“Disorders of discourse” – practices that constitute “barriers to communication” – can be subjected to critique, and critique can lead to the suggestion of different practices. Such changes in discourse may contribute to changes in the “structures of organizations.” However, in the absence of such structural changes, changes in discourse may actually result in more subtle, and thus more effective, forms of domination. That is the central problem raised in this book. Interaction between doctors and patients, teachers and pupils, politicians and publics, etc., can change in ways that eliminate the more obvious forms of interactional asymmetry, domination, or manipulation; yet whether such changes contribute to substantive democratization – or only give an appearance of democracy, which can make relations of domination more effective because less obvious – depends on how such new forms of interaction fit within the overall network of practices that constitutes the institution concerned.