Abstract
In Television and Health Responsibility in an Age of Individualism, Katherine A. Foss (School of Journalism, College of Media and Entertainment, Middle Tennessee State University) demonstrates how the personal responsibility model of health, prominent in the United States since the 1970s, is reflected and reinforced in prominent entertainment texts. The core of the original research is a thematic analysis of 536 episodes of American primetime television medical dramas from the 1990s and 2000s. Foss’s ultimate argument is that the ways these programs emphasize an individualistic understanding of health, while systematically de-emphasizing the social and institutional determinants of health, may weaken support among Americans for reforms that promote more universal access to quality care, such as 2010’s Affordable Care Act, legislation whose future remains uncertain and will likely need public support to continue.
A strength of this book’s analysis is the way Foss embeds it in two contexts: historical and sociological. The historical context includes a concise account of how health has been institutionally organized and popularly conceptualized going back to the country’s earliest years, as well as how doctors and medicine were portrayed in television from the 1950s through the 1980s. The sociological context includes how the doctor–patient relationship has evolved in the context of the personal responsibility model.
This contextualization allows Foss to draw out interesting juxtapositions and contrasts between the ways stories are commonly told in primetime medical dramas, and “real-life” trends and perceptions of health care. For example, Foss convincingly demonstrates that while the primetime dramas she studies—Chicago Hope, E.R., House, M.D., and Grey’s Anatomy—deal with medical errors, they do so in ways that largely preserve the image of doctors as heroes, a trope well established in medical dramas from previous decades. Although recent dramas sometimes show doctors making mistakes, no doubt in response to greater attention to medical errors by policy makers and the press, Foss argues that the authority of physicians is ultimately preserved by showing that they immediately learn from their mistakes, and only become better doctors as a result. Truly “bad” doctors who make negligent errors are typically minor characters who are swiftly ejected from the profession. By individualizing the issue of medical errors, these medical dramas suggest that they are not common, nor are they the result of institutional pressures and processes, two impressions that Foss says are inaccurate.
Foss also examines how patients are represented in these dramas, thereby addressing a gap in scholarship on medical dramas which heretofore have focused mostly on doctors. Foss explores whether patients are depicted as responsible for their diseases or injuries. We learn that providers in these programs do consistently blame patients, either implicitly or explicitly, for their health conditions, suggesting that they have not engaged in healthy behaviors or have been noncompliant with previous medical advice. Furthermore, patients on these shows are more likely to be blamed if they are members of groups already stereotyped as irresponsible, including African Americans, the poor, and the young. These thematic trends in medical dramas contribute to the hegemony of personal responsibility, but Foss’s analysis suggests that the programs stop short of promoting patient empowerment. Although the personal responsibility model of health has led to government explicitly inviting patients to be more “active” in their health care, Foss finds that medical dramas portray active patients—who look up medical information on the Internet, for example, or seek out alternative therapies—to be annoying, and likely to interfere with doctors’ ability to provide effective medical care.
Foss’s thematic analysis of these programs is carefully done and clearly written, and the significance of these themes is made clear through contextualization in the institutional and opinion context surrounding health in the United States. Foss draws on past research to demonstrate that medical shows have been shown, in the past, to influence attitudes and behaviors, but whether the emphasis on the personal responsibility model in these programs has had such an influence is not directly demonstrated here.
Television and Health Responsibility in an Age of Individualism brings textual analysis into conversation with the dominance of the personal responsibility model in American health care. The specificity to the American context is something that might have been acknowledged. Broadening the lens for this project could include closer engagement with scholars who have theorized the rise of personal responsibility as it relates to broader shifts in governance, including health care, such as Deborah Lupton (The Imperative of Health: Public Health and the Regulated Body), Nikolas Rose (The Politics of Life Itself), and Rebecca de Souza (“Local Perspectives on Empowerment and Responsibility in the New Public,” in Health Communication). Readers could come away from the book with the impression that the personal responsibility model is solely the product of American commitments to individualism and the particular desire of American institutions to minimize their burdens. However, theorists have traced the rise of responsibilization across political formations broadly recognized as neoliberal. By engaging in dialogue with this critical, international work on health, Foss might have deepened this book’s theoretical contribution, and broadened the audience for its findings.