This article, “Health sociology from post-structuralism to the new materialisms,” authored by Nick J Fox and published in Health in 2016, provides a comprehensive review of significant theoretical shifts within health sociology over the past two decades. The paper primarily examines the impact of post-structuralism and postmodern social theory on the field, before transitioning to discuss the emergence of new materialist perspectives.
The article traces the rise of post-structuralism in health sociology, noting that Michel Foucault was a pivotal figure who introduced many sociologists to this perspective through works like Madness and Civilization (1971) and The Birth of the Clinic (1976). Foucault’s critical insight was that the treatment of mental illness was historically contingent and constituted in relation to power and knowledge systems, rather than inherently “better” in contemporary times. His work introduced concepts such as the “medical gaze,” which described how bodies, power, and knowledge were configured in the clinic, allowing patients and diseases to be subjected to a penetrating medical scrutiny. This gaze, through a micropolitics of surveillance and archiving, served to discipline the sick and establish modern medical science and professions. This Foucauldian approach was widely applied to various areas of health and medicine, including public health, nursing, health promotion, and dentistry.
Post-structuralism, sometimes labeled “constructivism” in health sociology, builds on the idea that embodiment and subjectivity are intricately linked to power and social constructs. It moved away from structuralist sociology’s focus on overarching social structures, instead exploring how “systems of thought or ‘discourses’ shaped social action in historically and culturally contingent ways, resulting in only partial versions of phenomena”. Influenced by literary theorists like Roland Barthes and Jacques Derrida, post-structuralism embraced a “radical constructionist epistemology”. Key to this was Derrida’s concept of différance, which suggests that language and abstract concepts endlessly defer our ability to gain direct knowledge of the “real world,” as signifiers only refer to other signifiers, leading to the assertion that “there is nothing beyond text”. This perspective fundamentally established post-structuralism’s relativism, recognizing a multiplicity of realities and challenging claims to “truth” as means to establish authority and control, particularly in post-Enlightenment scientific disciplines. Despite criticisms of relativism, proponents argued it was a crucial recognition of the context-dependency of knowledge and the perniciousness of power relations.
The article also delves into the “postmodern turn,” which coincided with post-structuralism and challenged the certainties of modernity founded in science and rationalism. Postmodernism is characterized by a suspicion of “meta-narratives” or grand theories (like Marxism or psychoanalysis) that make absolute claims to truth, instead acknowledging the validity of multiple perspectives. It led to critiques of scientific claims as being embedded in power structures like colonialism and patriarchy. Within health sociology, this postmodern sensibility led to understanding health as a biocultural “postmodern illness” governed by cultural systems of knowledge and power, and provided a radical critique against pervasive economic rationalism. It also emphasized reflexivity in academic texts and embraced fragmentary, multivocal analyses, moving beyond traditional notions of validity and reliability to focus on transgression and collapsing barriers between theory and political action. A significant consequence was the focus on power and resistance at the level of actions and interactions in health settings, examining how “technologies of power” such as observation and record-keeping shaped healthcare institutions and relationships.
The paper then marks a shift “beyond post-structuralism” to the “turn to matter,” acknowledging that while the “linguistic turn” was influential, it was criticized for potentially ignoring the materiality of well-being, life, and death. This led to the emergence of a “sociology of the body,” which sought to move sociological focus from epistemology (how we know) to ontology (what exists), centering attention on materiality—not just flesh, but all physical and biological elements interacting with bodies, along with sociocultural constructs.
The “new materialisms” are presented as distinct from both constructionist and realist approaches, sharing post-structuralism’s concern with power but firmly focused on matter and the materiality of social production. Key tenets of new materialisms include the idea that:
- The material world is relational, uneven, and contingent.
- “Nature” and “culture” are contiguous, not distinct, with both physical and social elements having material effects.
- Agency extends beyond human actors to the non-human and inanimate.
The article highlights the significance of philosophers Gilles Deleuze and Félix Guattari in this new materialist turn within health sociology. Their relational ontology provides a radical material conception of health, illness, and embodiment, defined by “what a body can do, rather than what it is”. In this view, the body is not independent but part of an “assemblage”—a network of biological, psychological, cultural, economic, and abstract relations. These relations affect and are affected by others through “affects,” which specify or “territorialize” a body’s capabilities. Changing these relations can enhance capacities, offering possibilities for improving quality of life or enabling new identity-positions like “expert patient”.
The utility of a DeleuzoGuattarian perspective is explicated through the concepts of an “ill-health assemblage” and a “health assemblage”. An ill-health assemblage comprises myriad physical, psychological, and social relations (e.g., organ, disease, doctor, technology, family responsibilities), and the affects between them produce a “sickening-body”. This assemblage is not fixed, fluctuating based on affective forces. Conversely, “health” is not merely the absence of illness but the “proliferation of a body’s capacities to affect and be affected,” a “relational achievement”. Health is framed as a “process of becoming,” involving rallying capacities, resisting physical or social “territorialization” (limitations), and experimenting with what a body is and what it might become. This model has been applied to various health topics, including chronic illness, ageing, drug use, and sexual health, and sees engagement in creative pastimes as enhancing what a body can do.
In conclusion, the article argues that new materialisms offer a path beyond the epistemological debates between constructionists and realists by shifting the focus to ontology. This approach, in common with post-structuralism, eschews notions of overarching social structures, instead exploring how natural and cultural relations assemble, the forces (affects) between them, and the capacities these affects produce. It provides a means to understand not only power but also resistance, which is seen as an inevitability as bodies engage with diverse relations, leading to new capacities. Health, from this new materialist viewpoint, is fundamentally about the body’s capacities to affect and be affected and its inherent resistance to forces that limit these capacities.
Reference: Fox, N. J. (2016). Health sociology from post-structuralism to the new materialisms. Health, 20(1), 62–74. https://doi.org/10.1177/1363459315615393
