Lee F. Monaghan

Key concepts in medical sociology

Introduction PART ONE: SOCIAL PATTERNING OF HEALTH Social Class - Graham Scambler Gender - Ellen Annandale Ethnicity - James Y. Nazroo Place - Sally Macintyre and Anne Ellaway Material and Cultural Factors - Graham Scambler Psychosocial Factors - Antonia Bifulco Life Events - Antonia Bifulco Neo-liberal Globalization and Health Inequalities - Roberto De Vogli, Ted Schrecker and Ronald Labonte Ageing and the Life Course - Tarani Chandola Social Capital - Orla McDonnell PART TWO: EXPERIENCE OF HEATH AND ILLNESS Medicalization - Jonathan Gabe Illness and Health-Related Behaviour - Lee F. Monaghan Stigma - Lee F. Monaghan and Simon J. Williams Embodiment - Simon J. Williams and Lee F. Monaghan Emotions - Gillian Bendelow Chronic Illness - Mike Bury and Lee F. Monaghan Disability - Nicholas Watson Illness Narratives - Mike Bury and Lee F. Monaghan Risk - Jonathan Gabe The Sick Role - Mike Bury and Lee F. Monaghan Practitioner-Client Relationships - Alison Pilnick Quality of Life - Mary Boulton Awareness Contexts - Lee F. Monaghan PART THREE: HEALTH, KNOWLEDGE AND PRACTICE Medical Model - Mike Bury Social Constructionism - Orla McDonnell Lay Knowledge - Gareth H. Williams Reproduction - Jane Sandall Medical Technologies - Alex Faulkner eHealth - Michael Hardey Geneticization - Rebecca Dimond and Jacqueline Hughes Bioethics - Clare Williams and Steven P. Wainwright Surveillance and Health Promotion - Sarah Nettleton PART FOUR: HEALTH WORK AND THE DIVISION OF LABOUR Medical Autonomy, Dominance and Decline - Mary Ann Elston and Jonathan Gabe Trust in Medicine - Jonathan Gabe Nursing and Midwifery as Occupations - Abbey Hyde Social Divisions and Formal Health Care - Catherine Theodosius Health Professional Migration - Ivy Lynn Bourgeault Complementary and Alternative Medicine - Michael Hardey Emotional Labour - Catherine Theodosius Informal Care - Sue Hollinrake PART FIVE: HEALTH-CARE ORGANIZATION AND POLICY Hospitals and Health Care Organizations - Per Maseide Privatization - Jonathan Gabe Managerialism - Jonathan Gabe Consumerism - Jonathan Gabe Citizenship and Health - Gareth H. Williams Social Movements and Health - Nick Crossley Medicines Regulation - Jonathan Gabe Evaluation - Nicholas Mays Malpractice - Jonathan Gabe

Looking good, feeling good : the embodied pleasures of vibrant physicality

Social scientists of medicine have largely, although by no means exclusively, focused their research on illness and sickness thus obscuring social scientific investigations of positive health and wellbeing. Undoubtedly, important reasons exist for this but the relevance of studying ‘healthy’ bodies requires emphasis and wider acknowledgement within the newer (embodied, non-dualistic) sociology of health and illness. This is necessary because the concrete corporeal manifestations of ‘health’ in everyday life – components of and preconditions for embodied social practice – may, paradoxically, erode bodily capital while simultaneously contributing to it. Using qualitative data generated during an ethnography of bodybuilding subculture, this paper contributes to the sociology of ‘healthy’ (transgressive) bodies. It describes the somatic representation of health and youth, the so-called erotics of the gym and the perceived benefits of anaerobic exercise for everyday pragmatic embodiment. Contra critical feminist studies, it furthers an appreciative understanding of ‘risky’ bodywork in post- or late modernity and underscores the value of bringing healthy lived bodies into medical sociology.

Big Handsome Men, Bears and Others: Virtual Constructions of ‘Fat Male Embodiment’

Using embodied sociology, this article offers a virtual ethnography of ‘fat male embodiment’. Reporting and analysing qualitative data generated online, it includes a typology of big/fat male body-subjects and supportive/admiring others. These fat-friendly typifications are unpacked by referencing advocated codes of self–body relatedness, sexualities and the relevance of food. The virtual construction of acceptable, admirable or resistant masculinities is then explored under the following headings: (1) appeals to ‘real’ or ‘natural’ masculinity; (2) the admiration and eroticization of fat men’s bodies; (3) transgression, fun and the carnivalesque; and (4) the pragmatics and politics of fat male embodiment. While alternative (positive) understandings of fatness are presented online, discrepancies between virtual and actual identities render stigma an ever-present possibility for those with ‘real’ fat male bodies.

Men and the War on Obesity : A Sociological Study

1. Introduction: Beyond Militarized Medicine 2. Bodily Alignment and Accounts: From Excuses to Repudiation 3. Smoking Guns, Wartime Injury and Survival: Men and Dieting 4. McDonaldizing Mens Bodies? Rationalization, Irrationalities and Resistances 5. Physical Activity and Obesity Fighting Campaigns: Mens Critical Talk 6. Conclusion: Social Fitness and Health at Every Size

Obesity Epidemic Entrepreneurs: Types, Practices and Interests

This article explores the enterprising act of socially constructing fatness, or overweight and obesity, as an individual and collective problem. We argue that this process is complex and hence draw liberally on and extend an eclectic range of scholarship (e.g. the sociology of the body, moral panic theory, critical weight studies) when presenting a typology of obesity epidemic entrepreneurs, that is, those who actively make fatness into a correctable health problem. Using a variety of data, we consider six main ideal typical entrepreneurs: creators, amplifiers/moralizers, legitimators, supporters, enforcers/administrators and the entrepreneurial self. We conclude with a critique of obesity epidemic entrepreneurship and underscore the broader salience of our work for the sociology of the body/embodiment. The relevance of social studies of the body for the obesity debate and critical weight studies is also highlighted.

Challenging medicine? Bodybuilding, drugs and risk

This paper draws on data from a qualitative study of bodybuilding and drug-taking. It discusses the ambiguous role of medicine as a source of knowledge and expertise among participants who systematically disavow medical pronouncements on the uses and dangers of ‘physique-enhancing’ drugs. Empirical data on perceptions of the medical profession, risk, and bodybuilders’ various sources of ethno-scientific knowledge, suggest that medicine is simply one ‘authority’ among many in the construction of the self and body within late modernity. These ethno-graphic observations correlate with sociological claims that medical orthodoxy is currently being subjected to an external critique and that implicit trust in both the individuals who practice medicine and the underlying system of knowledge may have been weakening.

McDonaldizing Men's Bodies? Slimming, Associated (Ir)Rationalities and Resistances

Using Ritzer’s McDonaldization of Society thesis as a reference point, this article contributes sociologically to burgeoning critical obesity studies. It does this using qualitative data from a study of men and weightrelated issues undertaken in northern England. Taking a counter-intuitive approach, it explores whether slimming proceeds in accord with the rationalizing principles of the fast-food restaurant: calculability, efficiency, predictability and technological control. Rather than reproducing a simplified and ultimately stigmatizing account, where fatness is a pathological bodily state caused by fast food, this article explores the degree to which fatness is actively made into a correctable problem using McDonaldized principles. Irrationalities and meaningful resistances associated with the public and private fight against fat are also considered.

Obesity discourse and fat politics: research, critique and interventions

Since the WHO (1998) lamented the so-called ‘obesity epidemic’ over a decade ago, there has been much rhetoric and concern about fatness/weight/obesity across an increasing range of national contexts. Alarmist claims about an ‘obesity time-bomb’ are continually recycled in policy reports, reviews and white papers, each of which begin with the assumption that fatness is fundamentally unhealthy and damaging to national economies (UK examples include: AMRC 2013; Foresight 2007; HOC 2004). This rhetoric and the associated moral panic have been amplified by a dramatising mass media (Boero 2012; also, see Boero in this issue) and have in no way dissipated even though certain ‘sceptics’ maintain the ‘crisis’ is coming to an end (Gard 2011; for a critique, see Lupton 2013). Recent examples of what Saguy and Almeling (2005) call ‘fat panic’ are not difficult to find. In February 2013, shortly before we finalised this special issue, the AMRC (2013, 7) released a well-publicised report, Measuring Up, which reiterated the dominant view: fatness is ‘a problem of epidemic proportions’ that ‘must now be tackled urgently’. Similar to earlier manifestations of fat panic (see McPhail 2009, for example), these public health concerns intersect with broader political economic anxieties about poor national fitness, with the UK labelled as ‘the “fat man” (sic) of Europe’ (AMRC 2013, 3). This document, like others before it, legitimises calls for various interventions to tackle the ‘problem of obesity’ (e.g. intensified surveillance inside and outside of the clinic, including injunctions that healthcare professionals must attend to their own weight); interventions which aim to literally reduce the number of bodies of ‘size’ and the size of individuals’ bodies (Evans and Colls 2009). This dominant ‘obesity epidemic’ narrative and rhetoric – what John Evans et al. (2008) term ‘fat fabrications’ – not only emerges in policy reports but also in academic literature, including papers written by respected contributors to this journal. For example, Bagwell (2013) and De Vogli et al. (2013) are concerned respectively with public health efforts to ‘tackle’ and ‘control’ the ‘obesity epidemic’. Such studies, similar to sociological publications on obesity rates (Crossley 2004) and geographical work on so-called ‘obesogenic environments’ (Smith and Cummins 2008; for critiques see Colls and Evans forthcoming; Evans, Crookes and Coaffee 2012; Guthman 2011; Kirkland 2011), are useful insofar as they draw attention to the ways in which social, political and economic factors shape and constrain people’s life chances and consumptive practices. However, we disagree with the common research and policy emphasis on body size/weight/fatness as a proxy for health as well as the assumption that diet and/or physical activity unequivocally explain trends in obesity regardless of other possible contributors (e.g. endocrine disruptors, sleep debt, smoking cessation and side effects from medicines) (see Keith et al. 2006). Specifically, we question the assertion of a Critical Public Health, 2013 Vol. 23, No. 3, 249–262, http://dx.doi.org/10.1080/09581596.2013.814312

Embodying Gender, Work and Organization: Solidarity, Cool Loyalties and Contested Hierarchy in a Masculinist Occupation

Despite a ‘somatic turn’ in the social sciences, there remains a dearth of theoretically informed research on male working bodies, the embodied doings of masculinities independent of biological sex and intra–gendered workplace relations. This is unfortunate because embodiment is thoroughly implicated in major social divisions, including gender domination in institutional contexts. Using an embodied sociological perspective and data generated during an ethnography of British nightclub and pub security work, this article goes some way towards embodying the social study of plural masculinities, work and organization. Exploring worker solidarity, cool loyalties and contested hierarchy in this risky masculinist occupation hopefully makes several contributions to the literature. Furthering the (theoretically informed) empirical study of masculinities and socially embedded bodies, the article sensitizes other researchers to gendered/embodied processes possibly taking a more diluted form in other work settings.

Bodily Sensibility: Vocabularies of the Discredited Male Body

Warning: this article contains strong language. This paper explores how men might interpret and respond to a masculine bodily aesthetic in the wake of the putative obesity epidemic that reportedly affects most men in Western nations. This aesthetic, legitimated through discourses of health and risk management, is also shaped by popular representations of lean, toned and hard male bodies and their antithesis: the grotesque, ‘morbidly obese’ (sic) body. Empirically, this paper benefits from insights generated during a slimming club ethnography in Northeast England and in-depth interviews with men, although valuable observations were also made at informal situations where talk about weight and bodies was commonplace. In particular, the paper explores the use of vulgarised idioms (e.g. ‘fat bastard’) that emerged among men when constructing masculine identities, and other people who could shape or spoil their identities. A four-fold ideal-type typology is presented in order to understand how men, in association with other people, reproduced and resisted the aesthetic as part of their gendered identity work. The typology highlights what we call a bodily sensibility and vocabularies of the discredited body, which reflect and provide ways of managing everyday life and the stigma of what medicine calls obesity. This is in a culture where war has been declared on obesity and men have increasingly to account for themselves if they are seen to deviate from bodily ideals, or normative embodiment.