Cancer self-health programmes: an ethos for negotiating multiplicities of healthcare

Abstract

Cancer self-health programmes are a popular form of healthcare in the UK, Australia and North America. This article explores how they bring together heterogeneous and possibly incommensurable modes of healthcare (including complementary and alternative medicine, self-help, psychotherapy, and systems theory from bioscience) to form programmes of self-health. Through a discourse analysis of four programmes -The Bristol Approach; Health Creation Programme; CANCERactive; and, The Healing Journey -this article explore how these programmes promote: (1) Strategies to delineate spheres of living, such as mind, body, and spirit; (2) Relational practices such as, holism, connectedness, listening, and healing; (3) Empirically pragmatic attitudes that individualise techniques and practices; and, (4) Purposes to life that emphasise a dialogical movement between dichotomised positions. Significantly, through these strategies, techniques and practices cancer self-health programmes are able to promote an ethos that seeks to affect the user, without determining an individual's specific needs or choices.Keywords Complementary and alternative medicine, self-help, psychotherapy, cancer, systems biomedicine, sociology. within) could be tempered by the ethical difference these programmes make to the ways users understand their healthcare. In order to consider this, this article explores how the strategies, techniques, practices and aims of cancer self-health programmes are proffered to the user as one way of managing the multiplicity of tensions in selfhealthcare. MethodThe following four cancer self-health programmes 1 were selected for analysis  Chris Woollams' 'CANCERactive' (Woollams 2005(Woollams , 2008.1 While the founders or users of these programmes may not specifically use the label 'cancer self-health', I do not believe the conceptualisation would be one either alien to them or construed as necessarily problematic.2 Cooke wrote most of the book on The Bristol Approach, however it introduces an approach inspired by Penny Brohn and Pat Pilkington (the founders) (PBCC 2013) and that was the product of years of collaboration from numerous CAM and biomedical practitioners at the Bristol center. The books that were selected from each programme represent the core texts for each approach, introducing the main ideas, attitudes and practices to the (potential) user.The programmes themselves extend much further than these books, offering websites, newsletters, blogs, DVDs and podcasts, as well as courses and retreats. However, in order to focus on the central messages of the programmes these were excluded from this analysis.The field of cancer self-health is an international and multi-million dollar enterprise and so other programmes were considered for analysis. unlike the other four programmes, which seek to bring together a heterogeneous mix of treatments, therapies and practices, these approaches emphasise one discipline to the exclusion of others. LeShan and Hay primarily focus on the psychological aspects of illness,...

Balancing exercises: Subjectivised narratives of balance in cancer self-health

“…While an ontology of balance has been developed (Christiansen and Matuska, 2006;Lipworth et al, 2011;Wagman et al, 2011), this article aims to explore an area that has received less attention: how ideas, practices and techniques of balance affect peoples' experiences of cancer, particularly when they are engaged with modalities of self-health (MacArtney, 2015;Broom, 2009). …”

“…Similarly, CAM use by women that was posited as an escape from gender norms found in biomedicine has been found to reinforce many gendered aspects of healthcare (Nissen, 2013;Sointu, 2006b;Stacey, 1997). However, others have argued that while using CAM and self-help might result in reconfigured disciplinary practices and techniques of governance, it is also possible to demonstrate that within these discourses, practices and technologies of the self is the potential for the user to refashion her self beyond such boundaries (MacArtney, 2015;Broom, 2009;Fullagar, 2002;Meurk et al, 2013;Sointu, 2013). This is to argue that within Foucault's work, there is the possibility of a more nuanced position than simply positing that following health advice is subjugation and rejecting it is resistance (Armstrong and Murphy, 2012).…”

“…However, CAM use today can also be understood as part of a wider ‘self-health’ (Stacey, 1997) trend that sees users bringing a range of healthcare modalities together as part of a bricoleur approach to healthcare (Broom, 2009). These hybrid approaches to the healthcare field not only bring more possibilities but also more complexity as it now falls to users to respond to contemporary norms to care for their self and health (MacArtney, 2015; Frank, 1998; Gale, 2014; Novas and Rose, 2000; Rose, 2007).…”

“…In response, ideas, practices and techniques of ‘balance’ are one way people can negotiate this seemingly increasingly complex milieu of healthcare; as one cancer self-health programme advocated to its users, ‘the emphasis is on seeking to achieve equilibrium, the right balance for you’ (Beales, 2003: 39). While an ontology of balance has been developed (Christiansen and Matuska, 2006; Lipworth et al, 2011; Wagman et al, 2011), this article aims to explore an area that has received less attention: how ideas, practices and techniques of balance affect peoples’ experiences of cancer, particularly when they are engaged with modalities of self-health (MacArtney, 2015; Broom, 2009).…”

“…Balance is therefore often understood as a practice through which numerous oppositions found in healthcare – such as between the mind and body, hope and fate, empowerment and disenfranchisement – are negotiated (Daykin et al, 2007; Wagman et al, 2011). As a space where multiple dimensions of healthcare and wellbeing coincide, cancer self-health approaches portend to be an important site of analysis of how balance affects experiences and understandings of the self, health and life (MacArtney, 2015; Broom and Tovey, 2007; Mullen, 1992; Shapin, 2011).…”