The proliferation of algorithmic classification systems in healthcare raises fundamental questions about medical normativity: who determines the standards of health, and through what mechanisms are those standards constructed and enforced? This paper makes three original contributions. First, it conceptualizes algorithmic normativity as a multidimensional phenomenon operating through training data selection, loss function design, and clinical deployment contexts. Second, it forges a novel analytical link between population-level structural inequity and the undertheorised phenomenological dimension of diagnostic identity fragmentation. Third, it proposes a human-centric governance framework integrating transparency, plural normativities, and meaningful patient participation as a coherent alternative to purely technical approaches to algorithmic fairness. Drawing on medical sociology, science and technology studies, and bioethics, I argue that algorithmic systems do not simply discover pre-existing medical truths but actively construct normative frameworks that reflect and reproduce social inequities embedded in their development. The question of who decides what is healthy cannot be answered through computational means alone but requires sustained democratic engagement with the ethical, social, and political dimensions of algorithmic medicine.
This study explores the experiences of women seeking diagnosis and treatment for migraine symptoms in Ontario, Canada, and contributes to the growing literature on the concept of medical gaslighting. Migraine patients, particularly women, often report feeling disempowered within medical settings, where their symptoms and concerns may be minimized or dismissed. In recent years, the term medical gaslighting has increasingly been used by patients and in the media to describe these types of experiences. Guided by a critical ethnographic approach, this study seeks to illuminate how gaslighting is experienced within clinical interactions and traces the connections between women's lived experiences and the broader social, political, and cultural contexts that shape them. Qualitative interviews were conducted with 17 women in Ontario, Canada who had received a diagnosis and/or treatment for migraine. Analysis of participants' narratives revealed three key themes: questioning realities, narratives of diminishment, and shifting responsibility. Participants' accounts highlight how deeply embedded cultural norms and dominant discourses can shape healthcare experiences, reinforcing oppressive assumptions related to sex, ability, and what constitutes "good care." By foregrounding these experiences, this study adds depth to emerging scholarship seeking to define what medical gaslighting is and identifies strategies to address these concerns within clinical environments.
Umbilical cord blood (UCB) banking has been criticised in social science scholarship as emblematic of the neoliberal responsibilisation of parenthood. Yet this article foregrounds what most parents actually do: they do not store UCB. Drawing on the concept of non-use in the social studies of technology, we examine this non-use of cryopreservation services. Our empirical material from Germany shows that non-use does not necessarily reflect inertia or ignorance but instead points, first, to alternative practices surrounding UCB and, second, to the situational circumstances of decision-making. As an increasingly common alternative use of UCB, we discuss delayed cord clamping (DCC). Here, blood flows back to the child rather than into sterile plastic containers, facilitating a slower pace of postnatal care. At the same time, our inquiry indicates that neither UCB banking nor DCC necessarily results from a decision having been made. Parents often encounter the option to store UCB under circumstances that preclude deliberation - namely pain, exhaustion, and a lack of time or engagement. Thus, we argue, practices involving UCB frequently emerge from what we term non-decisions.
This review article for Health ’s 30th anniversary special issue provides an update on an article I contributed for the 20th anniversary of Health in 2016 which outlined how the sub-field of critical digital health studies has been explored in the journal. The current review article is in two parts. It begins with an overview of digital health research published in Health in the decade since the first review was published, reflecting on the methods and conceptual approaches that have been used over the past 10 years to engage with this topic. The second part goes on to consider how critical digital health studies might address the latest ‘big thing’ in digital health: generative AI applications. Some bold claims have been made about the benefits that generative AI models are supposed to offer patients and healthcare providers, but their impacts have not yet been fully evaluated from a critical digital health perspective. The article ends by emphasising the importance of acknowledging and identifying how the introduction of generative AI applications into medicine and health care can harm humans and the ecosystems of which they are part. Critical digital health studies should therefore expand its focus beyond its current human-centric preoccupations. As an interdisciplinary social research journal from its inception, Health is well-placed to offer a home for such critical analyses.
De/Medicalisation has become a staple of medical sociology to make sense of social issues at the intersection of health and illness. Broadly understood as the processes through which issues assume qualities that locate them within or beyond the remit of medicine, de/medicalisation continues to inform theoretical innovation and empirical research. The emergence of law clinics for people experiencing housing instability and homelessness offers a case study of how de/medicalisation can enrich the analysis of problems at the interstices of health and social care. Law clinics, often co-located or attached to primary and tertiary health care settings, aim to augment housing, health, wellness and social care offerings. Yet, this proximity - conceptual and spatial - may inadvertently reify understandings of homelessness as an individual pathology while aiming to offer pragmatic support to people who are otherwise excluded from core institutions in society. We present findings from a Roundtable with participants from law, social and health care professions and interviews with people experiencing housing instability (n = 27), lawyers, GPs and social workers (n = 10) in an Australian urban centre. In the vexed dynamics of the law clinic in-between different professions, de/medicalisation emerges as boundary-making and boundary-crossing to negotiate responsibilities, classify problems and reconcile competing logics.
Cancer rehabilitation in Denmark is publicly funded and framed as a universal and ongoing element of the cancer pathway, aimed at restoring everyday functionality after diagnosis. Yet participation remains uneven, particularly among citizens marked by social vulnerability. This article examines how such inequality unfolds in practice by focusing on moments of misalignments: situations where users' bodies call attention to themselves by not aligning with the spatial orders of rehabilitation. Drawing on ethnographic fieldwork in two rehabilitation units, we explore how such misalignments become visible in small gestures of hesitation, partial participation, or strategic withdrawal. By tracing moments of misalignment, we show how spaces of rehabilitation are structured by normative expectations of movement, progress, and improvement, while also containing cracks where alternative bodily logics surface. Attention to misalignment, we argue, offers a new lens on health inequality: shifting attention from formal access to the question of which bodies, rhythms, and ways of being are recognized and sustained within contemporary healthcare.
Nursing care work in Germany has been facing significant challenges, among them a steadily increasing shortage of nursing care workers. Funding programs promote the use of care robotics to mitigate these challenges' negative effects and to support nursing care practice. However, most robotics research on the topic has so far followed a technology-centered approach that hardly considers nursing care experts' distinct experiences, knowledge, or expertise. Drawing on interviews, focus groups, and workshops with nursing scientists, students, and practitioners, this study investigates the perspectives, evaluations, and imaginaries of German nursing care experts regarding care robotics. In their accounts, we found three salient themes that highlight care robotics as an open-ended, empirical concern for the nursing sciences; as a means for delineating between automatable and non-automatable nursing care activities; and as a potential remedy for nurses' assistive and executive responsibilities. Each of these themes highlights a particular set of challenges that nursing care work currently faces in the context of German healthcare from the nursing care experts' perspective and that shapes their perspectives on care robotics. We discuss the nursing care experts' responses as a reference point to re-articulate deep-seated disciplinary and professional concerns along three distinct dimensions: a nursing-as-science, nursing-as-practice, and nursing-as-profession dimension. We further conceptualize these dimensions as matters of care that care robotics research should engage with to generate care for nursing care work and workers. We conclude by suggesting ways for incorporating these dimensions into care robotics research and development.
The prevalence of mental health challenges, such as anxiety and depression, highlights the need for accessible and practical methods to enhance wellbeing as a preventative measure. Over half of the global population (54%) owns a smartphone, and the number of mobile users worldwide was projected to reach 7.49 billion by 2025. With smartphone cameras widely available, individuals can easily document daily moments, potentially benefitting their emotional wellbeing. This qualitative study explored the impact of photo-taking on individual wellbeing through a 3-week intervention grounded in positive psychology principles. Nineteen participants, recruited via social media took a daily photo for 3 weeks, each based on a theme set by the researcher: something they were grateful for (week 1), a selfie or self-portrait highlighting positive traits (week 2) and a picture to share with someone else (week 3). Participants then engaged in online one-on-one interviews with the researcher. Reflexive thematic analysis identified four core themes: (1) appreciation of life’s value, (2) shifts in mindset, (3) cultivation of purpose and (4) pursuit of positivity. The findings suggest that this intervention contributes to fostering a positive outlook and enhancing feelings of happiness, contributing to participants’ emotional wellbeing. While the study demonstrates a promising link between photo-taking and wellbeing as an accessible and preventative tool, further research is needed to examine additional variables, particularly across diverse age groups and ethnicities. As technology becomes increasingly integrated into daily life, such methods hold the potential for promoting individual and community flourishing with minimal effort.
Contemporary health research often examines patient objectification, patient self-objectification, and good patient performance as separate concerns. Treating them in isolation makes it difficult to see how they combine to shape what patients feel able to express in clinical encounters. To address this gap, this study examines how cancer survivors describe objectification, internalization, and performance within oncology care. Through this analysis, we develop a unified analytic account of these three experiences. In doing so, we reframe the "medical gaze" in existential terms as the "medical look," by drawing on Sartre's account of how becoming visible to another reshapes lived experience and existence. We interpret clinical visibility as a structure that unfolds across encounters, rather than as isolated interactional events. Drawing on 29 interviews with cancer survivors, our findings show that being positioned through clinical routines, adopting those framings as self-measures, and calibrating self-presentation in anticipation of clinical judgment were lived as connected movements within one structure of visibility. Recognizing this continuity clarifies communication pressures and constrained agency in oncology, and identifies points where clinical practice may ease the conditions under which patients manage how they appear.
The past 30 years have seen significant changes in how Attention-Deficit/Hyperactivity Disorder (ADHD) is understood, with public discourse and prevalence rates reaching an all-time high. While its evolution in the U.S. is well documented, recent global and digital shifts prompt a reexamination of ADHD research. The significance of this article is that it maps and analyzes, for the first time, an extensive and heterogeneous body of scholarship, spanning the sociology and anthropology of health and mental health; science, technology, media, and disability studies; and medical humanities, to propose the definition of a new subfield of "social studies of ADHD." By synthesizing key conceptual developments, social theories, and empirical findings therein, our article fills in a substantive gap in the literature, identifies main analytical frameworks, and outlines future research directions. We first trace the history of ADHD diagnosis and the DSM, rendered as an exemplary case of medicalization-as both theory and process-in the sociological literature since the mid-1970s. Second, we examine debates on the globalization of ADHD diagnosis and treatment to illuminate new areas of study and cross-national comparison. Third, we discuss alternative models and emergent perspectives on demedicalization, decolonial approaches, and the neurodiversity paradigm, which operates both as a social scientific concept and a movement. We then synthesize the latest research on the digital health turn to consider how emergent technologies and online platforms are reconfiguring ADHD knowledge, subjectivity, and sociality. To conclude, we use our critical analysis as a launchpad for setting a future interdisciplinary agenda for ADHD research in three areas that are relevant to the social study of health, illness, and medicine more widely: (1) digital and more-than-human perspectives on attention and care; (2) ethnography and phenomenology of ADHD affect and embodiment; and (3) intersectional, decolonial, and community research approaches.
Despite being unrelated to feminized organs or bodily processes, the contested condition called fibromyalgia is said to be overwhelmingly feminized and diagnosed predominantly in (assumed-) women. Few social scientific studies have explored the reasons or pathways for fibromyalgia's genderedness. In this article, I analyze medical scholarship on fibromyalgia over five decades to trace how it is gendered in this body of knowledge and how this genderedness is negotiated. I show that the genderedness of fibromyalgia is enacted multiply through the construction of fibromyalgia patient archetypes, through the reinscription and repudiation of clinical axioms in research design, and the elucidation of diagnostic criteria.
Health care systems globally are redistributing the responsibilities to address workforce shortages, yet task redistribution may create tensions between professional groups. Through this ethnographic study, I examine medication management as a case for exploring how professional boundaries are negotiated and reshaped during the redistribution of tasks. Fieldwork in three Norwegian nursing homes comprised 87 hours of observations and seven semi-structured interviews with nine informants. The data were thematically analysed and interpreted through Wenger's concepts of participation, reification, negotiation and boundary objects as well as Abbott's concepts of jurisdiction and workplace assimilation. Certified nursing assistants' (CNAs) participation in medication management created opportunities for knowledge development, as CNAs approached nurses for support. Medication administration records (MARs) functioned as boundary objects, enabling alignment but often lacking information meaningful to CNAs, leading them to seek clarification from nurses. These interactions facilitated knowledge sharing but simultaneously created tensions, as nurses experienced them as interruptions during high-risk tasks. Due to resource constraints and formal divisions of labour, CNAs' participation remained a form of peripheral, partial jurisdiction that both blurred and reconfigured boundaries while adding to nurses' workload. The study demonstrates that task redistribution is not a straightforward transfer of tasks but a dual process of knowledge development and negotiation of jurisdiction. Recognising this duality is crucial for designing policies that support the situated realities of professional work.
This article examines the sociomaterial inequalities encountered by young adults experiencing distress at the micro level with a focus on how various forms of material deprivation become embedded within recovery assemblages. Drawing on the Deleuzian-Guattarian new materialist approach, we define assemblages as human and nonhuman networks that connect material and immaterial elements together. In these assemblages, matter is considered to have 'agentic' capacity, and thus, agency is attributed, in addition to human actors, to nonhuman elements. By using interview data, our analysis identifies three distinct recovery assemblages arising from different forms of material deprivation in the recovery processes of young adults. The first assemblage relates to a lack of safe recovery environments, the second involves insufficient financial resources, and the third reflects the loss of bodily strength and diminished capacity for everyday functioning. Assemblages marked by material deprivation can become relatively permanent and territorialized, limiting the agency of young adults experiencing distress. However, these assemblages are also subject to destabilization and deterritorialization through micropolitical actions. We demonstrate how young adults and their family members can disrupt these assemblages and influence material deprivation. According to the new materialist perspective, small acts can ignite significant change, offering the potential to challenge sociomaterial inequalities on a broader scale.
Anti-stigma efforts with the goal of increasing treatment are often prioritized over anti-stigma efforts with the goal of improving the sociocultural status of a stigmatized way of being. We argue that a similar phenomenon exists within basic stigma research: research that enables efforts to increase rates of diagnosis and treatment has been prioritized over research that enables efforts to destigmatize. We refer to this as the medicalization of basic stigma research. In this critical review, we show that the medicalized state of stigma research manifests in several ways: the medicalized impetus and justification for much stigma research, the medicalized focus on the consequences of stigma, and the continued influence of attribution theory despite its empirical and practical limitations. We argue that researchers, reviewers, and funders should work to demedicalize stigma research, highlighting three potential steps. First, we must distinguish between improving the sociocultural valuation of a stigmatized way of being (destigmatization) and increasing the extent to which a way of being is defined and treated as a medical problem (medicalization). Second, we must prioritize research into what causes the sociocultural devaluation of stigmatized ways of being. Third, we must develop new theories of stigma that decenter health and illness and instead center cultural processes of devaluation.
The use of human enhancement drugs (HED), which include prescription drugs and other substances used for reasons beyond their intended medical use, has been the subject of considerable interest since the late 2000s. However, there is a lack of research exploring how working conditions and organisational norms may significantly contribute to an individual's decision to use substances for enhancement or performance purposes. Building on the concept of pharmaceuticalisation to examine the case of enhancement drugs use in the financial industry, this article highlights how the social context, particularly the workplace, can be central to analysing the causes and modalities of substance use for performance or enhancement purposes. This study therefore approaches the financial sector as a site where such processes may be observed in particularly acute forms. Through a qualitative analysis of an online forum, this study explores the experiences, motivations, opinions and beliefs about such substance use in the financial industry. The findings suggest that substance use is openly discussed in the forum and that difficult working conditions appear to contribute to shaping the modalities of such use. Stress and long working hours were the most reported problems associated with substance use. The study also shows that, far from being neutral, medicines and in particular HED themselves play a key social and normative role in the process of accepting these extreme working conditions. The narratives about the use of performance-enhancing substances created and disseminated within the community studied contribute to the idea that the micromanagement of the worker's bodies is ultimately the main tool available to adapt to their working conditions.
Interest in posthuman concepts and ideas, philosophies and theories has grown enormously over the last 25 years, and posthumanism is now one of the most vibrant and innovative frontiers in healthcare thinking. At its most basic, posthumanism is a philosophical approach that decentres the human and considers other non-human or more-than-human objects as equally important. But this description belies the many challenges posthumanism presents to the researcher. There are many competing approaches to consider, there is often opaque language to navigate, and there are many structural problems to overcome. In this paper we tackle three major methodological challenges: vitalism, or the question of what gives life to things; transcendence, and the substance problem; and correlation, or latent anthropocentrism. We consider how it might be possible to research with a process-based ontology in a world dominated by substance-based principles. And we conclude with four related recommendations: a focus on key principles, concept creation, deep reading and attention to ontological slippage, before reflecting on our own experiences researching walking for people living with persistent pain.
Individuals with severe mental illness (SMI) and/or substance use disorders (SUD) face profound levels of stigmatizing behaviors from family members, the general population, employers, and healthcare providers. These stigmatizing behaviors have the potential to deeply affect their emotional, mental, physical, and social wellness. Individuals who experience stigmatization may have decreased self-esteem, self-efficacy, physical and mental wellness, quality of life, and service-seeking in the healthcare sector. We conducted a qualitative phenomenological inquiry with individuals with SMI and/or SUD, exploring their experiences receiving healthcare provisions. The intention of collecting these data was to highlight and amplify the voices of individuals with SMI and/or SUD, as they have historically been silenced. Moreover, we wanted people with lived experience (PWLE) of SMI and/or SUD to inform the development of a de-stigmatization training program for healthcare students. We interviewed focus groups comprising PWLE using open-ended questions from a semi-structured interview guide to better understand their perceptions of and engagement with healthcare providers. Thematic analysis of our data resulted in six themes: (1) Agency in treatment decisions, (2) Emotional and structural challenges to healthcare, (3) Power dynamics in healthcare, (4) Interpersonal relationships between patients and healthcare providers, (5) Healthcare advocacy, and (6) Dehumanization and disregard of patient insight. These findings demonstrate the many ongoing challenges and barriers that individuals with SMI and/or SUD face when seeking healthcare services. Moreover, these data provide important considerations for the development and implementation of future de-stigmatization training programs for individuals in the healthcare sector.
Suicidal ideation is highly dynamic and can rapidly escalate to suicide attempts. Traditional clinical assessment tools rely on retrospective, one-off evaluations, limiting their effectiveness in timely intervention and individual prevention. Digital technologies offer promising alternatives by enabling real-time, context-sensitive assessments and interventions. In response to this potential, a multidisciplinary French team developed EMMA-a smartphone application designed to assess and help prevent suicide directly from an individual's pocket, as part of a clinical trial. Drawing on new materialist and sociomaterial perspectives, this study aims to explore how the use of EMMA reconfigures relationships and practices within the emerging paradigm of digital suicide prevention. Semi-structured interviews were conducted with individuals experiencing severe suicidal ideation, all of whom participated in the clinical trial and used EMMA over a 6-month period. The goal was to capture their subjective experiences and engagement with the digital tool. Participants initially engaged with EMMA as a source of support during a vulnerable post-hospitalization period, perceiving it as an extension of care. Use was most intense in the early weeks, then declined as their condition improved. While EMMA enabled self-reflection and awareness of emotional patterns, it also elicited ambivalent responses-some found it comforting, others intrusive or overwhelming. The app reshaped connections not only to the self but also to relatives and the healthcare system, acting as a relational interface within a broader network of care. Overall, the findings suggest that using EMMA involved forms of digital intimacy within a sociotechnical assemblage, engaging in a complex feedback loop involving the tool, themselves, their relatives, and the healthcare system. This study highlights that innovation in suicide prevention does not reside solely in technological design, but emerges through socio-material practices and the ways digital tools become entangled with lived experience and care relationships.
This article examines how healthcare professionals working on COVID-19 wards experienced psychosocial burdens during the pandemic and how they managed these within the intersecting pressures of personal vulnerability, professional duty, and institutional expectation. Drawing on deep-structure hermeneutics, 13 qualitative interviews were analysed to explore latent meaning structures underlying professional discourse. From this corpus, one analytically rich interview was selected for an in-depth single-case analysis. It illustrates how a rhetoric of positivity and a strictly maintained professional role served as protective defences against anxiety, helplessness, and loss of control. Within this dynamic, functionality emerged as a latent mode of coping that re-established a sense of agency and order, yet simultaneously suppressed emotional expression and acknowledgement of personal needs. These findings reveal a psychosocial paradox at the heart of clinical work under crisis conditions: maintaining reliability and composure while risking emotional detachment and exhaustion. As a theoretically informed implication of these findings, we propose the potential value of "spaces of non-functioning"-temporary contexts that allow relief from performance demands without destabilising professional identity. Such protected spaces may provide a more sustainable balance between care for others and self-care within the culture of contemporary healthcare.
Public, policy, and media discourses increasingly frame loneliness as a "modern epidemic," raising concerns that this complex emotional and social experience is being medicalized. However, empirical attempts to trace the extent and mechanisms of this process remain limited. Adopting a social constructionist perspective, this article operationally defines medicalization as the process of "making an experience medical" and analyzes 23,182 loneliness-related publications in the Web of Science (1980-2024) to map disciplinary locations, citation impact, and temporal growth patterns. Findings show that while psychology maintains a substantial presence, suggesting a prominence of emotional framings, there is marked growth in psychiatry, public health, and neurosciences. This trend may indicate that loneliness is being increasingly incorporated into mental health and neurobiological domains. Drawing on traditional medicalization theories, the article proposes a four-phase trajectory model as a provisional framework for further discussion. Within this framework, psychologization potentially facilitates an individualization that may serve as a basis for biomedical intervention. Furthermore, public health may play an ambivalent role: while retaining its social-reformist orientation, it could potentially accelerate medicalization by reframing loneliness as a "risk factor." Looking forward, it remains to be seen whether frameworks viewing deficits in the quality and quantity of social relationships as health risks will emerge, potentially extending medicalization to domains beyond the individual as risk and surveillance technology advances. Despite its macro-level scope, this study provides empirical insights for the theoretical development of medicalization by exploring how everyday experience aligns with biomedical domains.
