‘I take a small amount of the real product’: Elevated cholesterol and everyday medical reasoning in liminal space

Abstract

The medical consequences of elevated cholesterol are widely known, as are the medical regimens to control and manage it. At the same time, elevated cholesterol is bereft of bodily signs. Being symptomless places the condition in a no man's land: people with elevated cholesterol are assessed as medically sick but their bodies signal wellness. In this article I refer to this ambiguous grey area, betwixt and between being healthy and being sick, as liminal space . The aim of this article is to show how people manage the symptomless condition of elevated cholesterol in liminal space. Particular attention is paid to everyday medical reasoning in that space. Based on interviews with people with elevated cholesterol, I show that medical regimens are 'up against' - challenged by - a variety of competing conditions in everyday life, illustrating ambiguity. Facing this dilemma between medicine and everyday life, they ongoingly need to navigate - edit, modify, adjust - medical regimens against everyday conditions. This navigating work can be seen as ritualized strategies to sort ambiguity. People with elevated cholesterol do not so much act 'against medical regimens' as they simultaneously need to take account of other matters they are up against in trying to stay healthy. Medical regimens are sometimes central, sometimes peripheral. Adapting medical regimens to the situation at hand, people continuously comply with medical regimens, producing and reproducing medical regimens in moral contexts of everyday life.

Stories of Liminality

“…For example, Navon and Morag (2004) describe ambiguous situations for men with advanced prostate cancer receiving hormonal treatment. Hoel Felde (2011) describes liminality as an “in-between grey area between two well defined and known everyday categories” (p. 606) where experiences or identity no longer fit easily into categories. Similarly, Forss, Tishelman, Widmark, and Sachs (2004) use liminality to describe women receiving abnormal Pap smear results.…”

Patients‐in‐waiting or chronically healthy individuals? People with elevated cholesterol talk about risk

“…For example elevated cholesterol does not produce symptoms and cannot be diagnosed without testing (Angus et al . , Hoel Felde ). Although the pathological effect of high cholesterol, the thickening of the arterial walls and narrowing of blood vessels, could in principle be measured, this has not been established as a standard clinical procedure.…”

Associations between patients’ risk attitude and their adherence to statin treatment – a population based questionnaire and register study

“…It is well documented that patients’ comorbidity, co-medication, and socioeconomic status are important determinants of poor adherence [ 6 – 8 ]. Furthermore qualitative research on adherence has focused on how persons’ everyday conditions such as family life, holidays, and leisure schedules and societal eating rules influence on the management of adherence and adaptation of medical treatment [ 9 , 10 ]. During the past decades the influence of risk attitude on health behaviour and health outcome has received little but an increasing attention in the literature [ 11 – 15 ].…”