1970, Garfinkel 1967). That the interaction between someone who is sick

and others is like this is not, in sociological terms, very surprising.

However, when the body of the sick person intrudes into interaction in

ways which others cannot overlook or ignore this kind of public accounting

may be sorely tested, demonstrating the importance of the body to

social interaction. There are also the private accounts about the sufferer

produced by others, which may sometimes involve negative stereotyping.

This is the type of accounting process in which 'normal people' reaffirm

their normality with reference to the deviance of the sufferer. The fear of

this kind of negative stigmatisation - the private accounts of others - can

have a far more pervasive effect on the sufferer than outright discrimination

as has been demonstrated in the case of epilepsy (Scambler and

Hopkins 1986, Jacoby 1994). Once again, these private accounts flow

from the cues of the bodily differences of the negatively labelled individual.

Once this type of private account goes public, the individual has to

organise their life around their public and 'deviant' identity. No amount

of euphemism or politically correct discourse can detract from the centrality

of the public and physical difference. It cannot be socially constructed

out of existence. The body is central both to the experience and

feelings associated with illness (self) and in the social processes involved

in its management (identity).

We can summarise the body's role in chronic illness as threefold. First,

it is the point at which self is in touch with itself; it is the point of immediate

salience for self. Second, the body is an obvious, though sometimes

ambiguous, point of reference for external labels. It is an important and

easily available cue to the nature of the appropriate public identities

which may be bestowed. Third, labelling and identification feed back

directly to self-conception as the chronically ill person constructs and

reconstructs the meaning of their bodily mal-functioning and the

responses of others to this.

The interplay between self and identity provides a theoretical bridge to

manage sociologically the relation between biological and social facts.

The biological and physical facts are significant sociologically because (a)

they impinge directly on self, (b) they provide the signals for identity construction,

and (c) they act as limiting factors on social action for the sufferer.

The physical facts have a physical reality sui generis and hence may

be described in the language of bio-physical science. That language may

lead to significant physical interventions which have both physical and

social consequences for the illness career. They also have a social reality

© Blackwell Publishers Ltd/Editorial Board 1996

252 Michael p. Kelly and David Field

sui generis which can be articulated through the analytic constructs of self

and identity. Biological facts become social facts because others respond

to the person in terms of their physicality. They are also social facts for

the individual because the individual sufferer is aware of, and has to take

steps to cope with, that physical reality. At the same time the sufferer and

his or her significant others have to balance the demands of social life

with the compelling demands of the subjective feelings and the physical

demands and restrictions on the body.

Over the years, a great many sociological accounts of chronic illness

have made these points, if only by implication. However, the impact of

this kind of sociology has not been as marked as it should have been

because of the elusive characterisation of the body and its physical manifestations.

The human suffering and misery occasioned by diminished

bodily capacity must be captured in the sociological analysis of illness.

Our argument is that by reintegrating a substantive conceptualisation of

the body into the analysis of chronic illness linked to the concepts of self

and identity, it is possible to produce a language that enables us to reconcile

levels of analysis which while they may be treated quite separately

and independently, provide a more satisfactory form of understanding

when related to each other.

Address for correspondence: Professor M.P. Kelly, School of Social

Sciences, University of Greenwich, Bronte Hall, Avery Hill Campus,

Eltham, London, SE9 2HB

Acknowledgements

This paper was first given at the plenary session on chronic illness at the 1992

BSA Medical Sociology Conference. After some further work it was re-presented

at the 1994 Conference. We would like to thank the audience on that second

occasion for the lively and indeed uncomfortable discussion as well as perceptive

criticism. A special thanks to Richenda Power for helpful post-conference suggestions.

Thanks also to the anonymous reviewers of Sociology of Health and Illness.

We have not, we are sure appeased all our critics. However we hope the debate

will continue.

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