Health identities: a framework for research - University of Sheffield

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Dec 13, 2013 (3 years and 6 months ago)

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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).

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.

Image: ‘
The bride stripped bare by her bachelors, even
’. Marcel Duchamp,
1923.


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 feeding
-

assemblage


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 health
-
related 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 self
-
preservation 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


self
-
awareness
-

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