Couples' management of lifestyle change in health and after coronary heart disease
: A Foucauldian-Deleuzian approach

Traethawd ymchwil myfyriwr: Traethawd Ymchwil DoethurolDoethur mewn Athroniaeth


Non-communicable diseases, such as coronary heart disease (CHD), are the leading cause of death globally, and their link to lifestyle behaviours has led to national and global investment in healthy-lifestyle promotion. Located within the logic of neoliberal governance, health promotion constructs healthy lifestyle as a matter of individual responsibility and choice. Critical research identifies the potential for judgement and blame through this individualistic construction, suggesting an alternative framework is needed. But there is a gap in critical health research that considers how dominant health discourses are negotiated by couples. In contrast, mainstream health psychology research identifies intimate relationships as important mediators of health benefits. But findings are inconclusive, and indicate that wider social factors may contribute to the complexity of couples’ health behaviours.

Drawing these two literatures together, this thesis aimed to explore couples’ management of individualistic and pervasive healthy lifestyle advice. In developing a theoretical framework that accounted for the complexity of couples’ health behaviours, it also aimed to provide an affirmative alternative to the logic of blame. To meet these aims, people in long-term relationships were interviewed about lifestyle and lifestyle change, both in the absence of diagnosed illness (Study 1), and after a diagnosis with CHD (Study 2). Their talk was analysed using a novel poststructuralist theoretical framework that combined Foucauldian Discourse Analysis (FDA) with Deleuzian concepts of affect, assemblages, and time.

Study 1 was designed to identify key issues in participants’ talk about healthy living within relationships and test the analytical framework. In individual semi-structured interviews with seven people (five women and two men), participants extended neoliberal discourses of individual health responsibility to encompass their partners. Within this joint endeavour there were three discourses: ‘weight…is a relationship thing’, in which participants’ negotiated distinct but parallel discourses of appearance and health; ‘risky relationships’, in which they constructed healthy lifestyle as joint risk management; and ‘drift back into comfortableness’, which built an account of healthy lifestyle as fluid, effortful and short term.

The salience of health led to the exploration of how couples negotiate lifestyle advice in the context of illness. Study 2 was a substantial, longitudinal qualitative project with 22 people (nine couples and four men in long-term relationships who chose to participate alone), recruited within two weeks of a partner receiving a new diagnosis of CHD, and interviewed once a month for three months, creating a total of 37 interviews. Using FDA with Deleuzian concepts, three main discourses were identified: ‘Ideal health citizens, ideal partners’, in which couples’ negotiated conflicting norms of ideal coupledom and responsible health citizenship; ‘expert patients, expert partners’, where couples managed competing knowledges and ensuing power relations; and ‘multiple temporalities of lifestyle change’, where couples referred to multiple time-frames or durations of illness, recovery, and ageing which afforded acceptance, stoicism, and the assertion of values other than the narrow pursuit of health through healthy lifestyle. The novel contributions of this thesis include the following: A reconceptualization of ‘technologies of the self’ meant that couples’ joint practices could be understood as work on both self and other to produce desired subject positions, and revealed that imperatives of health can transgress relationship norms. Far from always being in alignment, ideals of coupledom could compete and conflict with those of good health citizenship. The thesis also contributed a novel understanding of how couples’ co-construction of risk through multiple experiential and expert knowledges produced intricate power relations. Finally, this thesis developed the field with an original application of Deleuze’s notion of time to couples’ talk of multiple and fluid temporalities of illness, recovery, and health could work for or against engagement in lifestyle change. In health psychology literature, intimate relationships are assumed to be protective and supportive of health, but the thesis indicated that couples’ joint management of lifestyle increases complexity and therefore possibilities for both affirmative and negative experiences. The Foucauldian-Deleuzian approach successfully engaged with the complexity and dynamism of couples’ health negotiations, offering an affirmative and ethical perspective on couples’ management of lifestyle advice and change that has valuable implications for future research and practice.
Dyddiad Dyfarnu2017
Iaith wreiddiolSaesneg
Sefydliad Dyfarnu
  • Prifysgol Aberystwyth
GoruchwyliwrSarah Riley (Goruchwylydd) & Elizabeth Gagen (Goruchwylydd)

Dyfynnu hyn