LAND OR PEOPLE? ON THE IATROGENESIS OF CONFLATION

In a wish to abandon essentialism to contingency, this paper looks into whether the rural-urban binary could be a cultural burden so incompatible with the layered realities of advanced deprivation that instead of helping the deprived, it deprives the help of its carrying capacity. Departing from the idea that cultural mechanisms are capable of allowing for conceptual dichotomies to create oppression, this paper addresses the concepts of ‘rural’ and ‘urban’ as potentially counterproductive ideas in policy and planning when deployed in areas of severe social deprivation. Using a Swedish example, this problem is addressed in the context of a recently finalized development project, whose focus of approach shifted from ‘urban’ to ‘rural’. We demonstrate how ‘rural’ and ‘urban’ are not neutral spatial qualifiers but problematic filters superimposed onto the already problematic concept of “social sustainability”. Here, we draw on the principle of iatrogenesis, which denotes any benevolent action that inadvertently produces undesired outcomes. We argue that since many areas lack the presumed conceptual foundation for a specific brand of action, development programs labeled as ‘rural’ or ‘urban’ are not only likely to fail, but also to potentially cause harm. We conclude that more context-sensitive understanding of the human condition beyond inflexible labeling is needed in order to arrive at more adequate interventions.


INTRODUCTION
Achieving sustainability is not merely a simple matter of 'doing it' by subscribing to some winning formulathere are many choices to be made in the process.Given that conceptual frameworks always guide our thoughts, judgments and actions [1][2] [3], the ways in which we relate to conceptsand especially concepts chosen to serve as matrices for specific directions of developmentbecome expressly relevant if our aim is to create a more sustainable society.Since any type of action requires a target area, spatial representations hold an important place in the process of conceptual filtration.This is perhaps why programs designed to ease social deprivation are often differentiated on account of the target areas' spatial classification.These, however, often align with the problematic rural-urban binary, despite many areas exhibiting identical or much similar problems [4] [5][6] [7] [8].Put simply, development goals can sometimes become problematicif not unachievabledue to preconceived ideas about how issues associated with certain spatialities ought to be handled [9].
In this paper, we explore one such case from Sweden, dealing with the implementation of ideas of an "urban development project" in a marginalized area of the city of Gothenburg.Set out to combat social deprivation, the project was characteristic in that it was extremely costly, but also because it included many controversial moves along a conceptual rural-urban axiswith much questionable results.Most notably, the dramatic change of heart was transposed onto the socially deprived without consideration of their needs.In other words, stereotyped landscape characteristics were conflated with the residents' alleged problems, while inadvertently maintaining social deprivation, wasting taxpayers' money and causing massive disillusionment.
In medicine, this type of misdirection is known as an iatrogenic effect, where iatrogenesis refers to the unintended consequences of professional help (e.g.bloodletting, lobotomy or trepanation).In this paper, we highlight this iatrogenic aspect of rural-urban ideations when utilized in the context of deprivation.We signal that as researchers we need to be wary of this dimension of rural/urban, because if we perpetuate certain landscape stereotypes without understanding the hyper-complexities attached to the concepts those landscapes purportedly represent, we may turn them into pernicious conceptual filters that divert attention from pressing (un)sustainability issues.

'URBAN' AND 'RURAL' -STILL AROUND AND WELL
In geography (and in social sciences at large), the concepts of rurality and urbanity are increasingly being treated as cultural constructs rather than sets of geographically bounded spaces [4] [5][6] [10].Steady, fast-paced transformations in the environmental, economic and social dimensions have rendered simple spatial classifications inadequate in terms of usefulness, especially those rooted in a centurieslong dichotomous imaginary that defies contemporary reality of interconnectedness.As Cloke & Johnston [11] note, the rural-urban binary is one conceptual pair that "has survived the onslaught of material reality and philosophical re-positioning" (p.10), in which "urban/rural differences have carried with them other more hidden messages" that "[go] beyond the material look of the land and [imply] more deep-seated differences" (p.11).
In line with this stance, a number of factors speak for the rural-urban distinction as a flawed source for conceptual guidance.First, although lexicologically a dualism (i.e. a conceptual pair), 'rural' and 'urban' are often used as a dichotomy (i.e. as two mutually exclusive parts); dichotomies, however, are known to be badly suited to reflect a messy, nuanced world [12].Second, 'rural/urban' are complex concepts, which today can denote almost everything (high interpretative flexibility) [6][13] [14]; however, the more is thrown into a concept, the more difficult it becomes to operationalize [15].Third, 'rural/urban' are used globally, which is at risk of using them as if they were universally invariable [16]; this, in turn, is a threat to effective communication.Fourth, 'rural' and 'urban' are multiaspectual by reduction and their associated components can vary independently of each other [5]; it is hence impossible to determine what 'rural' or 'urban' is without resorting to implications and artificial mean values.Fifth, 'rural/urban' are very old concepts [4] and hence require conscious and continuous justification to keep them afloat in a much changed reality.Sixth, 'rural/urban' were not constructed to better understand the world, but were taken out from a 'messy reality' and a posteriori remolded into ontologized, scientified and politicized themes [17]; cultural conceptsdue to their imprecisenessare inherently unfit to get things done.Seventh, 'rural/urban' are spatially biased concepts; basing human-oriented governance on a spatial category may smack of the much critiqued spatial fetishism [18].Eighth, 'rural/urban' are ridden with power relations and unspoken 'othering mechanisms' [19]; the universal notion that 'rural people' are different from 'urban people' is one such outcome [20].Ninth, 'rural/urban' are both colloquial and specialist concepts; widely understood concepts used in unfamiliar ways are likely to become contentious [21].Lastly, 'rural/urban' are heavily stereotyped concepts [22], despite the knowledge that stereotypes rarely illuminate but obfuscate issues [23].
As this very brief outline shows, rurality and urbanity should perhaps best be understood today as 'narratives' [24] or 'conversational realities'; however, the ruralurban distinction remains a viable objectivized framework that continues to influence large sectors of societal organization [25].As Hoggart [8] observed, "[p]erhaps, as a loose descriptive vehicle, there is merit in acknowledging a distinction between rural and urban.However, what starts as loose description too readily attains causal status" (p.247).This, in turn, is likely to contribute to unintentionally negative consequencesa path of causality known as iatrogenesis.

"THE ROAD TO HELL IS PAVED WITH GOOD INTENTIONS"
The titular aphorismsometimes attributed to St Bernard of Clairvaux (1090-1153)captures loosely, yet poignantly, the main analytical concept of this paperiatrogenesis.Iatrogenesis (literally 'caused by the healer') is a Greek term derived from medicine, where it denotes inadvertent yet preventable induction of disease or complications by the medical treatment or procedures of healthcare professionals.Before the advent of penicillin and modern medicine, hospitals were much more likely to kill their patients than to cure them.For instance, physicians coming from autopsies went on directly to examine pregnant women or deliver babies.Without knowledge of the germ theory, diseases spread from patient to patient, killing them in numbers.Unsurprisingly, hospitals were referred to by their contemporaries as seminaria mortis or 'seedbeds of death' [26].
Although iatrogenesis is a well-established concept within medicine, it is relatively unknown outside of it, the main reason being that the sheer notion that knowledge production can be linked to harm is usually resisted (cf. the now rejected eugenics and 'scientific racism') [27, pp. 110-131].Iatrogenesis, however, is present well beyond the confines of medicine.A contemporary example is the financial crisis of 2008, which followed the US housing market bubble.Policymakers' interventions, which pushed for deregulation of the financial market, unwittingly laid the foundation for the crisis.Although the risks were pointed out to regulators, the policymakers nevertheless continued with the course for deregulation.In effect, although their intervention was not the direct cause of the crisis (predatory lending practices were), it did set up the initial conditions for the economic collapse and hence amplified the effect.Another noticeable iatrogenic of our time are the phenomena of overeating and obesity in well-off societies.Civilizational and technological progress pursued to reduce physical labor and maximize 'quality of life' has contributed to an abundance of food, with cheap, readily available and often unhealthy staples being over-consumed.Additionally, unequal geographic distribution of those resources has added to hunger and malnutrition problems in the underdeveloped parts of the world.
Language and metaphors are also known to create iatrogenic symptoms.Foucault [28] was one of the first raising concerns for the social construction of 'madness', when the emerging medical (professional) discourse re-conceptualized mental illness as moral failure.By appealing to guilt and religious sentiment, the 'patient' was constantly judged, corrected and threatened, which much exacerbated his or her condition.Drawing on those early insights, contemporary philosophy of medicine is aware of the hybrid naturalist/constructivist nature of disease (including its individuation) and its prescriptive role through the use of causal concepts [29].Also Žižek [30] has argued that regulatory institutions both shape and normalize human behavior.For instance, metaphoric language (rather than specialist jargon) has been demonstrated to catalyze positive change in psychotherapy.When a patient understands the metaphor, the evoked imagery can "[dilute] preconceived pathological understandings of behavior" [31, p. 250].More often than not, however, patients "become 'fixed' on the metaphor and define reality rigidly within the metaphor's linguistic boundaries" [31, p. 251].Such pathological internalization, in turn, is likely to considerably restrict their behavior and prospect of recovery.
To avert the effects of iatrogenesis, Meadows [32, p. 162] emphasizes the importance of "exposing paradigmatic assumptions, or the shared ideas […] that constitute our deepest beliefs about how the world works", especially those that "unknowingly support actions that are no longer useful" [33, p. 591].In other words, "if worrying signs develop in the way society is working, we need to […] look beneath everyday understandings and practices for old conceptual infrastructures which may have gone wrong [34, p. 310].In an effort to find the answer to why people, organizations, and systems do not change, Kegan & Lahey [35] metaphorize the inertia as an 'immune system' designed to protect us against negative impacts, disequilibria and anxiety.While important for the proper functioning of individuals and structures, the system, however, "can be dangerous when it rejects new material that it needs in order to heal itself or to thrive" [33, p. 591].
In conclusion, there are premises suggesting that iatrogenesis is a universal phenomenon inherent of the human (biologically conditioned) tendency to assist others on the one hand, and the limitation of the human brain to anticipate undesired effects on the other ("to err is human").Since meaning in the West, as Derrida [12, p. 41] put it, is defined strictly in terms of "a violent hierarchy of binary oppositions", dualisms -'rural/urban' includedare especially important to look systematically into [21].

ESCAPING THE 'TYRANNY OF DUALISMS'
In order to communicate and act in the world we divide it into categories, with boundaries that define belonging and exclusion.Categories take shape through processes influenced by, for example, history, discourses, ecologies, and power relations.Although we intellectually know that categories are social constructs we tend to treat them as if they have an intrinsic reality of their own when we describe and act in any given landscape [36, p. 207].
Each concept comes with its own imaginariness, spatial demarcations, identified problems, envisioned aims and proposed solutions [37] [38].Turning attention towards the constitution of concepts (rather than their implied signification) has helped isolate linkages between conceptual dichotomies and social oppression in the past [39][40] [41].While reflective trends within human geography have drawn attention to the implications of certain concepts on harmdoing (e.g.race, gender and class), this reflexivity has not been applied to all concepts equally.In regard to the rural-urban binary, similar contingencies have been largely downplayed due to the concepts' inherently spatial nature, whereby urbanity and ruralityas spatial conceptsare less regarded as causal or contributive factors to socio-economic problems than as neutral (spatial) containers associated with specific types of problems [6][42] [43].Given the lack of appropriate concern for the strong cultural dimension embedded in the ruralurban conception, it remains uncertain to what extent its retention as a pair of seemingly neutral spatialities contributes to the retention of some longstanding, unresolved societal problems.
The principal argument is that by shifting the focus to the performative nature of 'rural-urban' as concepts, their potential for harmdoing can be better understood [44].The notion of performativity comes from gender studies, where it denotes the capacity of language not simply to communicate but rather to consummate an action.Butler [45, p. 174] defines performance as an action, which consolidates a certain image by taking on certain roles or acting in certain ways.By taking cue from earlier developments, post-structuralists exposed a host of paradoxes, false axioms and hidden power structures implanted into the neutralized realities of racism, colonialism and patriarchy (to mention but a few) [28][46][47] [48].Effectively, hitherto neutralized concepts, such as 'black-white', 'civilized-wild' or 'male-female', have now become hotwired.
There are premises suggesting that this acumen is equally valid in respect to the concepts of 'rural' and 'urban', whose inherently dichotomous character, objectively blurred characteristics, immense spatial coverage and aspectual all-inclusiveness results in an odd marriage between imagery of bygone world views and fast-paced transformations of the 21 st century.What is perhaps most worrying is the way rural/urban have become desensitized and treated as a pair of seemingly neutral analytical categories.In this respect, although the likeness between rural/urban ideations and, for instance, gender are in many ways compelling, rural/urbanunlike genderlack a potential 'victim' attached directly to the concept at hand (for instance, fewer would react to slurs of rural-urban connotation than to sexist affront).As a result of that, we no longer (explicitly, at least) sustain patriarchal projects, racist programs or imperial policies, but we do devise rural and urban development strategies.Equally, few professionals today would dare to overly biologize the terms 'male' and 'female' as a result of the large body of gender-centered theory that made us see them as socially constructed, convoluted, and, most importantly, covertly virulent concepts.While, akin to gender, rural and urban do have a physical and biological underlay, in light of the proliferating body of criticisms they are perhaps best seen as cultural constructs burdened with all intricacies 'culture' may imply.Hence, while the constructionist nature of the rural-urban binary has been widely acknowledged by critical geographers, its more pernicious aspects have not received similar attention.
Of course, this line of inquiry cannot be elaborated to the fullest in this paper; however, critical scholarship, such as gender studies, can act as an instructive analogy and a source of inspiration.Understanding 'hotwiring' as rendering something sensitive to its veiled liabilities, the hotwiring of the discursive connotations attached to the seemingly neutral uses of gendered language made us aware of dimensions which previously did not raise a brow.Likewise, a hotwired 'rural' and 'urban' could make actors and stakeholders more responsive to the non-neutrality of these concepts, especially when deployed as putatively "spatial categories" in human-oriented contexts, which by their scope and content transpire as more 'human' than 'spatial'.This, it seems, is the only way to "escape the tyranny of dualisms" [49, p. 264] and their tacit legacy encased in ubiquitous yet largely neutralized concepts.

METHODS AND AREA OF STUDY
The methodological task of this paper is to reflect upon some generally accepted cultural norms and practices through insights from long (8 years) involvement with the case area, Angered.The presented findings are the result of a multi-methodological approach (or mixed methods research), combining quantitative and qualitative data in order to enhance research quality.The methods include: policy analyses, multiple field visits, organized excursions, questionnaire surveys, interviews and workshops with various local stakeholders, such as residents, NGO managers, politicians, administrators, cultural workers, and other actors.The analysis deployed in this paper forms a summative narrative resulting from the most impressionable inconsistencies between the socio-economic context of Angered and the (seemingly iatrogenic) direction a recent development project deployed there had taken.
Angered is a suburb of Gothenburg, Sweden's second largest city with 550.000 inhabitants.Angered consists of several isolated land islands located 10 km north-east of the city proper (hence collectively referred to as "the North-East").Since the built area consists of anything between 10-storey clustered buildings and Swedish-style red wooden family houses, its density varies greatly.As of 2013, there were c. 60.500 people living in the area.The share of individuals with non-Swedish backgrounds amounts to around 90%. Around 35% live off welfare, while the average yearly income plummets 50% below the Gothenburg average and stays barely above the official poverty limits for Sweden.60% of the local students fail to pass the ninth grade with satisfactory marks, disqualifying as much as one third from continuing with their studies.In regard to crime statistics, a police report (2007) has placed the area first in the region.All these factors, along with bad nutritional habits and low levels of exercise, create a situation where life expectancy is 9 years lower when compared to other parts of Gothenburg.

ENTER 'DEVELOPMENT NOTRH-EAST'
Onto this scene enters project Development North-East (hereinafter DNE).Set out to improve the unsustainable socio-economic situation of Angered, the project was only one of many earlier such projects.However, with a budget of 10.4 million €, DNE was, to date, the biggest EU-sponsored "urban development project" in Sweden.The project lasted between 2011 and 2013, and was financed at 40% by the EU and at 60% by the City of Gothenburg.Operating within four themes -'culture', 'urban milieu', 'vision & communication' and 'job market', DNE set out to create 220 new jobs within i.a.green technology, information services and other high-tech branches.Improving the visual appearance of the area was central to DNE's efforts.The project also heavily emphasized Angered's multiculturalism as a positive force of attraction for potential investors and as resources for job opportunities per se.Towards the end, the project involved an unexpected change of approach from "urban" to "rural".
The presented findingssummarized into three overarching criticismsform the empirical part of our study.

Urban stereotypification
As outlined earlier, one major problem with formalized designations of "urban areas" is their frequent lack of correspondence with the actual content of the area in question.This drawback often reduces 'urbanity' to one or two attributes (usually the most conspicuous ones), and these attributes tend to be overemphasized when devising development programs aimed at "urban areas".DNE's focus on 'urbanity' led, among others, to the creation of an art gallery and a cultural city park, beautification of the public square, renovation of a theatre stage and the construction of a large cultural center with an adjacent swimming pool.However, such seemingly benevolent projects are questionable in areas whose 'urbanity' is not enough clear-cut.For one, the establishment of a local university branch (Center for Urban [sic] Studies) -allegedly to "counteract distorted recruitment"is one such inconsistency.Given that several schools in the area are being shut down, and considering the already high rate of local students failing to qualify for higher education, raises the question of whom exactly this university is supposed to attract in terms of eligibility for admittance.For another, installing a modern art gallery along a 160 m spot-lit escalator in a neighborhood with no food store (Hammarkullen) is another conundrum (especially when the "art gallery" came to serve as an agreeable setting for local drug dealers).In effect, the deployed exaggerated 'urban' discourse has raised urbanityas a guiding lightto an ultimacy at which it cannot deliver.In the meantime, the area grovels at a much more fundamental development stage, particularly in terms of centrality, economy, function and consciousness (e.g.lack of basic institutions and facilities, spatial isolation, vagrancy, waste defenestration, territory-mindedness, failed transculturation, etc.).
In the end, not only was DNE's official job target not met by less than a half, but the established companies were small-scale low-tech businesses, such as taxi service, house cleaning or building maintenance.Similarly, the pressure to take advantage of the area's alleged 'urban' cosmopolitanism ("rural" settlements are considered more homogenous in terms of population structure) led to much controversial results, an issue that forms the second point of our analysis.

Urban-style cosmopolitanization
Anxious to find at least one strong resource around which Angered's economic advancement could be fixed, DNE saw its many nationalities (transposed onto the concept of 'world culture') as a possible contender for success.While the concept of cosmopolitanism assumes the existence of relationships of mutual respect despite e.g.ethnic, religious or political differences (inherent of cities like New York, London or Amsterdam), random multicultural welters of immigrants from war-torn zones do not inscribe themselves in that definition [50].
By confounding the both concepts, a highly "urban" cultural approach was chosen and thrust into outposts of poverty, illiteracy and ethnic tensions.The endorsed 'culture hype' fed instead to the already vast number of "cultural clubs", whose repertoire could consist of TV-watching (turning children into couch-potatoes), being used as platforms for proliferating macho culture (by excluding women) or serving as hideaways for certain illegal activities.Hence, by sanctioning cultural activities as a nexus for economic growth, DNE at the same time overlooked their simple function of enabling social interaction amidst acute unemployment when no Swedish language was spoken.Indeed, one of DNE's main advertisements depicted tango-dancing couples alongside enticements to start a new business venture.In translation, this would be like asking ethnic Swedes to live off dancing hambo [a Swedish folk dance] or selling meatballs [a Swedish national dish].Possible?Yes.Plausible?Not very.

Urban-to-rural subversion
The recourse to 'culture' was also the starting point for DNE's sudden howbeit controversial change of heartour third line of critique.Towards the end, when the highly 'urban' approach inevitably failed to align with social sustainability, a new rural approach called 'The Urban Countryside' was launched.Aiming to introduce agriculture and animal husbandry into the area as a new way of creating job opportunities, the plans included the establishment of a camel center, a pig farm and ecological vegetable gardens.According to the project's initiators, there is "plenty of agricultural knowledge in the area", andquoting the founder of 'The Urban Countryside' -"Syrians are known to be sheep-people".This new line too came to treat 'rural' in a grotesque way.Plans to establish a large-scale pig farm in a predominantly Muslim neighborhood were clearly unpopular, while the rhetoric of exoticization used to justify the establishment of the 'Camel Center' was eerily similar to how DNE came about to 'sell' the cultural diversity of the residents.
Set out purportedly to contribute to sustainability by "making the most of Angered's cultural diversity and local people's resources and competences", most of the arguments presented in the official documentation of the Camel Center come across as trivial or infantile at best, or outright unsustainable at worst.The documentation is overrun with pictograms and slogans that tremble on the verge of ridicule, presenting camels as kissable friends that can be used for romantic picnics, cabaret shows, weddings and Christmas celebrations (we learn that "Shakira loves camels"), but also as slippers, beanies, bags and kebab.Since the discourse of "camel-your-best-friend" does not correlate with killing the animals, camel meat (from naturally deceased dromedaries) to be sold at the Center will instead be imported from Australia.Ignoring the misconception that freighting camel cadaver across the globe is all but sustainable, the project's initiators, are also unaware of the orientalist and sexist slurs that accompany the Center's putative recipe for sustainability ("Somalis like to have camels around them to feel at home" or "Somali women [sic] can sit and sell souvenirs outside the Camel Center").
Some more critical voices from within claim this was simply a cover-up to avoid targeting the more substantial yet "inconveniently insoluble" problems.Most disturbingly, the dramatic change of approach reified a rigid, stereotyped rural-urban dichotomy ("if they are not urban, then they must be rural"), without consideration of the people concerned.Having conducted a survey amongst 80 afflicted residents and numerous interviews, we found no outspoken affiliations with some 'rural-urban' schemata in terms of backgrounds, lifestyles and employment historiesthere were no high-tech developers and no agronomists.In other words, the respondents are not interested in "strange projects", most of which they have not even heard of.They want the quickest way into "normality".In that vein, whether the exorbitantly positive 'rural' rhetoric that accompanies the creation of 'The Urban Countryside' (organic food, local knowledge, camel milk as anti-wrinkle remedy) is yet another smokescreen or whether it builds upon an informed inquiry, is still too early to determine.As of now, the Camel Center employs two people and no animals have yet arrived.As Siwe [51] put it, our project society is indeed "a camel kick [in the behind] of those who really need help".

THE IATROGENICS OF CONFLATION
Having introduced iatrogenesis as a concept associated with medical interventions, the case of DNE bears a number of resemblances, or analogues.Essentially, DNE was a project launched to avert social deprivation.As such, it can be likened to medical intervention set out to cure a disease.In terms of iatrogenics (harmdoing factors), the outcomes of DNE could be likened to at least three aspects of sheer intervention: (1) the adverse effects of prescription drugs; (2) overuse of drugs; and (3) prescription drug interaction.
Firstly, if a drug does not induce the effect it is intended for, we can speak of adverse effects.Since DNE did not fulfill its intended goals, the medical analogy is here useful.Secondly, the sheer deployment of an 'urban' development program (which later turned 'rural') is a sign of how overused these terms are.When people are hungry, lack access to education, are discriminated -these are not 'rural' or 'urban' problems, they are problems.To ascribe them spatial inscriptions with confidence, we must, as Halfacree [10, p. 389] observes, "pinpoint spaces distinguished enough by their own causal forces that they can be labeled 'rural' [or 'urban']".However, when the same problems occur in much differentiated geographic settings, such labeling smacks of overuse.This can be likened, for instance, to the dreaded antimicrobial resistance brought forth by the overuse of antibiotics.Thirdly, prescription drug interaction is another well-known example of iatrogenesis (e.g. the mixing of antidepressants and methadone).In this vein, we can ask why an "urban" (and later "rural") development program was launched, and not, for example, a "housing program", a "language program" or a "health program".Although such labels are less complex, they are more direct and clearly dictate where and how intervention ought to be deployed.On the contrary, where is an "urban" development program supposed to take us?In the case of DNE, the fatal mixing of various fuzzy "urban" domains such as 'culture', 'urban milieu' and 'vison & communication' drained into a discordant mess of goodwill with no observable improvement upon the underlying affliction.
Conceding for a while to the idea that an "urban" program was indeed rational, we need to understand why Angered was deemed 'urban' in the first place.As indicated earlier, 'urbanity' is often condensed to mental schemata which coincide with the morphological aspect, which stands in for a subconsciously coded cultural archetype of urbanity (stereotype, if you will).Hence, due to its morphologically 'urban' appearance (also by being administratively part of the city of Gothenburg), Angered became 'urban' by default.Since 'urbanity' is a complex concept encompassing at least 40 attributes, a morphological or administrative approach may have dire consequences for areas whose 'urbanity' is irregular or fractured.This, in turn, aligns with the analogy to medical error, or simply, misdiagnosis.
Similarly, the medical term negligence also finds reflection in the case of DNE.Understanding negligence as failure to exercise the care that a reasonably prudent person would exercise in like circumstances, the lack of basic reconnaissance about the target group (who are the people?what are their competences?)has resulted in orientalist and sexist stereotypes assembled into the pseudo-asset of "world culture".
Lastly, the concept of nosocomial infectionan iatrogenic that is explicitly hospital-acquiredis instructive.In analogy, considering Angered's inhabitants the "patients" and the DNE managers the "hospital" responsible for the inhabitants' wellbeing, some of the choices made by the latter come off as having been "contaminated" already during the initial brainstorming phase.In other words, they transpire as the result of outsider-consultants convening in 'think incubators' with minimal or no touch with reality.Although the level of confidence behind a(ny) choice is always "determined by the coherence of the best story one can tell from the evidence at hand" [52, p. 194], that story's validity will largely depend on the "regularities of [the] environment" it is applied to, and hence often remains the source of many biases and failures in so-called 'expert judgments' [53, p. 515].How else could someone come up with the idea that a few camels could help obtain sustainability?
Submitting that a 'rural' or 'urban' development program directed towards people makes per definition assumptions about what 'rural' and 'urban' are (while differentiating between the two), then those assumptions (when transposed onto characterizations of people and their problems) are thought to reflect some model of reality.Now what does that imply?As Boisvert & Faust [31, p. 251] note, labels and suggestive language "may sometimes inadvertently lead therapists to falsely believe that they have captured the essence of the [patient's problem] and truly understand complicated clinical phenomena".This, in turn, causes harm.Seeing 'urban' and 'rural' as suggestive labels projected onto Angered's inhabitants ("the patients") by the DNE project managers ("the therapists") recruited to salvage the former from deprivation ("the complicated phenomenon"), the unfortunate conflation between land and people came to follow the familiar pattern of iatrogenesis.

CONCLUSION
As Gibson-Graham & Roelvink [54, p. 342] note, "[t]heory has taken on a new relation to actionto understand the world is to change it".This, however, involves "questioning […] the assumptions underlying contemporary science, policy, and practice" [33, p. 594].Departing from the idea that cultural mechanisms are capable of allowing for conceptual dichotomies to cause harm, in this paper we have opened up a discussion about unreflected adherence to the concepts of 'rural' and 'urban' as guiding forces in development programs, which can create an iatrogenic effect and contribute to counterproductive plans of action.
Using the example of an "urban" development program deployed in a Swedish suburb, we have shown that elements of what could be described as 'urban' and 'rural' are fuzzy to the point of rendering those concepts largely ineffective.While labeling projects by the likes of 'rural' and 'urban' may pass unnoticed in certain circumstances, when deployed as panaceae for general development and thrust into outposts of deprivation, the high odds of failure become less forgiving.In this particular context, the most important task, so it seems, would be to listen and respond to the real needs of the residents as they perceive them, in order not to create additional filters when targeting social deprivation.In a wish to eschew conventional explanations of failure, we have instead turned our attention towards some more systemic flaws in the conceptual design of large-scale development programs labeled 'rural' and 'urban', arguing that one of those flaws could be the idiomatic 'elephant in the room'.
For one, 'rural' and 'urban' are seldom regarded as causal or contributive factors to marginalization but merely as neutral canvases for special types of problems.For instance, the question of whether intensified crime, disease, fear and poverty are problems of the city, or merely social problems that happen to be located in cities is rarely addressed [6].For another, commonplace usage of 'rural/urban' as labels in various development problems tends to defy the latest achievements in social theory.The last decades have seen the emergence of non-essentialist approaches to urbanity and rurality (including actor-network theory, performativity and more-than-human approaches) that eschew notions of a coherent social totality and of various conceptual binaries, including 'rural/urban'.Nevertheless, "rural" and "urban" development actions aimed at people still seem to depart from landscape characteristics (morphology, land use, population density)a procedure which goes against the scientifically established weak correlation between spatial and social variation [10].This, in turn, iatrogenically conflates land with people, making 'rural/urban' not only the 'elephant in the room' but also a 'white elephant'a conceptual behemoth which cannot be disposed of despite its cost being out of proportion to its usefulness.
On the one hand, the spirit of our time urges us to strive for holism and "representations that can take more of the world in" [55, p. 89].On the other, responsibility tells us to disaggregate fuzzy concepts not only to take in but also to make sense of that world.'Rural' and 'urban'due to their complexity, chequered history, global disconformity, conceptual overlapping, and an ever greater subjectivity stemming from that overlappingare becoming increasingly difficult to handle in practice [21].In anticipation of an even greater 'rural-urban blurring' in the nearest future, the time seems ripe for a Rural-Urban Redux on a par with other problematic concepts, to which the society not too long ago was similarly indifferent.By hotwiring the rural-urban binary in a fashion akin to race, class or gender will certainly not solve the problems of our time.Nevertheless, it may make us think again before they are thrown into the game.