Ceuterick Melissa, Christiaens Thierry, Creupelandt Hanne, Bracke Piet
Ghent University, Belgium.
Health (London). 2023 Sep;27(5):847-866. doi: 10.1177/13634593211060770. Epub 2021 Nov 25.
Drawing on a critical social-psychological framework for discourse analysis, data from a popular forum for people over 50 were analysed to study how the habitual use of benzodiazepines and Z-drugs (BZD/Z) is discursively negotiated by Flemish older adults. We present five different repertoires (risk and addiction; alternative pathways; suffering; rationalisation; cessation) that illustrate how a pharmaceutical imaginary of these medications is constructed online and how posters act as reflexive users taking on a health role. Most repertoires emerge from a tacit norm on the undesirability of medication use for sleeping problems. In the alternative pathways and cessation repertoires this norm is implicitly accepted by focussing on how to either prevent or overcome chronic use with various alternative solutions or through tapering off, while the risk and addiction repertoire is used to more openly defend and discursively magnify the idea that medication has to be avoided at all cost. We discuss how this reflects a prevailing imperative of health and ethos of healthicisation of sleep. The rationalisation and suffering repertoires on the other hand challenge this norm by defending medication use. We further explore how these repertoires are used to self-position as either 'noble non-user', 'deserving and/or compliant patient' or 'rational user', reflecting previously found moral positions in offline settings. Our data add another position that has thus far not been discussed extensively with regard to prescription medication use, namely that of a 'recovered user'. As such, this study shows how this particular online community is a site for contestation of health promotion and medical/pharmaceuticalised discourses on sleep by users and non-users alike and offers a unique insight into how people in the age group that is known to use most BZD/Z discursively negotiate the use of these medications in pseudonymised online interactions.
借鉴批判性社会心理话语分析框架，对一个面向50岁以上人群的热门论坛数据进行分析，以研究佛兰芒老年成年人如何在话语层面协商苯二氮卓类药物和Z类药物（BZD/Z）的习惯性使用。我们呈现了五种不同的话语模式（风险与成瘾；替代途径；痛苦；合理化；戒断），这些模式说明了这些药物的药学想象如何在网上构建，以及发帖者如何作为反思性使用者承担起健康角色。大多数话语模式源自对使用药物治疗睡眠问题不可取的默认规范。在替代途径和戒断话语模式中，通过关注如何用各种替代解决方案预防或克服长期用药，或通过逐渐减量，这一规范被隐含地接受，而风险与成瘾话语模式则被用来更公开地捍卫并在话语层面放大不惜一切代价避免用药的观点。我们讨论了这如何反映了健康的首要要求和睡眠健康化的风气。另一方面，合理化和痛苦话语模式通过为用药辩护来挑战这一规范。我们进一步探讨这些话语模式如何被用来自我定位为“高尚的非使用者”、“应得的和/或顺从的患者”或“理性使用者”，反映了之前在离线环境中发现的道德立场。我们的数据增加了一个迄今为止在处方药使用方面尚未广泛讨论的立场，即“康复使用者”的立场。因此，本研究表明，这个特定的在线社区是用户和非用户对睡眠健康促进以及医学/药学话语进行争论的场所，并提供了独特的见解，即了解已知使用最多BZD/Z的年龄组人群如何在匿名的在线互动中通过话语协商这些药物的使用。
