Academic journal article Health Sociology Review

On Being Credibly Ill: Class and Gender in Illness Stories among Welfare Officers and Clients with Medically Unexplained Symptoms

Academic journal article Health Sociology Review

On Being Credibly Ill: Class and Gender in Illness Stories among Welfare Officers and Clients with Medically Unexplained Symptoms

Article excerpt

INTRODUCTION

The construction of the identity of an ill person is a social process guided by ideas of normality, similar to what we have seen in Goffman's (1965) work on stigma. Using this approach, we become aware of factors outside the individual body that infl uence what it takes for a person's illness story to be seen as credible, and this makes the growing number of people who suffer from undiagnosed illnesses especially relevant in our attempt to understand the formation of patient identities (Brookes- Howell 2006; Dumit 2006; Nettleton 2006; Ring et al. 2005; Werner and Malterud 2003). These people are not just ill; they are also not 'normal'. Since few inequality studies look at how the categories of class and gender (and in our case the defi nition of a credible illness story) are mutually reinforcing processes (Acker 2006:442), my intent in this paper is to analyse how gender, class and illness intersect when welfare offi - cers discuss and describe clients with medically unexplained symptoms (MUS); and when the clients themselves discuss and describe their situation. As the analysis shows, the gender of the clients and their educational background infl uence how welfare offi cers view the clients' reported pains and illness stories as credible (men and better-educated women) or not credible (poorly educated women).

In order to capture this gender and class aspect of the negotiation of illness I draw on theory that focuses on the institutional aspect of identity constructions (e.g. Goffman 1965, 1990; Gubrium and Holstein 2001) and Bourdieu's (e.g. 1996, 1998) concepts of fi eld, capital and habitus. On a more general level the study is shaped by intersectionality theory (e.g. Risman 2004) and by previous organisational research into identities and organisation. In 2003, Townsley (2003:624ff) made a seemingly off-hand remark that construed 'gender as power relations'. I want to continue that conversation but also bring the issue of class into the picture.

The relationship between identity processes and the body in organisations has been studied before. For example, gender studies have focused on the gender identities produced in organisations (e.g. Adkins 1995; Townsley 2003; Wilson 1996), just as race and sexuality have attracted attention in organisational research (e.g. Deitch et al. 2003; Ward and Winstanley 2003). The sharpened focus on human relations in organisations, which we have witnessed in recent times, has spurred new research that focuses on identity work and power effects (e.g. Alvesson and Willmott 2002; Ball 2005; Casey 1999; Hoobler 2005; Merilainen et al. 2004; Trethewey 1999). In this paper I am, however, looking at how the identity of the credibly ill person is constructed in ways similar to other social identities such as race, class and age, which have all been shown to be gender-constructed categories (Acker 1988; Ainsworth 2002; Spelman 1990).

THEORETICAL AND ANALYTICAL ASSUMPTIONS

Bringing the corporeal body to the forefront of the analysis requires a comment on the body. This paper's analysis is inspired by research that views the body as a locus of power, which is why specifi c bodies in specifi c time periods are defi ned as 'normal' and other bodies as abnormal or (Blaikie et al. 2004; Mik-Meyer 2010a, 2010b). A central point in constructionist research on the relationship between the body and society is that the body is seen to be an 'unfi nished entity' (Shilling 1994) and that research into, for example, illness stories that cannot be conceptualised by medical discourses therefore need to bring in central sociological categories such as gender and class when negotiating a body's state of health.

Research has long problematised the dichotomy of illness and disease (Jutel 2009; Mol 2002:9ff) and has drawn the fi eld of bio-medical diagnosis into sociology (Jutel 2009) and questioned, for example, the value of evaluating illness narratives as either 'fact' or 'fi ction' (Bury 1991). …

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