The Good Citizen with cancer: managing an ambivalence in Sweden, Denmark and the UK

Our team has conducted narrative interviews with patients recently diagnosed with either lung or colorectal cancer in three European countries. Around 160 interviews were collected by a sociologist (UK) an anthropologist (Denmark) and nurse researchers (Sweden) using a common approach and interview guide. The wider aim of the study is to seek explanations, through narrative interviews, for the different cancer outcomes for patients in these three countries and to identify potentially modifiable factors in awareness, diagnosis and referral.
In this paper we will focus on people’s accounts of the process that led to the diagnosis, including their recognition of symptoms and their decisions to consult a doctor, and their descriptions of self care during and after treatment. We find that patients in all three countries present certain health related behaviours as creditable while others are positioned as understandable deviations. For example, assuming that a symptom cannot be serious because the person otherwise feels well, or for which they can find another rational explanation. A third group of behaviours were described as less acceptable, but this last category was usually applied to hypothetical behaviours, not to themselves ( and may be considered a distancing mechanism).
Drawing on sociologist Robert K Merton’s 1976 essays on Sociological Ambivalence, we demonstrate that cancer patients in these northern European settings display numerous examples of ambivalence in relation to their health behaviours. For example we show that the good patient (and good citizen) is characterised as someone who is attentive to their health (but not obsessed with it) , who responds to media campaigns on symptom awareness (but does not present at the doctors as a ‘worried well’ patient), who follows advice from the doctor (but also listens to their own body and is prepared to challenge advice) who is optimistic, positive and hopeful (but is not gullible or prey to wild theories).
In this paper we will demonstrate that the ‘Goldilocks Zone’ that patients are trying to inhabit as good citizens and responsible partners in their health care presents considerable difficulties in all three countries.