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Article published In: Pragmatics and Society
Vol. 7:2 (2016) ► pp.196–216

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Discursive construction and negotiation of laity on an online health forum

 | Aarhus University
 | University of Bergamo
Published online: 16 June 2016
DOI logo with link
https://doi.org/10.1075/ps.7.2.02fag
E-patients are increasingly using the Internet to gain knowledge about medical conditions, thereby problematizing the biomedical assumption that patients are ‘lay’. The present paper addresses this development by investigating the epistemic identities of patients participating on an online health forum. Using poststructuralist discourse analysis to analyze a corpus of cardiology-related threads on an ‘Ask a Doctor’ forum, we compare how patients are discursively constructed by online professionals as ‘knowing’ or ‘not knowing’ with the online knowledge identities patients choose for themselves. Analysis reveals a complex picture, with patients positioning themselves and being constructed as biomedical novices, as well as claiming the subject positions of (semi-)experts challenging medical expertise. This paper provides a snapshot of an important social identity in transition, illustrates a procedure for comparing language use around imposed and self-appropriated identities, and considers discursive choice in relation to the metapragmatic matter of “sayability” (Mey 2001: 176).
References (71)
Andersen, Niels Åkerstrøm. 2003. Discursive Analytical Strategies: Understanding Foucault, Koselleck, Laclau, Luhmann. Bristol: The Policy Press. Google Scholar logo with link to Google Scholar
Anderson, Robert M., and Martha M. Funnell. 2010. “Patient Empowerment: Myths and Misconceptions.” Patient Education and Counseling 79 (3): 277–282. Google Scholar logo with link to Google Scholar
Aujoulat, Isabelle, William d’Hoore, and Alain Deccache. 2007. “Patient Empowerment in Theory and Practice: Polysemy Or Cacophony?” Patient Education and Counseling 66 (1): 13–20. Google Scholar logo with link to Google Scholar
Balint, Enid. 1969. “The Possibilities of Patient-Centered Medicine.” Journal of the Royal College of General Practitioners 17 (82): 269–276.Google Scholar logo with link to Google Scholar
Ball, Marion J., and Jennifer Lillis. 2001. “E-Health: Transforming the Physician/Patient Relationship.” International Journal of Medical Informatics 61 (1): 1–10. Google Scholar logo with link to Google Scholar
Blumer, Herbert. 1954. “What is Wrong with Social Theory?” American Sociological Review 19 (1): 3–10. Google Scholar logo with link to Google Scholar
Caron-Flinterman, J. Francisca, Jacqueline E.W. Broerse, and Joske F.G. Bunders. 2005. “The Experiential Knowledge of Patients: A New Resource for Biomedical Research?” Social Science & Medicine 60 (11): 2575–2584. Google Scholar logo with link to Google Scholar
Cislaru, Georgeta. 2011. “The Discourse of Social Achievement.” Pragmatics and Society 2 (2): 163–170. Google Scholar logo with link to Google Scholar
Czarniawska, Barbara. 2013. “Negotiating Selves: Gender at Work.” Tamara Journal of Critical Organisation Inquiry 11 (1): 59–72.Google Scholar logo with link to Google Scholar
Dahlberg, Lincoln. 2001. “Democracy via Cyberspace: Mapping the Rhetorics and Practices of Three Prominent Camps.” New Media & Society 3 (2): 157–177. Google Scholar logo with link to Google Scholar
Davies, Bronwyn, and Rom Harré. 1990. “Positioning: The Discursive Production of Selves.” Journal for the Theory of Social Behaviour 20 (1): 43–63. Google Scholar logo with link to Google Scholar
De Fina, Anna. 2010. “The Negotiation of Identities.” In Interpersonal Pragmatics, ed. by 
Miriam A. Locher and Sage L. Graham, 205–224. Berlin: Mouton De Gruyter.Google Scholar logo with link to Google Scholar
Decker, Georgia, and Colleen O. Lee. 2011. “Complementary and Alternative Medicine (CAM) Therapies in Integrative Oncology.” In Cancer Nursing: Principles and Practice, 7th ed., ed. by Connie Henke Yarbro, Debra Wujcik, and Barbara Holmes Gobel, 626–654. Sudbury, Mass.: Jones and Bartlett Publishing.Google Scholar logo with link to Google Scholar
Dixon-Woods, Mary. 2001. “Writing Wrongs? An Analysis of Published Discourses about the Use of Patient Information Leaflets.” Social Science & Medicine 52 (9): 1417–1432. Google Scholar logo with link to Google Scholar
Doctorslounge. 2012a. “Ask a Doctor.” Accessed December 11, 2013. [URL].
. 2012b. “Doctors Lounge Medical Forum Rules & User Guide.” Accessed November 12, 2013. [URL].
Dorrestijn, Steven. 2012. “Technical Mediation and Subjectivation: Tracing and Extending Foucault’s Philosophy of Technology.” Philosophy & Technology 25 (2): 221–241. Google Scholar logo with link to Google Scholar
Engel, George L. 1977. “The Need for a New Medical Model: A Challenge for Biomedicine.” Science 196 (4286): 129–136. Google Scholar logo with link to Google Scholar
Eysenbach, Gunther. 2001. “What is E-Health?” Journal of Medical Internet Research 3 (2): e20. Google Scholar logo with link to Google Scholar
Fage-Butler, Antoinette Mary. 2011. “The Discursive Construction of Risk and Trust in Patient Information Leaflets.” Hermes 461: 61–73.Google Scholar logo with link to Google Scholar
Fage-Butler, Antoinette Mary, and Matilde Nisbeth Jensen. 2013. “The Interpersonal Dimension of Online Patient Forums: How Patients Manage Informational and Relational Aspects in Response to Posted Questions.” Hermes 511: 21–38.Google Scholar logo with link to Google Scholar
Fairclough, Norman. 1985. “Critical and Descriptive Goals in Discourse Analysis.” Journal of Pragmatics 9 (6): 739–763. Google Scholar logo with link to Google Scholar
Ferguson, Tom. 2007. “E-Patients: How They Can Help Us Heal Health Care.” White Paper. E-patients Scholars Working Group , San Francisco, Calif. Accessed December 9, 2013. [URL].
Feste, Catherine, and Robert M. Anderson. 1995. “Empowerment: From Philosophy to Practice.” Patient Education and Counseling 26 (1–3): 139–144. Google Scholar logo with link to Google Scholar
Foucault, Michel. 1972. The Archaeology of Knowledge. New York: Pantheon.Google Scholar logo with link to Google Scholar
. 1973. The Birth of the Clinic: An Archaeology of Medical Perception. Translated by A.M. Sheridan. Abingdon: Routledge.Google Scholar logo with link to Google Scholar
. 1982. “The Subject and Power.” Critical Inquiry 8 (4): 777–795. Google Scholar logo with link to Google Scholar
. 1985 [1984]. The Use of Pleasure: The History of Sexuality, Vol. 21. Harmondsworth: Penguin.Google Scholar logo with link to Google Scholar
. 1986 [1984]. The Care of the Self: The History of Sexuality, Vol. 31. Harmondsworth: Penguin.Google Scholar logo with link to Google Scholar
. 1994 [1982]. “Technologies of the Self.” In Ethics: Subjectivity and Truth (Essential Works of Foucault, 1954–1984, Vol. 1), ed. by Paul Rabinow, 223–252. London: Penguin.Google Scholar logo with link to Google Scholar
Goeree, Ron, Camilla von Keyserlingk, Natasha Burke, Jing He, Janusz Kaczorowski, Larry Chambers, Lisa Dolovich, J. Michael Paterson, and Brandon Zagorski. 2013. “Economic Appraisal of a Community-Wide Cardiovascular Health Awareness Program.” Value in Health 16 (1): 39–45. Google Scholar logo with link to Google Scholar
Graham, Linda J. 2010. “Schooling and ‘Disorderly’ Objects: Doing Discourse Analysis using Foucault.” Accessed April 10, 2016. [URL].
Hardey, Michael. 1999. “Doctor in the House: The Internet as a Source of Lay Health Knowledge and the Challenge to Expertise.” Sociology of Health & Illness 21 (6): 820–835. Google Scholar logo with link to Google Scholar
. 2001. “’E-Health’: The Internet and the Transformation of Patients into Consumers and Producers of Health Knowledge.” Information, Communication & Society 4 (3): 388–405. Google Scholar logo with link to Google Scholar
Harré, Rom, and Luk van Langenhove. 1999. Positioning Theory: Moral Contexts of Intentional Action. Oxford: Blackwell.Google Scholar logo with link to Google Scholar
Hoving, Ciska, Adriaan Visser, Patricia Dolan Mullen, and Bart van den Borne. 2010. “A History of Patient Education by Health Professionals in Europe and North America: From Authority to Shared Decision Making Education.” Patient Education and Counseling 78 (3): 278–281. Google Scholar logo with link to Google Scholar
Huang, Yan. 2012. Oxford Dictionary of Pragmatics. Oxford: Oxford University Press.Google Scholar logo with link to Google Scholar
Jones, Rodney. 2013. Health and Risk Communication: An Applied Linguistic Perspective. 
London: Routledge. Google Scholar logo with link to Google Scholar
Kuhn, Thomas S. 1970 [1962]. The Structure of Scientific Revolutions. 2nd ed. Chicago: University of Chicago Press.Google Scholar logo with link to Google Scholar
Lazar, Michelle M. 2009. “Entitled to Consume: Postfeminist Femininity and a Culture of Post-Critique.” Discourse & Communication 3 (4): 371–400. Google Scholar logo with link to Google Scholar
Linell, Per, and Thomas Luckmann. 1991. “Asymmetries in Dialogue: Some Conceptual Preliminaries.” In Asymmetries in Dialogue, ed. by Ivana Marková, and Klaus Foppa, 1–20. Hemel Hempstead: Harvester Wheatsheaf.Google Scholar logo with link to Google Scholar
Löfstedt, Ragnar E. 2008. Risk Management in Post-Trust Societies. London: Earthscan.Google Scholar logo with link to Google Scholar
Lucy, John A. 2004. Reflexive Language: Reported Speech and Metapragmatics. Cambridge: Cambridge University Press.Google Scholar logo with link to Google Scholar
Lupton, Deborah, and Wendy Seymour. 2003. “I Am Normal on the ‘Net’: Disability, Computerised Communication Technologies and the Embodied Self.” In Discourse, the Body, and Identity, ed. by Justine Coupland and Richard Gwyn, 246–265. Gordonsville, Va.: Palgrave Macmillan. Google Scholar logo with link to Google Scholar
Mahon, Michael. 1993. “Michel Foucault’s Archaeology, Enlightenment, and Critique.” Human Studies 16 (1–2): 129–141. Google Scholar logo with link to Google Scholar
Martín Rojo, Luisa. 1995. “Division and Rejection: From the Personification of the Gulf Conflict to the Demonization of Saddam Hussein.” Discourse & Society 6 (1): 49–80. Google Scholar logo with link to Google Scholar
. 2008. “Imposing and Resisting Ethnic Categorization in Multicultural Classrooms.” In Analysing Identities in Discourse, ed. by Rosana Dolón and Júlia Todolí, 31–56. Amsterdam: John Benjamins. Google Scholar logo with link to Google Scholar
Martín Rojo, Luisa, and Angel Gabilondo Pujol. 2011. “Michel Foucault.” In Philosophical Perspectives for Pragmatics, ed. by Marina Sbisà, Jan-Ola Östman, and Jef Verschueren, 85–103. Amsterdam: John Benjamins. Google Scholar logo with link to Google Scholar
Måseide, Per. 2007. “The Role of Signs and Representations in the Organization of Medical Work: X-Rays in Medical Problem Solving.” In The Discourse of Hospital Communication: Tracing Complexities in Contemporary Health Care Organizations, ed. by Rick Iedema, 201–220. Basingstoke: Palgrave Macmillan. Google Scholar logo with link to Google Scholar
Mead, Nicola, and Peter Bower. 2002. “Patient-Centred Consultations and Outcomes in Primary Care: A Review of the Literature.” Patient Education and Counseling 48 (1): 51–61. Google Scholar logo with link to Google Scholar
Mey, Jacob L. 2001. Pragmatics: An Introduction. 2nd ed. Oxford: Blackwell.Google Scholar logo with link to Google Scholar
Mey, Jacob L., Hartmut Haberland, and Kerstin Fischer. 2010. “Editorial.” Pragmatics and Society 1 (1): 1–8. Google Scholar logo with link to Google Scholar
Pavlenko, Aneta, and Adrian Blackledge. 2004. “Introduction: New Theoretical Approaches to the Study of Negotiation of Identities in Multilingual Contexts.” In Negotiation of Identities in Multilingual Contexts, ed. by Aneta Pavlenko and Adrian Blackledge, 1–33. Clevedon: Multilingual Matters. Google Scholar logo with link to Google Scholar
Payne, Sheila A. 2002. “Balancing Information Needs: Dilemmas in Producing Patient Information Leaflets.” Health Informatics Journal 8 (4): 174–179. Google Scholar logo with link to Google Scholar
Pollock, Kristian. 2005. Concordance in Medical Consultations. Abingdon: Radcliffe Publishing.Google Scholar logo with link to Google Scholar
Rodogno, Raffaele. 2012. “Personal Identity Online.” Philosophy & Technology 25 (3): 309–328. Google Scholar logo with link to Google Scholar
Rose, Nikolas. 2007. The Politics of Life itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century. Princeton, N.J.: Princeton University Press. Google Scholar logo with link to Google Scholar
Sarangi, Srikant. 2001. “On Demarcating the Space between ‘Lay Expertise’ and ‘Expert Laity’.” Text 21 (1/2): 3–11.Google Scholar logo with link to Google Scholar
Triandafyllidou, Anna, and Ruth Wodak. 2003. “Conceptual and Methodological Questions in the Study of Collective Identities.” Journal of Language & Politics 2 (2): 205–223. Google Scholar logo with link to Google Scholar
Umefjord, Göran, Katarina Hamberg, Hans Malker, and Göran Petersson. 2006. “The Use of an Internet-Based Ask the Doctor Service Involving Family Physicians: Evaluation by a Web Survey.” Family Practice 23 (2): 159–166. Google Scholar logo with link to Google Scholar
Van de Belt, Tom H., Lucien J.L.P.G. Engelen, Sivera A.A. Berben, and Lisette Schoonhoven. 2010. “Definition of Health 2.0 and Medicine 2.0: A Systematic Review.” Journal of Medical Internet Research 12 (2): e18. Google Scholar logo with link to Google Scholar
Van Dijk, Teun A. 2007. “Discourse & Communication: A New Journal to Bridge Two Fields.” Discourse & Communication 1 (1): 5–7. Google Scholar logo with link to Google Scholar
Van Leeuwen, Theo. 2009. “Discourses of Identity.” Language Teaching 42 (2): 212–221. Google Scholar logo with link to Google Scholar
Wear, Delese, and Julie M. Aultman. 2006. Professionalism in Medicine: Critical Perspectives. New York: Springer. Google Scholar logo with link to Google Scholar
White, Robert E. 2008. “Health Information Technology Will Shift the Medical Care Paradigm.” Journal of General Internal Medicine 23 (4): 495–499. Google Scholar logo with link to Google Scholar
Whitehead, Lisa Claire. 2007. “Methodological and Ethical Issues in Internet-Mediated Research in the Field of Health: An Integrated Review of the Literature.” Social Science & Medicine 65 (4): 782–791. Google Scholar logo with link to Google Scholar
Wynne, Brian. 1996. “May the Sheep Safely Graze? A Reflective View of the Expert-Lay Knowledge Divide.” In Risk, Environment and Modernity: Towards a New Ecology, ed. by S. Lash, B. Szerszinski, and B. Wynne, 44–83. London: Sage.Google Scholar logo with link to Google Scholar
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