Deborah Lupton

Medicine as culture : illness, disease and the body in Western societies

Introduction Theoretical Perspectives on Medicine and Society The Body in Medicine Representations of Medicine, Illness and Disease in Elite and Popular Culture The Lay Perspective on Illness and Disease Power Relations and the Medical Encounter Feminisms and Medicine Conclusion

Risk as Moral Danger: The Social and Political Functions of Risk Discourse in Public Health:

Risk is a concept with multiple meanings and is ideologically loaded. The author reviews the literature on risk perception and risk as a sociocultural construct, with particular reference to the domain of public health. Pertinent examples of the political and moral function of risk discourse in public health are given. The author concludes that risk discourse is often used to blame the victim, to displace the real reasons for ill-health upon the individual, and to express outrage at behavior deemed socially unacceptable, thereby exerting control over the body politic as well as the body corporeal. Risk discourse is redolent with the ideologies of mortality, danger, and divine retribution. Risk, as it is used in modern society, therefore cannot be considered a neutral term.

Quantifying the body: monitoring and measuring health in the age of mHealth technologies

Mobile and wearable digital devices and related Web 2.0 apps and social media tools offer new ways of monitoring, measuring and representing the human body. They are capable of producing detailed biometric data that may be collected by individuals and then shared with others. Health promoters, like many medical and public health professionals, have been eager to seize the opportunities they perceive for using what have been dubbed ‘mHealth’ (‘mobile health’) technologies to promote the public’s health. These technologies are also increasingly used by lay people outside the professional sphere of health promotion as part of voluntary self-tracking strategies (referred to by some as the ‘quantified self’). In response to the overwhelmingly positive approach evident in the health promotion and self-tracking literature, this article adopts a critical sociological perspective to identify some of the social and cultural meanings of self-tracking practices via digital devices. Following an overview of the technologies currently available for such purposes, I move on to discuss how they may contribute to concepts of health, embodiment and identity. The discussion focuses particularly on how these technologies promote techno-utopian, enhancement and healthist discourses, and the privileging of the visual and metric in representing the body via these devices.

The Emotional Self: A Sociocultural Exploration

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Blurring the boundaries: breastfeeding and maternal subjectivity

Contemporary medical and public health discourses represent breastfeeding as vital to infant development and the mother-infant bond. Little research from a medical or sociological perspective has sought to investigate the qualitative breastfeeding experiences of women. This article draws on a range of feminist perspectives on the body and subjectivity, together with empirical data from a series of interviews with 25 Australian first-time mothers, to theorise the experience of breastfeeding. These women’s accounts revealed that, although nearly all of them subscribed vehemently to the dominant discourse of ‘breast is best’, the experience of breastfeeding differed markedly among them. Some of the women experienced breastfeeding as a connected, harmonious and intimate relationship between themselves and their baby. For others, however, the breastfeeding relationship between mother and infant was difficult to reconcile with notions of identity that value autonomy, independence and control. We use insights from feminist philosophy on subjectivity and embodiment to explain why the latter response predominated among our interviewees.

‘Precious cargo’: foetal subjects, risk and reproductive citizenship

In the interests of promoting the health and wellbeing of their foetuses, pregnant women are subject to imperatives which expect them to engage in an intense ascetic regime of self-regulation and disciplining of their bodies. This review article draws upon scholarship from the humanities and social sciences on pregnancy, foetal personhood and risk to explain why, at this particular moment in the history of western societies, pregnant women and their foetuses are such potent focal points for regulation, monitoring and control. It is argued that in recent years the foetus has become fetishised as a precious body to the exclusion of the pregnant womans needs and rights. Biomedical technologies have played an important role in the construction of the contemporary foetal body and the meanings which surround it, as have the discourses and practices of neoliberal politics and risk society.

Femininity, responsibility, and the technological imperative: discourses on breast cancer in the Australian press.

The manner in which the popular press represents health issues influences, and is demonstrative of, societal attitudes toward illnesses and those who suffer from them. Cancer is one of the most feared diseases in modern society, and breast cancer attacks women at the bodily site where notions of femininity intersect. This article examines the discourses surrounding breast cancer as represented in the Australian press in the period between 1987 and 1990. It is argued that the presss portrayal of breast cancer during that time drew upon dominant cultural metaphors and discourses concerning femininity, the individuals responsibility for illness, and medical and technological dominance.

Caveat emptor or blissful ignorance? Patients and the consumerist ethos

The notion that consumerist behaviour is, or should be, prevalent amongst individuals seeking health care has underlain recent United States and British governmental policy directives. Consumer groups make similar assumptions when exhorting individuals to treat health care like any other service. This paper enquires to what extent patients conceive of themselves and others as adopting consumerist behaviour when seeking and evaluating primary health care. Three hundred and thirty-three patients attending general practices in Sydney, Australia, were asked in open-ended questions to state why they chose their regular doctor, why they continued to visit that doctor, if they had ever changed their doctor, if they thought most people could tell if a doctor were good or bad, and what qualities they thought constituted a good and bad doctor. It is concluded that the patients surveyed tended not to think of themselves as consumers who should be wary of the quality of service offered by doctors. Rather they preferred to trust their doctor, and therefore did not devote effort to actively seeking out information about their doctor or evaluating his or her services.

Health promotion in the digital era: a critical commentary

A range of digitized health promotion practices have emerged in the digital era. Some of these practices are voluntarily undertaken by people who are interested in improving their health and fitness, but many others are employed in the interests of organizations and agencies. This article provides a critical commentary on digitized health promotion. I begin with an overview of the types of digital technologies that are used for health promotion, and follow this with a discussion of the socio-political implications of such use. It is contended that many digitized health promotion strategies focus on individual responsibility for health and fail to recognize the social, cultural and political dimensions of digital technology use. The increasing blurring between voluntary health promotion practices, professional health promotion, government and corporate strategies requires acknowledgement, as does the increasing power wielded by digital media corporations over digital technologies and the data they generate. These issues provoke questions for health promotion as a practice and field of research that hitherto have been little addressed.

Holding the line online: exploring wired relationships for people with disabilities

Clearly, the Internet represents a huge new step in interpersonal communications. It offers people with disabilities the possibility of confronting the issues of time, space, communication and the body, but what happens when people with disabilities engage with the computer? Do they use the Internet to develop friendships and intimate relationships? Does online communication enhance self‐identity and social being? Do people use the Internet to transcend the vagaries of their frail and vulnerable bodies? Or are they simply ‘holding the line’ online, using the Internet as they would use a letter or a telephone? Is the Internet a chimera, a failed promise, for people with disabilities?