My new book: The Quantified Self

My new book The Quantified Self: A Sociology of Self-Tracking is due out with Polity Press this April. The publishers are offering a 20% discount for six months (from 18 January 2016 to 31 July 2016) if it is ordered via their website. Please use the code PY703 when you order to receive the discount.

Here is a PDF of the Introduction: Lupton 2016 Introduction to The Quantified Self.

Table of Contents

Acknowledgements

Introduction

1          ‘Know Thyself’: Self-tracking Practices and Technologies

2          ‘New Hybrid Beings’: Theoretical Perspectives

3          ‘An Optimal Human Being’: the Body and Self in Self-Tracking Cultures

4          ‘You are Your Data’: Personal Data Meanings, Practices and Materialisations

5          ‘Data’s Capacity for Betrayal’: Personal Data Politics

Conclusion

References

Index

 

POLITY-Lupton-Quantified Self Visuals-AUG24-3 (1)

 

Medical diagnosis apps – study findings

Over 100,000 medical and health apps for mobile digital devices have now been listed in the Apple App Store and Google Play. They represent diverse opportunities for lay people to access medical information and track their body functions and medical conditions. As yet, however, few critical social researchers have sought to analyse these apps.

In a study I did with Annemarie Jutel we undertook a sociological analysis of medical diagnosis apps, and two articles have now been published from the study. Annemarie is a sociology of diagnosis expert and we were interested in investigating how these apps represented the process of diagnosis. We drew on the perspective that apps are sociocultural artefacts that draw on and reproduce tacit norms and assumptions. We argue that from a sociological perspective, digital devices such as health and medical apps have significant implications for the ways in which the human body is understood, visualised and treated by medical practitioners and lay people alike, for the doctor-patient relationship and the practice of medicine.

In one article, published in Social Science & Medicine, we focused on self-diagnosis apps directed at lay people. We undertook a search using the terms ‘medical diagnosis’ and ‘symptom checker’ for apps that were available for download to smartphones in mid-April 2014 in the Apple App Store and Google Play. We found 35 self-diagnosis apps that claimed to diagnose across a range of conditions (we didn’t include apps directed at diagnosis of single conditions). Some have been downloaded by tens or hundreds of thousands, and the case of WebMD and iTriage Health, millions of smartphone owners.

Our analysis suggests that these apps inhabit a contested and ambiguous site of meaning and practice. The very existence of self-diagnosis apps speaks to several important dimensions of contemporary patienthood and healthcare in the context of a rapidly developing ecosystem of digital health technologies. They also participate in the quest for patient ‘engagement’ and ‘empowerment’ that is a hallmark of digital health rhetoric (or what I call ‘digital patient engagement’).

Self-diagnosis apps, like other technologies designed to give lay people the opportunity to monitor their bodies and their health states and engage with the discourses of healthism and control that pervade contemporary medicine We found that app developers combined claims to medical expertise in conjunction with appeals to algorithmic authority to promote their apps to potential users. While the developers also used appeals to patient engagement as part of their promotional efforts, these were undermined by routine disclaimers that users should seek medical advice to effect a diagnosis. While the cautions that are offered on the apps that they are for ‘entertainment purposes only’ and not designed to ‘replace a diagnosis from a medical professional’ may be added for legal reasons, they detract from the authority that the app may offer and indeed call into question why anyone should use it.

In our other article, published in the new journal Diagnosis, we directed attention at diagnosis apps that are designed for the use of medical practitioners as well as lay people. We analysed 176 such apps that we found in Google Play and the Apple App Store in December 2013. While 36 of these were directed at lay people, the remainder were for medical practitioners. The Diagnosis article mainly concentrates on the latter, given that our other article was about the self-diagnosis apps for lay people.

Our research suggests that these apps should be used with great caution by both lay people and practitioners. The lack of verifiable information provided about the evidence or expertise used to develop these apps is of major concern. The apps are of very variable quality, ranging from those that appear to have the support and input of distinguished medical experts, specialty groups or medical societies to those that offer little or nothing to support their knowledge claims. While at one end of the spectrum we can see apps as a delivery system for information which has been subject to the conventional forms of academic review, at the other extreme, we see apps developed by entrepreneurs with interests in many topics outside medicine, with little input from medical sources, or with inadequate information to ascertain what the sources might be. The lack of information provided by many app developers also raises questions about how users can determine the presence of conflicts of interest and commercial interests that might determine content.

Quantifying the sexual and reproductive self

I have just had an article accepted for publication in the journal Culture, Health & Sexuality, to be published in a special issue on medical and health technologies. The article looks at mobile smartphone apps for self-tracking and quantifying sexual and reproductive functions and activities. A pre-print version is available here.

This is the abstract for the article:

Digital health technologies are playing an increasingly important role in healthcare, health education and voluntary self-surveillance, self-quantification and self-care practices. This article presents a critical analysis of one form of these technologies: mobile apps used to self-track features of users’ sexual and reproductive activities and functions. After a review of the content of such apps available in the Apple App Store and Google Play store, some of their sociocultural, ethical and political implications are discussed. These include the role played by these apps in participatory surveillance, their configuration of sexuality and reproduction, the valorising of the quantification of the body in the context of neoliberalism and self-responsibility and issues concerning privacy, data security and the use of the data collected by these apps. It is contended that the apps represent sexuality and reproduction in certain defined and limited ways that work to perpetuate normative stereotypes and assumptions about women and men as sexual and reproductive subjects. Furthermore there are significant ethical and privacy implications emerging from the use of these apps and the data they produce. The article ends with suggestions concerning ‘queering’ such technologies in response to these issues.

Update : This article has now been published – details here.

Thinking about the ethics and politics of public health campaigns

Over the past few years one of my research foci has been that of fat embodiment and obesity politics. This interest builds on my longstanding research on the sociocultural dimensions of health, medicine and public health, as well as the sociology of food and eating and the sociology of the body.

In July 2012 I wrote a piece for The Conversation critiquing a new Australian anti-obesity campaign, LiveLighter. The campaign included visual material and text that sought to evoke disgust (the ‘yuck factor’) about body fat in audiences. I argued in my piece that such strategies need to be examined for the ethical and moral issues they raise. Should health promotion campaigners be attempting to make people feel hatred and revulsion about their own bodies? To what extent are certain individuals and social groups identified by others as disgusting via such campaigns, and as a result subjected to social discrimination and stigma? How do such campaigns reproduce and exacerbate existing social disadvantage?

These questions have been addressed in several other publications of mine since then. In 2013 my book Fat appeared, in which I investigated the historical, social and cultural underpinnings of the disgust and revulsion that fat bodies tend to evoke in contemporary western culture. And I followed up my interest in public health campaigns and their use of strategies that attempt to arouse negative emotions such as disgust, shame and fear in two journal articles that were published recently.

One of these articles, published last week in Critical Public Health, builds on the piece I wrote for The Conversation by exploring the reasons why disgust is used in public health campaigns directed not only at obesity but also other issues, such as tobacco, excessive drinking and illicit drugs. It is entitled ‘The pedagogy of disgust: the ethical, moral and political implications of using disgust in public health campaigns’. Here is the abstract:

The developers of public health campaigns have often attempted to elicit disgust to persuade members of their target audiences to change their behaviour in the interests of their health. In this critical essay, I seek to problematise this taken-for-granted and unquestioned tactic. I assert that the pedagogy of disgust in public health campaigns has significant ethical, moral and political implications. In outlining my argument, the literature on the social, cultural and political elements of disgust is drawn upon. I also draw more specifically on scholarship demonstrating the ways in which disgust has operated in relation to health and medical issues to reinforce stigmatisation and discrimination against individuals and groups who are positioned as disgusting. It is concluded that advocates of using such tactics should be aware of the challenge they pose to human dignity and their perpetuation of the Self and Other binary opposition that reinforces negative attitudes towards already disadvantaged and marginalised individuals and social groups.

The other article was published last month in Fat Studies and is entitled ‘How do you measure up?’ Assumptions about ‘obesity’ and health-related behaviors and beliefs in two Australian ‘obesity’ prevention campaigns’. This article was based on research I undertook using documents reporting on the formative and evaluation research by market research companies that was undertaken for two other Australian anti-obesity campaigns: the ‘Measure Up’ and the ‘Swap It, Don’t Stop It’ campaigns. Analysing these types of documents provides an interesting insight into the mentalities and rationales that underpin their development on the part of public health authorities and the people they employ to develop the content and strategies of their social marketing efforts. This is the abstract:

This article presents an analysis of two related Australian government-sponsored ‘obesity’ prevention campaigns, including documents produced by commercial social research companies reporting the formative research and evaluation of these campaigns. This material is critically analyzed for its underlying assumptions about weight, ‘obesity’ and the public’s health-related behaviors and beliefs. These include the following: the concept of ‘good health’ has meaning and value that is universally shared; to be ‘overweight’ or ‘obese’ is to be physically unfit and at risk of higher levels of disease and early death; individuals are responsible for their own health status; individuals lack appropriate information about health risks and providing this information leads to behavior change; and information should be provided in a way that arouses concern and a belief that individuals should make a change. These assumptions are challenged from a critical sociological perspective.

Anyone who would like a copy of these articles can contact me on deborah.lupton@gmail.com.

The body-being-born: how women conceptualise and experience the moment of birth

Newborn child, seconds after birth. The umbili...

Newborn child, seconds after birth. The umbilical cord has not yet been cut. (Photo credit: Wikipedia)

Although there is a large body of literature about labour and childbirth in the social sciences, surprising few researchers have sought to investigate women’s experiences of the moment of birth.

Virginia Schmied and I recently published an article in the Sociology of Health & Illness that drew on interview data with Australian women who had recently given birth. We asked women to recount their birth stories to us, and the data that eventuated gave interesting insights into women’s perceptions and experiences of what we call ‘the body-being-born’. We use this term to refer to the foetus/infant, an ambiguous body at the moment of birth because it is not quite inside but not quite outside the maternal body. When inside the maternal body, this body is technically a foetus; once expelled from the maternal body, it is called an infant. But in the process of vaginal labour and birth itself, when the body-being-born is passing through the cervix, parts of this body (most commonly its head) slip inside and outside the maternal body, moving back and forth as the woman works to deliver the body.

This stage of labour, therefore, is a highly liminal one, involving the two-in-one foetal/maternal body in the process of individuating to become two separate bodies over a period of time.  Women who gave birth vaginally without anaesthetic often described this process as a ‘splitting’ of their bodies, a sensation of their bodies ‘opening to the world’ over which they had no control.

We found that most of the women we interviewed struggled to conceptualise this process, as it was so foreign to their embodied experiences. They also needed to take some time following the birth to come to terms with the idea that the foetus was now ‘my baby’: a body/self that was physically separate from their own, now foreign and strange as it was outside their bodies. As one of our interviewees put it:

The midwife handed her straight to me and I held her, but I had held her for a while, I just was — it was like looking at her and wondering ‘Where did this baby came from?’ You know, despite what I’d gone through, it was hard to associate that she was actually mine and she was out of my stomach … Even holding her for the first few minutes — just, it wasn’t like she was mine, my kid, which is weird …when you think of what you went through, it was really quite strange.

This is a time in which women have to deal physically and emotionally with the disrupted boundaries of their bodies, the significant distortion and opening that has occurred with the birth and the splitting of body/self. There is a sense of disbelief, of wonder that this amazing, unique and strange process has happened to them.

An important finding from our study was that women who had undergone a caesarean section had even greater difficulties coming to terms emotionally and conceptually with the notion that their infant was now separate from them; that they had, indeed, ‘had a baby’. Because they did not undergo the physical rigours and often intense pain of prolonged labour and the experience of actually expelling the body-being-born from their own bodies, and because their bodies were numbed to surgically deliver, women who had had a caesarean took longer to accept the fact that the infant was now out of their bodies. They talked about feeling alienated from their infants and struggling to come to terms that it was actually ‘my baby’. In the words of another of our interviewees:

It was very hard to think that she was my daughter after she was born, because I had a caesarean under general anaesthetic and all of a sudden I’m not pregnant any more. And I wake up a few hours later and you’re presented with a baby. You think, ‘Oh, why isn’t this, why aren’t I feeling any kicks in my abdomen anymore?’ — you know. And there’s the baby and it’s very hard to relate to it.

Virginia and I conclude our article by arguing that the circumstances in which women give birth are pivotal to how they experience the process of coming to terms with the body that was once inside them emerging to the outside. Our findings suggest that health professionals and attendants working with women in labour and childbirth need to allow not only for the physical and the emotional but also the ontological dimensions of how a woman experiences both her own body and that of the body-being-born, and the significant difference that undergoing a caesarean section can make to the woman being able to achieve the transition from two bodies in one to two separate bodies successfully.

Cashing in on patients’ experiences: the commodification of patient support and opinion websites

English: The PatientsLikeMe Profile of Stephen...

English: The PatientsLikeMe Profile of Stephen Heywood, brother of the co-founders of the company, who was diagnosed with ALS when he was 29 years old. This profile describes his experience with the disease including his functional rating scale, treatments, symptoms, breathing capacity, and weight. (Photo credit: Wikipedia)

As part of the digital health phenomenon, a plethora of interactive digital platforms have been established in recent years to elicit lay people’s experiences of illness, medical treatments and healthcare. These include such sites as PatientsLikeMe, Smart Patients, Health Unlocked, CarePages and Cure Together, as well as many condition-specific sites.

The function of these platforms, as expressed on the main pages of their websites, is to provide the tools and forums whereby patients and caregivers, and in cases medical practitioners, can share their experiences with others, benefit from the support and knowledge of other contributors, comment on healthcare providers and contribute to large aggregated data archives as part of developing better medical treatments and services and conducting medical research. However what may not always be readily apparent to the users of these platforms are the growing commercial uses by some of the platforms’ owners of the archives of the data they contribute.

I have just published a working paper (available here) in which I discuss what I term ‘the digital patient experience economy’. This term relates to patients’ online accounts and details of their medical conditions and their ratings and opinions of healthcare providers and institutions having become valued not only for the support and information they offer to other patients but also for the increasing commercial value they have for other actors. These data have become treated as another form of digital intellectual property, owned not by the patients themselves but by the companies that encourage patients to upload their experiences that accumulate in the data archives they own and over which they have control. While some of these platforms are not-for-profit and operate solely as forums for patients to interact with each other or to report their experiences with healthcare providers (for example, Patient Opinion), a growing number have been established by companies seeking to profit from the harvesting of these data and on-selling them to their clients.

Lay people’s experiences and opinions as they are expressed in digital media forums, with all the suffering, hope, despair, frustration, anger and joy that are often integral aspects of coping or living with a medical condition or surgical procedures, have become commercial properties for market exchange. They are not offered and nor do they receive financial compensation for providing their experiences. The value they derive is non-commercial, while the exchange value of the data they upload is accumulated by the for-profit companies that provide the platforms for patients to share their experiences or trawl the web to harvest the data and render it into a form that is valuable for commercial entities.

As I argue in the working paper, patients may benefit in many ways from the affective labour in which they engage as part of contributing to these websites. Research suggests that many patients appreciate the greater access to information about their conditions and the emotional support, opportunity to express themselves, feeling part of a community and greater sense of control over their illness that they may gain from their participation in such forums. They may further gain satisfaction from contributing to scientific research, the production of better understanding of their condition or the provision of facilities or improved healthcare that may benefit themselves or others with their condition.

However many contributors may not be aware of the ways in which the data they upload may be harvested for commercial purposes. The overt rhetoric of the for-profit platforms on their main pages emphasises patient support and the democratic sharing of data for the good of all. The information about how these data are monetised for the benefit of the platforms’ owners is often buried in ‘terms and conditions’ or ‘privacy policy’ pages that people who join as members may not bother to read or may not fully understand.

The use value of the data produced by contributors is restricted by the limits imposed by the platform they are using. Indeed it can be extremely difficult for people to retrieve for their own purposes the data they upload to patient experience platforms, enter as part of their electronic medical records or that are generated as part of their participation in clinical trials. Contributors’ efforts to collate their own small data aggregates may be frustrated in the face of the interests of commercialised big data: hence the recent development of the Small Data website, designed to assist them to gain access to their data.

We know little about to what extent the people who contribute to these sites are aware of how their data are used by third parties, commercially or otherwise; how they feel about this use if they are aware of it; how they experience the sites as users; and to what extent they may wish to gain access to their own data for their own purposes. I argue, therefore, that patients’ opinions and illness narratives may be expressed in more diverse and accessible forums than ever before, but simultaneously they have become exploited in novel ways in the era of digital health.

Living the quantified self: the realities of self-tracking for health

The end of 2012 and the dawning of a new year brought with it a multitude of news reports and blogs on the phenomenon of the quantified self or using self-tracking tools for health promoting purposes. Much hype has been generated around ‘digital health’ or ‘mHealth’ technologies, or mobile digital devices such as smartphones and wearable materials with embedded sensors that are able to connect to device apps or websites and download the data collected. These technologies include thousands of health-related apps for smartphones, tablet computers and iPods that can keep track of the user’s food and alcohol consumption, physical activity, body weight, ovulation cycle, stress levels, mood, sexual activity and many other physical functions and habits. It has been argued that by using such apps the smartphone can become a ‘”soulmate device” that knows your body better than you know it yourself’.

There are also an increasing number of specifically designed devices such as the Fitbit, Jawbone’s Up, Nike Fuelband and Zeo headband and various brands of adhesive patches that are available for self-tracking. All of these are designed to be worn upon the body to automatically collect data on bodily functions such as physical activity, pulse, heart rate, body temperature, calories burned and sleep patterns. Some can be worn 24 hours a day to provide constant readings of biometrics. Digital body weight scales, blood oxygen saturation monitors and blood pressure monitors that link to smartphones are also on the market. To motivate users, some devices include ‘gamification’ strategies. These use built-in reward or docking systems so that points or real money can be collected or paid if various commitments (to regular exercise or weight loss goals, for example) are either met or unmet, as well as websites where one’s metrics can be compared competitively against those uploaded by other users.

Nike+ FuelBand

Nike+ FuelBand (Photo credit: LoKan Sardari)

The combination of New Year resolutions season, predictions for digital innovation in 2013 and the reporting of the new technologies that were showcased at the 2013 Consumer Electronics Show in Las Vegas has contributed to the recent intensified focus on self-tracking for health reasons. Self-tracking mobile devices, apps and gadgets were reported as the new way of ensuring resolutions to lose weight or engage in more exercise would be accomplished (see here and here). They were frequently mentioned in lists of trends to watch in digital health technologies in 2013 (see here and here). Weird and wonderful devices such as self-tracking devices for dogs to wear to monitor their exercise levels, smartphones that could detect bad breath and other odours and a ‘smart fork’ embedded with sensors that could warn people they were eating too fast all received media attention in the early days of 2013.

I have written elsewhere about the ways in which self-tracking for health and the quantified self movement may be theorised sociologically, drawing attention to some of the ethical, moral and political issues (see here and here for previous blog posts on the topic and here for a lengthy academic article). Little academic research has yet been published on how people are taking up this approach to health promotion as part of their everyday lives. But accounts are beginning to appear in news stories and blog posts that have begun to explore the lived experience of self-tracking.

On the positive side, several self-trackers have reported that they feel more in control of their health using digital devices and have argued that there are many benefits to quantifying the self. Many people have discovered that tracking of their food intake and body weight has allowed them to achieve weight-loss goals. One success story is that of Dan Hon, who has type 2 diabetes and uses the Nike Fuelband and the Fitbit to monitor his physical activity levels as well as a digital blood glucose meter and weight scales. He reported that the combination of these technologies had allowed him to reduce his blood sugar levels to normal and that he had ‘healed myself through data’ (see here for his story). Another user experiencing problems with sleep used a Zeo headband to track his sleep patterns and experimented with taking magnesium supplements, giving up caffeine and changing the lighting in his room to see which of these factors affected his sleep. Using the data downloaded from the headband he eventually worked out how to best achieve a good night’s sleep. Other people with a diverse range of health problems have used self-tracking devices to monitor medical treatments for acute diseases or chronic conditions, evaluate the moods created by eating certain foods, track their alcohol consumption  and many more aspects of their bodily functions, health and illness states. Patients have also been able to ‘crowdsource’ the data they have collected on websites such as PatientsLikeMe and CureTogether, allowing the massing of data for a better understanding of what treatments are effective (see here and here for overviews).

Image representing PatientsLikeMe as depicted ...

Image via CrunchBase

Also beginning to emerge are accounts by people who have tried self-tracking for health reasons but have become disenchanted with the practice. As these stories demonstrate, the realities of quantifying the self do not always meet expectations. The devices do not share data with each other, so it is impossible to track different activities using more than one device and then produce statistics that combine the data collected. Some users find them inconvenient or uncomfortable to wear. Some people quickly become bored with the effort involved in self-tracking. It has been reported that the devices are often not compatible with some types of smartphones.

Other users who have tried self-tracking for health have suggested that the intense focus on the body that these devices encourage may place too much pressure on oneself, leading to feelings of failure and self-hatred. It has been argued that intense self-tracking may cause ‘cyberchondria’, leading to people becoming unduly anxious about their health state based on the data they collect. Devices may be used by people such as anorexics to facilitate health-destructive behaviours by engaging in too much obsessive self-tracking. Activities such as walking may become viewed through the lens of the self-tracking device rather than for the other pleasures they may bring, as one commentator wrote of his experiences using a Fitbit while visiting Paris. As he noted, ‘the data mind is hard to shake’, even while immersed in the sights and sounds of one of the most celebrated cities in the world.

Privacy issues are a concern as more and more data are collected by self-trackers. The manufacturers of self-tracking devices are beginning to approach workplaces as a site for encouraging people to use them and compete against each other. There are concerns that people may feel pressured into using them to meet employers’ expectations and that employers may use the data. Other critics have questioned what may happen if health insurance companies begin to expect their clients to use the devices if they wish to avoid higher premiums (see here for an account of these issues). The quality and efficacy of health apps and their potential for harming rather than promoting users’ health have also been questioned, given that they are currently not regulated (see here).

Using digital devices to self-track for health reasons is a very new phenomenon. While stories such as those referred to above are beginning to identify both positive and negative dimensions, it is a practice that still requires much more investigation and analysis in the face of all the hype.

July 2012 on ‘This Sociological Life’

Part of this month was devoted to writing my three-part series on digital sociology. The first two of these posts: ‘Digital sociology 1: what is it?’ and ‘Digital sociology 2: professional digital practice‘ were republished on the LSE Impact of the Social Sciences blog. I have been working on collecting these posts, along with some other writings on using social media in academia, into a document that I will publish electronically next month, entitled Digital Sociology: An Introduction (watch this space for news on when the document will become available).

I also published two Storify presentations this month. One looked at the homage to British medicine and the NHS in the Olympics Opening Ceremony (including reactions on social media) (it can be viewed here). The other Storify presentation summarised the proceedings of a forum on the Social Determinants of Health that I helped to organise at the University of Sydney (see it here).

My piece on disgust in anti-obesity campaigns appeared in The Conversation. I am continuing to write about how disgust is used in public health campaigns for a journal article. I have been collecting examples of public health campaign materials on a Pinterest board as part of this research: the collection can be seen here.

This month I also finally completed the second revised edition of my book Risk (first published by Routledge in 1999) and sent it off to the publishers. One of my blog posts this month drew on one of the aspects I cover in the book: risk, concepts of space and place and the Other.

My article ‘M-health and health promotion: the digital cyborg and surveillance society’ was published in Social Theory & Health this month (see here for details).

New book: (Re)thinking Violence in Health Care Settings

This comprehensive volume explores various forms of violence in health care settings. Using a broad range of critical approaches in the field of anthropology, cultural studies, gender studies, political philosophy and sociology, it examines violence following three definite yet interrelated streams: institutional and managerial violence against health care workers or patients; horizontal violence amongst health care providers and finally, patients’ violence towards health care providers. Drawing together the latest research from Australia, Canada, the UK, and the US, (Re)Thinking Violence in Health Care Settings engages with the work of critical theorists such as Bourdieu, Butler, Foucault, Latour, and Žižek, amongst others, to address the issue of violence and theorise its workings in creative and controversial ways.  As such, it will be of interest to sociologists and anthropologists with research expertise in health, medicine, violence and organisations, as well as to health care professionals.

  • Contents:   Foreword, Dave Holmes; Introduction: (re)thinking violence in health care settings, Dave Holmes, Trudy Rudge, Amélie Perron and Isabelle St-Pierre; Part I Institutional and Managerial Violence: A critical reflection on the use of behaviour modification programs in forensic psychiatry settings, Dave Holmes and Stuart J. Murray; The violence of tolerance in a multicultural workplace: examples from nursing, Trudy Rudge, Virginia Mapedzahama, Sandra West and Amélie Perron; Changing discourses of blame in nursing and healthcare, Hannah Cooke; Hospital policies regarding violence in the workplace: a discourse analysis, Penny Powers; Exploring violence in a forensic hospital: a theoretical experimentation, Amélie Perron and Trudy Rudge; Nurses’ failure to report elder abuse in long-term care: an exploratory study, Gloria Hamel-Lauzon and Sylvie Lauzon. Part II Horizontal Violence: Foucault and the nexus between violence and power: the context of intra/inter professional aggression, Isabelle St-Pierre; Examining nurse-to-nurse horizontal violence and nurse-to-student vertical violence through the lens of phenomenology, Sandra P. Thomas; The rise of violence in HIV/AIDS prevention campaigns: a critical discourse analysis, Marilou Gagnon and Jean Daniel Jacob; Bullying in the workplace: a qualitative study of newly licensed registered nurses, Shellie Simons and Barbara Mawn; Sexual health nursing assessments: examining the violence of intimate exposures, Patrick O’Byrne and Cory Woodyatt; Bullying on the back-channels: everyday interpersonal communicative relations in telephone talk as a space for covert forms of professional manipulation, Jackie Cook and Colette Snowden. Part III Patients’ Violence: Assessment of risk and special observations in mental health practice: a comparison of forensic and non-forensic settings, Elizabeth Mason-Whitehead and Tom Mason; Policing pornography in high-secure care: the discursive construction of gendered inequality, David Mercer; Warning – this job contains strong language and adult themes: do nurses require thick skins and broad shoulders to deal with encounters involving swearing?, Teresa Stone and Margaret McMillan; Prison nursing: managing the threats to caring, Elizabeth Walsh; The mentally ill and civil commitment: assessing dangerousness in law and psychiatry, Cary Federman; Working in a violent environment: the pitfall of integrating security imperatives into forensic psychiatry nursing, Jean Daniel Jacob; Index.

About the Editor:  Dave Holmes is Professor and University Research Chair in Forensic Nursing, School of Nursing, Faculty of Health Sciences, University of Ottawa, Canada and co-editor of both Critical Interventions in the Ethics of Healthcare and Abjectly Boundless: Boundaries, Bodies and Health Work. Trudy Rudge is Professor at Sydney Nursing School, University of Sydney, Australia, and co-editor of Abjectly Boundless: Boundaries, Bodies and Health Work. Amélie Perron is Assistant Professor, School of Nursing, Faculty of Health Sciences, University of Ottawa, Canada.

New book: Medicine as Culture: Illness, Disease and the Body

Medicine as Culture: Illness, Disease and the Body is unlike any other sociological text on health and medicine. It combines perspectives drawn from a wide variety of disciplines including sociology, anthropology, social history, cultural geography, and media and cultural studies. The book explores the ways in which medicine and health care are sociocultural constructions, ranging from popular media and elite cultural representations of illness to the power dynamics of the doctor-patient relationship.

The Third Edition has been updated to cover new areas of interest, including:

– studies of space and place in relation to the body

– actor-network theory as it is applied in research related to medicine

– The internet and social media and how they contribute to lay health knowledge and patient support

– complementary and alternative medicine

– obesity and fat politics.

Contextualising introductions and discussion points in every chapter makes Medicine as Culture, Third Edition a rigorous yet accessible text for students.

SAGE: Medicine as Culture: Illness, Disease and the Body: Third Edition: Deborah Lupton: 9781446208953.