Posts Tagged 'identity'

Am I a patient?

Alan Cribb unravels the transition from an epidemiological approach to a philosophical approach to healthcare he discusses in his new book – Healthcare in transition – by examining how his identification, or not, as a patient impacts on his research.

Whilst working as an academic I tend not to identify myself as a patient. 

In the last few years one of the themes of my work has been patient-centred or person-centred healthcare, and I have just completed Healthcare in transition, a book in which I tried to tease out some of the elements of, and tensions within, this idea. But I have never self-identified as a patient in my writing and I only occasionally do so in my face to face encounters with trusted colleagues and in what feel like safe spaces to me.

In some ways this is odd. I am not simply a patient in a notional sense – like very many people, I have regular interactions with medical consultants and other health professionals, I follow a regime of treatment and I have health-related conditions that challenge my identity and frame the way I organise my life. So why not self-identify as a patient in my academic work?

“Why not self-identity as a patient in my academic work?”

Partly it is probably just about privacy or for reasons of self-protection – not to invite threatening line of enquiry from others. But it feels as if it is about something more than that. First and foremost it seems presumptuous. It feels like I have been invited to the meeting with one ticket – as a researcher – but now I am claiming to have a further ticket and am expecting to vote twice!

This sense of cheating applies however I think about what counts as a patient, and I have to confess that I am confused about this. In health services research, for example, it is now a methodological and ethical norm to worry about the inclusion of either patient perspectives or patients in some fuller sense. But there is a spectrum of attitudes and practices in response to this norm.

In some cases – and this is to exaggerate for effect – ‘patients’ is treated as a kind of self-fulfilling marginal category, such that if people happen to have any other source of relevant expertise – they are health professionals, or researchers, or activists or even heavily engaged in a peer led patient group then they will to some extent be disqualified as ‘patients’.

This attitude stems from an understandable concern that the identity of patients isn’t colonised and misrepresented by powerful voices but, at the same time – certainly in this exaggerated sense – it risks reproducing a deficit view of patients.

“I feel either disqualified or under qualified.”

At the other end of the spectrum there are strong patient voices and groups who will not only lobby for involvement in research but will themselves lead research and will challenge prevailing orthodoxies – for example, questioning not only the practices of patient involvement but also the ways in which research agendas are set and research is conducted and so on. These kinds of patient voices play an important role and can be inspirational. But there is also a danger here – again at the extreme – that the identity of patient itself becomes professionalised and owned by a few well-organised people.

The first account coincides with my worry about being presumptuous. I need to be cautious about saying I am speaking as a patient, especially with any implication that it is on behalf of other patients, when I already have a hearing as an academic.

But I am equally ruled out on the second account. I have not taken any special steps to become an expert patient; nor do I have any particular credentials to claim a quasi-professional status in this regard. For me to act as if I had would be to cheat.

In short, I feel either disqualified or under qualified. But the issue of my patient identity will not go away completely. It seems unavoidable because even not mentioning it feels like a significant choice. In some contexts there are temptations to mention it – because for certain audiences it may add a sense of authenticity and credibility. In other contexts there are temptations not to mention it – because, for example, some clinicians or others may worry about what axe I have to grind and see it as a source of ‘bias’.

How far this issue is seen to be of importance, and in what respects, is arguably a function of the kind of research we are talking about and also of disciplinary assumptions and conventions. But for anyone who thinks ‘reflexivity’ matters it does seem to be a question worth asking.

If I am being reflexive as an academic then I can treat my identity as a source of problems or limitations that need to be acknowledged, or as a source of legitimacy or authority, or sometimes as a combination of both. This seems as relevant to patient identity as to other aspects of identity. On this account there seems to be something seriously lacking in my approach to date.

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Once upon a time there was a country called Europe

Authors Dimitris Ballas, Danny Dorling and Benjamin Hennig, whose forthcoming book The Social Atlas of Europe publishes on Wednesday 25 June, share their views on Europe.

Dimitris Ballas Danny Dorling Benjamin Hennig 2

‘We cannot aim at anything less than the Union of Europe as a whole, and we look forward with confidence to the day when that Union will be achieved’

It may sound inconceivable today that a statement such as the above could be made by a British Prime Minister and even more so by the leader of the Conservative Party. Yet, this is an extract from a speech delivered by Winston Churchill at the Congress of Europe in The Hague on 7 May 1948. It is just an example of numerous similar statements and activities supporting European integration and union. These were part of wider efforts and actions by the people of a continent shattered by war towards a common purpose and future, which have been imaginatively ‘narrated’ by a member of Europe’s next generation in an award-winning video ‘We are Europe’ – see below. These efforts have been steadily leading towards a Europe United in Diversity and to the formation of a European identity underpinned by common values and ideals such as the establishment of democratic institutions, the respect of human rights and the protection of minorities, as well as solidarity and social cohesion.

However, Europe has now reached a critical crossroads after several years of a severe economic crisis and austerity measures that have disproportionately and brutally hit the most disadvantaged. There has also been an apparent revival of old nationalisms and divisions coupled with the rise of extremist far right and populist parties.

The performance of such parties in last month’s European parliament elections has highlighted the need for reform and change. But there are very different perspectives taken with regards to what the response to the rise of Eurosceptic parties should be. On the one hand, there are Eurosceptic calls for a stop or even a reversal of the plans for further integration and political union. In contrast, there are also strong voices of support for changes that are “needed to keep the European dream alive”, shifting the focus from austerity towards supporting “investment on jobs and on growth” and for a new radical manifesto for Europe calling for “less Europe on issues where member countries do very well on their own, and more Europe when union is essential”.

European identity

"One's destination is never a place, but a new way of seeing things" Goodreads 2013

The Social Atlas of Europe, Map 13 – “One’s destination is never a place, but a new way of seeing things” Goodreads 2013

As three European geographers whose first languages are Greek, English and German respectively, we hope that our book The Social Atlas of Europe can be used to enhance the perception of European identity and solidarity. The Atlas, which includes all countries that have shown a clear and strong commitment to a common European future, not only shows how different are the separate countries, regions and great cities of this continent, but also how often they are so similar. There are a huge number of ways in which people living in different parts of Europe have so much in common. Often the real differences are not found across national borders but between villages and cities or between rich and poor quarters of a town. And the rich quarters of Europe are all more similar to each other than to the poorer areas that are nearer to them. Looking at the maps in this atlas you can begin to believe that you are looking at the geography of a single large group of people. You can see what happens to all the people of Europe collectively and have a better grasp of their collective hopes, fears and lives.

“What does it mean to be European today?”

In The Social Atlas of Europe we offer a new human geography and human cartography perspective and contribution to debates about the above issues by bringing together a great many maps and facts about Europe and its people. Our approach is underpinned by the view that Europe is something much more than just a world region and a collection of nation states and by the idea that we are hopefully moving more towards the belief that so many of us are a “European people” instead of a “Europe of nations”. We argue that the EU needs to be thought of as an entity that is more than just a union of member states, more than just a common market or just a potential monetary or fiscal union. What does it mean to be European today? To what extent do the citizens of EU member states feel that they are citizens of something larger than their own country?

One way of moving towards a “European people” instead of a “nation-state” mentality and of bolstering European identity further is to think of Europe and its economy, culture, history and human and physical geography in terms of a single large land mass. This is already happening to some extent, especially in the minds of the rapidly increasing numbers of Europeans who live in a member state other than their country of birth perceiving Europe and its people in a more fluid way. An example of this is the story of a 7-year old boy from Valencia in another award-winning video.

In The Social Atlas of Europe we highlight the notion of Europe in these terms by looking at its physical and population geography whilst simultaneously utilising the latest available demographic, social, and economic data on a wide range of topics. Using state-of-the-art geographical information systems and new cartography techniques we reveal beautiful versions of Europe shaped by its social values, culture, education, employment, environmental footprints, health and well-being, and social inequalities and cohesion. The Social Atlas visualises and maps Europe in a way that makes it more likely for Europeans to make more sense of their local area’s physical and human geography and also to think of Europe as one place: the place they belong to or their “home” (which is perhaps the way in which the next generation of Europeans will think when asked ‘where do you come from?’).

Overall, The SoThe social atlas of Europecial Atlas of Europe offers a fresh perspective and a new way of thinking about Europe as a continent of cities rather than states, a continent of people rather than power and one of hope rather than decline, reminding its people how much they have in common and highlighting that there is now, more than ever, a need to carry on working together rather than pulling apart.

Click here if you’d like to purchase your copy of The Social Atlas of Europe and receive a 20% discount on the list price – £19.99 (RRP £24.99)


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