureau)
And cell phone subscriptions reached half this number...
Perhaps minus one
Please note, saturation of the worlds population with cell phones is not 50%; many of us have more cell phones than we know what to do with!
I confess to having more cell phones in my family than people (its useful to have a spare for people from o/s, or for when one goes down, gets washed, dies (cell phone I meant).
My last poll in a large lecture class showed all but one student had a cell phone, many had more than one, several confessed to living in households where the numbers were in excess of the people. I am not alone.
NZ Prime Minister Helen Clarke confessed she has 3, and arguably has found texting a useful diversion during Monarchy and Heads of State addresses. Nice to know she is multi-talented, and up with the play. I like this in a PM.
I can wonder if she was receiving the aussie updates on polling or playing that cute duck game with the traintrack you have to construct...
I like problem solving if not hand eye coordination in a PM too.
Sadly she cant remember; this is a less positive attribute in a PM :(
I wonder when she's going to get her own Bebo page so i can add her to my list of friends :)
On a more serious note, the use of cell phones is fast becoming a very normal practice. The rate of change as people debate the etiquette, the good, the bad, demonstrates how change is negotiated.
My description of cell phone use for counselling seemed to cause consternation amongst the group of psychotherapists I conversed with at a recent social event. Shock horror, I still have social outings... but there seemed to be furtive glancing about, as if a sudden need for crosses, holy water, garlic or stakes. I went looking for the chardonnay.
After all i might need a glass to put out my smoking paw...