‘You Owe It to Yourself, Everyone You Love and to Our Beleaguered NHS to Get Yourself Fit and Well’: Weight Stigma in the British Media during the COVID-19 Pandemic—A Thematic Analysis

The portrayal of obesity in the media can impact public health by guiding peoples’ behaviours and furthering stigma. Individual responsibility for body weight along with negative portrayals of obesity have frequently dominated UK media discourses on obesity. This study aims to explore how the media has represented obesity during the COVID-19 pandemic through a thematic analysis of 95 UK online newspaper articles published in The Sun, The Mail Online, and The Guardian. The first theme, lifestyle recommendations, accounts for media coverage providing ‘expert’ advice on losing weight. The second theme, individual responsibility, emphasises media appeals to self-governance to tackle obesity and protect the NHS during the pandemic. The third theme, actors of change, explores how celebrities and politicians are presented as examples of weight management. These results suggest that individuals are held responsible for their weight and accountable for protecting the NHS during the COVID-19 pandemic. Stigma can be furthered by the decontextualisation of lifestyle recommendations and exacerbated by the actors of change presented: Celebrity profiles reveal gendered goals for weight management, and politicians exemplify self-governance, which consolidates their power. In conclusion, individualising and stigmatising discourses around obesity have taken new forms during the pandemic that link health responsibility to protecting the NHS and invokes celebrities and politicians to foster action.

Opportunistic cognitive screening in Sweden: What the tests mean and do for patients and healthcare professionals

Since 2017, opportunistic screening for cognitive impairment takes place at the geriatric ward of a local hospital in Sweden. Persons above the age of 65 who are admitted to the ward, who have not been tested for cognitive impairment during the last six months nor have a previously known cognitive impairment, are offered the Mini-Mental State Examination and the Clock-Drawing Test. This article analyses what the opportunistic screening practice means for patients and healthcare professionals. It combines a phenomenologically-oriented focus on subjectivity and sense-making with a focus that is inspired by science and technology studies on what the tests become within the specific context in which they are used, which allows a dual focus on subjectivity and performativity. The article shows how the tests become several different, not infrequently seemingly contradictory, things: an offer, an important tool for knowledge-production, something unproblematic yet also emotionally troubling, something one can fail and an indicator that one belongs to a risk group and needs to be tested. Further, the article shows how the practice is shaped by the sociocultural context. It examines the role of the affective responses to the test for subjectivity – particularly patient subjectivity – and offers a set of recommendations, if this practice were to expand to other hospitals.

"We at least say we are equal": Gender equality and class in healthcare professionals' discursive framing of migrant mothers

In the last few decades, the demography of Iceland has become increasingly diverse with an immigrant population similar to that of the other Nordic countries. Women comprise almost half of all international migrants and many of those female migrants require maternity care in their host countries. While some literature describes how migrant women experience the healthcare provisions of their host countries, less is known about the experience of providing the service, from the perspective of the healthcare practitioners. In this study we adopt a social constructionist perspective to explore the discourses of knowledge healthcare professionals in Iceland draw on in their discussion of prenatal and postpartum healthcare in Iceland. Interviews were conducted with 16 healthcare professionals with extensive experience of providing maternity care to migrant women to understand how they construct and make sense of the needs and behaviour of migrant women seeking maternity care. Our findings suggest that some healthcare professionals subject migrant women to normative professional discourses of parenting, without considering how those ideals are tailored to white, middle class women. Migrant mothers and pregnant women are thus excluded from the middle-class mothering norms that are ascribed to Icelandic women. Our findings also highlight how national identity, such as being part of a gender equal society and the image of Iceland as a classless society, influences how healthcare professionals view migrant women. This underscores the importance of cultural reflexivity, and policies and scholarship where an intersectional understanding of gender, class and migrant worker status is at the forefront.

Sexuality, risk, and organisational misbehaviour in a secure mental healthcare facility in England

Sexuality in secure mental healthcare has been overlooked in both clinical praxis and academic research. In the UK, there exist no formal policies to inform staff approaches to managing inpatient sexuality. The limited research that has been undertaken in this field has found that often, prohibitive approaches are favoured, which may affect how inpatients conceptualise and experience their sexuality in the long-term. The aim of this study was to identify discursive constructions of inpatient sexuality, as articulated in semi-structured group interviews with inpatients and ward staff from a secure mental healthcare facility in England. The analysis identified constructions of inpatient sexuality within two overarching and conflicting discourses: one of the normalcy and legitimacy of sexual expression in human experience; and the other of risk, wherein sexuality needed to be regulated and obstructed. Inpatients' expressions of sexuality could often only be conceptualised in terms of 'organisational misbehaviour', acts that violated the implicit norms and codes of the institution. It is suggested that recoding inpatient sexuality as misbehaviour could have implications for inpatients' long-term recovery.

'It's Always About the Eating Disorder': Finding the Person Through Recovery-Oriented Practice for Bulimia

Bulimia is an eating disorder characterised primarily by binging and 'inappropriate' compensatory behaviours, such as purging or excessive exercise. Many individuals with bulimia experience chronic disordered eating, dissatisfaction with treatment, and difficulty establishing a 'new life'. Recovery-oriented practice, which focuses holistically on the person and their own aspirations for treatment, has recently been advocated in the treatment of eating disorders in Australia and other countries. However, questions have been raised about how this practice might be integrated into existing treatment approaches. Taking a social constructionist approach and using a case study of one woman's account, together with literature on patients' treatment experiences, we examined recovery from bulimia. Three themes were identified: bulimia was constructed as 'consuming one's life', an experience protracted through treatment ('treatment and becoming the eating disorder'), which makes life 'beyond treatment and attempting to live without bulimia' challenging. Based on this analysis, we argue that recovery-oriented practice, while seemingly commensurate with patients' needs, may be challenged by long-standing meanings of mental illness and experience of bulimia specifically.

"It Takes a Man to Put Me on the Bottom": Gay Men's Experiences of Masculinity and Anal Intercourse

In anal intercourse between gay men, men who are typically insertive ("tops") are often perceived as, and may identify as, more masculine than those who are typically receptive ("bottoms"). "Versatile" men, who may adopt either position, may be perceived as more gender balanced and may transcend the gender-role stereotypes associated with self-labeling as top or bottom. The aim of this study was to explore how gay men's beliefs about masculinity were associated with their beliefs about the gendered nature of sexual self-labels and their behavior in anal intercourse. Individual semistructured interviews were undertaken with 17 UK-based gay men. Interpretative phenomenological analysis (IPA) identified that perceptions of tops and bottoms as gendered social identities varied depending on the extent to which gay men subscribed to the mandates of hegemonic masculinity, the dominant masculinity in Western society. The findings also suggested that some gay men differentiated between top and bottom as social identities and topping and bottoming as gendered behaviors. This had implications for gay men's behaviors in anal intercourse. It is suggested that future efforts to engage with gay men about their sexual behavior should account for their beliefs regarding the gender-role stereotypes associated with gay sexual self-labels.

Young Australian women's accounts of smoking and quitting: a qualitative study using visual methods

Background

Although the overall rate of smoking in Australia continues to decline, the rate of decline has begun to slow. Rates of smoking among young women in Australia have been a particular concern, which has led to the development of targeted public health campaigns. Poststructuralist theory has successfully been used in research to explore the way in which young women experience smoking. However, there is an absence of poststructuralist analysis of young women’s experiences of quitting. This study aims to address this gap.

Methods

We carried out 27 interviews with young Australian women smokers and ex-smokers. Eighteen of those women then participated in a photography activity and follow-up interviews. A Foucauldian discourse analysis of the data was conducted.

Results

Through our analysis, we identified three discourses: ‘The irresponsibility of smoking: Quitting as responsible’, ‘The difficulties of quitting: Smoking as addictive’, and ‘Making a decision to quit: Smoking as a choice’. In relation to these discourses, participants took up contradictory positions of responsibility and resistance, addiction and agency. Taking up these positions had implications for young women’s subjectivity, and the way they engaged with tobacco controls and cessation support.

Conclusions

The analysis highlights the complex and contradictory nature of young women’s experiences with smoking and quitting. The study’s findings are considered in relation to the improvement of tobacco control policies and cessation support programmes targeted at young women.

The happiness imperative: Exploring how women narrate depression and anxiety during pregnancy

This article explores how women account for their experiences of pregnancy distress in light of cultural imperatives to be the perfect, happy mother. Our analysis is based on the accounts of 18 Australian women, interviewed during pregnancy on the basis of their reports of experiencing depression and/or anxiety. Working within a feminist discursive framework, we focus on the discourses that informed (and threatened) women’s positions as a good mother. In particular, we focus on the discourses women relied on to explain their distress and the discursive strategies they used in the construction of their (“distressed”) maternal identity(ies). We ask how women articulate and label distress, and with what rhetorical effects. Our analysis explores how women’s experiences of negative moods and distress were in direct opposition to cultural imperatives for mothers to stay happy and positive during pregnancy and beyond, posing rhetorical challenges to women’s accounts and hence their capacity to make meaning of their (negative) experiences. Three discursive strategies are explored: distancing from the depressed self, speaking between/around/without words, and in search of a balance. We close by considering the implications of the complex ways in which women account for idealised motherhood and how this serves to oppress vulnerable women.

Talking about sunbed tanning in online discussion forums: Assertions and arguments

OBJECTIVE

There is increasing evidence of both health and appearance risks associated with sunbed use. At the same time, the sunbed industry promotes the benefits of using sunbeds, and the image of a tanned skin as attractive and healthy arguably remains embedded within contemporary western culture. These tensions are played out in everyday conversations, and this paper reports a study which explored how sunbed users manage them within online discussion forums.

DESIGN

A total of 556 posts from 13 sunbed-related threads, taken from six different UK-based online forums, were analysed thematically followed by techniques from discourse analysis.

MAIN OUTCOME MEASURES

Informed by social representations theory and discursive-rhetorical psychology, the way social representations of sunbed use are constructed, debated and disputed in online discussion forums were explored.

RESULTS

Sunbed users drew upon numerous representations to distance and protect themselves from negativity they were confronted with in the forums, utilising a range of rhetorical, discursive strategies to help them.

CONCLUSION

Theoretical contributions and potential practical implications of the findings are discussed. Findings indicate, for example, that those working on campaigns and interventions in this area need to consider the wider negativity and argumentative orientation of sunbed users' responses.

Provider ambivalence about using forensic medical evaluation to respond to child abuse: A content and discourse analysis

Forensic medical evaluation rates for child abuse victims in Texas are low relative to national rates. In exploring reasons, researchers collected quantitative and qualitative interview and focus group data from multidisciplinary child abuse response team members across the state. This paper presents results of a secondary analysis of (N=19) health care providers' interview and focus group transcripts, looking specifically at experiences with conducting forensic evaluations - thoughts, struggles, and ethical issues. The analysis was conducted from a critical realist perspective using content and discourse analysis. A theme of ambivalence was identified and explored. Three discursive themes were identified: ambivalence about the legal role, the health care role, and about unintended outcomes of evaluations. Extra-discursive elements related to the physical body, resource distribution, and funding policy were examined for their interaction with discursive patterns. Implications of findings include addressing issues in the current approach to responding to child abuse (e.g., uniting around common definitions of abuse; refining parameters for when FME is helpful; shoring up material resources for the abuse response infrastructure) and considering modification of providers' roles and activities relative to forensic work (e.g., deploying providers for prevention activities versus reactive activities).

More Than Just a Break from Treatment: How Substance Use Disorder Patients Experience the Stable Environment in Horse-Assisted Therapy

Inclusion of horse-assisted therapy (HAT) in substance use disorder (SUD) treatment is rarely reported. Our previous studies show improved treatment retention and the importance of the patient–horse relationship. This qualitative study used thematic analysis, within a social constructionist framework, to explore how eight patients experienced contextual aspects of HAT’s contribution to their SUD treatment. Participants described HAT as a “break from usual treatment”. However, four interrelated aspects of this experience, namely “change of focus”, “activity”, “identity”, and “motivation,” suggest HAT is more than just a break from usual SUD treatment. The stable environment is portrayed as a context where participants could construct a positive self: one which is useful, responsible, and accepted; more fundamentally, a different self from the “patient/self” receiving treatment for a problem. The implications extend well beyond animal-assisted or other adjunct therapies. Their relevance to broader SUD policy and treatment practices warrants further study.

Taking a hard look at the Heart Truth campaign in Canada: A discourse analysis

The Canadian Heart and Stroke Foundation launched the Heart Truth campaign to increase women’s awareness of heart disease. However, little is known about how such campaigns intersect with broader understandings of gender and health. This discourse analysis examined the construction of gender, risk, and prevention within campaign material. Two primary discourses emerged: one of acceptable femininity, which outlines whose risk, survivorship, and prevention matters, and another of selfless prevention. Women of diverse ethnic, sexual, and socio-economic background were largely absent. Prevention was portrayed as a personal choice, eclipsing conversations about social determinants of health and the socio-political context of heart disease.

Critical Realism in Discourse Analysis

In critical realism, language is understood as constructing our social realities. However, these constructions are theorized as being shaped by the possibilities and constraints inherent in the material world. For critical realists, material practices are given an ontological status that is independent of, but in relation with, discursive practices. The advantage in taking a critical realist, rather than relativist, approach is that analysis can include relationships between people's material conditions and discursive practices. Despite calls to develop a critical realist discourse analysis there has been little empirical critical realist work, possibly because few have addressed the critique that critical realists have no systematic method of distinguishing between discursive and non-discursive. In this article we outline a three-stage procedure that enables a systematic critical realist discourse analysis using women's talk of motherhood, childcare and female employment as an example.

Why We Should Watch What We Say

This paper develops the use of the concept of positioning as a way of thinking about and analysing the production of relational subjectivity. It discusses some practical implications for both the analysis and production of human subjectivity and relationship in conversation that arise from taking a thorough-going social constructionist stance. Examples from everyday speech are used to discuss the importance of enabling the taking up of agentive positions in the narratives of our own lives, and how these opportunities may be offered through different ‘position calls’. It is suggested that this conceptual tool is useful not only for understanding everyday conversations, but also for understanding personal experiences of exclusions from social interactions. Such considerations arise from a specific focus on therapy, but it is argued that if we are interested in enhancing possibilities for egalitarian relationships and multi-voiced dialogical interaction, it is important to notice the impact of speech action, whether in therapy, in everyday conversation, or in the practices of academic psychology.

Understanding the health of lorry drivers in context: A critical discourse analysis

This article moves beyond previous attempts to understand health problems in the lives of professional lorry drivers by placing the study of drivers' health in a wider social and cultural context. A combination of methods including focus groups, interviews and observations were used to collect data from a group of 24 lorry drivers working at a large transport company in the United Kingdom. Employing a critical discourse analysis, we identified the dominant discourses and subject positions shaping the formation of drivers' health and lifestyle choices. This analysis was systematically combined with an exploration of the gendered ways in which an almost exclusively male workforce talked about health. Findings revealed that drivers were constituted within a neoliberal economic discourse, which is reflective of the broader social structure, and which partly restricted drivers' opportunities for healthy living. Concurrently, drivers adopted the subject position of 'average man' as a way of defending their personal and masculine status in regards to health and to justify jettisoning approaches to healthy living that were deemed too extreme or irrational in the face of the constraints of their working lives. Suggestions for driver health promotion include refocusing on the social and cultural - rather than individual - underpinnings of driver health issues and a move away from moralistic approaches to health promotion.

Pain as Symptom, Pain as Sign

This article proposes a theoretical contribution to critical health psychology. Charles Sanders Peirce’s semiotics provide health psychology and related fields with an analytic that centers interest at the intersection where the co-constitution of reified categories occurs. I begin with the terms symptom and sign as used in medical contexts. Symptoms and signs can be reinterpreted, drawing on the Heideggerian notion of ‘attunement’, and upon Peirce’s semiotics. Next, I present Peirce’s concept of sign, with its triadic structure of object-representamen-interpretant. An understanding of pain as a sign in this sense is developed on this basis. The value of Peircian semiotics for a critical health psychology is illustrated with some examples drawn from a qualitative study. Pain is not only something of concern and the bearer of meanings, but a way of interpreting one’s situation. This semiotics of pain furthers the project, common to phenomenological and discursive approaches in health psychology and related fields, of studying the upsurge of meaning in speech and in other acts that co-constitute it.

‘Healthy Weight’ at What Cost? ‘Bulimia’ and a Discourse of Weight Control

Public health messages emphasizing ‘healthy weight’ link good health to a narrow range of body weights and stress energy regulation to achieve this. We examined whether women who practise bulimia deploy notions of ‘healthy weight’ in their talk about body management activities. Analysis is based on interviews with 15 women who practise bulimia and on material collected from cultural locations containing ‘health promotion’ advice. Poststructuralist discourse analysis revealed that slenderness was constituted as healthy in both sites and that the careful regulation of energy intake and output was similarly reified as a healthy practice. We conclude that a discourse of ‘healthy weight’ cannot be unhinged from a cultural imperative of slenderness for women, and that paradoxically ‘health’ practices provide a rationality that supports the practices of binge eating and compensating.

Accounts of Quitting among Older Ex-smokers with Smoking-related Disease

This article uses a discourse analytic method to explore how a sample of ex-smokers with smoking-related illness position themselves, and are positioned by, the language they use in their accounts of quitting. The article suggests that discursive constructions (having ‘no choice’ and getting ‘another chance’) used by the respondents position them in a way that constrains behaviour by closing down the option of smoking and/or opening up the possibility of change. In each telling, the respondents' (non-smoking) identities are confirmed anew and this affirmation may assist in sustaining the change and provide protection against relapse. Moreover, the article suggests that the development and exchange of these stories may contribute to the growth of shared beliefs about the experience of quitting, opening up the option of quitting for current smokers. In so doing, accounts of quitting provided by ex-smokers undermine or resist dominant social understandings that even among those highly motivated to stop smoking, quitting is a difficult, if not impossible, endeavour.

"I am a waste of breath, of space, of time": metaphors of self in a pro-anorexia group

According to recent research on eating disorders, heavy users of pro-anorexia (pro-ana) sites show higher levels of disordered eating and more severe impairment of quality of life than non-heavy users. A better understanding of how pro-ana members self-present in the virtual world could shed some light on these offline behaviors. Through discourse analysis, I examined the metaphors the members of a pro-ana group invoked in their personal profiles on a popular social networking site, to talk about the self. I applied the Metaphor Identification Procedure to 757 text profiles. I identified four key metaphorical constructions in pro-ana members' self-descriptions: self as space, self as weight, perfecting the self, and the social self. These four main metaphors represented discourse strategies, both to create a collective pro-ana identity and to enact an individual identity as pro-ana. In this article, I discuss the implications of these findings for the treatment of eating disorders.

Dangerous agent or saviour? HPV vaccine representations on online discussion forums in Romania

PURPOSE

Whereas Romanian health officials have launched two national human papillomavirus (HPV) vaccination campaigns, the uptake rate remained insignificant. Understanding local perceptions of the vaccine is necessary, as they could inform future educational programmes. Given that social media provide new opportunities to communicate about vaccination, this paper sought to explore the public's constructions of the HPV vaccine as they were expressed on Internet discussion forums.

METHODS

Twenty discussion forums, with a total sample size of 2,240 comments (2007-2012), were included. We conducted a thematic analysis with a focus on language, informed by a discourse analytic approach.

RESULTS

Positive discourses relying on evidence-based arguments or cancer-related experiences battled with negative discourses that focused mostly on pseudo-scientific information and affect-based testimonials. Both camps made use of appeals to authority in order to provide powerful messages. Critics expressed high levels of mistrust in the health system and perceived the vaccine as dangerous, as part of a conspiracy, as unnecessary or as a promoter of promiscuity. By contrast, supporters considered the HPV vaccine to be helpful and criticized the irrationality of opponents. Ambivalence and uncertainty also emerged, along with criticism toward the suboptimal organization of the vaccination programmes. Findings highlight ways in which views about the vaccine are embedded in broader perspectives about science, the national medical system, society development and economic inequality.

CONCLUSION

Online posts are likely to elicit fear and doubts around vaccination, which in turn may impair decisions. Findings indicate that targeted education campaigns are needed in order to address public concerns about vaccination.

Uncontrollable behavior or mental illness? Exploring constructions of bulimia using Q methodology

BACKGROUND

In medical and psychological literature bulimia is commonly described as a mental illness. However, from a social constructionist perspective the meaning of bulimia will always be socially and historically situated and multiple. Thus, there is always the possibility for other understandings or constructions of bulimia to circulate in our culture, with each having distinct real-world implications for those engaging in bulimic behaviors; for instance, they might potentially influence likelihood of help-seeking and the success of treatment. This study used Q methodology to explore culturally-available constructions of bulimia nervosa.

METHODS

Seventy-seven adults with varying experience of eating disorders took part in this Q methodological study. Online, they were asked to rank-order 42 statements about bulimia, and then answer a series of questions about the task and their knowledge of bulimia. A by-person factor analysis was then conducted, with factors extracted using the centroid technique and a varimax rotation.

RESULTS

Six factors satisfied selection criteria and were subsequently interpreted. Factor A, "bulimia as uncontrolled behavior", positions bulimia as a behavioral rather than psychological issue. Factor B, entitled "bulimia is a distressing mental illness", reflects an understanding of bulimic behaviors as a dysfunctional coping mechanism, which is often found in psychological literature. Other perspectives position bulimia as about "self-medicating with food" (Factor C), "the pathological pursuit of thinness" (Factor D), "being the best at being thin" (Factor E), or as "extreme behavior vs. mentally ill" (Factor F). These constructions have distinct implications for the subjective experience and behavior of those engaged in bulimic behaviors, with some constructions possibly being more useful in terms of help-seeking (Factor B), while others position these individuals in ways that may be distressing, for instance as shallow (Factor D) or to blame (Factor E).

CONCLUSIONS

This study has identified a range of distinct constructions of bulimia. These constructions are considered to have implications for the behaviors and experiences of those engaging in bulimic behaviors. As such, further research into constructions of bulimia may illuminate factors that influence help-seeking and the self-perceptions of such individuals.

Efforts to maintain a ‘just great’ story: Lesbian parents’ talk about encounters with professionals in fertility clinics and maternal and child healthcare services

After lesbian couples have decided to become parents, their family-making journey entails a wide range of encounters with professionals in fertility clinics and/or in maternal and child healthcare services. The article presents the results of an analysis of 96 lesbian mothers’ interview talk about such encounters. In their stories and accounts, the interviewees draw on two separate and contradictory interpretative repertoires, the ‘just great’ repertoire and the ‘heteronormative issues’ repertoire. Throughout the interviews, the ‘just great’ repertoire strongly predominates, while the ‘heteronormative issues’ repertoire is rhetorically minimized. The recurrent accounts of health services as ‘just great’, and the mitigation of problems, are meaningful in relation to a broader discursive context. In a society where different-sex parents are the norm, the credibility of other kinds of parenthood is at stake. The ‘just great’ repertoire has a normalizing function for lesbian mothers, while the ‘heteronormative issues’ repertoire resists normative demands for adaptation.

'It should be the most natural thing in the world': exploring first-time mothers' breastfeeding difficulties in the UK using audio-diaries and interviews

Breastfeeding is a practice which is promoted and scrutinized in the UK and internationally. In this paper, we use interpretative phenomenological analysis to explore the experiences of eight British first-time mothers who struggled with breastfeeding in the early post-partum period. Participants kept audio-diary accounts of their infant feeding experiences across a 7-day period immediately following the birth of their infant and took part in related semi-structured interviews a few days after completion of the diary. The overarching theme identified was of a tension between the participants' lived, embodied experience of struggling to breastfeed and the cultural construction of breastfeeding as 'natural' and trouble-free. Participants reported particular difficulties interpreting the pain they experienced during feeds and their emerging maternal identities were threatened, often fluctuating considerably from feed to feed. We discuss some of the implications for breastfeeding promotion and argue for greater awareness and understanding of breastfeeding difficulties so that breastfeeding women are less likely to interpret these as a personal shortcoming in a manner which disempowers them. We also advocate the need to address proximal and distal influences around the breastfeeding dyad and, in particular, to consider the broader cultural context in the UK where breastfeeding is routinely promoted yet often constructed as a shameful act if performed in the public arena.

'Oh, I'm just, you know, a little bit weak because I'm going to the doctor's': young men's talk of self-referral to primary healthcare services

Young men visit their general practitioner (GP) less frequently than young women and tend to utilise primary healthcare services reluctantly. This research aimed to explore the ways young men used their talk to make sense of their own masculinity in the context of their healthcare visits, and to explore the ways they used their talk to make sense of those visits in terms of multiple masculinities and gendered behaviours. This was an important area for research as previous work has not focused on young men. Interviews, lasting approximately 1 h, were conducted by a male researcher with seven men aged 22-33. Questions related to visiting the GP, attention to healthcare and help-seeking behaviours. These were analysed, using an eclectic approach informed by Foucauldian discourse analysis and discursive psychology. Participants subscribed to a hegemonic masculinity that constructed men as strong, stoical and reluctant to seek help. However, at times, these men negotiated and disengaged from such discourses. Women were constructed as immediately responding to symptoms and seeking help for minor illnesses. In contrast to traditional masculinity, the young men drew upon discourses of vulnerability and embarrassment. These results are discussed in relation to their implications for Health Psychology.

'That's OK. He's a guy': a mixed-methods study of gender double-standards for alcohol use

Although drinking and drunkenness have traditionally been considered masculine behaviours, young women's alcohol consumption has increased in recent years. This mixed methods study was conducted to examine the extent to which young people endorse gender double-standards for alcohol use--i.e., less acceptance of drinking and drunkenness in women than men--and how these influence men's and women's alcohol consumption. A sample of 731 English university students completed an online survey of gender role attitudes, beliefs about the gendered nature of alcohol use and recent alcohol consumption. Sixteen participants were then purposively selected for individual interviews: eight women and men with the most egalitarian gender role beliefs, and eight women and men with the least egalitarian beliefs. The two sets of data revealed that although there were few sex differences in actual levels of drinking or drunkenness, gender double-standards for alcohol use persist: beer drinking, binge drinking and public drunkenness tended to be perceived as masculine, and even the most egalitarian respondents were more judgemental of women's drinking. Participants modified their drinking style so as to maintain a desired gender identity. Although gender double-standards could be a focus of interventions to encourage moderate drinking, such approaches could reinforce gender inequalities.

Shifts in subjectivity during the therapy for psychosis

OBJECTIVES

This paper examines the process of therapy with families in which a member has a diagnosis of psychosis. On a methodological level, the study aims to demonstrate the usefulness of discourse analysis as a method for analysing texts produced in therapy in the context of process research. On a clinical and theoretical level, it aims to contribute to the literature that approaches psychosis and its treatment from the viewpoint of narrative and discourse.

DESIGN

Several contemporary conceptualizations emphasize the role of discursive processes, such as a collapse of meaning and narrative and an alienation from shared communicative practices, in psychosis. Drawing from this perspective, discourse analysis was used on family therapy session transcripts to empirically examine these processes. Moreover, given that in different conceptualizations psychosis is seen to entail a profound disturbance to the person's sense of self, the analysis focuses more specifically on the identified patients' subjectivity.

METHODS

Seven sessions were analysed, drawn from the beginning, middle, and end phases of two therapies with families with a member with a diagnosis of psychosis. Discourse analysis was used and the analysis focused on the transformation of meaning and more specifically on shifts in the subject positions occupied by the identified patient in the clinical dialogue.

RESULTS

With regards to the identified patients' subjectivity, the analysis suggests that (a) psychosis was associated with the 'patient' being rigidly positioned exclusively through the psychiatric discourse in the first case and the lack of a voice in the second, and (b) that therapeutic change was associated with increased flexibility in the subject positions that the identified patient occupied in the first case and with the emergence of a personal and reflective voice in the second.

CONCLUSIONS

The findings in this study suggest that an important aspect in clinical work with families with a member with a diagnosis of psychosis relates to de-centring the dominant, pathology maintaining accounts and to the emergence of a wider range of less problematic explanatory frames.

‘It’s a double-edged thing’: The paradox of civil partnership and why some couples are choosing not to have one

Since their introduction in 2005, thousands of same-sex couples in the UK have had a civil partnership. However, many other couples have chosen not to have one. This qualitative study explores why some same-sex couples are choosing not to have a civil partnership. Seven semi-structured interviews were conducted with 12 people (five couples and two individuals) who identified as lesbian, gay or bisexual, and analysed using discourse analysis. Participants’ accounts were characterised by ambivalence about civil partnership, and three main paradoxes were identified: the ‘good but not good enough’ paradox, the ‘unwanted prize’ paradox and the ‘legal rights v. social oppression paradox. A major source of ambivalence was support for rights but resistance to assimilation into dominant heteronormative cultural frameworks. Participants negotiated this ambivalence in a variety of ways, including considering how to have a civil partnership that is different from ‘marriage’, and adopting a pragmatic position. The analysis highlights the importance of social recognition and support for a range of relationship forms and identities, as well as for an ongoing critical debate about civil partnerships and same-sex marriage.

"They can do whatever they want": Meanings of receiving psychiatric care based on a common staff approach

This study deepens our understanding of how patients, when cared for in a psychiatric ward, experience situations that involve being handled according to a common staff approach. Interviews with nine former psychiatric in-patients were analyzed using a phenomenological-hermeneutic method to illuminate the lived experience of receiving care based on a common staff approach. The results revealed several meanings: discovering that you are as subjected to a common staff approach, becoming aware that no one cares, becoming aware that your freedom is restricted, being afflicted, becoming aware that a common staff approach is not applied by all staff, and feeling safe because someone else is responsible. The comprehensive understanding was that the patient's understanding of being cared for according to a common staff approach was to be seen and treated in accordance with others' beliefs and valuations, not in line with the patients' own self-image, while experiencing feelings of affliction.

Discursive constructions of eating disorders: A story completion task

Using a post-structualist, discourse analytic framework this study investigates constructions of ‘anorexia’ and ‘bulimia’ made by young people. A story completion methodology was employed to allow young people to express their understandings of eating disorders. This involved participants completing two stories, about a fictional female character, Ashley, described as engaging in either anorexic-type or bulimic-type eating behaviour. Analysis of the resulting stories demonstrated several ways in which both ‘anorexia’ and ‘bulimia’were constructed as problematic, as pathologized and as requiring treatment. These constructions were framed within conflicting paternalistic and neo-liberal narratives, whereby Ashley was constituted as both a passive and active patient in her treatment. The implications of these narratives are briefly discussed in terms of their reproduction of normative constructions of young women’s eating patterns and in terms of representations of accountability for young women’s health.

Analyzing interactional contexts in a data-sharing focus group

In this article we describe the use of a data-sharing focus group for triangulation with face-to-face interviews. In contrast to member-checking triangulation, this focus group was undertaken to provide a different interactional context to analyze moral discourses in talk about asthma medicine taking. Using principles of discursive psychology to analyze data, participants adopted strategies to manage dilemmas of identification with research findings. Talk about medicine taking was contextualized to the demands of the interaction. Strategies included avoiding direct reference to findings; collectively aligning with medical perspectives; and using stories to carry opinions. Participants also expressed moral discourses around managing asthma in everyday life. These discursive variations strengthened assertions of the role of morality in participants' talk and highlighted advantages in engaging with participants' strategies in focus groups. Different viewpoints identified in this research create problems for member checking, suggesting that researchers need to be sensitive in considering methods of sharing data with participants.

I don't need anybody to tell me what I should be doing'. A discursive analysis of maternal accounts of (mis)trust of healthy eating information

Healthy eating initiatives, and messages about what one should be eating, are prolific in contemporary British society. This paper examines mothers' talk around food and feeding to determine how trust or mistrust in healthy eating information is established and rationalised. Discursive analysis of interviews with mothers (N=12, aged 25-45) isolated two prominent discursive positions that mothers established with regards to healthy eating messages. First, they legitimised an extensive mistrust of healthy eating information and messages on the grounds that they are at best, inconsistent and at worst, grossly contaminated by stakeholder bias. Second, and in contrast, they established (most) mothers as having a wholesome, privileged, and entirely sufficient instinctive knowledge about how to feed their children. However, an out-group of failing mothers, deemed to have inadequate nutritional knowledge, was also formulated. Mothers talk thus established a central dilemma whereby to accept nutritional advice compromised a good mothering identity. We argue that nutritional messages and interventions should be sensitive to this dilemma so that they facilitate, rather than threaten, a good mothering identity.

“I Don't Know Who to Blame”: Hiv-Positive South African Women Navigating Heterosexual Infection

Women who become HIV infected through heterosexual transmission are faced with the task of making sense of how they became infected. This paper presents a qualitative analysis based on interviews with 35 HIV-positive South African Black women. A specific theme, that blame of a male partner was avoided or disavowed in interviews, is explored in relation to broader contexts concerning gender and HIV. It is suggested that the repeated phrase “I don't know who to blame” expresses gender-differentiated speaking rights. It also protects women from voicing their own anger, guilt and internalization of badness as a result of an HIV-positive diagnosis. Further, it protects women from exposure to male destructiveness and from confronting the possibility that they themselves are implicated in the infection of others. Analysis offers opportunities for exploring how women both resist and repeat dominant discourses and dominant fears related to HIV-infected womanhood.

Women, alcohol and femininity: a discourse analysis of women heavy drinkers' accounts

Qualitative interviews were conducted with 24 women who were heavy drinkers, as part of a larger, longitudinal study of heavy drinking in the West Midlands of England. Critical discourse analysis was used to analyse the interviews, and resulted in the identification of two main discursive constructions: drink as self-medication, and drink as pleasure and leisure. However, women need to resist and negotiate stigmatizing subject positions of the ;woman drinker' in order both to justify their drinking and to protect their moral status as 'good women'.

Symptoms beyond diagnosis--a case study

The aim of this paper was to discuss how words for symptoms relate to experience and to find out how seriously ill patients two years after diagnosis and treatment articulated suffering. Nine patients who have had a cancer tumour of the central nervous system were interviewed in their homes and the findings were interpreted in a hermeneutic process. Bodily, obstructive, emotive and metaphorical expressions of symptoms appeared. The transformed life situation involved inability to perform everyday tasks and a feeling of frustration of needs and desires. The words for symptoms conveyed individual embodied experience connected to a discourse of shared meanings. The relationship between individuality and culture means that words for symptoms are created and understood in a process between patient and listener, between discourse, culture and history.

Self construction in schizophrenia: a discourse analysis

OBJECTIVES

Lysaker and Lysaker (Theory and Psychology, 12(2), 207-220, 2002) employ a dialogical theory of self in their writings on self disruption in schizophrenia. It is argued here that this theory could be enriched by incorporating a discursive and social constructionist model of self. Harr's model enables researchers to use subject positions to identify self construction in people with a diagnosis of schizophrenia that the dialogical model, using analysis of narrative, does not as easily recognize.

METHODS

The paper presents a discourse analysis of self construction in eight participants with a diagnosis of schizophrenia. Transcripts from semi-structured interviews are analysed, wherein focus falls on how participants construct self in talk through the use of subject positioning.

RESULTS

The findings indicate that Harr's theory of self and the implied method of discourse analysis enables more subtle and nuanced constructions of self to be identified than those highlighted by Lysaker and Lysaker (Theory and Psychology, 12(2), 207-220, 2002). The analysis of subject positions revealed that participants constructed self in the form of Harr's (The singular self: An introduction to the psychology of personhood, 1998, London: Sage) self1, self2, and self3. The findings suggest that there may be constructions of self used by people diagnosed with schizophrenia that are not recognized by the current research methods focusing on narrative. The paper argues for the recognition of these constructions and by implication a model of self that takes into account different levels of visibility of self construction in talk.

'Real men don't diet': an analysis of contemporary newspaper representations of men, food and health

Little research to date has focused on the meanings men attach to food and the relationship between diet and health. This is an important topic in light of the current 'crisis' in men's health and the role of lifestyle factors such as diet in illness prevention. Since the mass media is a powerful source of information about health matters generally, media representations bear critical examination. The present paper reports on an in-depth qualitative analysis of contemporary UK newspaper articles on the topic of men and diet (N=44). The findings indicate a persistent adherence to hegemonic masculinities predicated on health-defeating diets, special occasion cooking of hearty meals, and a general distancing from the feminised realm of dieting. At the same time, men are constructed as naïve and vulnerable when it comes to diet and health, while women are viewed as experts. The implications for health promotion with men are discussed.

Mothers Who Smoke: Confessions and Justifications

Interviews with mothers who smoke were analyzed to examine the influence of social discourses. Women presented themselves as knowledgeable about the health risks of tobacco, confessed guilt and shame, attempted to deflect accusations of neglect for smoking or exposing their children to tobacco, provided rationalization that they smoked for the sake of their children, and, although they were all smokers, demonstrated an antismoking stance. The findings indicate that mothers are in a "bind" when it comes to smoking and fulfilling societal expectations of a good mother. Health professionals must be cognizant of how discourses constrain women's choices in relation to tobacco.