Showing papers in "Sociology of Health and Illness in 2013"

Ageing with telecare: care or coercion in austerity?

Abstract: In recent years images of independence, active ageing and staying at home have come to characterise a successful old age in western societies. ‘Telecare’ technologies are heavily promoted to assist ageing-in-place and a nexus of demographic ageing, shrinking healthcare and social care budgets and technological ambition has come to promote the ‘telehome’ as the solution to the problem of the ‘age dependency ratio’. Through the adoption of a range of monitoring and telecare devices, it seems that the normative vision of independence will also be achieved. But with falling incomes and pressure for economies of scale, what kind of independence is experienced in the telehome? In this article we engage with the concepts of ‘technogenarians’ and ‘shared work’ to illuminate our analysis of telecare in use. Drawing on European-funded research we argue that home-monitoring based telecare has the potential to coerce older people unless we are able to recognise and respect a range of responses including non-use and ‘misuse’ in daily practice. We propose that re-imagining the aims of telecare and redesigning systems to allow for creative engagement with technologies and the co-production of care relations would help to avoid the application of coercive forms of care technology in times of austerity.

Unemployment, gender and mental health: the role of the gender regime

Abstract: Existing research suggests that gender differences in the effect of unemployment on mental health are related to the different positions and roles that are available for men and women in society and the family; roles that are connected with their different psychosocial and economic need for employment. The aim of this article is to analyse the role of gender in the relationship between unemployment and mental wellbeing in Sweden, representing a gender regime with a similar need for employment among women and men, and Ireland, representing a gender regime in which the need for employment differs between women and men. The results, based on longitudinal data from the two countries, show that unemployment was more negatively related to mental health among men than among women in Ireland, while men and women were equally affected by unemployment in Sweden. Factors related to the family and economic situation, as well as gendered selection into the unemployment population, explains the difference in mental health between unemployed men and women in Ireland. The overall conclusion is that the context has a major influence on the relationship between unemployment, gender and mental health.

Life in and after the Armed Forces: social networks and mental health in the UK military.

Abstract: This study focuses on the influence of structural aspects of social integration (social networks and social participation outside work) on mental health (common mental disorders (CMD), that is, depression and anxiety symptoms, post-traumatic stress disorder (PTSD) symptoms and alcohol misuse). This study examines differences in levels of social integration and associations between social integration and mental health among service leavers and personnel still in service. Data were collected from regular serving personnel (n=6,511) and regular service leavers (n=1,753), from a representative cohort study of the Armed Forces in the UK. We found that service leavers reported less social participation outside work and a general disengagement with military social contacts in comparison to serving personnel. Service leavers were more likely to report CMD and PTSD symptoms. The increased risk of CMD but not PTSD symptoms, was partially accounted for by the reduced levels of social integration among the service leavers. Maintaining social networks in which most members are still in the military is associated with alcohol misuse for both groups, but it is related to CMD and PTSD symptoms for service leavers only.

The end of life and the family: hospice patients' views on dying as relational.

Abstract: The end of life is a highly emotive and critical period in the life course and families often play a central role during this time. Despite significant sociological work on dying as a relational experience, there has been little exploration of the significance of contemporary family structures and relations. In this article, drawing on the accounts of twenty hospice in-patients, we explore how the end of life (in this case within an in-patient unit) is mediated by family dynamics and expectations. Participants' accounts reveal a range of interpersonal experiences, including: pressures and strains on families and patients; differentiation in family responses to and involvement in the dying process; and tensions between individual and family preferences/desires. We argue that family dynamics strongly influence individual experiences near death and that the focus on individual preferences and the management of disease in palliative care contexts must be augmented with sophisticated and nuanced understandings of the family context. We suggest that sociological conceptual explanations of shifts in social and family life, such as individualisation and ontological security, may also help us better understand the ways families approach and respond to the dying process.

Making sense of nonsense: experiences of mild cognitive impairment.

Abstract: Alzheimer's disease (AD) is a stigmatised condition popularly assumed to be a death sentence for diagnosed individuals. Consequently, people with AD are often deemed incapable (and perhaps unworthy) of contributing to the social discourse surrounding their illness experience. Data from qualitative interviews with 18 people diagnosed with the potential precursor of AD known as mild cognitive impairment (MCI) are examined. Using grounded theory methods, analysis revealed overarching themes of uncertainty concerning definitions of memory loss, MCI, and AD as well as distinctions between normal ageing and dementia. While this confusion over the terminology and prognosis mirrors the lack of scientific consensus about nosology and appropriate treatment regimens, such ambiguity creates social and psychological tensions for diagnosed individuals. Arguably, participants' unequivocal fear of and subsequent desire to differentiate their experiences from Alzheimer's, however, stems from the exclusively negative social constructions of AD. Drawing from Goffman, these findings demonstrate the psychosocial impact of 'framing contests' and how 'courtesy stigma' can apply not only to associated persons but also associated conditions, such as MCI to AD. Given the underlying nosological creep - or medicalisation - of the recent diagnostic guidelines proposing two new pre- dementia stages, understanding the illness narratives of MCI is critical.

Security and subjective wellbeing: the experiences of unaccompanied young people seeking asylum in the UK

Abstract: This article considers the relevance of the notion of ontological security � a sense of order, stability, routine and predictability to life � to contemporary conceptualisations of wellbeing. Drawing on in-depth interviews with unaccompanied young people seeking asylum in the UK, it demonstrates how a positive sense of self and being able to visualise a place and role in the world into the future were integral to their notion of wellbeing, offering an important counter to the pervasive sense of living in limbo. The article argues that this fundamental need for a projected self is largely neglected in contemporary discussions on wellbeing. To date the idea of security as a determinant of wellbeing has been primarily constructed around the notion of protection from harm and the provision of the requirements for physical, emotional, economic and social wellbeing in the here and now. Findings from this research suggest that those providing services and support to young people who have experienced trauma need to consider how they might best nurture in them a sense of place, belonging and security into the future. Equally, they have implications for how we conceptualise and operationalise wellbeing more generally.

The window of opportunity for death after severe brain injury: family experiences

Abstract: This article builds on and develops the emerging bioethics literature on the ‘window of opportunity’ for allowing death by withholding or withdrawing treatment. Our findings are drawn from in-depth interviews with 26 people (from 14 different families) with severely brain injured relatives. These interviews were specifically selected from a larger study on the basis of interviewees’ reports that their relatives would not have wanted to be kept alive in their current condition (e.g. in vegetative or minimally conscious states). Our analysis tracks the decisionmaking processes that have led to the situation in which life-sustaining treatments continue to be delivered to these patients – maintaining them in a state that some families describe as a ‘fate worse than death’. We show how the medico-legal ‘window of opportunity’ for allowing the patient to die structures family experience and fails to deliver optimal outcomes for patients. We end with some suggestions for change.

Chronic care infrastructures and the home

Abstract: In this article I argue that attention to the spatial and material dimensions of chronic disease management and its place-making effects is necessary if we are to understand the implications of the increased mobilisation--technologically or otherwise--of the home in chronic disease management. Analysing home treatment in asthma and haemophilia care, I argue that in relation to chronic disease management the home is not only always connected to the clinic but moreover, what the home is in part depends on the specificities of these attachments. Drawing primarily on the work of Susan Leigh Star and scholars of human geography I propose the concept of chronic care infrastructures designating the often inconspicuous socio-material elements (such as medication, control visits, phone calls, doses and daily routines), which are embedded in everyday life (of both the clinic and the home) and participate in producing the effect of treatment but also the effect of home. These chronic care infrastructures demand the emplacement of various objects and activities in everyday life and thus relate to negotiations of 'keepings'--hat to keep and care for and where to grant it room vis a vis other 'keepings'.

Initiating decision-making in neurology consultations: recommending versus option-listing and the implications for medical authority

Abstract: This article compares two practices for initiating treatment decision-making, evident in audio-recorded consultations between a neurologist and 13 patients in two hospital clinics in the UK. We call these 'recommending' and 'option-listing'. The former entails making a proposal to do something; the latter entails the construction of a list of options. Using conversation analysis (CA), we illustrate each, showing that the distinction between these two practices matters to participants. Our analysis centres on two distinctions between the practices: epistemic differences and differences in the slots each creates for the patient's response. Considering the implications of our findings for understanding medical authority, we argue that option-listing - relative to recommending - is a practice whereby clinicians work to relinquish a little of their authority. This article contributes, then, to a growing body of CA work that offers a more nuanced, tempered account of medical authority than is typically portrayed in the sociological literature. We argue that future CA studies should map out the range of ways - in addition to recommending - in which treatment decision-making is initiated by clinicians. This will allow for further evidence-based contributions to debates on the related concepts of patient participation, choice, shared decision-making and medical authority.

Macro-level gender equality and depression in men and women in Europe

Abstract: A recurrent finding in international literature is a greater prevalence of depression in women than in men. While explanations for this gender gap have been studied extensively at the individual level, few researchers have studied macro-level determinants of depression in men and women. In the current study we aim to examine the micro-macro linkage of the relationship between gender equality and depression by gender in Europe, using data from the European Social Survey, 2006-2007 (N=39,891). Using a multilevel framework we find that a high degree of macro-level gender equality is related to lower levels of depression in both women and men. It is also related to a smaller gender difference in depression, but only for certain social subgroups and only for specific dimensions of gender equality.

Overeducation and depressive symptoms: diminishing mental health returns to education

Abstract: In general, well-educated people enjoy better mental health than those with less education. As a result, some wonder whether there are limits to the mental health benefits of education. Inspired by the literature on the expansion of tertiary education, this article explores marginal mental health returns to education and studies the mental health status of overeducated people. To enhance the validity of the findings we use two indicators of educational attainment � years of education and ISCED97 categories � and two objective indicators of overeducation (the realised matches method and the job analyst method) in a sample of the working population of 25 European countries (unweighted sample N = 19,089). Depression is measured using an eight-item version of the CES-D scale. We find diminishing mental health returns to education. In addition, overeducated people report more depression symptoms. Both findings hold irrespective of the indicators used. The results must be interpreted in the light of the enduring expansion of education, as our findings show that the discussion of the relevance of the human capital perspective, and the diploma disease view on the relationship between education and modern society, is not obsolete.

Brain talk: power and negotiation in children's discourse about self, brain and behaviour.

Abstract: This article examines children’s discourse about self, brain and behaviour, focusing on the dynamics of power, knowledge and responsibility articulated by children. The empirical data discussed in this article are drawn from the study of Voices on Identity, Childhood, Ethics and Stimulants, which included interviews with 151 US and UK children, a subset of whom had a diagnosis of attention deficit/hyperactivity disorder. Despite their contact with psychiatric explanations and psychotropic drugs for their behaviour, children’s discursive engagements with the brain show significant evidence of agency and negotiated responsibility. These engagements suggest the limitations of current concepts that describe a collapse of the self into the brain in an age of neurocentrism. Empirical investigation is needed in order to develop agent-centred conceptual and theoretical frameworks that describe and evaluate the harms and benefits of treating children with psychotropic drugs and other brain-based technologies.

Introduction: why a Sociology of Pandemics?

Abstract: Infectious disease has re-emerged as a public health threat in an increasingly globalised era, adding trans-national actors to traditional national and local government actors. This special issue showcases new sociological work in response to this challenge. The contributors have investigated the social construction of new and re-emerging diseases; the development of surveillance systems, public health governance; the impact of scientific/technical modalities on uncertainty and risk, the interplay of infectious disease, public health and national security concerns, and public and media responses. The case studies range broadly across North America, Europe and Asia and define new agendas for medical sociologists and public health policymakers.

The family meal panacea: exploring how different aspects of family meal occurrence, meal habits and meal enjoyment relate to young children's diets.

Abstract: The general consensus in the research to date is that family meals are linked to healthier eating habits in children, compared to not eating with the family. Yet, few studies explore what it is about commensality which leads to better food choices among children. Using a representative Scottish sample of five-year-old children, this research explores the extent to which family meal occurrence, meal patterns regarding where, when and with whom children eat and perceived meal enjoyment predict the quality of children�s diets after controlling for indicators of maternal capital that influence both meal rituals and taste preferences. Eating the same food as parents is the aspect of family meals most strongly linked to better diets in children, highlighting the detrimental effect in the rise of �children�s food�. Although theoretical and empirical work pointed to the important health advantage in children eating together with parents, the results suggested that eating together was a far less important aspect of family meals. In evaluating the importance of the family meal, this article redirects attention away from issues of form and function towards issues of food choice. Policy implications and the importance for public health to recognise the way eating habits are defined by and reproduce social and cultural capital are discussed.

Non/infectious corporealities: tensions in the biomedical era of HIV normalisation

Abstract: In the contemporary HIV epidemic, antiretroviral treatments are increasingly considered so effective at viral suppression that they render people with HIV sexually non-infectious With its radical implications for global HIV prevention, this emerging paradigm is invested with the potential to turn the epidemic around and to 'normalise' one of the most feared infectious diseases in history, thus echoing wider trends of 'biomedicalisation' What remains unexamined is whether this paradigm shift will bring about a parallel shift in the embodied experiences of being HIV-positive This article explores the nascent trajectory from infectious to non-infectious corporeality against the backdrop of the discursive history of HIV, with particular focus on the landmark Swiss Consensus Statement, and in the context of research with heterosexuals with HIV in Australia In-depth interviews revealed that HIV corporeality was not a stable, homogenised experience across participants and time, nor did it simply follow medical discourses Instead, HIV corporeality emerged as a contingent set of tensions between conflicting discourses of infectiousness that were negotiated and made sense of within situated and embodied life histories These findings pose challenges to the imperative of HIV normalisation and the related tendency in HIV prevention to universalise the notion of 'infectiousness'

How did international agencies perceive the avian influenza problem? The adoption and manufacture of the 'One World, One Health' framework.

Abstract: Over the past few years, a 'One World, One Health' (OWOH) policy framework has become the guiding principle for international responses to avian influenza and other zoonotic infectious diseases. Several specialised inter-governmental agencies, including the World Health Organization, the Food and Agricultural Organization and World Organization for Animal Health, jointly endorsed and promoted this framework. This article attempts to explain why international agencies advocated OWOH despite its vagueness. By examining how these international agencies gradually reframed avian flu problems, this article illustrates the crucial roles of international agencies in constructing disease knowledge and relevant policy responses. It shows that the three agencies adopted an all-inclusive approach to reduce conflicts, defend their legitimacy, and facilitate commitment for collaboration. Not only has this new framework reduced tensions between agencies, it has also reshaped the interests and interactions of other global actors. The case thus illustrates how these organisational actors actively manufacture new cognitive frames and policy regimes that advance their own legitimacy and influence.

The medicalisation of revolt: a sociological analysis of medical cannabis users

Abstract: In a qualitative study, we investigated the medical motives of 100 Norwegian cannabis users, none of whom had legal access to medical cannabis. Cannabis was used therapeutically for conditions such as multiple sclerosis, attention deficit hyperactivity disorder and rheumatism, as well as for quality of life conditions such as quality of sleep, relaxation and wellbeing. The borders between medical and recreational cannabis use were blurred. This article identifies strategies of medical cannabis users to gain social acceptance. Several respondents downplayed effects such as intoxication and euphoria. Others used the language of medicine and knowledge of current research in psychopharmacology. Cannabis was contrasted with the potential for abuse of prescription medicines. The medical cannabis movement has had little success in Norway. Medical professionals are unable to accept that users may be more knowledgeable than experts and medical users cannot discard the values of traditional cannabis culture. Calls for medical cannabis use are thus perceived as a gambit in attempts to have cannabis legalised. We argue that, despite having had little effect on health authorities, the medical cannabis movement may be having the unintended effect of medicalising cannabis use and using it as a cure for everyday problems.

Neurobiological narratives: experiences of mood disorder through the lens of neuroimaging.

Abstract: Many scientists, healthcare providers, policymakers and patients are awaiting in anticipation the application of biomedical technologies such as functional neuroimaging for the prediction, diagnosis and treatment of mental disorders. The potential efficacy of such applications is controversial, and functional neuroimaging is not yet routinely used in psychiatric clinics. However, commercial ventures and enthusiastic reporting indicate a pressing need to engage with the social and ethical issues raised by clinical translation. There has been little investigation of how individuals living with mental illness view functional neuroimaging, or of the potential psychological impacts of its clinical use. We conducted 12 semi-structured interviews with adults diagnosed with major depression or bipolar disorder, probing their experiences with mental health care and their perspectives on the prospect of receiving neuroimaging for prediction, diagnosis and planning treatment. The participants discussed the potential role of neuroimages in (i) mitigating stigma; (ii) supporting morally loaded explanations of mental illness due to an imbalance of brain chemistry; (iii) legitimising psychiatric symptoms, which may have previously been de-legitimised since they lacked objective representation, through objective representations of disorder; and (iv) reifying DSM-IV-TR disorder categories and links to identity. We discuss these anticipated outcomes in the context of participant lived experience and attitudes to biologisation of mental illness, and argue for bringing these voices into upstream ethics discussion.

Suicide rates and socioeconomic factors in Eastern European countries after the collapse of the Soviet Union: trends between 1990 and 2008

Abstract: After the collapse of the Soviet Union the various Eastern European (EE) countries adapted in different ways to the social, political and economic changes. The present study aims to analyse whether the factors related to social integration and regulation are able to explain the changes in the suicide rate in EE. A separate analysis of suicide rates, together with the undetermined intent mortality (UD), was performed. A cross-sectional time-series design and applied a panel data fixed-effects regression technique was used in analyses. The sample included 13 countries from the former Soviet bloc between 1990 and 2008. Dependent variables were gender-specific age-adjusted suicide rates and suicide plus UD rates. Independent variables included unemployment, GDP, divorce rate, birth rate, the Gini index, female labour force participation, alcohol consumption and general practitioners per 100,000 people. Male suicide and suicide or UD rates had similar predictors, which suggest that changes in suicide were related to socioeconomic disruptions experienced during the transition period. However, male suicide rates in EE were not associated with alcohol consumption during the study period. Even so, there might be underestimation of alcohol consumption due to illegal alcohol and differences between methodologies of calculating alcohol consumption. However, predictors of female suicide were related to economic integration and suicide or UD rates with domestic integration.

Depression: the ambivalence of diagnosis

Abstract: The diagnosis of depression in the clinical context is extremely controversial and is subject to criticism of over-medicalisation and pharmaceuticalisation. Depression can be conceptualised across the entire spectrum of lay and medical belief, from the 'normal' highs and lows of the human condition to its inclusion in the dominant Diagnostic and Statistical Manual of Mental Disorders classificatory system, as a form of serious mental illness. In this context, a better understanding of how people describe, experience, negotiate and participate in the process of diagnosis is needed. This article draws on qualitative interviews to explore lay accounts of being diagnosed with depression. The findings reveal that lay accounts of depression vacillate in and out of the medicalised discourse of depression, highlighting the limitations of the biomedical approach to diagnosis and treatment.

Neurobiology in public and private discourse: the case of adults with ADHD

Abstract: How do people describe their health? How do their descriptions relate to public definitions? This article focuses on adult attention deficit hyperactivity disorder (ADHD). We look at Dutch adults who adopt the ADHD label and ask: which discourses structure their descriptions of ADHD? How do these relate to the dominant public discourse on ADHD? Do people use, for example, neurobiological explanations of ADHD? The research makes use of Q-methodology, which combines a discursive relational approach with factor analysis. We examine five different personal discourses that partly differ from the public discourse. People borrow neurobiological, psychological, sociological and even holistic arguments from public discourse to come up with a distinct set of discourses. Neurobiology resonates among adults with ADHD but does not dominate their thinking. Contrary to our expectation, this supports reflexivity instead of discipline theory.

Co‐construction of chronic illness narratives by older stroke survivors and their spouses

Abstract: Illness narratives have mainly focused on individual patients' accounts, and particularly those of people experiencing the onset of chronic illness in mid-life. However, a growing number of older people are spending their later life with their partner, with both experiencing complex morbidities. We examine the shared creation of meanings among older stroke survivors and their spouses and the implications for individual and couple identity. Joint biographical narrative interviews were held with 13 stroke survivors aged 75-85 and their spouses. The analysis examined both narrative content and narrative style. Three main types of co-presentation of identity were identified. The 'united couple' described couples who pulled together and emphasised their accommodation of the stroke and normality as a couple, despite often considerable disability, and was strongly underpinned by collaborative interaction in interviews. Caring relationships were distinguished as 'positive', involving self-reliant couples who took pride in how they managed and 'frustrated' in couples who emphasised the difficulties of caring and hardships experienced and were characterised by a conflictual style of narrative. We argue that joint interviews provide new forms of data that extend notions of how illness is lived and demonstrates how the marital relationship can mediate the experience of chronic illness and disability and its impact on identity.

Negotiating access to medical treatment and the making of patient citizenship: the case of hepatitis C treatment.

Abstract: Drawing on qualitative interview accounts with people who have injected drugs, we deploy ideas of biological and therapeutic citizenship to explore how the negotiation of access to hepatitis C treatment enacts patient citizenship potential. We find that the patient citizenship made through hepatitis C treatment divides those who are deserving from those who are not, largely in relation to their presentations of self-control, responsibility and recovery regarding drug use. Accessing treatment requires that patients negotiate their entitlement by reflexively producing the patient citizen role expected of them. In this context of rationed treatment expectation, access to treatment is constructed in relation to gratitude rather than entitlement. Rationed treatment expectation also interplays with a utilitarian approach to hepatitis C expertise. Accounts of the bio-effects of hepatitis C and its treatment as uncertain further weaken the potential for shared illness identity and biosocial membership as well as contributing to treatment delay. We conclude that the construction of hepatitis C treatment as a negotiation of 'recovery towards normality' positions people who continue to use or inject drugs as beyond patient citizenship. Our findings underscore the situated limits of therapeutic and biological citizenship, emphasising that these processes are unavoidably forces of governance.

Risk, governance and the experience of care.

Abstract: Drawing on perspectives from the governmentality literature and the sociology of risk, this article explores the strategies, tools and mechanisms for managing risk in acute hospital trusts in the United Kingdom. The article uses qualitative material from an ethnographic study of four acute hospital trusts undertaken between 2008 and 2010 focusing on the provision of dignified care for older people. Extracts from ethnographic material show how the organisational mechanisms that seek to manage risk shape the ways in which staff interact with and care for patients. The article bridges the gap between the sociological analysis of policy priorities, management strategy and the organisational cultures of the NHS, and the everyday interactions of care provision. In bringing together this ethnographic material with sociological debates on the regulation of healthcare, the article highlights the specific ways in which forms of governance shape how staff care for their patients challenging the possibility of providing dignified care for older people.

The use of boundary objects to enhance interprofessional collaboration: integrating complementary medicine in a hospital setting

Abstract: Because of the inherent complexity of human health, the provision of good quality patient care requires collaboration in multidisciplinary teams. Integrative healthcare provides a unique setting for the study of interprofessional collaboration in the context of power disparities. The research objective was to examine which means and mechanisms were used to facilitate interprofessional collaboration when integrating complementary medicine (CM) into a hospital's surgical department. Throughout 2010 we conducted a qualitative study in an Israeli public hospital's surgical department, using observations and 30 in-depth interviews with managers, surgeons, physicians, nurses, patients and CM practitioners. The sociological concepts of boundary actor and boundary object and the context of power relations served as a framework for this research. This article contributes to the field of interprofessional collaborative care research by: analysing types of collaboration inhibitors--epistemological and social-structural gaps; pointing to boundary actors who establish interprofessional collaboration in an integrative hospital setting and noting the boundary objects they use; and comparing collaboration levels. The collaboration between CM practitioners and the department's staff is a loosely coupled system. When coordination was achieved, reaching profound agreements seemed of lesser importance to the parties. Closer collaboration and cross-fertilisation were found among CM practitioners.

Contradictions of value: between use and exchange in cord blood bioeconomy

Abstract: Umbilical cord blood (CB) has become established as an increasingly viable clinical alternative to bone marrow in the treatment of leukaemia leading to the construction of a global network of CB banks promoted through a moral ethos of gift. Additionally, some banks offer the opportunity to retain stem cells privately. CB is discursively presented as clinical 'waste', a 'by-product' of birthing. In this way CB units are made available to a global exchange-based bioeconomy. Crucially, CB collection has developed in parallel with several necessary obstetric practices, especially the immediate clamping of the cord following delivery, essential to high volume collection. However, this article strongly suggests the promotional basis of CB banking (such as by gift, waste or donation) is in tension with the growing preference of new parents to delay cord clamping. Based on focus groups with expectant parents, the promotion of CB banking can in fact be seen to feed into critical reflection on the value of CB for newborn infants, potentially reinvigorating a tradition of delayed umbilical cord clamping. Theoretically, these contradictory systems of valuing are conceptualised through recent literature on bioeconomy and Marx's writings on the contrasting tensions between use and exchange value.

Splitting bodies/selves: women's concepts of embodiment at the moment of birth.

Abstract: Little sociological research has focused specifically on the moment of birth. In this article we draw upon interview data with women who had very recently given birth for the first time to explore the ways in which they described both their own embodiment and that of their infants at this time. We use the term ‘the body-being-born’ to describe the liminality and fragmentation of the foetal/infant body as women experience it when giving birth. The study found that mode of birth was integral to the process of coming to terms with this body during and following birth. The women who gave birth vaginally without anaesthesia experienced an intense physicality as they felt their bodies painfully opening as the ‘body-being-born’ forced its way out. In contrast the women who had had a Caesarean section tended to experience both their own bodies and those of their infants as absent and alienated. Most of the women took some time to come to terms with the infant once it was born, conceptualising it as strange and unknown, but those who delivered by Caesarean section had to work even harder in coming to terms with the experience.

Biographical value: towards a conceptualisation of the commodification of illness narratives in contemporary healthcare

Abstract: Illness narratives play a central role in social studies of health and illness, serving as both a key theoretical focus and a popular research method. Despite this, relatively little work has gone into conceptualising how and why illness narratives - be they in books, websites, television or other media - are commodified in contemporary healthcare and its social environment; namely, how distinctive forms of value are generated in the production, circulation, use and exchange of illness narratives. In this article we propose the notion of biographical value as a first step towards conceptualising the values attributed to illness narratives in this context. Based on a secondary analysis of 37 interviews with people affected by 15 different health conditions in the UK (all of whom have shared their illness experiences across various media) and drawing on understandings of value in research on the bioeconomy and the concept of biovalue in particular, we sketch out how epistemic, ethical and economic forms of value converge and co-constitute each other in the notion of biographical value and in broader economies of illness experiences.

Why the French did not choose to Panic: A Dynamic Analysis of the Public Response to the Influenza Pandemic

Abstract: To understand the French public�s response to the 2009 pandemic A/H1N1 influenza health threat a sequence analysis framework has been employed mobilising different theoretical strands such as innovations diffusion theory, surprise theory and social representation theory. These tend to suggest that disease episodes, public health policy and the public�s response should be considered within a larger socio-cognitive frame incorporating representations anchored by prior disease episodes and campaigns. It is suggested in this article that the public�s response was greatly influenced by the pervasive anchoring of the social representations of the pandemic threat to the 1918 Spanish flu in the lay and scientific media. These representations were eventually seen not to match the reality of the disease and consequently the French public did not panic during the 2009 pandemic. This hypothesis has been tested empirically by examining retrospective media, bibliographical data and an analysis of risk perception carried out through three cross-sectional studies prior to and during the pandemic episode and one month after the launch of the vaccination campaign. These findings suggest that alarmist framings of health threats may be counterproductive since they may reduce the capacity of public health organisations to mobilise the public in the case of more serious emerging disease.