Transcript Health identities: a framework for research

Health identities
What are they and how
can we research them?
Nick Fox
ScHARR
University of Sheffield
Introduction
• The concept
• Ontology and identity
• Identity-assemblages
• Methodology
• The health identities
of young men
Prologue
• Andrew is an illness-denier, who tries to
control his life to minimise stress.
• Rahul believes being active, fit and sporty
makes him masculine.
• Marco seeks balance and good health in
his life, and uses meditation, drugs and
alcohol to achieve this.
Health identities
• Health identities are health-related aspects
of identity.
• Associated with sport and exercise, body
modification, sexuality, health technology
consumption, disability, growing old, etc.
Why study health identity?
• To understand health and illness behaviour
• To recognise the range of factors affecting
health and illness in particular cultures.
• To explore social changes in how people
understand health and illness.
• To design services that can respond to the
range of health identities in the population.
Identity
• An individualistic concept.
• The ‘essence’ of who we
are.
• ‘Reflexive’ sense-of-self, or
subjectivity.
• Most sociologists consider
that identity emerges in a
social context.
Identity and Ontology
• Ontology describes the nature
of things’ existence in the world.
• For the past 2500 years, ontology has
emphasised the human individual, the
body and personal identity as the units of
study.
• But what if...
Plato, by Silanion
... we change the question
And ask not who a person is ...
But what (else) they can do?
To do or not to do ...
• What are the possibilities for action (e.g.
to eat, to speak, to work, to mate etc.).
• What are the limits to action?
• These depend upon assemblages of
relations between bodies, things and
ideas.
• Who we are is an outcome of what we can
do.
An Ontology of Assemblage
• Relations
• Networks
• Connectivities
shape the world, not
the things in the
network.
Body relations can be ...
• Physical (e.g. gravity, food, technologies).
• Psychological (e.g. pain, emotions,
stressors).
• Social-cultural (e.g. institutions, money,
norms and values).
• Philosophical and abstract (e.g.
‘homeland’, religion, democracy).
Image: ‘The bride stripped bare by her bachelors, even’. Marcel Duchamp,
1923.
Assemblages
• Assemblages are ‘a kind
of chaotic network of
habitual and non-habitual
connections, always in
flux, always reassembling
in different ways’
(Potts 2004: 19).
• Assemblages enable
and constrain action.
An Ecology of
Assemblage
• Assemblages bring together elements that
are organic and non-organic; material and
abstract , technological and natural.
• The unit of analysis should be the ecology
of relations, not individuals or bodies.
The Rabbit Assemblage
Rabbit-Assemblage
• Don’t think of an entity called ‘rabbit’ , but
of an ecology of rabbit-ing.
food – field – rabbit – other rabbits – warren
- predators – my roses – angry human –
shotgun
• I am part of the rabbit-assemblage and it
is part of the Fox-assemblage.
Sociology and Assemblages
• Stop looking at
individual ‘actors’.
• Look for processes that
emerge out of
assemblages of bodies,
things, ideas,
institutions.
• Look at what these can
do, not what they are.
Sociology and Assemblages
• Methodologically, this
means:
Focus on the relations
that bodies have with
other entities.
Look at how these
assemble to shape
bodily actions.
Examples of Assemblages
1. A feedingassemblage
mouth – milk –
nipple – mother
Examples of Assemblages
2. A biomedical
assemblage
patient – disease –
doctor – hospital biomedicine –
technology
Life is lived through
assemblages
Identity Assemblages
Identity ‘... consists of a changeable collection of
fragments among which the struggle between
powers and resistances takes place. A
panorama of possible experiences, modes of
conduct and reactions opens up. The ‘I’ is not a
unity but a wide range of experiences,
intentions, desires, powers, movements, souls
and the like.’ (Huijer 1999: 65-66)
Identity as Assemblage
• Identity is not an attribute of a person.
• Identity emerges from an assemblage of
relations with the material and social world.
• During childhood, self-hood stabilises from a
myriad of possible identities.
• Identity is never fixed, and may alter due to
health, ageing, experiences etc.
Examples of identity-assemblages
• Gender/sexuality assemblage:
sex organ – hormones – past experiences cultural stereotype –objects of desire
• Lifestyle assemblage:
food - ethical commitments – shopping –
food preferences - vegetarianism
Health identity-assemblages
• Clustering of relations around healthrelated aspects/ideas of embodiment:
sport and exercise, body modification,
sexuality, consumption, disability ,
growing old.
• These relations habituate a reflexive
source of identification.
HI example 1
A traditional ‘patient’ identity :
organ – disease – doctor – biomedicine health technology – daily responsibilities –
fear
HI example 2
A ‘resisting consumer’ identity among
members of a pro-anorexia group:
body shape – daily troubles – pro-ana –
thinspiration – sanctuary – weight loss
drugs – community
(Fox and Ward 2006)
HI example 3
A vegetarian health-identity
meat – vegetables - diseases and symptoms
– purity – holism – animal welfare –
environment - industrialisation
(Fox and Ward 2008b)
Young men’s health identities
• Secondary analysis of interviews with 31 young
men.
• Researchers: Roger de Visser and Jonathon
Smith (2006), as part of the Young Men,
Masculinities and Health 2003–2004 study,
funded by the Economic and Social Research
Council and distributed via the UK Data Archive,
University of Essex (UKDA 5371).
Methodology
• Fox and Ward (2008a):
1. Close reading of interviews to identify the
richness of relations in the assemblage.
2. Look for processes that stabilise or limit
possibilities of action.
3. Hypothesise assemblages.
4. What (else) can the body do? = Identity.
Findings
• Reading the interview transcripts:
The relations associated with health were many
and varied, including:
sports; fitness; injuries; alcohol use; drug use;
smoking; relaxation; yoga; sexual conduct;
future; masculinity; risk; peer pressure
• Focus on three participants
Andrew
• Key relations:
team sport – fitness – body size – health
professionals - biomedicine – alcohol stress – community
• Limits on action:
Stature; illness; food allergies; loss of
belonging when leaving home
Andrew: assemblages and HI
a) cricket - sporting success - fitness – body
size – embarrassment – training
b) illness – medicine – food - allergies - stress
– fear – health professionals - life
• Andrew denies his illness, avoiding
professionals , but his fear and urge for selfpreservation leads him to actions to minimise
stress in his life.
Rahul
• Key relations:
sport – fitness – masculinity – control of body –
risk – alcohol – religion/culture – belonging to
group
• Limits on action:
Lack of physical stamina; peer pressure to drink
alcohol; gender stereotypes; lack of money;
Rahul: Assemblages and HI
a) fitness – activity – involvement - masculinity
- health
b) alcohol – money – control – risk – health
• Rahul sees having a passion’ (sporting or
otherwise) as a key aspect to his masculine
identity. His choice not to drink (justified on
health grounds) challenges his social
identity as part of a group.
Marco
• Key relations:
body – energy – holism - health – well-being
- yoga - balance – drugs - alcohol
• Limits on action:
Lack of fitness; risk of losing control.
Marco: Assemblages and HI
a) balance – yoga – chanting – swimming - fitness health – soul - discipline
b) time – development – growing up – control – selfawareness - life plan
• Marco disciplines his body and mind to achieve
a balanced life and good health, and is trying to
manage the challenges of growing up and
planning his life ahead. He uses drugs and
alcohol to relax and gain balance in his life.
Discussion
• These three cases show the great variety
of health identities in young men.
• Health identities are composed of relations
that are myriad, context-specific and
assembled in countless ways.
• We cannot reduce health identities to
stratifications by gender and age.
References
• Fox, N.J. and Ward, K.J. (2006) Health
identities: from expert patient to resisting
consumer. Health, 10 (4), 461-479.
• Fox, N.J. and Ward, K.J. (2008a) What are
health identities and how may we study them?
Sociology of Health and Illness, 30 (7), 1007-21.
• Fox, N.J. and Ward, K.J. (2008b). You are what
you eat? Vegetarianism, health and identity.
Social Science & Medicine, 66 (12), 2585-2595.
In the Fox-assemblage
• Deleuze and Guattari
• Ansell Pearson
• Latour
• Buchanan
• De Landa
• Potts
Health identities
What are they and how
can we research them?
Nick Fox
ScHARR
University of Sheffield