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Social Representations and Health Psychology

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DOI: 10.1177/0539018402041004004

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Social Representations and Health Psychology


Hélène Joffe
Social Science Information 2002 41: 559
DOI: 10.1177/0539018402041004004

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Symposium: ``Social representations of health and illness''
Symposium: ``Les repreÂsentations sociales de la sante et de la maladie''

HeÂleÁne Joffe

Social representations and health psychology

Abstract. The author examines the speci®c contribution that social representations
research has made to health psychology. In particular, the approach highlights the
symbolic, emotive and social aspects of how lay people make meaning of facets of
health and illness, and emphasizes the importance of the evolution of these meanings.
Empirical work on health and illness is used to cast light on the speci®c workings
of social representations and on the enrichment of the health ®eld offered by this
naturalistic perspective. Distinctions are drawn between the social representations
approach and other social constructionist approaches in the health ®eld. In addition,
the differentiation between social representations and more mainstream approaches to
health issues is examined. Primarily, the social representations approach eschews the
notion of human thought as analogous to information processing, with the attendant
individualist, cognitivist and rationalist assumptions, and recognizes the importance
of non-verbal material in the study of the human psyche.

Key words. Emotions ± Meanings of health/illness ± Stigma ± Symbols

Background

The theories and methods chosen for exploring the psychology of


health and illness depend on the assumptions made about the
human mind. Mainstream paradigms, at least in Anglo-Saxon psy-
chology, tend to regard purely cognitive processes as most salient in

This article is based upon an earlier article published in French, which ®rst appeared in 1999 as:
``RepreÂsentations sociales et psychologie de la santeÂ'', Pratiques Psychologiques 4: 15±30.
Social Science Information & 2002 SAGE Publications (London, Thousand Oaks, CA and New
Delhi), 41(4), pp. 559±580.
0539-0184[200212]41:4;559±580;029121

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560 Social Science Information Vol 41 ± no 4

driving human thought and action. The present article proposes that
``health'' is a highly social, emotive and symbolic entity. Conse-
quently, theories and methods appropriate to the speci®c qualities
of this entity must be used in health psychology.
Social, emotive and symbolic facets are best captured by an
approach concerned with the meanings people make in non-arti®cial
response situations. In order to pursue these concerns, English-
language health-related psychological work has often turned to an
approach that originated in France: social representation theory
(SRT). The fundamental contribution of SRT to the health psychol-
ogy ®eld is its ability to enhance understanding of how lay people
make meaning of facets of health and illness, and of how these
meanings evolve. Mainstream Anglo-Saxon theories in the ®eld
of health psychology tend to focus on how individuals process
information about health issues. Discovery of how information is
erroneously ®ltered through each individual's ``membrane'' of
attitudes and beliefs is a key concern. The relationship between indi-
viduals' thinking and broader socio-cultural systems is severely
under-represented. The ``we'' contained in the thinking of the ``I''
is all but absent. SRT, on the other hand, focuses upon group-
based, symbolic understandings and communications regarding
health issues. SRT provides valuable tools for showing how socio-
cultural and historical forces impact upon the individual's health-
related thoughts and actions.
Within the social representations framework, there has been a
strong tradition of illness research. AIDS, in particular, was a
major focus in the 1980s and 1990s. This relates to the theory's con-
cern with the way in which new ideas and events that confront the
public are integrated by lay thinkers. Empirical work from within
and outside the AIDS ®eld is used in this article to throw light on
the contribution offered to the health ®eld by a naturalistic, social
representations perspective. Simultaneously, the particular con-
ception of the ``social representation'' used in the empirical work
is outlined.

The formation of social representations: relevance to the health and


illness ®eld

``Social representation'' refers to two interlinked notions. It refers to


the content of understandings of the everyday world: the ideas that

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Joffe Social representations of health and illness 561

circulate in a society and constitute common sense. Beyond the con-


cern with what people think, the study of social representations
focuses on the speci®c processes by which these contents are
shaped. The key processes are: the transformation of expert ideas,
via communication, into lay thinking; the bringing forward of past
ideas and imposing them on the new event which needs to be under-
stood; and the saturation of the event which needs to be interpreted
with the symbolic meanings that exist in the culture. Each of these
processes will be examined with reference to the health ®eld.
For Moscovici (1984a), the transformation of scienti®c knowl-
edge tends to be seen as a fundamental aspect of common sense:
common sense is science made common. Other theorists (e.g.
Duveen and Lloyd, 1990) challenge the supposition that all social
representations have their roots in the sciences. Even Moscovici's
own position is inconsistent. For example, Moscovici (1984b)
states that every representation is rooted either in science or in
another representation. However, less contentious is the supposition
that knowledge about contemporary health issues, in particular,
tends to originate in the medical sciences in the West, and that the
vocabularies and images that medical science invents are diffused
to lay people via the mass media. The prime position of science
in health-related knowledge stems from its high status in Western
cultures. Traditionally, what science names is deemed ``fact'' or
``material reality'', while other forms of knowledge, such as that
generated by the mass media or by lay people, are believed to
draw on more mythical elements (Comaroff, 1982). The imprint of
medical science is to be found in common-sense ideas regarding all
health issues, but the meanings that come to be held infuse scienti®c
with other ideas. As this article will show, these are not regarded as
de®cient deviations from a high-status, desirable knowledge base
but accepted as the ``reality'' for the particular lay people who
hold them.
The social representations approach is particularly concerned
with the transformation that occurs as knowledge moves from the
more rei®ed, scienti®c universe into lay thinking. The mass media
play a leading role in transforming expert knowledge into lay knowl-
edge. For example, ``Without the press, AIDS would have, for a
rather long time, concerned at most a few thousand persons
world-wide'' (Herzlich and Pierret, 1989: 1236). The layperson's
®rst contact with a health issue often comes through the news
media, or via other people relaying items presented in the news.

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562 Social Science Information Vol 41 ± no 4

Yet the news media do not merely present a ``photocopy'' of expert


knowledge for lay people to assimilate. Such media have to hold the
attention of mass audiences. To do so they simplify and sensationa-
lize expert issues. They convey the quarrels that occur between the
experts who attempt to explain the new event and they set up debates
concerning responsibility and blame. In their analysis of the news
media, Brown et al. (1996) show that health risks are framed in a
manner more related to moral outrage than to scienti®c notions of
calculable risk. This ®nding, which corroborates that of Herzlich
and Pierret (1989), highlights the role of the media in transforming
expert knowledge for the masses. Dissemination of medical ideas
involves the saturation of this knowledge with the core values and
social norms of the culture.
By its very de®nition, transformation involves making changes to
the initial content. Moscovici (1984b) uses this concept precisely to
emphasize the modi®cations that occur as scienti®c knowledge
gets re-presented in media and then in lay terms. Even though the
media may give issues a particular slant, such as moral outrage,
it should not be assumed that the audience adopts this leaning as
if by direct transmission. Ideas which pervade the media may be
accepted directly, yet their meaning may be negotiated or even chal-
lenged by lay thinkers (Hall, 1980). Social representations of new
phenomena often re¯ect resistance to scienti®c ideas (see Bauer
and Gaskell, 1999). The term ``lay thinker'', rather than ``lay
person'', is used in this article in order to highlight the fact that
lay people are not passive recipients of ideas from experts and the
mass media, they actively forge their own representations. It will
be demonstrated that they do so in line with the motivation to pro-
tect the self and the in-group. However, it must be recognized that
SRT also contains a more passive conceptualization of lay thought:
the media penetrate every home and seek out every individual to change him [sic]
into a member of a mass . . . It is the kind of mass, however, that is seen nowhere
because it is everywhere. The millions of people who quietly read their paper and
involuntarily talk like their radio are members of the new kind of crowd . . . They
stay at home, but they are all together, and all seem different, but are similar.
(Moscovici, 1985: 193)

It has been noted that one particular outcome of the circulation of


knowledge between science, the mass media and lay thinking is that
scienti®c knowledge takes on a moral dimension. It is integrated into
a moral system that regulates what is to be regarded as acceptable or
unacceptable in a society. Yet this raises a further issue: is scienti®c

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Joffe Social representations of health and illness 563

thinking free of the value dimension with which the media are said to
inject science? Moscovici (1984a) and many of his followers claim
that scienti®c thinking proceeds from premise to conclusion, relying
upon a system of logic and proof. It uses laws, such as maintaining
distance from the object, repetition of experiments, falsi®cation and
confronting evidence with counter-evidence. It epitomizes the very
attempt to overcome the tendency found in lay thinking to con®rm
the familiar, to prove what is already known. Other researchers who
use the social representations framework have found that the pro-
cesses that operate in scienti®c circles, at least at the point of assim-
ilation of new, threatening health issues, are similar to those found in
the media and lay realms. Herzlich and Pierret (1987) show that,
while medical debates are rooted in sophisticated epidemiological
models, they also draw upon the ``us'' versus ``them'' thinking that
exists in the society at large. This is typi®ed in the responses of
Western medics to AIDS. At least four distinct, major lines of
early medical inquiry pursued links between AIDS and ``the other''
(Joffe, 1999). This ``other'' includes foreign nations, out-groups and
alien practices. Having analysed medical writings on AIDS in the
®rst decade of its advent, Farmer noted that: ``North American
scientists repeatedly speculated that AIDS might be transmitted
between Haitians by voodoo rites, the ingestion of sacri®cial
animal blood, the eating of cats, ritualised homosexuality and so
on ± a rich panoply of exotica'' (1992: 224). This way of linking
AIDS with that which lies outside the morally acceptable terrain
within Western thought was also evident in the links made in pres-
tigious British and American medical texts between the cause of
AIDS and the use of ``poppers'' (e.g. Geodert et al., 1982), anal
sex (e.g. Lacey and Waugh, 1983) and African Green Monkeys
(e.g. Karpas, 1990). More recently, the link between ``primitive
butchery'' (Weiss and Wrangham, 1999: 385) of chimpanzees in
Central African hunting practices has been hailed as the de®nitive
cause of the cross-species transmission of the retrovirus that leads
to AIDS in humans. The strange excesses of ``the other'' are cited
as potentially causative of disease in all of these scenarios. Excess,
so frowned upon in the West, with its lauded ethic of moderation,
is projected onto ``the other'' in these scienti®c theories.
Using a social representations approach, Joffe (1996a, 1997a,
1999) ®nds that, in parallel to the scientists' ``panoplies of exotica'',
early lay thinking about AIDS had a tendency to concoct ``sin cock-
tails''. This involved the combining of a number of what were judged

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564 Social Science Information Vol 41 ± no 4

as alien or ``perverse'' practices, over-generalizing the extent to


which they were performed, and linking them to speci®c out-
groups within a society or to foreigners outside it. Taken together,
the medical and lay ®ndings contradict the tenet that scienti®c
knowledge is intrinsically different from lay knowledge. Like media
knowledge, both involve a pronounced value dimension, at least at
the point of assimilation of a new threat. The early scienti®c links
made between AIDS and a diverse range of ``others'' is testimony
to this.
It is not surprising that the processes at work in early scienti®c,
journalistic and lay thinking are similar, since the individuals who
work in these spheres all begin their thinking with conjectures.
Thereafter they proceed along different pathways, with only the
scientists adopting, at least to some degree, the methods of veri®ca-
tion mentioned above. SRT proposes that two speci®c processes are
used when people, be they scientists, journalists or lay people, initi-
ally integrate ideas: anchoring and objecti®cation (Moscovici,
1984a). These processes ensure that the core values and norms of
the society get stamped on to new events and drive the mutations
that occur as knowledge circulates in a society. They enable indivi-
duals to forge ideas about new events in ways that induce comfort:
they maintain the existing sense of order in a society by perpetuating
known concepts and stamping them on whatever must be newly
encountered. The link that was made initially in scienti®c, media
and lay circles between AIDS and ``the other'' is best understood
in terms of the anchoring mechanism. When a new event must be
understood, its integration is accomplished by taking the event
which is by de®nition unfamiliar and moulding it in such a way that
it appears continuous with existing ideas (Moscovici, 1984a). AIDS
was con®gured in terms of past epidemics, the majority of which had
been linked to foreigners, out-groups and perverse practices (see
Joffe, 1999). SRT posits that meaning will be made of many newly
discerned illnesses in line with known illnesses, whatever the differ-
ences at a material level.
Anchoring is not an individual process of assimilation. Rather,
the ideas, images and language shared by group members orientate
the way in which members come to terms with the unfamiliar. The
anchoring process is a social form of the more cognitive categoriza-
tion process. This act of classi®cation, of naming, makes the alien,
threatening event imaginable, representable. Since the new phenom-
enon takes on the characteristics of the category to which it appears

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Joffe Social representations of health and illness 565

similar, opinions that were held about the earlier phenomenon are
transferred to the new one. This removes the mysterious edge
from the new phenomenon. Of course it can also remove from the
®eld of thought what is speci®c and different about the new event.
Sayings which refer to past epidemics such as the ``black death''
were revitalized in early references to AIDS. Since it was known in
the West as the ``gay plague'' (see Wellings, 1988), its sufferers
were to be ``avoided like the plague''.
A characteristic feature of social representations studies is the
exploration of continuities and discontinuities between current
and past representations. This longitudinal view highlights the in¯u-
ence of socio-historical rather than internal cognitive processes on
health-related thinking. Herzlich and Pierret (1987) point out that,
in the past, dominant social representations of mass illnesses were
not substantially challenged by the ill groups. These illnesses do
not appear to have struck heterogeneous, politically organized
groups. Plagues struck so fast that sufferers did not live long
enough to be heard. By way of contrast, AIDS develops a number
of years after entering the body and has unfolded within a political
milieu. People with HIV/AIDS have an impact on the unfolding
social representations of AIDS. Herzlich and Pierret's study raises
the issue of ``voice'', developed in the work of Bakhtin (1981) and
Gilligan (1993). Markova and Wilkie's (1987) study of the parallel
social representations of AIDS and syphilis provides a useful illus-
tration of how the ``voice'' of marginalized groups can impact
upon social representations.
Markova and Wilkie show that social representations of AIDS in
the West re¯ect voices from the mass media, the women's and the
gay movement, transforming the representations about sexually
transmitted diseases that circulated in the syphilis epidemic of the
First World War. Both syphilis and AIDS have been anchored to
death, stigma, immoral behaviour and just punishment. The govern-
ment-led campaigns accompanying both have, to varying degrees,
emphasized protection of the body, via condom use, and defence
of dominant value systems, via monogamy. However, major differ-
ences between the responses to the two epidemics include: recogni-
tion of the sexuality of both genders in the time of AIDS, rather
than dwelling upon male sexuality requiring outlet, as occurred in
the time of syphilis; sexually explicit AIDS campaigns by contrast
to the discreet nature of the discussion of sexuality at the time of
syphilis; suggestion of a wide range of activities in relation to

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566 Social Science Information Vol 41 ± no 4

AIDS prevention rather than condom use alone, as was prescribed


for syphilis prevention. These changes re¯ect, among other factors,
the liberation of the voice of oppressed groups. Both women and gay
men have shifted the orientation of contemporary representations
away from heterosexual masculinity to wider sexual forces. Social
representations of AIDS re¯ect truly social processes such as that
of social in¯uence. A longitudinal view of the meanings made of
other illnesses, such as cancer, also reveals a great deal of change
in meaning over time. Beyond the political in¯uence of social move-
ments upon the meanings of illnesses, such changes are linked with
the level of mastery medical science has gained over the illness. Fear
of cancer ± re¯ected in the way in which the word ``cancer'' was
dif®cult to utter in the past (see Sontag, 1979) ± has diminished
with the greater medical understanding and material control of the
illness. Meanings of illnesses contain emotional and political,
rather than purely cognitive, elements.
In the formation of social representations, the process termed
``objecti®cation'' works in tandem with anchoring, transforming
the abstract links to past ideas set up by anchoring into concrete
mental content. Unfamiliar ideas can be made familiar by being
linked either to historically familiar episodes or to the culturally
familiar. Objecti®cation saturates an unfamiliar object with some-
thing easier to grasp. A study of social representations of health
and illness in the Chinese community in Britain (Jovchelovitch
and Gervais, 1999) indicates that food objecti®es a number of the
more abstract systems of thought carried in this culture. Balance
and harmony are considered to be basic components of health in
the Chinese community, in accordance with the principles of yin
and yang. Manipulation of nutrition to this end is the ®rst step in
maintaining good health and preventing or curing illness. The
authors conclude that food is a major carrier of social representa-
tions of health in this community. When food is prepared and
eaten, traditional knowledge about health is communicated and
transmitted down through the generations.
The process of objecti®cation overlaps signi®cantly with that of
symbolization, a useful but under-used concept in health research.
One fundamental function of a symbol is to provide people with a
means to experience abstract matters such as ideals, values, norms
and desires as well as entities such as gods and spirits. Once symbo-
lization occurs, both intellectual understanding and experience of

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Joffe Social representations of health and illness 567

the element follow: ``symbols contain complex messages which are


being represented in a simple and vivid way'' (Verkuyten, 1995: 274).
Symbols are also related to an emotional charge, rather than purely
to thinking and cognitive processes alone. They help to create and
maintain certain sentiments.
Both the French and English literatures on AIDS point to the
importance of symbolic meaning in people's adoption of safer,
rather than unsafe, sex. Having reviewed the French literature on
sexuality in the context of the HIV/AIDS epidemic, Giami and
Schiltz (1996) show that unsafe sexual practices are underpinned
by a particular social representation in all of the studies. When
people symbolize a partner as ``good'', they do not practise safer
sex consistently. The good partner includes one that is loved, long-
term, known, from the same social network, and/or has a pleasant
appearance. People are likely to have no sex, or to practise safer
sex, with those represented as ``bad''. This is corroborated by
Bajos et al. (1997), who show that condom use is inversely related
to the degree of perceived intimacy, regardless of what is known
about the partner's HIV status. In particular, people who de®ne
themselves as being ``in love'' are less likely to protect themselves
against HIV infection. This has been corroborated by many studies
both within and outside the social representations framework (see
Joffe and Dockrell, 1995; Joffe, 1997a).
Verkuyten (1995) notes the lack of focus on symbols within psy-
chology and sociology, as opposed to their being a focal concept
within anthropology, in which cultural symbols are seen as keys to
understanding cultures. Health psychology could certainly gain
from a greater emphasis upon symbolization. The concern with sym-
bols highlights a crucial difference between the social representa-
tional approach and both purely cognitive and purely discursive
frameworks. The social representations framework locates some of
its concerns beyond the linguistic expressions of individual respon-
dents. Social representations of illnesses, for example, lie in both
non-verbal symbols ± ``wordless thought'' ± and words. The mes-
sages condensed and made vivid by the pink and red ribbons sported
on many lapels worldwide are a testimony to this. Symbols permit
people to communicate and to experience a realm beyond the
bounds of speech. Meaning is understood without verbal inter-
action. Sympathy with and support for breast-cancer and AIDS
causes are easily communicated in the wordless communication
put out by people who wear the symbolic ribbons.

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568 Social Science Information Vol 41 ± no 4

The entities ``health'' and ``illness'' in themselves carry tremen-


dous symbolism in contemporary Western culture, according to
Crawford (1994). He proposes that health is laden with metaphors
about what it means to be a responsible, respectable and inherently
good citizen. He puts forward a powerful argument that health,
which he goes as far as to call the emblem of modern, Western
identity, has become a metaphor for self-control, self-discipline,
self-denial and will-power. To be healthy is to be ``good'' in the
terms prescribed by Western culture. This explains Westerners'
need to associate illness with the excesses of ``the other'', to project
what is symbolized as ``bad'' away from the space of the self and the
in-group in an endeavour to maintain the purity of this space. In a
complementary vein, Herzlich and Pierret (1987) propose that the
``new myth'' or key social representation surrounding disease in
the Europe of the 1980s is that of responsibility or choice. An
appeal is made to people to take responsibility for their own
health, an attitude which stands in stark contrast to past percep-
tions, in which the effects of a mass illness were deemed inevitable.
This shift re¯ects the increasing dominance of individualism. In a
line of thought intimated by Crawford (1977) and Sontag (1979),
Herzlich and Pierret remark that the seemingly biological phenom-
enon of illness is in¯uenced by the ideological currents that exist in
society, as well as by memories of past illnesses. The link between
contemporary illness and sin provides strong evidence of past,
biblically generated ideas being brought into the dialogue of the
present. Fatalistic ideas co-exist with beliefs that people bring ill-
nesses upon themselves through their choices, and that ``victims''
of illness can, therefore, be blamed.
Interestingly, Crawford (1994) proposes that in Western culture
the self is associated not only with control but also with a release
from it. Pleasures, grati®cation of desire and play are intrinsic
aspects of consumer culture. Health has become the arena in
which the tension between self-control and the release from it is
played out. However, rather than holding these two antithetical
components together, the culture expunges its association with the
uncontrolled aspects ± such as addictions ± linking them with dis-
paraged ``others''. These ``others'' are blamed for bringing their
ill-health upon themselves, and symbolically held outside the culture
so that the self cannot be morally infected.
Unlike purely cognitive theories of the human mind, SRT keeps
a space for symbols, infused with an emotional valence. It is emotion

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Joffe Social representations of health and illness 569

that motivates the formation of particular SRs. In the classic study


which originated the theory, Moscovici (1976) went so far as to state
that social representations emerge precisely in response to some
threat to the collective identity of the group and that, consequently,
a central purpose of representation is to defend against feeling
threatened. He posited that all concepts of the world are a means
of solving psychic or emotional tensions, compensations to restore
inner stability. Given this early work, the role of emotion has
received surprisingly little attention in contemporary SRT. Other
than Joffe's work (see 1996b, 1999), the translated writings of
Kaes (1984) and Jodelet (1991) are exceptional, in terms of the
English-language literature, in their focus on emotion. Other social
representational studies, such as that of Markova and Wilkie (1987),
have highlighted the need to theorize the precise role played by
emotions in response to social phenomena. This emphasis requires
development in the health sphere.
At the same time as protecting the sense of self and in-group
vulnerability from risks, the chosen social representation maintains
the status of certain groups in a society. In general, those already
construed as out-groups are the repositories of the projections main-
stream society wishes to distance itself from. This projection main-
tains a sense of purity and comfort for the self and in-group.
A further, overlapping motivation in terms of shaping a representa-
tion is that the chosen representation fosters solidarity within groups
and facilitates communication between group members. Kaes (1984)
indicates that shared representations provide a nucleus of identi®ca-
tion for the group, allowing it to distinguish itself from its out-
groups. This will be discussed in terms of the particular implications
of a social representations approach for health psychology.

Methodological challenges

The processes and motivations involved in the formation of social


representations are by no means simple to discern empirically.
Major methodological challenges are posed by the shift to social,
emotional and symbolic facets of human thinking. The researcher
cannot assume that people have access to the factors that feed
their representations. In many of the more mainstream models,
one merely asks individuals what their attitudes, beliefs and intended
actions are in order to understand their thoughts and potential

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570 Social Science Information Vol 41 ± no 4

actions. Yet the factors that forge thought and action are not neces-
sarily located in the private knowledge of individuals. A good way of
entering the sphere beyond the private, conscious knowledge of the
individual is to triangulate (Flick, 1992). This involves exploring
knowledge from various angles: in structures outside individual
minds, such as the mass media or medical journals, as well as in
interviews and free-association tasks with lay people. The goal is
to observe the transformations that occur when knowledge circu-
lates between the environment of the individual and the individual's
mind, and to discover how meanings of health issues link to particu-
lar identities. In practical terms, this tends to involve comparing
texts (and sometimes images) on a particular phenomenon produced
in scienti®c journals, the mass media and transcribed interviews with
lay thinkers (see Joffe, 1999; Joffe and Haarhoff, 2002). Focus
groups and national survey data can also be drawn upon in the
effort to capture the interplay between social environment and lay
thought (see Bauer and Gaskell, 1999).
In light of the orientation advocated, one would expect that many
social representation theorists had worked on methods for acquiring
implicit, symbolic material. Unfortunately the ®eld suffers from
over-reliance on verbal data. However, empirical methods for exam-
ining the symbolic content of thought are being developed. Tools
such as word-association tasks may yield useful results (e.g. see
Wagner et al., 1996). In addition, in the social representations litera-
ture on madness, drawings and participant observation have been
used effectively. The study conducted by Jodelet (1991), in particu-
lar, emphasizes the importance of the workings of the responses to
threat which have not reached a verbal level but are nevertheless
informative of action. Her participant observation, which revealed
that, when mentally ill lodgers were invited to stay in host families,
their eating utensils and clothing were washed separately from those
belonging to the hosts, indicates how a representation that cannot be
put into words can be enacted in another form. Fears of contagion
are expressed by the segregation of the lodgers' belongings through
``wordless thought'', not mentioned in the interviews. The apparent
inconsistency between what was observed in the participant observa-
tion and the voice of tolerance heard in the interviews points to the
importance of using multiple methods. It also indicates that self-
reports alone do not provide a valid account of the phenomenon
under investigation.

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Joffe Social representations of health and illness 571

This raises a particular point of difference between social repre-


sentations research and the growing range of qualitative methods
used in Anglo-Saxon health psychology. Interpretative phenomeno-
logical analysis (see Smith et al., 1997), grounded theory (see Michie
et al., 1996), and discourse analysis (see Potter and Wetherell, 1987)
are used increasingly in the health domain. All focus heavily upon
the verbal realm. The social representations perspective differs
from these social constructionist approaches not merely in taking
non-verbal data seriously (e.g. see Jodelet, 1991 and Joffe and
Haarhoff, 2002), but in the way it treats theory. This issue is
rather complex in the qualitative sphere. In a natural sciences
model, the method tends to involve the use of empirically derived
data for testing theories. Yet qualitative models tend to use data
in order to discover or develop, rather than to test, theory. This is
the key characteristic of the grounded theory method, though
others tend to operate in this way too. One of the problems with
this manner of treating data is the extent to which it can be
deemed scienti®c. In a social scienti®c view of what science is (see
Silverman, 1993), the question of whether a framework incorporates
the possibility of revision is a key issue. If data are used purely to
con®rm the assumptions of the researcher, they are non-scienti®c.
Even though there is an attempt to go to data without preconceived
ideas in the grounded theory method, the applicability of ®ndings is
limited if there is no mechanism with which to ``test'' them.
Although this issue is by no means resolved in the social representa-
tions ®eld, and is treated variably in different sectors of the ®eld, tri-
angulation, as outlined above, has emerged as a strong mechanism
for validation. Here, the power of a ®nding is seen to rest in whether
data gleaned from multiple methodological standpoints create a
plausible, robust and credible interpretation of the phenomenon
under investigation.
Having touched upon some of the divergences between SRT and
its social constructionist contemporaries, it is useful to juxtapose
SRT with the mainstream social psychological theories that are
used to understand responses to health and illness. Such comparison
further assists in clarifying the distinctiveness of the position offered
by SRT. The mainstream models, which dominate the health
®eld, have been used to look at the links between health-related
knowledge, attitudes, beliefs, intentions and practices. They differ
from the social representations approach in that they hold indivi-
dualist, cognitivist and rationalist assumptions about human beings.

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572 Social Science Information Vol 41 ± no 4

The Health Belief Model (HBM) (Maiman and Becker, 1974;


Rosenstock, 1974; Rosenstock et al., 1988), the Theory of Reasoned
Action (TRA) (Fishbein and Ajzen, 1975; Ajzen and Fishbein, 1980)
and the Theory of Planned Behaviour (TPB) (Ajzen, 1988, 1991)
focus on the individual decision-maker. This decision-maker is
seen as the locus of all thought and behaviour. There is little devel-
opment of an emphasis upon interaction with others and its impact
upon thought and behaviour, other than by way of a fairly narrowly
de®ned notion of ``subjective norm'' (which comprises the decision-
maker's sense of important other people's beliefs and attitudes). The
decision-maker is also viewed as volitional and agentic (see Joffe,
1996a for a fuller account). This not only plays down the role of
external pressures which may work against the will to carry out
health-enhancing behaviours, it also assumes that decisions are
under conscious control: people are assumed to use the information
they have in a reasoned fashion, to make decisions in relation to
their behaviour. When their reasoning does not correspond with
scienti®c reasoning, such as when they view themselves as invulner-
able to a risk, this is attributed to cognitive errors, such as an
optimistic bias (Weinstein, 1987). Reference to de®cits in cognitive
skills minimizes the role played by non-conscious motivations,
ranging from unconscious defences to taken-for-granted values, in
health behaviour.
Such models are particularly limited when it comes to certain
health-related behaviours. Insight into the dynamics of sexually
transmitted diseases, for example, is not facilitated by models that
focus on volitional or individual control. Sex is not generally con-
ducted alone, and no-one who takes a study of humankind seriously
could argue that desire is predominantly rational. Yet many promi-
nent studies of condom use are conceptualized within the TRA and
TPB. Not surprisingly, even those who use these models recognize
that their models are unsuitable: ``Cooperative behaviours such as
condom use are not under complete volitional control . . . and there-
fore go outside the theoretical scope of the TRA'' (Kashima et al.,
1993: 237). The researchers suggest that ``the dynamics of a sexual
encounter are complicated by the fact that two people are involved''
(p. 237). The fact that the dyad is represented as a complication in
these models re¯ects the extent to which individual cognition has
become the focus in studies of the psyche.
A key contention of those who work within the social representa-
tions model is that human thinking is distinct from individual infor-

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Joffe Social representations of health and illness 573

mation processing. The very notion of the mind as an information


processor lends it a machine-like quality. One implication of the
machine analogy is that it conceals what is essentially human: the
sense of being alive, with all the attendant emotional states. Further-
more, it obscures the symbolic, meaning-making quality of human
experience. Moscovici (1984b) writes that the cognitivist, rationalist
view of the human is

a terrible simpli®cation, not only because society is not a source of information but
of meaning, but also because factuality is never at the core of the exchanges
between members of society. Hence you cannot expect such a process [information
processing] to reveal the depths of the human mind. (1984b: 963)

As an ``anthropology of modern culture'' (Moscovici, 1987: 514),


the social representational approach endeavours to tap these depths.
In place of attempting to track and to understand what the cognitive
tradition labels ``biases in decision-making'', human thoughts are
studied in themselves, without reference to an ideal. It is assumed
that different pockets of shared knowledge in different groups
delimit what each group member sees as ``rational''. By way of con-
trast to the set of individualist assumptions contained in the main-
stream Anglo-Saxon models of health psychology, the social
representational approach insists that human thought is relational
at its root. Explanations are constructed in the ``unceasing
babble'', the ``permanent dialogue'' that people have with each
other, rather than within individual minds (Moscovici, 1984a).
Consequently, human thought processes cannot be studied as if
they arise within, and lie exclusively inside, individual minds.
The more social and communicative bases of thought are not
given pride of place in even the more newly derived, mainstream
models of health psychology. One fairly recent stream of cognitively
based health psychology apparently covers a fairly similar domain
to that of social representations of health and illness: the illness
representations approach. ``Illness representations'' are de®ned as
common-sense perceptions and conceptions of an illness including
how a particular illness feels, what causes it, how long it lasts and
how it can be controlled (Leventhal et al., 1997). Researchers who
use this approach seek to understand ``how individuals arrive at
common representations of diseases'' (1997: 39). They also declare
a need for a theory which brings social contextual factors into
their model. Yet illness representations are viewed as the mental
operations of the individual problem-solver and are treated from

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574 Social Science Information Vol 41 ± no 4

an intra-psychic perspective. Once responses to health issues are


viewed as intra-psychic, understanding of the social processes that
underpin them cannot be adequately explored. There is recognition
of this problem within this literature. Leventhal and Nerenz (1985)
state that their approach has only a partial understanding of illness
representations, since it lacks a grasp of the contextual factors that
impact upon them. They say of such contextual factors: ``Their
study requires methods that we have not discovered'' (1985: 549).
If such methods are to be discovered, a radical shift away from
the focus on cognitions held by individuals will have to take place.

Particular implications of a social representations approach for


health psychology

SRT injects into health psychology a concern with methods for


grasping the contextual factors that feed individual belief structures.
In itself SRT also represents a critique of models of ``perception'' in
the health and illness sphere, where people are regarded as erroneous
perceivers, and their patterns of perception are aggregated in order
to ascertain general trends. In the place of this, SRT focuses on
persons in particular, how they make sense of particular health
issues and the evolution of their meaning structures. People's
``rationality'' is respected. Beyond mapping lay people's ideas about
health issues, the framework has major implications for relation-
ships between ``self '' and ``other''.
SRT speaks to the issue of stigma and, following from this, to the
level of social support that ill people get. The process of anchoring,
in social representation formation, stamps new illnesses with older
representations. Since illness and sin were intricately connected in
the past, many current illnesses, such as those that are sexually trans-
mitted, are branded with connotations of deserved punishment. In
addition to containing a mechanism whereby an older stock of
ideas is brought forward, the process of objecti®cation in SRT
ensures that the new health issue is conceptualized in terms of
contemporary symbols. Prevailing ideas about illness link it to
immoderate lifestyles. In line with Crawford's (1994) thesis, repre-
sentations of illness imply that ill-health is self-procured: a lack of
self-control (e.g. addiction to cigarettes or alcohol, eating too
much fat, exercising too little or becoming too stressed) is associated
with ill people. By contravening the norm of moderation, illness is

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Joffe Social representations of health and illness 575

created. Social representations linked to those who fall ill, therefore,


contain elements of stigmatization for this contravention or, indeed,
for sinning. Stigma is intricately connected with social rejection (see
Crandall and Moriarty, 1995), and such rejection compromises the
social support which has proven such a key element in terms of ill-
ness prevention, recovery from illness and longevity.
However, owing to its focus on the evolution of representations,
SRT is able to highlight how stigma and social rejection are not
passively accepted by the stigmatized. Individuals are active
thinkers, they have ``voice''. Political and cultural forces, such as
the rise of the Gay Movement, for example, impact upon how ill-
nesses are represented. Political forces have challenged the links
made in societies between AIDS and the ``other'', forcing recogni-
tion in public pronouncements on AIDS of its potential to affect
both dominant and marginalized groups. In addition, since social
representations function as protective strategies, stigmatized groups
also represent illnesses in comforting ways. This is illustrated in the
AIDS sphere by Joffe's (1995) ®nding that, in the early years of the
pandemic, British gay men linked the invention of AIDS to a con-
spiracy by scientists, in the knowledge that scientists had made
links between gay men and the origin of AIDS. Beyond this recipro-
cal blaming, certain gay men also challenged the dominant social
representation of AIDS as punishment, with the assertion that
AIDS was a ``gift from God''. It was represented as an illness
which heightens appreciation of life (see Joffe, 1995; Crossley,
1997). These strategies can be viewed as methods whereby the effects
of a spoiled identity, which is often the consequence of being stigma-
tized (see Goffman, 1963), are managed. Ill people cope with the
representations that others have of them by setting up social repre-
sentations which challenge the dominant orthodoxy. The represen-
tations of dominant and marginalized groups interact, often
providing those with differing group identities with a comforting
basis for identi®cation and communication.

Concluding discussion

This article has argued that the link between individual thought and
broader social and institutional forces is crucial to an understanding
of the psychology of health and illness. In particular, the communi-
cation and ®ltering of medical expertise, often by a moralistic mass

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576 Social Science Information Vol 41 ± no 4

media and by ideological assumptions that lie deep within a culture,


are key elements of lay understandings of health issues. In making
the shift from cognition to the social transmission of ideas, and to
the emotional and symbolic realms, the approach abandons reliance
upon the respected experimental and survey methods. Over-reliance
on self-reports taken at face value can lead to an atrophy in theore-
tical thinking.
Considering the major health challenges of the 21st century,
ranging from increasing rates of obesity and food scares to greater
understanding of the genetic bases of many illnesses, psychological
models that theorize the complexity of human health-related
thought and action are called for. SRT's dual focus on group-
based and internal rationality provides a valuable orientation with
which to understand levels of worry about such scares, and what
motivates the actions taken in relation to them.
Social representations research has been criticized on a number of
different scores (e.g. see Potter and Wetherell, 1998; Potter and
Edwards, 1999). For example, Fife-Shaw claims that ``any data
could be used to assert the existence of a social representation
about anything'' (1997: 69). In addition, he claims that the theory
lacks linearity: ``Social representations cause both thought and
action and are both thought and action''. To this, Joffe (1997b)
responds that since linear, causal models are dominant in psychol-
ogy, non-predictive models appear ¯awed. Yet the social representa-
tions approach embodies a deliberate attempt to build up a complex
model of common sense which contains multiple, reciprocal in¯u-
ences. Triangulation, in terms of the use of different methods, has
emerged as a key mechanism for exploring such in¯uences simul-
taneously and for ensuring that ®ndings are robust. In line with
Silverman's (1993) proposition regarding rigorous research, social
representational studies are theory-driven. Yet this is balanced
with an openness to the elements that the data reveal. Without
willingness to discon®rm one's theoretical assumptions, Fife-Shaw
would be justi®ed in his fear that SRT ``adopts the qualities of an
article of faith'' (1997: 69).
The quest for understanding the complexity of human meaning-
making systems must therefore be pursued by using appropriate
methods for its object of study. Ideally social representations
research avoids two pitfalls that can plague health psychology.
Firstly, it avoids ``methodolatry'': ``a combination of method and
idolatry, to describe a preoccupation with selecting and defending

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Joffe Social representations of health and illness 577

methods to the exclusion of the actual substance of the story being


told'' (Janesick, 1994: 215). Secondly, it strives to avoid what
Spicer and Chamberlain (1996) have termed the ``pathology of
¯ow-charting''. This refers to the process of enclosing variables in
boxes and linking them with arrows to designate causality. Accord-
ing to Chamberlain (2000), among others, this works against careful
theory-building. The social representations approach offers a means
to build valid theories that provide understanding of the speci®c
dynamics involved in groups of people's understandings of health
issues.

HeÂleÁne Joffe is a social psychologist in the Department of Psychology, University


College London. Her most recent publications include: ``Risk: From Perception to
Social Representation'', British Journal of Social Psychology (in press); ``Represen-
tations of Far-Flung Illnesses: The Case of Ebola in Britain'', in Social Science &
Medicine (with G. Haarhoff, 2002). Author's address: Department of Psychology,
University College London, Gower Street, London WC1E 6BT, UK.
[email: h.joffe@ucl.ac.uk]

References
Ajzen, I. (1988) Attitudes, Personality and Behaviour. Chicago, IL: Dorsey.
Ajzen, I. (1991) ``The Theory of Planned Behaviour'', Organizational Behavior and
Human Decision Processes 50: 179±211.
Ajzen, I. and Fishbein, M. (1980) Understanding Attitudes and Predicting Social
Behaviour. Englewood Cliffs, NJ: Prentice-Hall.
Bajos, N., Ducot, B., Spencer, B., Spira, A. and ACSF Group (1997) ``Sexual Risk-
Taking, Socio-Sexual Biographies and Sexual Interaction: Elements of the
French National Survey of Sexual Behaviour'', Social Science and Medicine
44(1): 25±40.
Bakhtin, M. (1981) The Dialogic Imagination. Austin, TX: University of Texas Press.
Bauer, M. W. and Gaskell, G. (1999) ``Towards a Paradigm for Research on Social
Representations'', Journal for the Theory of Social Behaviour 29(2): 163±86.
Brown, J., Chapman, S. and Lupton, D. (1996) ``In®nitesimal Risk as Public Health
Crisis: News Media Coverage of a Doctor±Patient HIV Contact-Tracing Investiga-
tion'', Social Science and Medicine 43(12): 1685±95.
Chamberlain, K. (2000) ``Methodolatry and Qualitative Health Research'', Journal
of Health Psychology 5(3): 285±96.
Comaroff, J. (1982) ``Medicine: Symbol and Ideology'', in P. Wright and A. Treacher
(eds) The Problem of Medical Knowledge: Examining the Social Construction of
Medicine, pp. 49±68. Edinburgh: Edinburgh University Press.
Crandall, C. S. and Moriarty, D. (1995) ``Physical Illness Stigma and Social Rejec-
tion'', British Journal of Social Psychology 34(1): 67±86.

Downloaded from ssi.sagepub.com at University College London on April 13, 2014


578 Social Science Information Vol 41 ± no 4

Crawford, R. (1977) ``You Are Dangerous to Your Health: The Ideology and Politics
of Victim Blaming'', International Journal of Health Services 7(4): 663±80.
Crawford, R. (1994) ``The Boundaries of the Self and the Unhealthy Other:
Re¯ections on Health, Culture and AIDS'', Social Science and Medicine 38(10):
1347±65.
Crossley, M. (1997) `` `Survivors' and `Victims': Long-Term HIV Positive Individuals
and the Ethos of Self-Empowerment'', Social Science and Medicine 45(12): 1863±73.
Duveen, G. and Lloyd, B. (1990) ``Introduction'', in G. Duveen and B. Lloyd (eds)
Social Representations and the Development of Knowledge. Cambridge: Cambridge
University Press.
Farmer, P. (1992) AIDS and Accusation: Haiti and the Geography of Blame. Berkeley:
University of California Press.
Fife-Shaw, C. (1997) ``Commentary on Joffe (1996) AIDS Research and Prevention:
A Social Representational Approach'', British Journal of Medical Psychology 70:
65±73.
Fishbein, M. and Ajzen, I. (1975) Belief, Attitude, Intention and Behaviour: Intro-
duction to Theory and Research. Reading, MA: Addison-Wesley.
Flick, U. (1992) ``Triangulation Revisited: Strategy of Validation or Alternative?'',
Journal for the Theory of Social Behaviour 22(2): 175±97.
Geodert, J. J., Neuland, C. Y., Wallen, W. C., Greene, M. H., Mann, D. L., Murray,
C. F., Strong, D. M., Fraumeni, J. F. and Blattner, W. B. (1982) ``Amyl Nitrite May
Alter T-lymphocytes in Homosexual Men'', Lancet 412±15.
Giami, A. and Schiltz, M.-A. (1996) ``Representations of Sexuality and Relations
between Partners: Sex Research in France in the Era of AIDS'', Annual Review
of Sex Research 7: 125±57.
Gilligan, C. (1993) In a Different Voice: Psychological Theory and Women's Develop-
ment. Cambridge, MA: Harvard University Press.
Goffman, E. (1963) Stigma: Notes on the Management of Spoiled Identity. Englewood
Cliffs, NJ: Prentice-Hall Inc.
Hall, S. (1980) ``Encoding/decoding'', in S. Hall (ed.) Culture, Media, Language,
pp. 128±38. London: Hutchinson.
Herzlich, C. and Pierret, J. (1987) Illness and Self in Society, translated from the
French (1984). Baltimore, MD: Johns Hopkins University Press.
Herzlich, C. and Pierret, J. (1989) ``The Construction of a Social Phenomenon: AIDS
in the French Press'', Social Science and Medicine 29(11): 1235±42.
Janesick, V. J. (1994) ``The Dance of Qualitative Research Design: Metaphor,
Methodolatry, and Meaning'', in N. K. Denzin and Y. S. Lincoln (eds) Handbook
of Qualitative Research, pp. 209±19. Thousand Oaks, CA: Sage.
Jodelet, D. (1991) Madness and Social Representations. Hemel Hempstead: Harvester-
Wheatsheaf.
Joffe, H. (1995) ``Social Representations of AIDS: Towards Encompassing Issues of
Power'', Papers on Social Representations 4(1): 29±40.
Joffe, H. (1996a) ``AIDS Research and Prevention: A Social Representational
Approach'', British Journal of Medical Psychology 69(3): 169±90.
Joffe, H. (1996b) ``The Shock of the New: A Psycho-Dynamic Extension of Social
Representations Theory'', Journal for the Theory of Social Behaviour 26(2): 197±
219.

Downloaded from ssi.sagepub.com at University College London on April 13, 2014


Joffe Social representations of health and illness 579

Joffe, H. (1997a) ``The Relationship between Representational and Materialist Per-


spectives: AIDS and `The Other' '', in L. Yardley (ed.) Material Discourses of
Health and Illness, pp. 132±49. London: Routledge.
Joffe, H. (1997b) ``Juxtaposing Positivist and Non-Positivist Approaches to Social
Scienti®c AIDS Research: Reply to Fife-Shaw's Commentary'', British Journal of
Medical Psychology 70: 75±83.
Joffe, H. (1999) Risk and ``the Other''. Cambridge: Cambridge University Press.
Joffe, H. and Dockrell, J. (1995) ``Unsafe Sex: Lessons from the Male Sex Industry'',
Journal of Community and Applied Social Psychology 5: 333±46.
Joffe, H. and Haarhoff, G. (2002) ``Representations of Far-Flung Illnesses: The Case
of Ebola in Britain'', Social Science & Medicine 54: 955±69.
Jovchelovitch, S. and Gervais, M.-C. (1999) ``Social Representations of Health and
Illness: The Case of the Chinese Community in England'', Journal of Community
and Applied Social Psychology 9(4): 247±60.
Kaes, R. (1984) ``Representation and Mentalisation: From the Represented Group to
the Group Process'', in R. M. Farr and S. Moscovici (eds) Social Representations,
pp. 361±77. Cambridge: Cambridge University Press.
Karpas, A. (1990) ``Origin and Spread of AIDS'', Nature 348(13 December): 578.
Kashima, Y., Gallois, C. and McCamish, M. (1993) ``The Theory of Reasoned Action
and Cooperative Behaviour: It Takes Two to Use a Condom'', British Journal of
Social Psychology 32: 227±39.
Lacey, C. J. N. and Waugh, M. A. (1983) ``Cellular Immunity in Male Homosexuals'',
Lancet : 464.
Leventhal, H. and Nerenz, D. R. (1985) ``The Assessment of Illness Cognition'', in
P. Karoly (ed.) Measurement Strategies in Health Psychology, pp. 517±54. New
York: John Wiley and Sons.
Leventhal, H., Benyamini, Y., Brownlee, S., Diefenbach, M., Leventhal, E. A.,
Patrick-Miller, L. and Robitaille, C. (1997) ``Illness Representations: Theoretical
Foundations'', in K. J. Petrie and J. A. Weinman (eds) Perceptions of Health
and Illness: Current Research and Applications. Singapore: Harwood Academic
Publishers.
Maiman, L. A. and Becker, M. H. (1974) The Health Belief Model: Origin and
Correlates in Psychological Theory. New Jersey: Charles Slack.
Markova, I. and Wilkie, P. (1987) ``Representations, Concepts and Social Change:
The Phenomenon of AIDS'', Journal for the Theory of Social Behaviour 17(4):
389±409.
Michie, S., McDonald, V. and Marteau, T. (1996) ``Understanding Responses to Pre-
dictive Genetic Testing: A Grounded Theory Approach'', Psychology and Health
11(1): 455±70.
Moscovici, S. (1976) La psychanalyse, son image et son public. Paris: Presses Univer-
sitaires de France.
Moscovici, S. (1984a) ``The Phenomenon of Social Representations'', in R. M. Farr
and S. Moscovici (eds) Social Representations, pp. 3±70. Cambridge: Cambridge
University Press.
Moscovici, S. (1984b) ``The Myth of the Lonely Paradigm: A Rejoinder'', Social
Research 51: 939±69.
Moscovici, S. (1985) The Age of the Crowd: A Historical Treatise on Mass Psychology.
Cambridge: Cambridge University Press.

Downloaded from ssi.sagepub.com at University College London on April 13, 2014


580 Social Science Information Vol 41 ± no 4

Moscovici, S. (1987) ``Answers and Questions'', Journal for the Theory of Social
Behaviour 17(4): 513±28.
Potter, J. and Edwards, D. (1999) ``Social Representations and Discursive Psychol-
ogy: From Cognition to Action'', Culture and Psychology 5: 447±58.
Potter, J. and Wetherell, M. (1987) Discourse and Social Psychology. London: Sage.
Potter, J. and Wetherell, M. (1998) ``Social Representations, Discourse Analysis, and
Racism,'' in U. Flick (ed.) The Psychology of the Social, pp. 138±55. Cambridge:
Cambridge University Press.
Rosenstock, I. M. (1974) ``Historical Origins of the Health Belief Model'', Health
Education Monographs 15: 328±35.
Rosenstock, I. M., Strecher, V. J. and Becker, M. H. (1988) ``Social Learning Theory
and the Health Belief Model'', Health Psychology Update 15: 175±83.
Silverman, D. (1993) Interpreting Qualitative Data: Methods for Analysing Text, Talk
and Interaction. London: Sage.
Smith, J. A., Flowers, P. and Osborne, M. (1997) ``Interpretative Phenomenological
Analysis and the Psychology of Health and Illness'', in L. Yardley (ed.) Material
Discourses of Health and Illness, pp. 68±91. London: Routledge.
Sontag, S. (1979) Illness as Metaphor. New York: Vintage Books Edition.
Spicer, J. and Chamberlain, K. (1996) ``Developing Psychological Theory in Health
Psychology'', Journal of Health Psychology 1: 161±71.
Verkuyten, M. (1995) ``Symbols and Social Representations'', Journal for the Theory
of Social Behaviour 25(3): 263±84.
Wagner, W., Valencia, J. and Elejabarrieta, F. (1996) ``Relevance, Discourse and the
`Hot' Stable Core of Social Representations ± A Structural Analysis of Word
Associations'', British Journal of Social Psychology 35(3): 331±51.
Weinstein, N. D. (1987) ``Unrealistic Optimism about Susceptibility to Health
Problems: Conclusions from a Community-Wide Sample'', Journal of Behavioral
Medicine 10: 481±95.
Weiss, R. A. and Wrangham, R. W. (1999) ``From Pan to Pandemic'', Nature 397:
385±6.
Wellings, K. (1988) ``Perceptions of Risk'', in P. Aggleton and H. Homans (eds) Social
Aspects of AIDS, pp. 83±105. London: Falmer Press.

Downloaded from ssi.sagepub.com at University College London on April 13, 2014

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