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It has become something of a cliché that Western culture is obsessed with celebrity, glamour, and the opportunities ordinary people are now given (reality television, social networking sites, blogging) to become famous. These new engagements between fame and obscurity have been accompanied by energetic debates about the self, image and vanity. Similar debates are also underway in a domain apparently quite different from this digital realm – the corporeal domain of health, fitness, beauty and anti-ageing. Vanity, it seems, can account for both our least and most bodily modes of making the self. Despite these growing areas of debate, little or no sociological or cultural studies research on vanity has been conducted to date. This book sets out to remedy this. Exploring a range of sites of social and cultural production – from Helen Mirren's red bikini to The Biggest Loser reality weight loss show, from suffragists to Viagra, from anti-ageing medicine to Facebook – the book takes an engaging, sophisticated and wide-ranging look at new ideas and practices of vanity. How are contemporary subjects to cope with concurrent pressures both towards self-absorption and away from it? Taking an explicitly gendered approach to these questions, Vanity: 21st Century Selves conducts a broad analysis of a key concept shaping contemporary Western societies and their ways of understanding the self.

Widespread concern about a childhood obesity ‘epidemic’ has focused attention on the bodies, weight and food behaviours of mothers and their children. In childhood obesity-related discourse, mothers' bodies are framed in relation to the bodies of children, most directly in claims that fat mothers produce fat babies. Drawing on data from a qualitative study involving interviews with mothers of pre-school aged children, this paper examines how the blurring of body boundaries between women and children are translated into responsibilities in feeding. We argue that in the contemporary stigmatisation of fat, the external auditing of maternal feeding and children's bodies connects the bodies of mothers and children in detrimental ways. By focusing on the ways women are held responsible for both their own and children's bodies, we draw attention to how bodily aspirations, conflict and failure, shame, self-surveillance, judgement and guilt connect women to the bodies of their children. We stress the embodied significance of mother/child relations in early childhood nutritional care and we argue that a punitive anti-fat ethic threatens positive health outcomes for mothers and children.

Despite two decades of prevention activities and education, rates of hepatitis C infection remain high among people who inject drugs. In this article we draw on the findings of an extensive review of the content of print hepatitis C prevention materials circulating in Australia, examining these data in light of Petraglia’s (2009) theory of “authenticity” in social marketing. We identify three main areas in which resources could be redesigned: closer attention to language and terminology, a critical engagement with common concepts of the individual, and more acknowledgement of the role of social and structural factors in shaping injecting practice. To achieve a stronger sense of authenticity, and in turn become more equitable and efficient, future resources could address these issues using insights from social marketing literature.

In this article, we argue that the “problem” of addiction emerges as an effect of treatment policy and practice as well as a precursor to it. We draw on the work of Marrati to analyze interviews with policy makers and practitioners in Australia. The interviews suggest that the episode-of-care system governing service activity, outcomes, and funding relies on certain notions of addiction and treatment that compel service providers to designate service users as addicts to receive funding. This has a range of effects, not least that in acquiring the labels of “addict”, service users enter into bureaucratic and epidemiological systems aimed at quantifying addiction. Rather than treating pre-existing addicts, the system produces “addicts” as an effect of policy imperatives. Because addiction comes to be produced by the very system designed to treat it, the scale of the problem appears to be growing rather than shrinking.

© Suzanne Fraser and Kate Seear 2011. All rights reserved. Since the naming of hepatitis C in 1989, knowledge about the disease has grown exponentially. So too, however, has the stigma with which it is linked. Associated with injecting drug use and tainted blood scandals, hepatitis C inspires fear and blame. Making Disease, Making Citizens takes a timely look at the disease, those directly affected by it and its social and cultural implications. Drawing on personal interviews and a range of textual sources, the book presents a scholarly and engaging analysis of a newly identified and highly controversial disease and its relationship to philosophies of health, risk and harm in the West. It maps the social and medical negotiations taking place around the disease, shedding light on the ways these negotiations are also co-producing new selves. Adopting a feminist science and technology studies approach, this theoretically sophisticated, empirically info rmed analysis of the social construction of disease and the philosophy of health will appeal to those with interests in the sociology of health and medicine, health communication and harm reduction, and science and technology studies.

Introduction: ‘Addiction’ is an ambiguous concept. Its meaning, and how it is used in drug policy and treatment, depends on how it is conceptualised. While the ‘disease’ model of addiction is prevalent in Australia, differing, sometimes contradictory, interpretations of this model are mobilised.Methods: Drawing on 20 semi-structured interviews conducted with professionals working in the area of drug use in Victoria, Australia, this paper develops a typology delineating different approaches to addiction.Results: Five domains of meaning related to addiction were identified in the data. These were: (i) the sign of craving; (ii) susceptibility; (iii) social and psychological issues producing addiction; (iv) self-concept; and (v) social functions of addiction. These domains are further divided into two subtypes based on how the participants understood the role of a key notion in addiction: volition, that is, whether or not an ‘addict’ has control over drug use and other aspects of life.Discussion: By systematically mapping different conceptualisations of addiction, this typology identifies the ambiguities and contradictions in the models currently in use, especially with respect to the notion of volition. While a homogeneous approach to these issues is neither practical nor desirable, there is a need to consider the implications of this lack of coherence.Conclusions: Service providers, medical practitioners and policy makers need to reflect on their assumptions, and consider the implications of their different approaches for clients, some of whom encounter more than one approach when undergoing treatment for drug use.

Over the past decade intense concern has developed in the West about what has been characterised as an obesity epidemic. This concern is producing a range of effects, including changing attitudes towards food. Some foods are no longer just foods; they are increasingly framed as illicit substances. At the same time, overeating is coming to be seen as a form of addictive behaviour. How do new concerns about junk food, health and overeating impact on notions of drug use and addiction? In this article, I explore food and obesity as a case study of changing ideas about addiction. Drawing on an analysis of scientific journal articles that link obesity and addiction, the article examines the assumptions that drive such linkages, and their implications and effects. Wherever obesity is linked to addiction, this link is increasingly explained via neuroscientific theories of behaviour. The brain's hedonic and reward systems are cited to frame ‘excessive’ eating as addictive behaviour, and ‘highly palatable’ or junk foods as akin to conventional drugs. In the process, a range of phenomena are enacted. In science studies theorist John Law's [(2011). Collateral realities. In P. Baert & F. Rubio (Eds.), The politics of knowledge (pp. 156–178). London and New York: Routledge] terms, numerous important ‘collateral realities’ are produced. ‘Drug addiction’ is referred to as though no controversy exists over its interpretation. Likewise, ‘drugs’ are produced as a homogeneous group with no differentiating features. The article concludes by considering the limitations of such accounts of food, the body, health and well-being, and their reciprocal effects on the field of drug addiction.

Considerable effort has been expended in developing health education materials and programmes aimed at reducing transmission of hepatitis C virus (HCV) among people who inject drugs. Health education is considered more likely to be effective when it is targeted to defined segments of the population and when people actively identify with the messages presented. In this context, it is important to understand the health messages on offer in these materials. This article conducts a discourse analysis of an extensive corpus of Australian heath education literature on HCV to explore the kinds of messages these materials attempt to present. It questions the unexamined assumptions they include and it considers how effectively these materials address the social context of HCV transmission. It focuses on issues of individual and group conduct: in particular, because HCV transmission occurs commonly between sexual partners, on the place of couples who inject together in prevention education. The article concludes by arguing that these materials pay insufficient attention to couples, relying almost without exception, and despite a longstanding critique recommending new approaches, on the individual as the core unit of agency in HCV transmission and in turn prevention.

This article widens the debate surrounding supervised injecting facilities (SIFs) by exploring an aspect of SIFs yet to be examined in the scholarly literature: the relationships created between staff and clients within these settings. By analyzing entries made in the Sydney Medically Supervised Injecting Centre’s (MSIC) client comment books we explore the centrality of emotional connection to clients’ experiences of the service. We argue that the everyday contact between staff and clients—including the “accidental intimacy” that develops when clients inject in the presence of staff —counters the sensations of shame identified by many in the comment books, creating new relations, and new performative possibilities for the production of self, belonging and citizenship for clients of the service. In exploring the role of emotions in the operation of the MSIC we also aim to highlight the political, policy, and clinical value of qualitative forms of inquiry for the harm reduction field.

Over the last decade intense concern has developed about what has beencharacterised as an obesity epidemic in the West. This concern has been accompanied byequally intense debates over the validity of this characterisation. Many critics see theepidemic designation as part of an intensifying 'moral panic' about fat in which emotionsabout fat shape the public and scientific debate. In this article we explore thecritical literature on the obesity epidemic, noting the way in which it draws attention tothe role of the emotions in discourse on the epidemic. We argue that the action ofemotions in this context invites further theorisation, and that this theorisation needs tobe undertaken via concepts that: (1) explicitly integrate the body and the emotions withthe materialisation of political discourse, (2) avoid individualising and psychologisingaccounts of the emotions and (3) analyse the action of emotion in political debatewithout implying the need to eradicate emotion in generating more just and accurateperspectives. To this end, we turn to the work of Sara Ahmed, who has developed asophisticated account of the role of the emotions in constructing social collectivitiesthrough their engagement with ideas of the body. We argue that this theory can be usedto illuminate both the general relationship between public discourse and subjectivity,and the specific relationship between the self, the body and the oftentimes unmetimperative to slimness.

Currently in developed nations, childhood obesity is generating widespread concern and prompting social and institutional responses. Obesity is constructed as a broad public health crisis, but individuals are constructed as responsible for their own bodies and body sizes within this crisis. We are particularly interested in two aspects that focus on women as central to this phenomenon; the first is the imputation of maternal responsibility for the weight of children and the second is the role that specific fears about flesh and women’s bodies play in how childhood obesity is represented. We analyse media representations of childhood obesity in Australia and draw out the discourses of maternal responsibility and the intertwining of mothers and children’s bodies. We frame the childhood obesity crisis within a broader discussion of women, care and responsibility, suggesting that childhood obesity offers another embodied location to reinforce and extend women’s roles and responsibilities as mothers, in response to changing patterns of work and care.

Currently in developed nations, childhood obesity is generating widespread concern and prompting social and institutional responses. Obesity is constructed as a broad public health crisis, but individuals are constructed as responsible for their own bodies and body sizes within this crisis. We are particularly interested in two aspects that focus on women as central to this phenomenon; the first is the imputation of maternal responsibility for the weight of children and the second is the role that specific fears about flesh and women's bodies play in how childhood obesity is represented. We analyse media representations of childhood obesity in Australia and draw out the discourses of maternal responsibility and the intertwining of mothers and children's bodies. We frame the childhood obesity crisis within a broader discussion of women, care and responsibility, suggesting that childhood obesity offers another embodied location to reinforce and extend women's roles and responsibilities as mothers, in response to changing patterns of work and care.

Over the last decade intense concern has developed about what has been characterised as an obesity epidemic in the West. This concern has been accompanied by equally intense debates over the validity of this characterisation. Many critics see the epidemic designation as part of an intensifying 'moral panic' about fat in which emotions about fat shape the public and scientific debate. In this article we explore the critical literature on the obesity epidemic, noting the way in which it draws attention to the role of the emotions in discourse on the epidemic. We argue that the action of emotions in this context invites further theorisation, and that this theorisation needs to be undertaken via concepts that: (1) explicitly integrate the body and the emotions with the materialisation of political discourse, (2) avoid individualising and psychologising accounts of the emotions and (3) analyse the action of emotion in political debate without implying the need to eradicate emotion in generating more just and accurate perspectives. To this end, we turn to the work of Sara Ahmed, who has developed a sophisticated account of the role of the emotions in constructing social collectivities through their engagement with ideas of the body. We argue that this theory can be used to illuminate both the general relationship between public discourse and subjectivity, and the specific relationship between the self, the body and the oftentimes unmet imperative to slimness.

In accounts of hepatitis C, subtle distinctions are frequently made between “innocent” and “guilty” forms of transmission. Although such distinctions have been extensively critiqued, they continue to manifest in indirect ways, such as the articulation of emotions. We argue for a critical approach to the way in which emotions function in accounts of hepatitis C by analyzing textual accounts of hepatitis C, and interviews with people who have hepatitis C in Australia. Drawing upon the work of theorist Sara Ahmed, we argue that emotions work to constitute subjects, objects, and collectivities, including some individuals and excluding others. In this regard, the articulation of emotion can contribute to the marginalization and stigmatization of people living with hepatitis C. We also explore ways people with hepatitis C negotiate frameworks of guilt/responsibility. We conclude by considering how health promotion and policy texts might better address emotional responses to diagnosis without reproducing stigmatizing assumptions.

Contemporary Western societies focus considerable policy and media attention on the 'epidemic of childhood obesity'. In this paper we examine the mobilisation of notions of responsibility and consumption in these discussions, and consider the implications they have for women as mothers. In particular, we are interested to explore the potential conflicts mothers face as care providers and nurturers when responsible care is framed as withholding or managing the food consumption of children. We argue that the competing discursive frameworks around mothers'food provision invite further theorisation that explicitly addresses nourishment and consumption as elements of maternal practice and care. We draw on the work of Neysmith and Reitsma-Street (2005) regarding 'provisioning' to undertake a critical examination of the discourses in the 'childhood obesity'epidemic, with particular attention to Australian media and policy discussions. According to Neysmith and Reitsma-Street, mothers are central to social 'provisioning', that is, the labour that secures the necessities of life. This provisioning framework captures paid market work and unpaid caring labour, policy settings and social locations, allowing for a rich conceptualisation of the conditions mothers negotiate as they provide for their children. Taking up the possibilities of this framework, we argue that, insofar as health risks and responsibilities are largely individualised, mothering is framed as primarily about giving, and childhood obesity is considered a disease of affluence and over-consumption, imperatives for maternal provisioning and nurture are potentially in conflict with critiques of consumption and excess.

Knowledge about disease and illness usually emerges as a result of complex social negotiations among those with a stake in the outcomes of this knowledge. These negotiations can involve a range of agents and discursive avenues, some of which are contradictory and paradoxical. This is especially true for the blood-borne virus hepatitis C, the medical, social and political features of which - associations with injecting drug use, 'tainted blood' scandals and HIV - render it a controversial disease involving a range of highly motivated stakeholders. In this paper I analyse one such set of agents in the process of disease knowledge negotiation: self-help books on hepatitis C. In conducting this analysis I offer insights into the content of the books and the way they construct hepatitis C and those who have it. I do this by mapping three key issues helping to shape the way hepatitis C is constituted in these books: HIV, injecting drug use and iatrogenic (medically caused) transmission, and by exploring the implications of the themes of emotion, risk and guilt that arise in the playing out of these issues. In the process I aim to make sense of the complexity of disease, its social constitution and its role in shaping social phenomena such as stigma.

People who inject drugs access information about hepatitis C in a range of ways. For some, diagnosis is a key point at which information is encountered. This information is considered in public health circles to be important for initiating or enhancing safe injecting practice and self-care. Yet, not all of those diagnosed with hepatitis C continue to stay informed about the disease or about their health in general, preferring to postpone engagement with these issues. In this article, I draw on Nikolas Rose's idea of biological citizenship and interview material gathered from people who inject drugs, who have been diagnosed with hepatitis C to conduct an analysis of this deferral. Drawing on the empirical material, I note that in some cases, pursuing knowledge is sometimes overshadowed by more pressing material concerns such as homelessness. In other cases, the desire to acknowledge or confront the implications of the infection is absent to the point that 'keeping up' is not regarded as desirable. In other cases still, the information imparted at diagnosis is so incomplete that the merits of seeking further medical input are seen to be doubtful. Drawing on the theoretical material, the article asks, what kind of medical subjects, or biological citizens, are these interview participants, given their parallel status as hepatitis C patients and subjects of discourses of addiction I conclude by considering the effectiveness of the medicalisation of addiction.

Contemporary neo-liberal public health discourse is increasingly drawn to the language of 'addiction'. Disease models of addiction are mobilised to account for an expanding array of problematised activities, from the familiar smoking and drinking to newer candidates, such as overeating and gambling. Most models of addiction, including disease models, are underpinned by the idea that, unlike proper citizens of neo-liberal democracies, 'addicts' lack free will or agency. This lack can be attributed to any number of problems or dysfunctions: genetic, neurological, social or moral. One high-profile case, which challenges this approach to addiction, involves the famous Australian Rules football player Ben Cousins, one of Australia's most recognised and accomplished athletes. A highly decorated player in the Australian Football League (AFL), Cousins has publicly declared himself a 'drug addict'. In this article, we present an abridged version of an interview we conducted with Cousins around the end of his first season back in the sport (late 2009) following suspension by the AFL for 'bringing the game into disrepute'. In the interview, we explore Cousins' own understanding of drug 'addiction' and its relation to its apparent antithesis sporting prowess. We also examine the ramifications of the ostensible paradox between drug 'addiction' and sporting accomplishment for understandings of 'addiction' as compulsivity and lack of free will. Drawing on the work of the cultural studies theorist Sedgwick (1993), we identify in Cousins' own understandings of his drug 'addiction' a resistance to the absolute polarisation of voluntarity and compulsivity underpinning some of the most influential versions of the disease model of addiction. We discuss the implications of this polarisation, and of forms of resistance to it, for public health policies regarding drug addiction, and for the intersection of drug use and citizenship. Thinking through Sedgwick's alternative notion of 'habit'

Australian Football League (AFL) player Ben Cousins is one of the most highly acclaimed and recognised athletes in Australia. Followed closely in the media, his off-field activities are subject to as much attention and speculation as those on the field. In 2007, Cousins and his family confirmed long-standing rumours that he was an illicit (non-performance enhancing) drug user. Following a series of incidents, his football contract was terminated and Cousins publicly entered drug rehabilitation. In this article we explore the multiple extant accounts of Cousins' drug use. We examine media representations of his drug use, including accounts from a range of key stakeholders, and we also look at Cousins' public accounts of his own drug use. What emerges is paradoxical picture both of Cousins himself and of drug users more broadly. Cousins is simultaneously positioned as in control and out of control, as manipulative and as subject to the manipulations of his 'addiction', as criminal and victim, as culpable and innocent. In the process, he acts as a figure through which contemporary understandings of the nature and implications of addiction are produced and reproduced. What is addiction? If, as many now take for granted, it is a disease requiring a medical response, what can be said about the agency and responsibility of the 'addict' in the context of elite sport? How do mainstream understandings of elite sportsmen as intrinsically masterful, commanding and physically exemplary mesh with assumptions about drug addicts as passive and physically compromised? In considering this intersection of discourses of elite sports and of addiction, we also explore some of the unique dimensions of the Cousins case including the challenge his embodied athleticism poses to understandings of his drug use, and the significance attributed to his rehabilitation and 'comeback' in 2009. We conclude with some reflections on the ways in which Cousins' case troubles certainties about drug use, a

Rationality is central to modern biomedicine: not only are doctors expected to diagnose and prescribe rationally according to evidence-based guidelines, but patients are increasingly expected to behave in rational ways in their encounters with medical practitioners. Patients are offered guidance on how to ask rational questions of their doctors, and how to make reasoned decisions about what treatment options to pursue. Here, we examine the operation of such rationalities and their ‘others’ in two kinds of clinical encounter: those around methadone maintenance treatment, and those around hormone replacement therapy. In these contrasting but related cases, we argue, clients/patients struggle to perform the kinds of rationality figured in contemporary biomedical discourses. The historical freight of non-rationality attached to the medical conditions being treated, namely ‘addiction’ and the menopause, means that clients/patients are enacted as intrinsically non-rational, which renders suspect their capacity to make the kinds of reasoned decisions that contemporary patients are expected to make. Engaging with the work of cultural studies theorist, Eve Sedgwick, we suggest that such enactments can be understood as a form of habit, produced within the complex social space of the clinical encounter. It is only through taking seriously the habits of rationality and non-rationality in which particular kinds of patients are enacted that we can begin to understand the inevitable limitations of the rationalist model of clinical encounter presented as ‘ideal’ in contemporary health discourses.

Issues: In an effort to increase the number of people undergoing hepatitis C treatment, a range of initiatives are planned or underway to provide treatment in non-specialist services, such as opioid pharmacotherapy treatment (OPT) clinics. Approach: This commentary considers the implications of this new approach to treatment delivery, taking account of individual-level issues generally discussed in the literature, such as knowledge of treatment and concerns about side effects. In addition, because less visible organisational and structural factors would equally influence the successful implementation of hepatitis C treatment in OPT services, these are also explored. Key Findings: Provision of hepatitis C treatment in OPT services raises a broad range of pressing questions, from individual knowledge and concern about treatment, to workforce issues, such as discrimination, and tensions between the need for supportive care during hepatitis C treatment and the surveillant, regulatory nature of OPT clinic operations. Implications: A thorough critical examination of the structure and delivery of all services involved is necessary. Social research can play a unique role in this assessment because of its ability to generate detailed insights into lived experience and make use of social theories that allow previously invisible operations of power to become visible. Conclusion: The success of hepatitis C treatment in new sectors,such as OPT clinics, is not a given. Close attention needs to be paid to the context and culture in which OPT is delivered. In turn, this needs to be considered alongside the context and culture necessary for successful hepatitis C treatment delivery.

Rationality is central to modern biomedicine: not only are doctors expected to diagnose and prescribe rationally according to evidence-based guidelines, but patients are increasingly expected to behave in rational ways in their encounters with medical practitioners. Patients are offered guidance on how to ask rational questions of their doctors, and how to make reasoned decisions about what treatment options to pursue. Here, we examine the operation of such rationalities and their ‘others’ in two kinds of clinical encounter: those around methadone maintenance treatment, and those around hormone replacement therapy. In these contrasting but related cases, we argue, clients/patients struggle to perform the kinds of rationality figured in contemporary biomedical discourses. The historical freight of non-rationality attached to the medical conditions being treated, namely ‘addiction’ and the menopause, means that clients/ patients are enacted as intrinsically non-rational, which renders suspect their capacity to make the kinds of reasoned decisions that contemporary patients are expected to make. Engaging with the work of cultural studies theorist, Eve Sedgwick, we suggest that such enactments can be understood as a form of habit, produced within the complex social space of the clinical encounter. It is only through taking seriously the habits of rationality and non-rationality in which particular kinds of patients are enacted that we can begin to understand the inevitable limitations of the rationalist model of clinical encounter presented as ‘ideal’ in contemporary health discourses.

Background: While the pleasures of drug use are sometimes acknowledged, they are normally limited to those who are socially privileged. The drug use of those who are impoverished and marginalised is linked instead to crime, social misery and addiction. Studying poverty in connection with drug use enriches our understanding of both poverty and drugs, but there are limitations to these connections, including their neglect of pleasure. Method: This paper draws on 85 qualitative interviews with service providers and clients, conducted for a project entitled 'Comparing the role of takeaways in methadone maintenance treatment in New South Wales and Victoria'. Critical readings of psychoanalysis are used as a conceptual frame. Results: Although pleasurable and problematic drug use are often thought to be mutually exclusive, pleasure is reported from both the effects of drugs such as heroin and methadone, and from the social worlds of methadone maintenance treatment. Attention to drug users' narratives of pleasure has the potential for new understandings of drug use and social disadvantage. Conclusion: Common distinctions between kinds of drug use, such as problematic and recreational, are less useful than is normally thought.

A recent opinion piece published in the Sydney Morning Herald expresses a widely held perception that, among young same-sex attracted men in Australia, queer has well and truly supplanted gay as the language and lens through which self and practice is generated. In this article, I discuss findings from a qualitative research project that studied notions of community among young gay men, and argue that this assumption should not be taken for granted. The article explores participants' understandings of the concept of gay community, arguing that the young men studied share a common definition of community: one based on a conventional liberal model which prioritizes sameness and the cooperation of individuals to achieve common goals. This is of particular importance in that problems around fitting in with these understandings are also raised. In examining the potential place for queer alternatives to these formulations, however, the article finds that queer attracts little support among participants, raising questions about the bind young men may find themselves in if they prioritize sameness as fundamental to community, yet feel themselves to be excluded from community by their own or others' perceived difference.

The project on which this report is based investigated the role takeaways play in MMT in New South Wales and Victoria, and looked closely at the conditions under which methadone is diverted to street sale and to other forms of sharing and circulation. In the process, it also identified a range of other issues of significance to MMT clients, service providers and policy makers in Australia today.