Health and media: an overview

Why should medical sociologists study the media? Accounts of the experience of illness are common in medical sociology (see, for example, recent reviews of this field by Pierret 2003 and Lawton 2003). The information these provide has been helpful over the years in re-orienting the vision of health care providers away from a biomedical and reductionist view of patienthood, towards a more holistic understanding of the meanings of illness for those who experience it. In this way many sociologists have contributed to a more widespread construction of ‘patients’ (passive) as being instead ‘consumers’ (active), promoting recognition of the psychosocial element of biopsychosocial care. Thus the medical gaze has been extended to parts of life previously hidden from view, so that a new knowledge of illness has come to dominate thinking in certain health care arenas – perhaps particularly so in primary care and in nursing (Armstrong 1983a, 1984). In tandem with these developments has been the emergence of media and cultural studies as new disciplines. These have taken the (mass) mediated nature of personal experience to be an important topic. This can be understood as a component of the broader project of understanding what it is to be a person in late or postmodern social conditions. Thus it is very common, in these fields, to see accounts of media representations of gender, class or race (for example, Dines and Humez 2002), because these are felt to be important factors in understanding issues of identity, over which mass media have considerable influence. Personal identity is, to a great extent, a cultural construction (Rose 1999). Systems of knowledge, or discourses, are promoted in mass media and influence audiences in various ways. New media, such as the Internet, allow a new kind of experience (Castells 1996). We must, therefore, understand popular media if we are to understand experience and its rendering in narrative forms. Yet these two fields of study – media studies and the sociology of health and illness – appear to stand at a distance from one another. There are, of course, studies of medical knowledge itself as a cultural system (Armstrong 1983b, Lupton 1994) and historical accounts may reveal the role of medical and other scientific knowledge in constructing, say, gendered subject identities (Showalter 1987). In this respect, medical sociologists draw upon the same broad theoretical perspective as many sociologists of science and technology, in so far as the truth claims of other sciences are temporarily bracketed, or held in suspense, in order to understand the role of scientific knowledge in the social construction of its subject. Yet medical sociology does not generally reveal very much about the mass mediated nature of scientific knowledge, which has largely been studied as a separate field (for example, Nelkin 1995). To understand the potential relationship between media studies and medical sociology – at least where issues of identity and experience are concerned – we must address the issue of where experience comes from. On the whole, the discipline of psychology has a particular view of this, which many sociologists call an ‘essentialist’ vision of human nature. Sociologists must understand human experience differently from this, as at least in part a social construction rather than something that emanates from an inner essence. In constructing the self, modern culture makes available to individuals a great many options and resources. The resources might be understood as cultural scripts, or discourses, and modern self identity is formed in a manner that is sometimes quite reflexive (Giddens 1991), drawing on culturally available narratives, stories, scripts, discourses, systems of knowledge or, in more politically oriented analyses, ideologies. Perhaps the greatest repository of stories in late modern societies is made up from the various organs of the mass media – television, newspapers, magazines, radio and, increasingly, the Internet. Here, people find a rich collection of resources to draw upon in telling the story of their selves. When people get sick, or make decisions about health, or visit their health service providers, or decide what to think and vote about health care policy and finance, their behaviour may be formulated in large part from resources drawn from various mass media. These can include depictions of what it is like to be sick, what causes illness, health and cure, how health care providers behave (or ought to) and the nature of health policies and their impact. Particular stories may be promoted by particular interest groups seeking to exert influence over populations. Mass media depictions, of course, are not ‘true’. At best, they are partial truths. Sometimes we may even feel they are collections of lies! The producers of mass mediated messages about health have particular agendas, and this is likely to influence what is shown. As ordinary people we must decide to trust or distrust media messages in much the same way as we decide to trust or distrust medical advice or other expertise. As sociologists interested in the experience of illness, and in health care and health policy, we ought to be interested in which stories get told and which are suppressed, and in how members of the media audience (which includes health policy makers and health care providers themselves of course) respond to mediated health messages. Because I think this is important, I have provided an overview of the media and health research field (Seale 2003). I have also edited this monograph which contains some of the best examples of media studies of health that I have been able to elicit from the research community, in a process of selection that was unusually competitive. In this introduction, therefore, I have first discussed why I believe it to be important to bring together the fields of media studies and the sociology of health and illness. In the sections that follow I outline a general account of the media and health field, focusing first on different conceptualisations of the media audience, then on the general formal structure of popular mass media health representations. I feel that there is now sufficient knowledge to propose a general account of representations that can guide future research studies and assist those concerned to understand the underlying logic that produces particular media health stories1. Following this, I outline areas of media and health studies that have been quite thoroughly investigated and others that have been less this, I draw on recent of (Seale and of the of the by who to a for this In the of this I how of the in this the field and, in how these studies for future of I with a to the structure of the media studies as it is generally to is understood to broad areas of and of (for example, may the manner in which media producers or to understanding of the of media or a to media studies for example, about the nature of the influence by and on those for various media. influence for the say, the influence what we see in the media? to their and decide on what as a health groups the and the medical to health information available on the of of media messages studies may for or the of particular and or be concerned with messages are likely to or they may the formal of media messages as narrative or does a medical as messages about personal for health are in the advice of of the of health care systems get health information on the at with medical of of media (or of audience the towards a of audiences as much more in to mediated messages. of the audience towards a view of with and has also example, are important audience they are to mass media producers themselves are also members of the media they see in the media may influence what they To what are health policies to a media? 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