Health identities What are they and how can we research them?

1. Health identitiesWhat are they and how can we research them? Nick Fox ScHARR University of Sheffield

2. Introduction • The concept • Ontology and identity • Identity-assemblages • Methodology • The health identities of young men

3. 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.

4. 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.

5. 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.

6. 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.

7. 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. • Butwhat if... Plato, by Silanion

8. ... we change the question And ask not who a person is ... But what (else) they can do?

9. 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.

10. An Ontology of Assemblage • Relations • Networks • Connectivities shape the world, not the things in the network.

11. 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).

12. 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.

13. 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.

14. The Rabbit Assemblage

15. 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.

16. 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.

17. 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.

18. Examples of Assemblages 1. A feeding- assemblage mouth – milk – nipple – mother

19. Examples of Assemblages 2. A biomedical assemblage patient – disease – doctor – hospital - biomedicine –technology

20. Life is lived through assemblages

21. 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)

22. 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.

23. 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

24. 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.

25. HI example 1 A traditional ‘patient’ identity : organ – disease – doctor – biomedicine - health technology – daily responsibilities – fear

26. 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)

27. HI example 3 A vegetarian health-identity meat – vegetables - diseases and symptoms – purity – holism – animal welfare – environment - industrialisation (Fox and Ward 2008b)

28. 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).

29. Methodology • Fox and Ward (2008a): • Close reading of interviews to identify the richness of relations in the assemblage. • Look for processes that stabilise or limit possibilities of action. • Hypothesise assemblages. • What (else) can the body do? = Identity.

31. 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

32. 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

33. 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.

34. 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;

35. Rahul: Assemblages and HI • fitness – activity – involvement - masculinity - health • 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.

36. Marco • Key relations: body – energy – holism - health – well-being - yoga - balance – drugs - alcohol • Limits on action: Lack of fitness; risk of losing control.

37. Marco: Assemblages and HI • balance – yoga – chanting – swimming - fitness - health – soul - discipline • 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.

38. 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.

39. 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.

40. In the Fox-assemblage • Deleuze and Guattari • Ansell Pearson • Latour • Buchanan • De Landa • Potts

41. Health identitiesWhat are they and how can we research them? Nick Fox ScHARR University of Sheffield