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Hélène Joffe
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What is This?
HeÂleÁne Joffe
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.
Background
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
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.
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
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
Methodological challenges
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.
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)
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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