The experience of health and illness: Polycontextural meaning and accounts of illness

Accounts of illness have been explored for their significance, purposes and consequences. There have been relatively few papers exploring the sources of accounts of illness and even fewer that have adopted a structural approach to these sources. This article draws on a secondary analysis of existing data to argue that social systems theory may provide a promising way to explore the structural aspects of illness accounts. This article takes the example of accounts of illness of dentine sensitivity, a condition that can have a range of impacts from relatively minor to significant on the everyday lives of people. The analysis involved a staged study of the factual, social and temporal dimensions of sensitivity including seeking out the social semantics that condition accounts of dentine sensitivity. The results of the study include a secondary analysis of data taken from interviews with 23 adults, 15 of whom were women and eight were men. Participants included those who were currently experiencing sensitivity in their teeth and who were adults of all ages (18–65 years) and backgrounds. The subsequent analysis presented in this article seeks to highlight how accounts of the impact of dentine sensitivity have a ‘polyphonic’ character. By this, we mean they have multiple structural sources. Accounts of dentine sensitivity are conditioned by the imperative of dentine sensitivity. This imperative involves a paradox that people should be insensitive to their sensitivity. A consequence of this is that people frequently suffer significant disruptive impacts from their sensitivity but must suffer these impacts alone. In addition to the imperative, we find that dentine sensitivity is a non-problem problem. This means that it is not a problem for health care organisations and as such individuals must use individualised solutions to the problem either through avoidance or by consuming specific toothpastes. Finally, dentine sensitivity has an important moral component; it can result from relative oral ‘neglect’ or paradoxically too much care. In each communication we attempt to show how the semantics of dentine sensitivity are shaped by polyphonic horizons of communication (social, factual and temporal dimensions) and the participation of various communication systems (culture, the medical system and morality). The article concludes by discussing the usefulness of systems theory in understanding accounts of illness as a polyphonic unity of different horizons of communicat