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ASW Journal

Theses from Interdisciplinary Social Sciences (ASW)

Archive for the ‘Global Health Papers’ Category

indexElsemieke Tijmstra & Ester van Rooij

Introduction

I have eaten meat all my life. When I got older, I noticed that my grandmother did not eat meat when we did. I got curious and asked her why and she told me that she did not like meat because she did not see that piece of meat on her plate, but only a whole cow or a chicken. I was only about five or six years old, but I still remember this because I found it strange that I did not have the same feeling my grandmother had, while I did love animals so much. When my niece became a vegetarian a few years later, I started thinking about it more, but I never came to the point I really wanted to become a vegetarian myself.” (Elsemieke)

Since a few years, more and more people in our surroundings seem to have become vegetarian or even vegan. On the worldwide web more and more blogs are being written about vegetarianism and veganism (What’s with all the hype around being a vegan?, 2011). In August 2009, Doctor Oz spoke on the Oprah Winfrey Show about a revolutionary new berry called the acai berry. Since this broadcast of the show, a new hype started. This berry was a start of the ‘superfood hype’ (Kimbal, z.j.). This hype encouraged people to change their diet and adopt a ‘healthier’ lifestyle, since this berry was believed to contain huge amounts of antioxidants and therefore it would be very healthy. After the acai berry, other superfoods became popular too, like spelt, quinoa, goji berries, chia seed, among a huge amount of other products. When searching for articles about veganism, it seems like the amount of blogs and magazines writing about veganism increases around 2011. Apparently, in this year, the trend of going vegan or becoming a vegetarian increased strongly compared to previous years. Together with the hype of the superfoods, the trend to stop eating meat is reaching people all over the world. Also, going vegan seems to be a hype too, just like the superfoods. Going vegan seems to be more a hype than becoming a vegetarian, because there have always been a certain number of vegetarians. Going vegan seems to be something new. The vegan hype is getting more media attention when celebrities start participating in challenges to adopt this lifestyle for a certain amount of time. For instance, Jay-Z and Beyoncé accepted the challenge to eat vegan for a month (‘Jay Z and Beyonce: Vegan power or celebrity hype?’, 2014).

While searching for information about non-meat-eating lifestyles, it becomes clear that opinions about this topic differ widely. On the one hand, people argue that it is healthy to eat meat and unhealthy for the human body to stop eating meat and that this can even be dangerous on the long-term. On the other hand, people argue that meat is unhealthy and causes diseases, so not eating meat will be healthier.

Apart from the health concerns, animal cruelty is given as a reason to change to a non-meat-eating diet. Lately, there have been numerous meat scandals in The Netherlands. In 2013 the first big meat scandal came to the surface. In this case, beef was mixed with horse meat, which is a cheaper kind of meat, but sold as pure beef. At the beginning of 2014 the Nederlandse Voedsel- en Warenautoriteit (NVWA) discovered a similar situation, in which horse meat was being sold as beef (Timmer, 2014). Not only those meat scandals received media and political attention, after those scandals more documentaries appeared about meat production, for example documentaries made by ‘De Keuringsdienst van Waren’ and ‘Zembla’. Those documentaries focus on animal cruelty in the bio-industry, but also about effects on the environment due to meat production, as shown in the documentary Cowspiracy: the sustainable secret (2014). The recent attention for such scandals, might make people more aware of the meat they are eating. It could even be a reason to change to a non-meat diet.

Other reasons to change to a non-meat diet we found are climate change, change in lifestyle, influence of family and peers, but also the influence of surroundings. Media or rather social media play a huge role in the daily life of youth nowadays, which suggests that social media can influence the decision to stop eating meat. Because there are so many reasons to change to a non-meat-eating diet, we find it interesting to research this topic.

Our main research question is: ‘What is the difference in motivations between youth who stopped eating meat before this was a hype and youth who stopped eating meat after this became a hype?’ We are interested in the motivation of youth to stop eating meat. Youth are able to continue but also break with norms, cultural practices and traditions. They are able to influence society, through creating a society in which they want to live. It is also fascinating to see how this particular group is influenced by external influences since they are entering a time of discovering themselves and how they reclaim their space in society.

We decided to split our interviewees in one group of people who stopped eating meat before the year 2011, and one group that stopped eating meat after 2011, as we decided that the hype of becoming a vegetarian or vegan started in 2011. We are interested to see whether there are differences in motivations between these two groups, and to what extent they have been influenced by the hype. We have interviewed thirteen people in total. Six of those interviewees belong to the group who became vegetarian before 2011. The other seven belong to the group who became vegetarian after 2011. To make clear who belongs to which group when quoting an interviewee, the number of years for which they have been vegetarian will be mentioned behind the name of the person quoted. Those who have been vegetarian for approximately five years belong to the ‘after-group’. Those who have been vegetarian for more than five years belong to the ‘before-group’. By making this distinction, we will try to find if there is a difference in motivations to become a vegetarian between the people of those two groups.

We interviewed the thirteen interviewees through semi-structured interviews. Some of the interviews we did face-to-face. Other interviews were conducted over the phone, due to limited time and the inability to make an appointment with every interviewee. We don’t think this has influenced the reliability and credibility of the interviews. All interviews were held in Dutch and all of the interviewees have a Dutch nationality.

The table below gives an overview of the respondents and their cited motivations for adopting a non-meat-eating diet. The names in italics are those who have changed their diet before 2011. All names are pseudonyms to protect the privacy of the interviewees.

Interviewees Animal cruelty Environmental change Family, peers, surroundings Health Other
Milou (21) I I I No choice
Josje (43) I
Kate (22) I
Sophie (17) I I
Anna (20 I I
Liselot (25) I Change in life attitude
Marijke (23) I I
Elsa (23) I I do not need meat
Henk (47) I
Bert (22) I Does not feel right
Anouk (20) I I I
Isa (46) I No choice
Chantal (21) I I

Although there are different kinds of diets which do not contain meat, we will not make a distinction between all these differences. We will explain the types of vegetarians here. The first type of non-meat diet is semi-vegetarianism where people avoid meat, poultry and fish most of the time. The second type of vegetarianism is pesco-vegetarianism, where people avoid meat and poultry, but do eat fish. Lacto-ovo-vegetarianism is again a different sort of vegetarianism where people do not eat meat, fish, and poultry, but they do eat milk, cheese, yogurt, eggs and other dairy products. Then there are the vegans who avoid products of animal origin altogether (Pribis, Pencak & Grajales, 2010). We do not make a distinction between all these types of vegetarians, because it is hard to draw a line between the different kinds of vegetarians. Instead, we will use the term ‘non-meat-eaters’. This term contains all of the types of vegetarians. ‘Non-meat’ includes red meat and poultry, but excludes fish and shellfish.

Non-meat eaters in numbers

Data show the number of vegetarians around the world is on the rise. A research conducted by the Vegetarian Resource Group showed that, in 1994, approximately 1 percent of the U.S. population was vegetarian. In 2000 this percentage had risen to 2.5 percent and in 2003 2.8 percent of the U.S. population could be considered vegetarian. 2.3 percent represents approximately 7 million people (Stahler, 2006). In 2015, this 2.8 percent has risen to 5 percent of the U.S. population, which means that now 16 million people in the U.S. are vegetarian (Watters, 2015). According to an article in the Huffington Post (2014) about the rise of veganism, approximately 42 percent of the people who do not eat animal products claim that they went vegan after they saw an educational film about this topic. 69 percent of the people said they went vegan to support the ethical treatment of animals.

In the European Union the number of vegetarians is between 2 percent and 10 percent in 2013. According to a research by LEI Wageningen UR in 2012, 4,5 percent of the Dutch population was vegetarian or vegan. This would be approximately 750.000 people (Dagevos, et al., 2012). According to Ethisch Vegetarisch Alternatief, a Belgian NGO, 2 percent or 3 percent of the Belgian population was vegetarian in 2012 (Knack, 2012).

In other part of the world, for example in Israel, 2,6 percent of the population was vegetarian or vegan in 2010 and that percentage has grown with the years (Jewish Telegraphic Agency, 2014). In India the percentage of vegetarians in 2013 is around 31 percent. This high percentage is due to the fact that a large majority of the population in India is Hindu and they don’t eat meat for religious reasons. The number of vegetarians in the world is growing (Project on Livestock Industrialization, Trade and Social-Health-Environment Impacts in Developing Countries, 2003). Only a small percentage of the population in industrialized countries could be described as a vegetarian or vegan. Those lifestyles are more common in parts of the world where religion plays an important role in the daily life of the population. Vegetarianism is a growing minority in the West (Meat Atlas: Facts and figures about the animals we eat, 2014).

While searching for vegetarians who wanted to participate in our research, we didn’t come across many men. According to an article in the Huffington Post, of all vegetarians and vegans in the U.S. the vast majority is female. In 2009, when about 1 million people were vegan, 79 percent of those people were women. In 2013, women still make up 79 percent of the vegan group, and 59 percent are female vegetarians (Huffington Post, 2014). We figured that in 2015, this will be no different. Women will surely still be the majority of these groups. For our research we interviewed two men and eleven women, so this majority according the Huffington Post is consistent with our research.

vegeterian

“It was normal for me”

The reasons to adopt a non-meat diet are very broad and vary per person. In this paper the focus will be on some motivations to adopt a non-meat diet. The choice to stop eating meat is a personal one. A non-meat diet is chosen for different reasons depending on age, gender, religion, educational level and overall health beliefs. In 1992 a study published that the highest number of vegetarians, 46 percent, had chosen a vegetarian diet for health reasons. The same study found that 15 percent chose to be vegetarian for animal rights reasons, 12 percent because of friend/family influence, 5 percent for ethical reasons and the least, 4 percent, had chosen to be vegetarian because of environmental issues. 18 percent indicated ‘other reasons’ (Sabaté, 2001).

For most of our interviewees, it was a gradual process to stop eating meat. Others didn’t find it weird or hard because of the influence of their parents or peers. Anouk (1,5 years) says:

“I was 19 when I stopped eating meat. It was somewhere during my first year of college about 1,5 years ago. I started to think more about what I was eating. I dare to say that my education has some influences on those thoughts. I wanted to do something to help the earth.”

Also Sophie (1,5 years) wants to make a change:

“It was normal for me to change my diet. At home I didn’t experience any negativity. I just want to help stop climate change because we need the world. Not eating meat gives me the idea that I am doing something.”

Environmental change is not the only issue our interviewees want to change. Animal cruelty is another problem our respondents want to help solve. Chantal (11 years) says that she stopped eating meat after watching a documentary about chicken slaughter. She found it so disturbing and wrong that she decided to stop eating meat at the age of ten.

When Kate (10 years) found out at the age of seven that meat is a dead animal, she did not want to eat meat any more.

“Each time I saw meat, I saw a dead animal. I still see a dead animal when I look at meat. I find it so disturbing. When I am in the supermarket, I walk by the meat shelf as fast as I can, because I cannot look at it. ”

Anouk (1,5 years) decided to stop eating meat due the possible health issues.

“I read a lot that animals get hormones in order grow quicker and bigger. Those hormones also enter our body when we eat the meat. I did not like that idea. I believe that too much hormones in your body has a bad influence on your body. That is why I stopped eating meat.”

Most youth we have spoken with chose a non-meat diet for reasons of either environmental change, animal cruelty or health reasons. Youth are unhappy about the current situation surrounding the way animals are being treated or climate change. They try everything within their power to make changes. In this case that means to stop eating meat, in order to change the situation. By deciding to stop eating meat they try to do something about it. It gives them the feeling of power. They do not have to watch the situation getting out of hand without doing something. The change of diet empowers them and they believe that even though it is only them who stop eating meat, it is one person less for whom meat has to be produced. This gives them the feeling of being part of something bigger and that they really can make a difference.

Other interviewees told us about the struggle of changing their eating habits. Kate (10 years), for instance, had a hard time convincing her parents to allow her to stop eating meat. Not only convincing parents that it is not difficult to cook without meat turns out to be a struggle for some of our respondents, but also convincing themselves can be difficult. Marijke (3 years) says:

“I stopped eating meat when I was 20 years old. I wanted it for a while back then, but I never had the courage and the energy to really do it. I thought it would be hard to cook without meat. When I found out that this wasn’t the case at all, I soon became a vegetarian.”  

Sophie (1,5) is getting really enthusiastic about cooking without meat.

“You know, there are many delicious recipes. You get more creative when you cook without meat. I have this cookbook, a present form my sister, which is amazing! All sort of vegetarian meals, I have made almost all of them.”

Also Liselot (5 years) stopped eating meat due to the same thoughts about meat. It didn’t feel right for her to eat something which has been killed. All three want to have more control over their health by controlling what enters their body.

Changing to a non-meat diet is not the hard part, the tricky part is being able to hold on to a non-meat diet, according to some. As Anouk (1,5 years) admits:

“I have not been a vegetarian for that long and I did love meat a lot, maybe I still do love meat, so it has been quite hard for me to stick to a non-meat diet.”  

Also Sophie (1,5 years) had a hard time to hold on to her vegetarian lifestyle.

“My parents and sister all eat meat. Even though they cook separately for me, every evening there is this meat smell which makes it so much more difficult not to eat it.”

Since Chantal (11 years) stopped eating meat, her parents cooked different for her. Gradually her mother also started to share her diet which made it easier for her to hold onto it.

“It is awkward when you are the only non-meat eater”

Everybody will be influenced by their family, peers and surroundings according to different social learning theories (Grey & Bjorklund, 2014). We experience this with our own eating habits. They are much the same as our family and our peers. This made us wonder about the role of family, peers and surroundings in the decision of youth to change their diet to a non-meat one. Families include parents and siblings, meaning the inner family who have a direct influence on the upbringing of youth. Children learn to eat certain types of food when they see their parents or other adults eat it first (Grey & Bjorklund, 2014, p. 139). So when a family sticks to a non-meat diet, children will not learn to eat meat, according to Grey and Bjorklund (2014). This can influence the choice of young people to either continue a non-meat diet or start eating meat. This is very accurate for Milou’s (21 years) situation.

“My whole family is vegetarian. It started with my great-grandmother. My grandmother didn’t eat meat either because of her mother and her husband, my grandfather, stopped eating meat because of my grandmother, just like my father stopped eating meat because of my mother. I have never eaten meat or fish in my life, except for a few bites of some products, just to try it.”

Obviously, Milou’s family has had a huge influence on her being a vegetarian. She never really had a choice, which she sometimes finds a shame. In general, she is happy to be a vegetarian and living like this, but sometimes she wishes she would have had a choice.

“My stomach and intestines aren’t used to meat so when I do eat it, my stomach and intestines will be upset and it feels really bad. Also, when I tried a bite of meat and fish, it felt really weird mentally. It felt like I had literally an animal inside of me. It was not a nice feeling.”

In other interviews it became clear that family doesn’t always play a role in the decision to quit eating meat. Sophie (1,5 years):

“I am the only one in my family who does not eat meat. At first it was hard to eat with the family while they would still eat meat, but after some time you get used to it. After some time the meals my parents made for me got better. You know that you get really creative when you do not eat meat? My family supports me in my decision and I am grateful for that.”

Not only family members influence the choices of young people, but also peers have the power to steer choices of people of their age, like friends, classmates, teammates and neighbours. Children learn not only from watching adults but also from watching each other (Grey & Bjorklund, 2014, p. 472). This also applies when a peer changes his or her eating habits, for instance to a non-meat diet. Other peers see this new diet and might want to try this. This might be due to the fact that youth become ‘concerned about looking and behaving like their peers’, according to Grey and Bjorklund (2014, p. 484). A choice is not only influenced by people but also by wider social surroundings, such as schools or universities, work and social class.

As stated above, not only family may or may not play a role in the decision to stop eating meat; peers can also influence the decision. For instance, when peers already have a non-meat diet it is more ‘normal’ for someone to make the decision to change diet. Sophie (1,5 years):

“A lot of my friends are vegetarian or even vegan, so it was not strange for me to stop eating meat. In my group of friends it was already common.”

Anna (1 year) was also influenced by a friend of hers who was already a vegetarian. She was already considering to quit eating meat, because she already only ate poultry, since she didn’t like red meat. Her friend told her about the climate issues which would be caused by the meat industry. Together with her feelings about animal cruelty, Anna then decided to quit eating meat.

Family, peers and surroundings do not always have a positive input on the decision. In some cases, like Anouk’s (1,5 years), who is surrounded by people who eat meat, it is difficult for her to stay on her non-meat-eating diet.

“In my surrounding, most people eat meat. I tend to eat most of the time with others who have to consider my diet. This makes me feel uncomfortable, because they always have to make something different especially for me.”

Social surroundings can have a great influence on feelings concerning  a non-meat diet. Kate (10 years) feels this very strongly. Her family, boyfriend and his family all eat meat.

“When I cook, I do cook meat because Wouter (her boyfriend for four years) likes it. I feel sick when I have to cut it, but I love him enough to make it for him. However, I only buy organic meat for him. When we eat at his parents’ house I feel uncomfortable because his parents eat meat and I do not. I feel awful that they have to cook something different for me. I feel annoying, because they always have to take into account that I do not eat meat. One time we had fish for dinner, which I do eat on occasion, but the fish was not filleted yet which made it really hard for me to eat. I did not dare to say anything about it.”

More changes in lifestyle

According to Erikson’s life-span theory, as discussed in Grey and Bjorklund (2014, p. 483), adolescence is the stage of ‘identity crisis’, meaning that a young person is searching for a ‘new’, more grown up identity. In that context, youth can see changing lifestyle as a way to identify oneself with the image of who they want to be. Identity according to Jenkins (1996, in Macionis & Plummer, 2012, p. 227) is ‘our understanding of who we are and of who other people are and, reciprocally, other people’s understanding of themselves and of others’. During this time, youth thinks about life, changes and problems. This helps them to create an image of who they want to become. To reach that goal, youth have to make changes in their lifestyle.

Banning meat from their diet is for some of the interviewees not the only change they made in their lifestyle. Anouk (1,5 years):

“About 1,5 year ago, I stopped eating meat. Recently I tend to eat more vegan. For instance, breakfast and lunch are almost always vegan while dinner is pescotarisch, which means I do not eat meat, but I do eat fish.”

Very gradually, Anouk is changing her diet again. She said that this is happening without really thinking about it.

Elsemieke: “Have you made any other changes in your lifestyle?”

Liselot (5 years): “Yes, I did.”

Elsemieke: “Can you give me an example of some of these changes?”

Liselot (5 years): “I try to be more aware of what I am doing, thinking, feeling, eating and drinking. I try to live consciously. I started following yoga and meditation lessons, I cycle more instead of going by car. I try to eat as many local, seasonal and organic products as I can and least as possible pre-packed products.”

Liselot (5 years) did not only change her diet but her whole lifestyle, like Marijke (3 years) did. She does not use products which are tested on animals. Neither does she wear or buy leather or uses pillows filled with real feathers. Marijke (3 years) said:

“If you’re going to watch your diet, what happens if you stop eating meat, you will become naturally more aware of how ‘bad’ some things are.”

For some of the interviewees, to stop eating meat was not the first change they made in their lifestyle. Kate had already more or less stopped eating dairy products because she felt ill after consuming these products. Both Anouk (1,5 years) and Marijke (3 years) first changed their diet by eating only organic meat instead of ‘normal’ meat. Not only is buying only organic meat a change in lifestyle, but buying other organic products like vegetables is a change in lifestyle too. Kate (10 years):

“I try to buy as much organic products as I can, but this is really expensive. My dad’s new wife inspired me to do this, because she always buys organic products. I also only buy eggs of chickens who had a relatively good life. In this way I try to help the animals.”

Something that stood out in the interviews, was that the respondents said that it was easier to maintain a non-meat diet because of the many meat substitutes. Kate (10 years):

“Because going vegan or becoming vegetarian is a hype, you have so much more choice in the supermarket than ten years ago. This makes it easier. I now can sometimes cook meat substitutes for Wouter instead of meat, he is fine by that, as long as he still gets his meat.”

Likewise for Sophie (1,5 years), who says :

“Since there are so many options, it easier to cook for my parents as well as for myself. You can get really creative with the vegetarian and even vegan diet.”

At this moment there are meat substitutes in the supermarkets that look and taste like real meat. For people who just adopted a non-meat-eating diet this helps them adjust to this new lifestyle. Some of our interviewees argued that this is a bad thing, because it makes the step to eating meat again smaller. However, some did say that it is a positive thing that the meat substitutes look like and taste like real meat since that may stimulate people to choose a non-meat diet or eat a meat substitutes instead of real meat for some days per week. Also variation in different meat substitutes could have pushed some youth who were still doubting whether they would stop eating meat or not. There are more things to eat, which makes it easier to cook, according to Anouk (1,5 years).

Tweet: ‘I stopped eating meat! #feelgood #loveit #healthylife’

Social media play a big part in the lives of youth. We saw more and more posts on Facebook about trying a non-meat diet, environmental change and animal cruelty. This made us wonder how social media influence the choice of youth to stop eating meat. There are many different types of social media, but the main focus is on Facebook, Instagram, Twitter and blogs. Social media are used to share life experiences by using photo’s, text messages, videos and sharing articles from other media. Social media have been in use ever since the internet was accessible for youth. Chatrooms, for example, have become places where young people can express their feelings, which Slama (2010) calls the ‘agency of the heart’ (p. 325). Sherry Turkle suggests in her TED Talk (2012) that the youth live more and more in a virtual world. Ideas and events which take place in the virtual world can influence the opinions of young people. This implies that youth might also be influenced to stop eating meat through social media, because on social media many other young people tweet, blog and talk about a non-meat diet.

However, most of our interviewees claim that their choice to become vegetarian is not influenced by social media, which is quite surprising to us. We thought that the “after-group” certainly would be influenced by social media, since social media are now such a bigger part of everyday life than a few years ago. It is possible that they are unaware of the influence of social media on their behaviour. As Marijke (3 years) told us, media and social media did have a slight influence on her decision:

“I think that social media has a bigger impact than people might be aware of. You see so much on Facebook and television for example, all of which influences your way of thinking, even if it is just a tiny little bit and even when you are not aware of it. You read about stuff, you see little clips on topics. Think about ‘Keuringsdienst van Waren’, petitions, and charities. Because of things I read or saw, my urge to become a vegetarian became bigger.”

While our interviewees claim that they are not influenced by social media, they do not deny the use of social media to gain and spread knowledge about not eating meat. Sophie (1,5 years):

“I can imagine that some young people are influenced by social media. I think that those people are active on those media. I am not and think that is the reason why I am not influenced by this. Because when you are active on social media, like posting pictures, sharing stuff and commenting on things, you are quicker in contact with ideas to stop eating meat.”

One of our interviewees has recently become a member of a Facebook group for vegetarians. According to her this site does not influence her. She mainly uses it to find recipes and feel connected with other non-meat-eaters.

Social media are not only used to inform oneself, but also to convince others to embrace the non-meat diet. For instance, Kate (10 years) told us she used media to convince her parents.

“I used to search for information, documentaries and articles about vegetarianism on the Internet. I did this to gather enough information to convince my parents that I could stop eating meat. When I saw a documentary about a girl who was vegetarian and cooked for herself because her parents did not want to cook without meat, this was an argument I used and I did cook for myself for some time when I finally was allowed to stop eating meat.”

This is one example of how social media can be used to promote a non-meat diet without it influencing the motivations to do so.

Social media can be used in several ways, either to convince family and peers of the decision to stop eating meat or to get information on a non-meat diet. Even though our interviewees said that they are not influenced by social media this is not a fact. It is possible that they are unaware of the influence of social media on their decision to abandon meat from their diet. Our respondents also think that some youth might be influenced by social media.

During the interviews, it became clear that the main reasons to stop eating meat were animal cruelty and environmental change, we categorized those as moral reasons. Youth are in a period of rapid growth in sophistication of moral reasoning and the development of the moral self-image which is linked with identity (Grey & Bjorklund, 2014, p. 488). In those years, youth are developing the ability to think in an abstract manner, which will help them to think and argue about moral issues. To stop eating meat because of animal cruelty or climate change are ethical reasons which are decisions based on the developed moral self-image.

“Meat is a dead animal”

Animal cruelty includes the breeding, transportation and slaughter of the animals which is seen as immoral due to suffering of the animals and the violation of animal rights, which can be a motivation to stop eating meat (Beardsworth & Keil, 1993). For Josje (38 years), Kate (10 years), Anna (1 year), Marijke (3 years) and Anouk (1,5 years) animal cruelty was the main reason to become a vegetarian. Many of them and other interviewees said they are against bio-industry. They do not approve how the animals are treated in the bio-industry, knowing that they have no space and are with way too many in a stable. They prefer that animals are able to walk outside without being forced to eat as much as they possibly can to grow fat as fast as possible.

Anouk (1,5 years) says that even though she ate organic meat in the past, she started to question where the meat really came from. And whether the approved meat really is as animal friendly as it is stated to be. How strictly are those rules followed? Because she had issues with this and a hard time believing that the meat was really animal friendly, the choice to stop eating meat was suddenly easier for her to make. As for Anouk (1,5 years) it was not literally identifying meat as an animal, but more the condition under which the meat was ‘fabricated’.

For Kate (10 years) the motivation to stop eating meat was when she realized that meat comes from animals.

“I never wanted to eat meat again when I found out that it came from a dead animal. My parents made me eat it, but I always started crying. One day I had to cut chicken breast and I was crying so hard that my dad said “Okay, fine, you can stop eating meat!” I was 12 or 13 years old then, but it took maybe two whole years before my parents would allow me to stop eating it.”

The same goes for Josje (38 years):

“One day when I was seven years old, I asked my mother where the meatballs we were eating came from. She told me that it was meat from a cow. I was shocked and I never ate meat again in my life. When I was pregnant with my daughter, I suddenly had cravings for my grandma’s meatballs. So strange! I tried to eat one, but my body refused. I puked afterwards.”

Not all youth who adopt a non-meat-eating diet, sympathize with all animals. Sophie (1,5 years) says:

“Naturally I object to animal cruelty, but I cannot sympathize with all animals. For some animals I find it harder to see them as abused than others. For instance, I can sympathize with a chicken that lives with 30 other chicken in a small cage. Whose beak is chopped of so that she cannot kill the other chickens. While I cannot sympathize with a fish. They are alien to me. This is why I still eat fish sometimes.”

Also Anouk (1,5 years) keeps eating fish because it is not ‘real’ meat in her eyes. On the other hand, some sympathize with all animals. Kate (10 years) sympathizes too much with animals, according to herself. She does eat fish due to health concerns, otherwise she misses too much of the vitamins and nutrients her body needs to function well. While she does eat fish, the fish has to be fileted and without the skin. Shrimps have to be peeled, because otherwise she will not eat them.

“Once we were in a restaurant and I ordered shrimps, because there was no vegetarian dish. I thought they would be peeled already, but it turned out they were not. With tears in my eyes I peeled them, continuously thinking to myself ‘They are already dead so it is better that you eat them otherwise they have died for nothing.’ I buried the head and the skin under a napkin so that I didn’t have to look at it. I saw it as a way to give the shrimps a proper burial.”

There seems to be no difference between the group that stopped eating meat before the hype and the group which adopted a non-meat-eating diet after the hype. Both groups agree that eating less or no meat means less animal cruelty, due to the fact that there is less demand for meat and therefore less animals that need to be bred, fed and slaughtered for human consumption.

“We need the world”

Stock breeding produces emission and an extreme amount of manure, but also transport, storage and packaging of the animals and the meat have a negative effect on the environment (Voedingscentrum, z.j.). The animals in the meat industry need to be fed, as much as possible, to let them grow as fast as possible. Producing the forage for all these animals, takes its toll on the environment and is said to be causing climate change. For example, the procedure to produce Parma ham is not very environmental friendly. The pigs used for the Parma ham are transported from, for example, The Netherlands to Italy to be slaughtered. Only when the pig is slaughtered in a certain area in Italy, one is allowed to call it Parma ham. If the same pig is slaughtered elsewhere in the world, the same ham has a different name and is not allowed to be sold under the name Parma ham. After the slaughter the Parma ham is transported back to the country of origin. For some youth these kinds of situations are a reason to stop eating meat. Anouk (1,5 years) said that the environment was, and still is, her main motivation to stop eating meat. Also Anna (1 year), Elsa (1 year) and Sophie (1,5 years) say that they changed their diet due to environmental change. As Sophie (1,5 years) recalls:

“My main motivation to stop eating meat is the environment. At school we watched a documentary about coral riffs. I was shocked to see how much damage fishing ships do to these riffs. Off course I do not like to see animal cruelty but I think that environmental change is a bigger global problem.”

According to Sophie, though, not everyone has to adopt a non-meat-eating diet. She argues that it is not necessary for everybody to quit eating meat to solve the climate change problem, but if everyone would be eating less meat, it would help to fix this problem.

“Not everyone has to become a vegetarian of vegan. But I think that it would help to eat less meat than we are consuming now. If everyone would only eat meat three of four days a week, it would be so much better for the environment. There will be less emission since fewer trucks are needed to transport the meat to the supermarkets and animals to the slaughter.”

Not all interviewees agree with this theory. For instance, Kate (10 years) claims that it is not that easy to say that eating no meat will change the environment for the better. She saw a documentary about how the production of tofu – which is often eaten by many non-meat-eaters – has a negative influence on the environment and climate too. And when you do no longer eat meat, you will start eating more vegetables, which also have to come from all around the world. This has a negative impact on the environment. Therefore she does not think you can say that being a vegetarian is directly better for the environment.

The interviewees who stopped eating meat after the hype have given environmental change as a motivation to change their diet more often than those who stopped eating meat before the hype. This is an interesting finding. The reason for this is not completely clear. As a side note on this correlation, it could be that recently more media- and political attention is being given to the environment and the problem of climate change. Youth who decided for example 10 years ago to stop eating meat may not have thought of climate change because the effects of climate change were harder to see than they are now. Another possible explanation is that when youth decide to stop eating meat when they are still a child, they may not yet be able to understand climate change. At that age animal cruelty for example speaks more to them since they know what animals are and that you have to treat them right.

“Missing vitamins”

The final motivation focused on in this paper is health concerns. Health concerns include all health reasons for why young people stop eating meat. Health concerns could be on the increase because some big international news and health organizations, like the BBC, The Huffington Post, the World Health Organization, and in The Netherlands the Voedingscentrum, have all reported that eating meat is unhealthy. A diet without meat would reduce the risk of cancer and prevent heart diseases (Gallagher, 2013). The claim is that not eating meat means having a healthier heart. However, a non-meat diet has to be planned carefully so that the human body get all the vitamins and minerals it needs (Burr & Sweetnam, 1982). This is something that some of our interviewees also noted, such as Milou (21 years):

“I have not eaten meat in my whole life. I do read things about that meat is unhealthy for you, mostly red meat, but I don’t really dove into these researches because it does not concern me. So I do not really know that much about it. I do know that because I am a vegetarian, I don’t get all the nutrients a human body needs. I struggle with getting enough vitamins and nutrients and I had to go to the doctor twice with fatigue related complaints, which were caused by a lack of vitamin B12. I had to go to the doctor every month to get an injection with vitamin B12. Because of this, I sometimes think about starting to eat fish every once in a while.”

This shows just how important it is to get all the nutrients for the body. Just like Milou (21 years), Kate (10 years) knows that having a non-meat-eating diet results in not getting all nutrients the human body needs. She doesn’t think it is healthy to stop eating meat completely. She claims that you will have a lack of vitamin B12 and iron.

“It is normal for humans to eat meat. Meat contains vitamins and other important things you need to be healthy.”

However, even though some claim that they know that not eating meat is unhealthy since their bodies need certain vitamins and minerals, they still do it. Sophie(1,5 years):

“Since I stopped eating meat I take extra vitamins, because I need them.”

Both groups know that it is unhealthy but by taking extra vitamins they try to solve this problem. Again, there is no difference between the group who stopped eating meat before it was a hype and the group that changed their diet after the hype.

Another recent trending topic related to health concerns is that the media increasingly reports about added hormones in meat. These hormones seem to be unhealthy for human beings and seem to cause diseases (Storrs, 2011). Marijke (3 years) argues that she did not want to eat meat anymore, because she did not want to take in the hormones and antibiotics which tend to be in meat. Along with animal cruelty, this was her main reason to become a vegetarian. Anouk (1,5 years) said that during her education, Bedrijfs- en Consumentenwetenschappen, she learned about meat modification. What she learned about all the toxics that are used to create the best meat, shocked her. This helped her in her decision to stop eating meat.

Others will argue that with a non-meat diet they will lose weight (‘5 reasons to try a vegetarian diet’, 2014). Since obesity is a major issue nowadays, a very modern health concern, people can be motivated to stop eating meat in order to lose weight. Another reason to change diet is when the body does not react well to meat. For Liselot (5 years), health concerns played an important part in the decision to stop eating meat.

“Meat did not taste as good as it used to and my stomach would get a little upset when I would eat meat. It just didn’t felt right, physically and mentally. So I gradually stopped eating meat, and now I feel so much better.”

Through the interviews we have not seen a difference between the groups on health concerns. Both the interviewees who adopted a non-meat diet before the hype and those who stopped eating meat after knew that not eating meat meant having to take pills for the vitamins the human body lacks.

“It is normal for people to eat meat”

Just as meat-eating youth have a certain stereotypical image of non-meat-eating youth, this is also the other way around. During the interviews this was an interesting topic since we as researchers are both meat-eaters. It is interesting to see that most of the interviewees are completely fine with meat-eating youth. As Milou (21 years) says:

“I think it is really normal that people eat meat. The human being is an omnivore after all. Even though it is piteous for the animals, it is nature. I do think it is good when people eat organic meat. In general I don’t think in a bad way about people who eat meat, but I do think that a lot of people could eat less meat than they do now.”

Neither Milou nor any of our other interviewees are against people who eat meat, but all of them would like people to eat less meat. They all stress that it is everybody’s own choice, just like it is their choice not to eat meat.

Other aspects our interviewees mentioned, was that meat-eaters are ignorant in the sense of unknowing. Kate (10 years):

“I am not against eating meat. But I sure am against the bio-industry and how animals are treated and think that people need to be more aware where the meat comes from.”

So meat-eating youth should not only eat less meat, but should be also more informed where the meat they are eating comes from. Anouk (1,5 years) is more direct about this topic:

“I do think that people who eat meat are hypocrites. They do eat meat, but do not dare to slaughter the animal they are about to eat. In my opinion this is very contradictory. Or when people say that they shower less than ten minutes because of the environment, but eat steak at dinner. Then that shower of less than ten minutes does not matter anymore, eating that steak is worse for the environment than those showers of ten minutes. I get frustrated when thinking about it!”

Or according to Josje (38 years):

“I make no distinction between meat-eaters and vegetarians. Everybody has to do what they want. I do not want interference from others, so I won’t interfere with others too. As long as no one is forcing me to eat meat, it is all fine by me. I do feel like vegetarians get judged a lot by meat-eaters. My opinion is that as a meat-eater you are allowed to make comments on vegetarians, only when you shoot your own cow, slaughter it and prepare it all by yourself!”

Liselot (5 years) likes it when people understand her choice and not just the superficial idea of it.

“I try not to judge, everybody is different. But it is nice when people are sympathetic to me to not eat meat. It is even nicer when someone understands it on a deeper level, and often this is someone who is also vegetarian or someone who lives consciously and makes conscious choices about their lifestyle and nutrition.”

Other vegetarians as ‘not real vegetarians’

Just as non-meat-eating youth have an opinion about meat-eating youth, they also have a certain image of non-meat-eating youth, just like we had before we started this research. We know a few vegetarians ourselves, of which a few are quite condemnatory against meat-eaters. They come across as very aggressive and because of the rejection they are causing, they put other vegetarians in a bad light too. We do not blame them for being a vegetarian, so they should not blame us for eating meat. Through the interviews it became clear that actually all of our interviewees thought the same way about this. They also did not like the vegetarians who acted in this aggressive way and said that this will only have the opposite effect. Milou (21 years):

“I sometimes catch myself thinking about other vegetarians as ‘not real vegetarians’. I know this is stupid, but I think this is because almost everybody I know has not been vegetarian as long as I am. Also it is just part of my nurture. My parents have a strict idea in their head of when you are a ‘real’ vegetarian and when you are not. For example, when people don’t eat meat, but do eat fish, I see them as ‘not real vegetarians’. I’m glad though, that so many people have stopped eating meat. Even when they have stopped eating meat for a while and then started again. I find people who try to force others to become a vegetarian annoying. In my opinion this is not the right way, you cannot force someone to stop eating meat.”

Not only Milou (21 years) thinks that some vegetarians or vegans are creating a negative image for the group they belong to, by being so aggressive to meat-eaters. Kate (10 years) says:

“I find a lot of vegetarians and vegans very annoying. They give other vegetarians a bad name because they are telling others that they are doing it wrong and telling them they are ‘murderers’ for eating meat. This is how vegetarianism gets a bad name. I am not like that at all. I even feel like people could find me annoying when I am having dinner with people I do not know that well and have to tell them that I am a vegetarian. They have to take into account that I do not eat meat and that is not always a nice feeling.”

Anna (1 year) states the same opinion, she finds people who are forcing others to become vegetarians also annoying.

“I personally feel better when I don’t eat meat, which has nothing to do with others. People who talk about their vegetarianism and brag about it on Facebook or something annoy me, to me it feels like that is not the point of being a vegetarian.”

Not all our respondents were negative about other non-meat-eating youth. For instance Anouk (1,5 years) approves of other non-meat-eating youth. However:

“I do make differences between people who do it for the environment, people who do it for the animals and people to do not eat meat, because they do not like it. I have more respect for the people who really do like meat, but out of principle do not eat meat.”

Sophie (1,5 years) is also quite positive about other non-meat-eating youth. She had an image in her head of non-meat-eating youth who would be “activists, have an alternative music choice and clothing, dopey, and extreme involved in different issues”. Sophie is happily surprised that this is not the case, according to her.

“Everyone is just normal. Very relaxed. Not pushing others to adopt the same diet.”

This is the complete opposite from what Anna (1 year), Kate (10 years) and Milou (21 years) told us. This is possible due the other non-meat-eating youth our respondents know or their perception of what it means to have a non-meat diet.

Conclusion

When we started this research, we had a few expectations, of which most turned out not to be true. We expected to find a difference in motivations to adopt a non-meat diet between the youth who stopped eating before it became a hype and those who stopped eating meat after the hype. This was not the case at all. The reasons were the same for both groups, with the majority mentioning animal cruelty and climate change as their motivation to stop eating meat. We did expect that animal cruelty and environmental change would play a major role in the decision to adopt a non-meat diet, however we expected that there would be a significant difference between the two groups. Our expectation was that the groups who stopped eating meat before the hype would mention animal cruelty and environmental change as their main motivations to stop eating meat and the groups who stopped eating meat after the hype would mention health concerns more often. It is interesting to see that animal cruelty and environmental change are almost always combined motivations for our interviewees to adopt a non-meat-eating diet. Our respondents said that they were quite shocked when they learned about the bio-industry and where the meat they ate every day came from. They did not approve these animal abusive meat production and wanted to do something. By not eating meat they feel like they have power to contribute to stop the bio-industry and slow down, if not stop, climate change. The main motivation concerning animal cruelty is the bio-industry. All interviewees named the bio-industry in the interviews as something that has to be stopped. Only a few mentioned animal rights and the treatment of animals. Environmental change is a big, worldwide issue which needs to be solved. The interviewees mentioning the environment as the main reason to stop eating meat, felt like they made a difference and contribute in the long road to a better environment.

The second most mentioned reason to stop eating meat is health concerns. Through the interviews we have not seen a difference between the two groups considering health concerns. Both groups, the interviewees who adopted a non-meat diet before the hype and those who stopped eating meat after it became a hype, knew that not eating meat would have a negative impact on their body. Our interviewees knew that they had to take extra vitamin pills since their bodies would lack certain nutrients. This did not stop them in their decision to quit eating meat. The reasons to have health as an motivation to stop eating meat are, however, diffuse. Some respondents mentioned that they felt ill after eating meat, while others mentioned the hormones in the meat as a heath concern.

Another surprising result concerns the influence of social media. All interviewees said that they were not influenced by social media, but do believe that some youth are influenced by it. The reasons our interviewees gave us were that they are not as active on social media as others and therefore not that easily influenced by it. However, it is hard to not be influenced by social media since it has taken up a great part of youths’ daily lives. We believe that youth are influenced, even if they say they are not. It is possible to be influenced by certain (social) media without registering it. Unconsciously, youth can be influenced by for example the pictures of animal cruelty or an article about hormones and antibiotics in meat. Still, it is not possible for us to state whether social media really did or did not influence the decision to quit eating meat, since according to our interviewees social media do not play a role in the decision in changing their diet to a non-meat-eating one.

Neither have we found a difference between the two groups in their lifestyle changes or influence of family, peers and surroundings. Only one interviewee said that she changed her diet due to a change in her lifestyle. She suddenly had the idea that she had to change her lifestyle since the got another attitude to life. Furthermore, there are no specific things our interviewees changed in their lifestyle neither is there a structure which each group follows in our created groups. In both group, some of the interviewees had started eating organic meat before quitting eating meat altogether. As said earlier, we ourselves are both influenced by our parents’ eating habits, as are some of our respondents. Their family never ate meat, so they did not eat meat either. This has influenced their diet choice significantly. However, except for those three respondents, most of our interviewees were not influenced by their family. Nor did any of them say that they are influenced by their peers. Some did mention that it was not strange for them to adopt a non-meat-eating diet, since their friends had the same diet, but other interviewees had friends who did eat meat. It is not always something they talk about with their peers. It is possible that the interviewees could be influenced by their peers, while they were not aware of it. This could be the case when friends had already stopped eating meat and therefore it is not that alien anymore as it otherwise might have been. Surroundings did not play a role in changing to a non-meat-eating diet but did make our interviewees quite often feel uncomfortable. Many of the interviewees mentioned feeling awkward and annoying when they were in company of others who eat meat, because those people had to take into account that they would not eat meat and cook another dish for them.

We interviewed some people face-to-face and others over the phone. We do not think this has influenced our interview results, although we were not able to see the body language of the people we interviewed over the phone. What could have influenced our results, is that we knew some of the interviewees beforehand. This is an advantage because we did not need to establish a relationship with the interviewee since we already had one. However, it is possible that, because we already knew each other, not all answers were completely honest. But this is an issue one will also have with unknown interviewees. Another thing which could have influenced the answers was that most of the interviewees knew that we both are meat-eaters. This could have resulted in less passionate answers, but it can also be a trigger to answer passionately about a non-meat diet in trying to convince to stop eating meat. Also, through the snowball effect we were able to speak with a whole family about changing to a non-meat diet. The results from this family can be biased since the family members have likely influenced each other in the way of thinking about a non-meat diet.

Another fault in our research could be that we created the two different groups and categorized our interviewees in them, based on the number of years they have not been eating meat. This to distinguish between youth who stopped eating meat before it became a hype to change your diet to a non-meat-eating one, and youth who stopped eating meat after this hype. It is possible that the last group is influenced by all the information which has come with the hype and that because of that their motivation has changed unconsciously. We have made the distinction between the two groups at the year 2011 to the ‘before-group’ and the interviewees who adopted a non-meat diet after the year 2011 belong to the ‘after-group’. But 2011 is four years ago and much could have changed in those four years. It is possible that youth who stopped eating meat in, for example, 2009 are also influenced by the hype, even though the hype was not at its peak yet. The same goes for youth who stopped eating meat after 2011. It is not said that all youth who stopped eating meat after 2011 are certainly influenced by the hype. We generalized youth into those two groups without real evidence that they are or are not influenced by the hype of changing your diet. This might be why we have not found a difference in motivations to stop eating meat.

For further research it might be interesting to organize a focus group with youth from before the hype and after the hype. This might be a better way than only one-on-one interviews to search for a possible difference in motivation between the two groups. Then the research can observe where the groups have different views or have similar ideas.

Ultimately, this research has changed our way of thinking about eating meat. We already were quite aware of where our meat came from and the circumstances in which the animals have to live before they are slaughtered. But interviewing the non-meat-eaters put things more into perspective. Still, to stop eating meat altogether is something neither of us is willing to do. Ester loves meat too much to stop eating it and Elsemieke also thinks it cannot be healthy for a human body to not eat meat. So, we will not become vegetarians after this research, but we sure are more aware of eating meat.

(Research paper written for Youth Cultures in a Transnational Context, ASW)

References

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Global Health Papers , Global Youth Papers

Selinde_Rouwenhorst_illustratieSelinde Rouwenhorst

Inleiding

De onderzoeken van de World Health Organisation (WHO) laten zien dat sinds 1980 het percentage personen met obesitas is verdubbeld (World Health Organisation, 2014). Obesitas wil zeggen dat de BMI (Body Mass Index) van een individu boven de 30 is. Een BMI >25 wordt gezien als overgewicht. De BMI is uit te rekenen door het gewicht te delen door de lengte in meters in het kwadraat (kg/m2).

In 2008 kampten wereldwijd meer dan 200 miljoen mannen en 300 miljoen vrouwen met obesitas. De prognose is dat met de tijd deze aantallen verder stijgen en het probleem zich bij steeds jongere mensen voor gaat doen (World Health Organisation, 2014). In Amerika kampt 35,1% van de bevolking boven de 20 jaar met obesitas, 33,9% van de bevolking boven de 20 jaar heeft overgewicht. Hieruit kan worden afgeleid dat overgewicht en obesitas in Amerika een groot probleem zijn (Fryar et al., 2014).

Doordat obesitas mondiaal een probleem is geworden, wordt dit door de media gebruikt als manier om door te dringen tot het publiek. De media toont een stereotype beeld van gezonde mensen. De reclames die voorbij komen over afvallen en fit worden, zijn niet meer weg te denken van de televisie en uit tijdschriften en de modebladen staan vol met zeer slanke, afgetrainde modellen. Ata en Thompson (2010) tonen aan dat berichtgeving door de media van invloed is op de manier waarop de samenleving kijkt naar mensen die kampen met obesitas. Los van de lichamelijke problemen die mensen met obesitas ervaren, worden zij anders aangekeken doordat hun lichaam afwijkt van het ideaaltype (Ata & Thomson, 2010). Het stigma wat ontstaan is in de samenleving zorgt voor een negatief denkbeeld wat de samenleving heeft gecreëerd met betrekking tot de mensen die kampen met obesitas. Mensen met obesitas ervaren hierdoor een andere behandeling dan individuen die weinig of niet afwijken van het ideaalbeeld op de arbeidsmarkt, in de gezondheidszorg, relaties en opleiding. De media spelen hierin een grote rol doordat sociale normen ook door de media worden weerspiegeld (Ata & Thompson, 2010). Voor de verschillende mediakanalen die de Westerse wereld bevat, is dit een interessant fenomeen om te gebruiken en mensen aan te sporen om iets aan obesitas te doen. Van de vrouwen die op televisie verschijnen in Amerika heeft ongeveer 33% ondergewicht, terwijl dat in de Amerikaanse samenleving maar 5% voor van de vrouwen geldt. Van de vrouwen op televisie heeft maar 13% overgewicht, terwijl dat van de vrouwen in de samenleving maar liefst 51% is (Ata & Thompson, 2010).

Naast de oorzaken van obesitas worden mensen blootgesteld aan de gevolgen van obesitas via de media. Men verkrijgt dus meer kennis door middel van de media, maar wordt ook, al dan niet bewust, aangespoord om vroegtijdig in te grijpen, vaak op een medische manier door middel van een maagverkleining, medicijnen of andere medische ingrepen. Hier wordt de interventie voorgelegd op basis van medicatie terwijl obesitas vooral veroorzaakt wordt door een bepaalde levensstijl of een samenstelling van de genen. Daarnaast speelt de sociale omgeving van mensen met obesitas ook een rol (Daansen, 2010). Veel bedrijven gebruiken de media om direct potentiele klanten te benaderen en te wijzen op de problemen die deze klanten wellicht hebben, en een daarbij passend product om deze gewichtsproblemen op te lossen (Padamsee, 2011). Interessant is hier de rol die de media hebben in het proces van het medicaliseren van obesitas. Peter Conrad (2004) definieert medicalisering als ‘het bepalen en behandelen van voorheen niet-medische problemen als medische problemen. In de twintigste eeuw is de vraag naar medische oplossingen voor problemen sterk gestegen. Dit valt te verklaren door het groeiende vertrouwen in de wetenschap en de afnemende waarde van religie (Conrad, 2004).

Daarnaast heeft er een verschuiving plaatsgevonden van het hebben van symptomen en voor deze specifieke symptomen behandeld worden, naar het zoeken naar passende gezondheidszorg, omdat mensen het gevoel hebben dat er iets mis is en op zoek gaan naar een oplossing die wordt aangeboden via advertenties (Camargo, 2013). Dit wordt in verband gebracht met de opkomst van de farmaceutische markt, die inspeelt op de vraag van de consument. Door de wisselwerking van vraag en aanbod ontstaat de commodificatie van medische goederen. Met de commodificatie van goederen wordt dat goederen een geldwaarde toegekend krijgen, waardoor het een koopwaar is geworden (Conrad, 2004). Farmaceutische bedrijven zijn tegenwoordig de hoofdrolspelers als het gaat om prijsbepaling op de medische markt, die bestaat uit consumenten (de patiënten), de ‘betalers’ (de verzekeringsmaatschappijen) en de providers (de huisartsen, ziekenhuizen en andere zorgverleners) (Conrad, 2004).

Dit paper richt zich op de medicalisering van obesitas door de media aan de hand van twee disciplines; sociologie en communicatiewetenschappen. Vanuit beide disciplines zal er worden belicht hoe er wordt aangekeken tegen medicalisering van obesitas door de media. Het is belangrijk om dit verschijnsel interdisciplinair te behandelen, omdat er verschillen zitten in de manier waarop er vanuit twee verschillende disciplines gekeken wordt naar hetzelfde fenomeen. Enerzijds kan de sociologie inzicht bieden in de gevolgen voor de samenleving van het toenemen van de medicalisatie van obesitas door de media. Anderzijds kan er vanuit de communicatiewetenschap gekeken worden naar de manier waarop dit gebeurt en waarom dit op deze manier gebeurt. Concepten die hierbij een rol spelen zijn obesitas, medicalisering, media, en sociale norm.

De centrale vraag in dit paper is als volgt: Hoe medicaliseert de media obesitas in de westerse wereld?

Om deze hoofdvraag te kunnen beantwoorden wordt er gekeken vanuit twee verschillende disciplines. In de eerste paragraaf ‘obesitas epidemie’ wordt er beschreven hoe er vanuit sociologisch perspectief naar de medicalisering van obesitas door de media wordt gekeken. Vervolgens zet de paragraaf ‘mediahype’ uiteen hoe de communicatiewetenschappen schrijven over de medicalisering van obesitas door de media.

Er is veel onderzoek gedaan naar zowel obesitas als medicalisatie. Boero (2006) beschrijft de weergave van obesitas in de media. Door middel van een analyse van 751 artikelen die The New York Times heeft gepubliceerd tussen 1990 en 2001 is uit diens onderzoek naar voren gekomen dat de term ‘epidemie’ steeds vaker gebruikt wordt om het probleem van obesitas duidelijk te maken. Het gebruik van het woord ‘epidemie’ duidt al aan dat het hier gaat om een medisch probleem en geen sociaal probleem (Boero, 2006). De steeds groter wordende rol die farmaceutische industrie speelt op de medische markt draagt er aan bij dat het aanbod voor consumenten ook steeds groter wordt. De hedendaagse medische markt is een zeer belangrijk kanaal voor medicalisatie (Conrad, 2004).

Bandura (2001) gebruikt zijn sociaal cognitieve theorie van massa communicatie om de rol van massa media op de samenleving uit te leggen. Volgens deze theorie zijn mensen niet alleen maar kenners en uitvoerders. Ze bezitten ook de mogelijkheid om zichzelf te sturen in gedrag. Norbert Elias (2000) zette uiteen dat deze sturing van gedrag komt door invloeden van zowel binnenuit de mens, als van buitenaf. Het indammen van gedrag komt voort uit de ontwikkeling van de maatschappij. De maatschappij bepaalt hierin de norm, en mensen passen zelfregulering toe om te voldoen aan verwachtingen (Elias, 2000). Deze zelfregulering is nodig voor mensen om te zo dicht mogelijk te komen bij de voorgegeven standaard (Bandura, 2001).

Obesitasepidemie

Om vanuit sociologisch perspectief naar de medicalisering van obesitas door de media te kijken, is het noodzakelijk om naar verschillende concepten te kijken. Concepten die uiteengezet worden in deze paragraaf zijn: het woord epidemie, het ontstaan van sociale constructen, de redenen waarom er meer mensen kampen met obesitas, de rol van de farmaceutische industrie en het ontstaan van stereotypering.

Sobal (1995) stelt dat in de huidige westerse maatschappij dik zijn als afwijking wordt gezien door de samenleving. Individuen in de samenleving zijn deze afwijking als een sociaal probleem gaan beschouwen. Gedurende de ontwikkeling van de westerse samenleving heeft er een verschuiving plaatsgevonden van dik zijn als slecht, naar de medicalisering van dik zijn als ziekte. Voor de jaren ’50 was overgewicht nog geen sociaal probleem en werd het gezien als gezond en rijk, omdat men in dit geval genoeg rijkdom kende om voldoende voedsel tot zich te nemen. Vanaf de jaren ’50 werd obesitas en overgewicht steeds vaker besproken door medici als probleem waar interventie noodzakelijk was. Door herhaaldelijk dit soort statements in boeken of via andere media kanalen te uiten, is de medicalisering van obesitas tot stand gekomen (Sobal, 1995).

Boero (2006) concludeert in haar paper dat het gebruik van het woord ‘epidemie’ als het gaat over obesitas in Amerika, door de jaren heen is toegenomen. Dit doet zij door vanuit het sociologisch perspectief te kijken naar de onderzochte artikelen. Hierbij beschouwt Boero de artikelen als sociale constructen. De manier waarop de media een houding aannemen ten opzichte van obesitas wordt hier blootgelegd. De media spelen een cruciale rol bij de vorming van het fenomeen ‘epidemie’. De obesitasepidemie is anders dan voorgaande epidemieën uit de geschiedenis, door Boero ook wel omschreven als de postmoderne epidemie. Bijzonder hieraan is de individuele verantwoordelijkheid die mensen hebben voor hun eigen gezondheid en het feit dat iedereen risico loopt op het krijgen van obesitas (Boero, 2006). Wat daarnaast ook opvallend is, is het gegeven dat er door de media net zoveel aandacht wordt besteed aan het krijgen van overgewicht en obesitas, als het hebben van obesitas en de gevolgen ervan (Boero, 2006).

Brown (1995) bespreekt in zijn artikel hoe diagnoses en ziekten door de maatschappij geconstrueerd worden. Een belangrijk vraagstuk daarbij is of de sociale problemen die er zijn, echt bestaan of dat ze zijn gevormd door mensen die op zoek zijn naar sociale problemen en deze daadwerkelijk benoemen. De sociale constructie van ziekten begint vooral bij het ervaren van ziekten en de symptomen ervan, om ze op deze manier te kunnen linken aan een specifiek ziektebeeld. Om hier beter inzicht in te kunnen krijgen, moet er gekeken worden naar verschillende ervaringen van ziekten, op zowel persoonlijk- als op groepslevelniveau (Brown, 1995). Er is sprake van sociale actiegroepen, die specifieke ziekten in het daglicht zetten om op deze manier bewustzijn te creëren binnen een samenleving. Deze actiegroepen zijn onmisbaar voor het behandelen van ziekten, omdat er naast angst en verwachtingen ook meer zelfbewustzijn wordt gecreëerd, waardoor men zelf beter op zijn gezondheid gaat letten (Brown, 1995). Wanneer deze uitkomsten worden toegepast op obesitas, zou dus de sociale constructie van de ziekte obesitas een positieve invloed hebben op de behandeling ervan. Door mensen van de ziekte bewust te maken met negatieve gevolgen, zou het automatisch een tegenbeweging oproepen.

De vraag hoe obesitas kan voorkomen in een lichaamsbewuste samenleving is uiteengezet door de socioloog Crossley (2004). Hij concludeerde aan de hand van een literatuur review dat het percentage obesitas binnen een samenleving een sociaal feit is. Het hangt af van het energie ratio, namelijk wat mensen tot zich nemen in vorm van voedsel en drinken, en wat mensen verbranden door middel van lichaamsbeweging. Los dat genen een rol spelen in de opname van calorieën, is de toename van lichaamsgewicht het gevolg van een overschot aan energie-opname (Crossley, 2004). Dit is een sociaal feit, omdat het betrekking heeft op de veranderingen in percentage binnen een samenleving, en niet de verandering van een individu. Deze gegevens kunnen verschillen tussen samenlevingen, maar ook veranderen binnen een samenleving (Crossley, 2004). Een verklaring hiervoor is zowel een toename van de energie-inname, en daarbij ook een afname in de lichaamsbeweging. Westerse samenlevingen zijn vandaag de dag dus minder lichamelijk actief, maar consumeren meer voedsel, voornamelijk buitenshuis. Beide veranderingen komen samen in de levensstijl van de Westerse samenleving. De verklaringen hiervoor hebben hun wortels in de modernisering van de samenleving, zoals technologische ontwikkelingen, waardoor lichaamsbeweging minder noodzakelijk is (bijvoorbeeld het regelmatig gebruiken van een auto) en de opkomst van de fastfood industrieën (Crossley, 2004).

Een onderzoek van Padamsee (2011) toont aan dat farmaceutische bedrijven hun publiek kunnen beïnvloeden en hoe deze dit doen. Vroeger waren de medisch specialisten degene die een medische afwijking benoemden en behandelden, tegenwoordig zijn het de winstmakende farmaceutische bedrijven die inspelen op de afwijkingen binnen een samenleving. Op deze manier creëren zij een markt om tegen hoge winstmarges hun middelen te verkopen aan het publiek. Dit doen ze door potentiele patiënten in te lichten van eventuele lichamelijke tekortkomingen en deze te koppelen met een bijpassend ziektebeeld van een ziekte. Zo maken ze het publiek bewust van mogelijke problemen en de manier waarop deze, met hun producten, te verhelpen zijn (Padamsee, 2011). Het onderzoek van Padamsee (2011) komt wat betreft theorie overeen met de conclusie van Crossley (2004), die concludeert dat actoren in de mediawereld goed gebruik maken van de lichaamsbewuste samenleving. Volgens Crossley (2004) werkt niet, omdat een samenleving lichaamsbewust is, en er ideaaltypen bestaan, zoals slanke, gespierde mensen. Wanneer een samenleving dit bewustzijn niet of weinig heeft, zal er weinig respons komen op reclames van afslankmethoden (Crossley, 2004).

Discriminatie en vooroordelen op het gebied van gewicht gaan gepaard met de stereotypering die is ontstaan door de hedendaagse media. Mensen met obesitas worden vaak op een negatieve manier geprofileerd in de media, waardoor vooroordelen en discriminatie ontstaan. Slachtoffers hiervan ondervinden in het dagelijks leven een afwijkende behandeling, wegens de afwijking van het sociale ideaalbeeld. Men wordt beschouwd als minder schoon, minder gelukkig en minder succesvol. In Noord-Amerika is de prevalentie van discriminatie op basis van obesitas met 66% gestegen, zodat het nu op hetzelfde niveau zit met de rassendiscriminatie (McClure et al., 2011).

De sociologie heeft als kijk op de medicalisering van obesitas dat de media een rol speelt in deze medicalisering, omdat de media onder leiding van farmaceutische bedrijven en hun winstoogmerk gebruik maakt van de sociale normen die een samenleving kent. Dit kan alleen met succes in westerse samenlevingen aangezien er een besef is van lichaamsgewicht en het gevoel hebben dat men niet wil afwijken van het ideaaltype. De media heeft hier net zoveel aandacht voor de gevolgen van obesitas, als dat het het publiek waarschuwt en bewust maakt van obesitas en het krijgen ervan.

Mediahype

Deze paragraaf onderzoekt de rol van de media in het medicaliseringsproces van obesitas vanuit de communicatiewetenschappen. Dit gebeurt door de invloed van de media uiteen te zetten, onder andere door de sociaal cognitieve theorie van Bandura. Daarnaast wordt er uitgelegd hoe sociale problemen worden geconstrueerd en hoe individuen zich identificeren met de ideaaltype op televisie.

Het construeren van sociale problemen gebeurt volgens Vasteman (2005) regelmatig. Wanneer de media over een kortere periode veelvuldig één onderwerp belichten, wordt het niet alleen gezien als een hype waar veel over gesproken wordt, maar waar het ook bijna een strijd lijkt te gaan worden om met de meest recente feiten betreffende dat onderwerp te komen. Zo kan een nieuwsonderwerp dat een aantal maal benoemd is in de media zijn eigen leven gaan leden (Vasteman, 2005). Daarnaast hebben de media een overtuigende kracht om het gedrag van het publiek te sturen. Salant (2006) concludeert dat de aandacht in de media voor specifieke medische ingrepen om obesitas te bestrijden zich vooral focussen op de redenen om het wel te doen. De negatieve kanten van deze medische ingreep, of andere mogelijk passende oplossingen, worden buiten beschouwen gelaten. Op deze manier sporen media patiënten aan om vooral voor een medische oplossing te gaan (Salant, 2006).

Media hebben ook invloed op de sociale norm. In de media wordt er een profiel geschetst dat doorwerkt in de normen van de maatschappij ten aanzien van uiterlijk en gedrag (Brown, 1995). Mensen die kampen met obesitas worden in de media vaak afgebeeld als ongezond, ongelukkig, lelijk en lui (Greenberg, 2003). Deze stereotypering over obesitas heeft naast de fysieke gevolgen ook psychische gevolgen voor mensen met obesitas. Gezondheid bestaat niet alleen uit fysieke gesteldheid, maar ook uit discriminatie en kwaliteit van leven. Deze kwaliteit van leven bestaat onder andere uit sociale acceptatie. Deze sociale acceptatie verschilt wanneer er dusdanig afgeweken wordt van het ideaaltype, bijvoorbeeld door het hebben van obesitas (Greenberg, 2003).

Daarnaast is het effect wat media heeft op het publiek onderzocht door verschillende wetenschappers (Cohen, 2001). Het grootste effect wat media heeft op het publiek is de identificatie die plaatsvindt tussen het publiek en de personages die bijvoorbeeld in een film of boek voorkomen. De kijker leeft zich in een film, zodat het lijkt alsof hij zelf het verhaal meemaakt en op deze manier identificeert hij zich aan de personages (Cohen, 2001). Deze identificatie speelt een hoofdrol in mediaonderzoek.

De sociaal cognitieve theorie wordt door Bandura (2001) gebruikt om de invloed van media op een toeschouwer te verklaren. De toeschouwer is in staat om elke prikkel die via de hersenen binnenkomt te symboliseren en te koppelen aan de aspecten van hun leven. Door middel van deze symbolen geven mensen betekenis en vorm aan hun ervaringen en de informatie die zij verkrijgen. Op deze manier kunnen mensen informatie en symbolen terugkoppelen en toepassen op de zelfregulering van gedrag. Deze zelfregulering wordt gedreven door interne doelen die iemand aan zichzelf stelt en bepaalt individueel gedrag en is de basis voor zelfreflectie. De gedachte en het gedrag worden bepaald door de sociale controle die wordt uitgevoerd door stigma’s (Bandura, 2001). Te veel blootstelling aan de ideaaltypen op televisie en andere media kunnen het denkbeeld van de toeschouwer dusdanig beïnvloeden, dat het denkbeeld over de realiteit dusdanig wordt aangepast door de ideaaltypen op televisie. Hierin speelt niet de tijd voor de televisie de grootste rol, maar de inhoud wat er wordt gekeken (Bandura, 2001).

Een onderzoek van McClure et al. (2011) toont aan dat de manier waarop een foto van een persoon met obesitas in de media wordt gepresenteerd, invloed heeft op de publieke opinie van obesitas. Dat wil zeggen dat wanneer een persoon met obesitas in verband wordt gebracht met negatief nieuws, dit doorwerkt in een negatief vooroordeel over mensen met obesitas in het algemeen.

Bovenstaande bronnen geven aan dat het gebruik van ideaaltypen in reclames de geloofwaardigheid van producten verhoogt, met als gevolg een toename in de verkoop van dat betreffende product. Kortom, wanneer een persoon met een slank postuur een afvalmiddel aanprijst, zal dit de kijker doen geloven dat het daadwerkelijk helpt. De media branche stimuleert met de inzet van ideaaltype de verkoop van medische producten om obesitas aan te pakken, wat een duidelijke vorm van medicalisering is. Obesitas bespreken in de media als een ziekte, wat een negatieve lading heeft voor het publiek, en het onderbouwen met beeldend materiaal, zorgt ervoor dat de boodschap harder binnenkomt. Men voelt zich aangesproken en heeft de behoefte om deze ziekte aan te pakken en zich te kunnen spiegelen aan het ideaaltype. De farmaceutische industrie gebruikt deze kennis over de invloeden van de media om zijn bereik te vergroten en de winst te verhogen.

Conclusie

Vanuit sociologisch perspectief bestaan er verschillende theorieën over het ontstaan van negatieve denkbeelden over mensen met obesitas. Deze komen voort uit een combinatie van het bestaan van het ideaaltype, obesitas als sociaal probleem en het niet willen afwijken van de norm omdat dat als negatief wordt ervaren.

Vanuit de communicatiewetenschappen kan er geconcludeerd worden dat er al bekend is wat de invloed is van media en hoe media inspeelt op het publiek. De mogelijkheid om een specifiek topic te ‘hypen’ geeft farmaceutische bedrijven de kans om hier dusdanig op in te spelen, dat het publiek medische behandelingen als de enige juiste oplossing van het obesitas probleem gaat zien.

Concluderend vanuit beide perspectieven kunnen we stellen dat de media een leidende rol hebben in de manier waarop het publiek tegen sociale verschijnselen aankijken. Ze zijn in staat om een onderwerp te ‘hypen’ door het over een langere periode herhalend te laten terugkomen in de media. Op deze manier komt obesitas herhaaldelijk naar boven en wordt het door verschillende invalshoeken belicht. Het is bekend dat de media invloed hebben op sociale verschijnselen, maar het is belangrijk om te kijken naar de manier waarop de media obesitas profileren. Dit gebeurt vooral door obesitas groot uit te meten als een probleem, zowel medisch als maatschappelijk. Om dit verschijnsel af te laten nemen in de samenleving, wordt er al snel geadverteerd met medische oplossingen. Dit is een duidelijk geval van medicalisering, omdat er voornamelijk gekeken wordt naar oplossingen op het medische gebied. Doordat de westerse samenleving een samenleving is met ideaaltypische lichamen, heeft het adverteren met afslankmanieren ook daadwerkelijk effect. Dit zou anders zijn in een maatschappij waar men minder of geen lichaamsbewustzijn heeft en de focus minder ligt op een ideaal, volgens de sociale norm, slank lichaam.

Door obesitas breed uit te meten in de media wordt er ook op het sociale vlak een norm gesteld hoe individuen eruit zouden moeten zien om aan dezelfde norm te voldoen. Het feit dat in Amerika 51% van de vrouwen kampt met overgewicht, en van de vrouwen die op televisie te zien zijn maar 13% overgewicht heeft, geeft aan dat de media in staat is om een ander beeld van de samenleving te scheppen. De manier waarop de media een ideaalbeeld creëert, dat van slanke vrouwen en gespierde mannen, werkt door in de samenleving als stigma. Mensen gaan zich identificeren aan dit ideaaltype en door afwijken hiervan ondervinden individuen met obesitas nadelige consequenties. Deze identificatie komt voort uit het inleven in hetgene wat het publiek voorgeschoteld krijgt. Je zou kunnen stellen dat men zich bewust is van deze identificatie bij het maken van media. Mensen zijn geneigd om zichzelf te spiegelen aan datgene wat ze voorgelegd krijgen en zien dit als het ideaalbeeld. De manier waarop obesitas dus wordt vertoond, heeft direct invloed op het beeld wat er gecreëerd wordt over obesitas. Dit geldt ook voor de medicalisering van obesitas, aangezien mensen de informatie die verstrekt wordt, overnemen en zien als de passende oplossing voor het probleem.

Discussie

Inzichten vanuit de sociologie en de communicatiewetenschappen bieden vernieuwende inzichten over dit onderwerp. Toch zou er nog meerwaarde verkregen kunnen worden door dit onderwerp vanuit meerdere disciplines te onderzoeken. Voorbeelden hiervan zouden kunnen zijn: de economie, om de marktwerking uiteen te zetten en de beweegredenen van farmaceutische bedrijven bloot te leggen. Daarnaast zou de medische kennis over obesitas toegepast kunnen worden op de manier van behandelen. De ontwikkeling van een samenleving zou ook interessante achtergrond informatie kunnen geven, verklaard vanuit historisch perspectief. Tot slot zou er op gebied van politicologie gekeken kunnen worden naar de rol van de overheid en de verbintenis tussen de overheid en de media.

Daarnaast is het naar mijn mening onmisbaar om ook empirisch de rol van de media hierin te onderzoeken, aangezien er dan daadwerkelijk een conclusie gegeven kan worden naar de invloed van de media. Door middel van literatuuronderzoek zijn de theorieën uiteengezet, maar de noodzaak van empirisch onderzoek kan hier niet achter wegen gelaten worden. Er zouden bijvoorbeeld diepte interviews afgenomen kunnen worden onder een groep mensen die kampen met obesitas om hun beweegredenen tot gewichtsverlies te achterhalen. Een interessante vraag is of zij daadwerkelijk beïnvloed worden door de media en hun sociale omgeving. Daarnaast zou een kwantitatief onderzoek naar ideaaltype en denkbeelden over mensen met obesitas dit paper goed ondersteunen.

(Geschreven voor Global Health)

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Global Health Papers

Marte Ydema - Illustratie1Marte Ydema

Introduction

Ritalin is a prescription stimulant drug developed for treating attention disorders like ADHD (Attention Deficit Hyperactivity Disorder) and ADD (Attention Deficit Disorder), but it is increasingly used by students for studying purposes. Its effects are highly similar to the effects of cocaine and amphetamines (White, Becker-Blease & Grace-Bishop, 2006). I became interested in Ritalin instantly when I experienced the effects of the drug myself. One night I was studying with someone I know well, who had been taking Ritalin without prescription. When he offered me to try Ritalin as well I first refused the offer, but I became curious about the effects and tried it after all. I was startled by the effectiveness of the drug, which made me extremely focused and kept me studying for 6 or more hours straight. I felt trapped in a tunnel vision; without being distracted by hunger, thirst, physical inconveniences or other distractions I wanted to keep reading and studying. I felt I had to know every detail in the text. Dull information about the personal lives of classical sociologists suddenly seemed super-interesting and fascinating to me.

I was also startled by the side effects of Ritalin: I got very cold, had sweaty hands and feet, I lost my appetite and heavy emotions seemed to be oppressed. Thinking about the effectiveness, but also the troubling side-effects I experienced, I became curious about how other students, be it medical or non-medical users, experience the use of prescription stimulants. What does Ritalin mean to them and their lives? Is Ritalin a magic cure, or a tragic curse? I also wondered what students think of the acceptability of Ritalin. Does increasing prevalence of use also induce widening acceptance or normalization of Ritalin? Or is non-medical Ritalin use considered a form of cheating? In this paper I explore these questions, as well as questions regarding how Ritalin use relates to broader concerns about our educational system. Could it be that a ‘pharmaceuticalized university’ has emerged, in which problems have to be solved with medications to keep up with the pace and teaching methods?

In the United States the use of prescription stimulant drugs like Ritalin has been steadily increasing (White, Becker-Blease & Grace-Bishop, 2006; Esteban McCabe, Knight, Teter & Wachsler, 2004; Moline & Frankenberger, 2001; Judson & Langdon, 2009). With this use, misuse and abuse are inevitable. Much literature about non-medical use of prescription stimulants provides evidence that misuse and abuse is a growing problem among students. Most of this research is conducted in the United States. As a Dutch student, however, I think this trend is present among students in the Netherlands as well. In recent years the Dutch media have paid much attention to the increasing prevalence of medicine use among young children, but reports about non-medical use of prescription stimulants are rare, and thorough qualitative studies are virtually absent. To prevent misuse and abuse, but also for our society to create a healthy conduct towards the use of prescription stimulants, research about Ritalin use is highly relevant and needed. In this ethnographic study, I try to illuminate this subject from a student point of view.

Six in-depth interviews were conducted to explore the questions and issues stated above and other aspects related to prescription stimulants use. The following main question is central to this research: What are the attitudes of Dutch students who use prescription stimulants towards the use of those prescription stimulants for academic purposes? The attitudes explored in this paper focus on experiences of Ritalin use, both positive and negative, the reputation of Ritalin with regard to health risks, the nature of Ritalin use according to the respondents, and the perceived necessity of Ritalin use for study purposes.

Ritalin use can be analyzed in a broader, global context. An important question central to this analysis is: Why do students use Ritalin? Ritalin is often mentioned in relation to ‘pathologization’ and ‘medicalization’. Pathologization refers to the trend to classify behavior as abnormal and therefore as a disorder or disease, and medicalization is the related tendency to treat those abnormalities with medicines. An underlying force to these developments is the idea of ‘malleability’; the idea that life can be influenced and formed to one’s own will. In this paper I will explore if the use of prescription stimulants is related to global processes of malleability in any way, as some researches argue (Miller & Leger, 2003). Of course this is hard to assess, so I will limit my discussion to students’ own attitudes towards the use of prescription stimulants and associated feelings of individual malleability and agency.

Giddens has argued that being a purposive agent is an inherent part of being a human. Humans can reflect upon their actions and discuss why they take certain actions (Stevenson & Knudsen, 2008). This is also the case with practices involving Ritalin use. In this paper I will try to call attention to the role of agency in relation to Ritalin use. Are Ritalin users active decision-makers in taking Ritalin? Do they think Ritalin is a changing agent in their lives, or do they feel it is a mere tool to increase their agency? Either way, do they think using Ritalin is ‘normal’?

(Ab)normal?

Karl Popper, seen as the founding father of science philosophy, once said that all science is based on a marsh of human input (Dehue, 2012). Nowadays we are increasingly capable of detecting the physical and neurological causes of diseases. But as Popper’s quote illustrates, in defining the boundaries of diseases there are always normative aspects involved. What do we classify as normal, and what do we classify as abnormal? This is perhaps even more the case with psychological disorders, since these are often not attributable to a physical cause or visible disability.

ADHD and ADD have recently attracted much attention, especially because of the growing prevalence and associated problems as mentioned before, but also regarding the related diagnostic process. ADHD is seen by some as a controversial disorder (for example Singh, 2012), and there are concerns that the current standards of diagnosis leave too much room for over-diagnosis (Bloemink, 2011). After all, ADHD is merely the name for a cluster of symptoms that are decided on by the Diagnostic and Statistical Manual for Mental Disorders (DSM), and the criteria used to diagnose ADHD or ADD are becoming more flexible (Bloemink, 2011), as more types of behavior are being marked as ‘abnormal’. The flexible norms about abnormality exposes the degree of pathologization in our society.

Pathologization and the related medicalization are creating dilemmas for our society. Should we treat a diagnosed disorder with medication or should we try to solve the problem in other ways? Medicalization is often referred to as the tendency to treat all possible abnormalities or deviations, whether they are life-threatening diseases or small inconveniences, with medicines. ADHD and ADD, and the drugs used for their treatment, are very evident subjects in the debate on medicalization. In ten years time the number of persons that take Ritalin has risen from 40,000 (2002) to 200,000 (2012) (Dehue, 2012).

Both pathologization and medicalization are seen as underlying causes – as well as effects – of ‘malleability’. If an individual has a disorder he or she is expected to do something about it, more and more often in the form of medicine-taking. Toby Miller and Marie Claire Leger (2003: 1) highlight the way in which Ritalin thus becomes ‘a part of modernity’s project of turning people into individuals—in this case, a kind of US transcendence fantasy—which, along with discourses and institutions, promises to transform young subjects and biocosmetically alter their futures.’

It is undeniable that the idea of malleability through medicine use is already present in schools and universities. The roots of this phenomenon, however, are not easily dismantled. Medicalization could have an effect on schools, creating a demand for prescription stimulants by providing them, but developments in the educational system could also be creating this demand. The most likely scenario is that developments in education together with medicalization are affecting students, and according to many scholars in harmful ways.

Tazin Karim (2013) analyzes Ritalin use in what she calls a ‘pharmaceuticalized university’. She notes that many anthropologists have argued that the increasing availability of pharmaceuticals has generated a sense of agency on healthy Americans who feel they could benefit from these medical technologies for non-medical purposes. She states that if society continues to value performance over learning, this ‘pharmaceuticalized culture’ will only grow larger. More students will think that Ritalin is a good solution to raise their grades. To discourage Ritalin use, she advises to change the teaching strategies that are currently implemented at schools and universities, like replacing a ‘one assessment model’ with multiple mid-term assignments and exams. The question is, could a pharmaceuticalized culture, or medicalization, also be affecting students in the Netherlands?

Methodology

To examine this issue, six in-depth interviews were conducted with tertiary education students about their views on Ritalin use. Three of them were medical users of Ritalin, two were non-medical users, and one was a non-user. The initial plan was to focus on ‘students’ in the broadest sense by interviewing medical users, non-medical users and non-users, so that students with different relations to Ritalin would be represented. Because of the limited scope of the research, and because the narratives of Ritalin users proved to be so interesting and extensive, I decided to focus on the attitudes of Ritalin users. After changing the focus from ‘student attitudes’ to ‘user attitudes’, the interview conducted with the non-user became less relevant. Still, it was useful to see if any striking differences could be noticed in this interview, which turned out not to be the case. In the end the interview was not used for quotes or anecdotes, but it did serve to expand my general understanding of attitudes towards Ritalin use. It must be said that the distinctions that were made in prospect of the research between medical users and non-medical users proved to be flexible. In two cases medical users obtained Ritalin without a prescription, and in two cases non-medical users diagnosed themselves with ADD. One of these non-medical users was in the process of getting officially diagnosed.

Besides taking a student point of view, I also assumed a somewhat critical perspective in this research. In a study about ‘smart drugs’ (drugs that enhance cognitive achievement), Canterbury and Lloyd  (1994: 198) stated that: ‘Nootropics may be to the human mind what steroids are to the body.’ This statement illustrates what interests me about the topic, and at the same time aptly summarizes my opinion as a researcher, with an emphasis on ‘my’. Do people really need Ritalin, or are there alternatives for people to cope with their problems? I am curious to find out what other students think of the above statement about nootropics. Because of my own opinion on Ritalin, I asked my respondents certain questions to stimulate critical thinking. In this way, my somewhat critical opinion led to interesting and critical stories and anecdotes. During the research, I tried to be aware of my subjective point of view at all times. Furthermore, I tried to make sure that my opinion was never dominant or insulting, to give all the space needed for respondents to talk about the subject.

The interviews with my respondents lasted for an hour to an hour and fifteen minutes. Some respondents were unknown to me before the research, some were acquaintances, and some were friends. The use of prescription stimulants is not free from taboos and disapproval, and speaking to people whom I already knew and had a trust relationship with gave me the chance to talk freely about otherwise sensitive topics. The people whom I did not know, however, proved to be no less open and willing to talk about personal topics. All names in this paper are fictional.

Marte Ydema - Illustratie

Is it a magic cure…

‘I was tying my laces, and it just made me cry. For the first time I was actually tying my laces, and not… [thinking about something else] I grounded on earth.’ (Lotte, talking about the first time she took Ritalin)

It was quite a while ago for Lotte, a 23-year-old student who has been taking Ritalin for ADD, four years actually, but her first experience with Ritalin was still vivid and clear in her memory. Everything finally made sense to her when she got diagnosed with ADD four years ago. She mostly got good grades, but she always had trouble concentrating and planning her schoolwork. The low grades she got for listening comprehensions were unexplainable, and that is why her school finally noticed that something had to be wrong. She still lives at home with her mother, father and younger sister. Her father and sister have both been diagnosed with ADD as well. At the moment Lotte does not have her own prescription, but she gets Ritalin from her younger sister.

Lotte is not the only one I talked to who does not have her own prescription, but gets Ritalin from family. Roderick, a 21-year-old student, gets his Ritalin from his younger brother. Roderick is not diagnosed with ADD yet, but at the moment of the interview he is involved in a diagnostic process. Jasper, a 21-year-old student, does have a diagnosis for ADD, but he gets his Ritalin from the mother of one of his friends, who is a psychiatrist. He tells me that he could get a prescription for ADD so that he can get his own Ritalin, but that would take time and effort, and that this way it is much easier. Bram, a 21-year-old student, is the only student I spoke to who takes Ritalin every school day on a medical basis. He has his own prescription. Mo, a 22-year-old student, takes Ritalin on a non-medical basis. He gets Ritalin from friends. He tells me that, while he feels that he has some gradation of ADD or ADHD, he does not really feel in need of a diagnosis.

Lotte tells me that only after she started taking Ritalin, she realized that she had been living in a ‘dream world’ all the time. When she takes Ritalin, she feels as she is alive again. She feels motivated and awake. Similar stories were told to me by other students. Roderick tells me:

‘I found it quite heavy. Normally, a thousand things rush through my head, but after using Ritalin I only had one goal, and that is studying, studying, studying.’

To Roderick the effect was absolutely overwhelming, he tells me. Jasper tells me:

‘It is a bit like shutting your brain off [verstand op nul], and you can completely commit yourself to something.’

Also Bram has a similar experience with Ritalin:

‘There is chaos in your head [without Ritalin], it’s all a bit more organized [with Ritalin]. Your thoughts are not going everywhere.’

Regarding the functional effectiveness of the drug, all respondents are positive. There seems to be a consensus among them about the functional effects. Ritalin helps them in doing schoolwork. For Lotte, Ritalin also helps her in planning and organizing her work. Ritalin is perceived by the respondents to clear their mind; to enable them to focus on one thing. They all say that Ritalin makes studying much easier. Jasper explains that it really helps him to do more in a short time. Without Ritalin, he would not be able to concentrate enough, and would not be able to learn as much as he has to.

… or tragic curse?

‘I have quite a lot of problems with side effects, so I really don’t think it’s relaxed. I get a bit ‘brain dead’ [hersendood] I think.’ (Jasper)

Side effects play an important role in the use of Ritalin for most of the students. Before I even mentioned the subject myself, it was automatically introduced, because side effects affected important aspects of their lives. Jasper stopped taking Ritalin on a regular basis because he experienced too many side effects. He felt emotionally unstable, became aggressive, had weird dreams and felt down. He thinks Ritalin makes people ‘mind dead’ [geestdood]. Furthermore, he is also troubled by physical side effects. He does not like the fact that Ritalin takes away your appetite, another reason that he takes the pills as little as possible. At the moment, he only takes Ritalin when he thinks he really needs it to concentrate, mostly during exam weeks.

Side effects also play an important role in Lotte’s life. She started taking Ritalin when she was 19. In the beginning she took three pills a day, usually two in the morning and one in the afternoon. However, not long after her first pill she stopped, because she experienced many side effects. She lost a lot of weight, and her hands and feet got really cold, and sometimes almost turned blue, purple, or even black. She went to the hospital because of her cold hands, and she immediately had to get an electrocardiography (a visual scan of your heart activity). She tells me that nothing was wrong in the end, but she is still troubled by cold and blue hands and feet, also known as Raynaud’s phenomenon (a disorder which causes spasms in the blood vessels). Just like Jasper, she now only takes Ritalin if it is really necessarily. She seems to be worried about the healthiness of the drug in general. When asked if she ever gave Ritalin to someone without a prescription, she answers that she would be too afraid that something bad would happen to that person.

Roderick and Mo also mention side effects, both physical and mental. Roderick mentions a whole bunch of physical side effects:

‘I had lots of side effects. I was extremely cold, especially my hands and feet. But on the other hand, you do start to sweat. Your heart rate rises excessively. Your whole blood pressure rises. And you loose your appetite; the whole day you don’t eat anything. And it is also laxative. These are all things that made me think; it’s not just common doping [huis-tuin-en-keuken doping]. It has its disadvantages. That is one of the reasons why I don’t just do it during the week.’

Mo tells me that Ritalin makes him feel somewhat tired, weak and feverish. Moreover, both Roderick and Mo mention that Ritalin can change your character: it makes you dull and anti-social.

Tim is the only one who tells me that he is not troubled by side effects. The only thing that is important for him is that he does not take a pill late in the evening, because it makes him sleepless. However, he does give pills to friends sometimes, and he hears about side effects from them. It is therefore, he tells me, that he is a lot more cautious now when giving Ritalin to friends. He explains that if he reads the medical instructions he often thinks to himself that he should stop giving his Ritalin to friends.

Ritalin is ‘real crap’

Side effects do not only have a direct effect on the lives of the students I spoke with. Ritalin’s reputation with regard to health and safety may largely be dependent on it. While students praise the functional benefits they can achieve with Ritalin, namely concentration and focus, and a ‘clear mind’, they are negative about the many side effects which most of them experience. Except for Bram, all the students think that Ritalin is something you have to be careful with. Lotte is quite worried about the health effects of Ritalin. She says:

‘It is real crap [troep], and I don’t understand why other students use this just… just extra.’

She does not seem to be too concerned with ethical issues. If students want to use Ritalin for academic benefits she can understand, but she thinks that people should not be messing with it because of the health risks. To back up her argument, she points to the possible risk of having a sudden heart attack. Jasper thinks that Ritalin is crap as well. But he is less worried about the healthiness of Ritalin. He uses other drugs quite often, so he says it would be hypocritical to be worried about it. But still he also wants to use Ritalin as little as possible. This also applies to Roderick and Mo.

Ritalin as a functional tool

‘I do not really care about it. [Ik lig er niet wakker van].’ (Roderick, talking about non-medical use for academic purposes)

When talking to respondents, I got the overall impression that they are not really concerned with ethical issues. Lotte continuously mentions the health aspect, by saying that non-medical Ritalin use is very dangerous, but she thinks that students should make their own decisions regarding using Ritalin or not. When I confront them with the question if Ritalin use could be seen as cheating, some respondents changed opinion a few times, which illustrated that they had not thought about ethical concerns before. After thinking about it for a while, all respondents responded that Ritalin use is not really cheating. Several metaphors used by the respondents illustrate their opinion. Bram sees Ritalin as a tool which makes concentrating easier, but not as a wonder drug doing all the work for you:

‘If you, for example, went clubbing the night before and the next day you go to a lecture, then it is not efficient to sit in the lecture hall because you are too hung-over or you can’t concentrate. That is the same with this [Ritalin]. I don’t really need it, but it makes it all a bit easier and more efficient. So why would I live without?’

He also makes a comparison with doping. He tells me:

‘It’s not, at least that’s what I think, as cycle racing; that somebody uses doping, and that someone gets better than the rest. It’s more; it’s just a sort of tool that you… [does not finish sentence] Look, if everybody just has a better bike, then it’s just fine.’

Lotte also uses a doping metaphor to illustrate her point::

‘If you take doping, it directly influences your physical performance. But if you take Ritalin you get more controlled, and that does not influence if you’re smart or not. You can take Ritalin, and then still postpone everything.’

Jasper uses a surprisingly similar metaphor:

‘Doping influences everything, it’s often with endurance sports that doping is used. That is influencing the total sport. Ritalin gives you a ‘little push in the back’ [duwtje in de rug].’

Because Ritalin is seen as a tool, and not as a super drug, Ritalin use is not seen as cheating. Mo puts it this way:

‘If you are short of time, it’s just a handy tool to use. So it’s actually not really cheating, it’s more of a tool.’

It is clear that respondents use their agency here to make active decisions, and also expect this from their peers. Respondents feel like they make active decisions about when and why they use Ritalin. Their statements show that they think people make their choice to use Ritalin themselves. Statements as, ‘Why wouldn’t I use it?’ (Roderick), illustrate this, or as Jasper puts it:

‘If it really upsets you that people are cheating, then why don’t you just take Ritalin yourself?’ 

Just as Miller and Leger (2003) state, Ritalin to some extent induces individualization and medicalization; everybody is expected to work on his or her own future and to alter his performances with medicines if possible. It can be stated that Ritalin use is more or less accepted by the students.

Marte Ydema - Illustratieflip

A life without Ritalin

From the interviews I noticed that side effects generally play an important role in the lives of respondents. They want to take Ritalin as little as possible, because they feel Ritalin is crap or unhealthy. Nevertheless, I discovered that they feel they have to use Ritalin, that they really need it. An interesting finding is that this idea was present among medical users, but also among non-medical users. When asked if, regarding the many side effects he experienced, he thought the advantages were still overruling the disadvantages, Roderick answers:

‘In my case it is, because otherwise I just can’t do it. I have to [take Ritalin]. Otherwise I just don’t have… Otherwise I just can’t learn, and I don’t have any motivation.’

Lotte, Tim and Jasper all mention that they need Ritalin because something is different in their brains due to the ADD or ADHD. Because of those disorders, they are otherwise not able to concentrate enough on their schoolwork. Ritalin takes away or eases the problem for them. The latter conclusion creates a really interesting paradox; while most of the respondents experience severe or troubling side effects, they still feel the need to use Ritalin. Why would that be? Part of the answer may be related to Karim’s (2013) theory of a ‘pharmaceuticalized university’, in which problems have to be solved with medicines to keep up with the pace and teaching methods. Narratives from respondents did point in that direction. Jasper admits that he uses Ritalin to learn a lot in a short amount of time, and that he actually always starts revising too late. He says:

‘It [Ritalin] makes learning a lot easier, because actually I always start too late. And then I actually do need Ritalin to cram so much subject material in one go.‘

Even though Jasper blames himself for starting too late, I think that it is the task of schools to intervene here, by training students to adopt healthy learning habits.

When I ask him what his life would be like without Ritalin, he says that he would not be able to do so much subject material in such a short time. If he would adjust his learning behavior by starting to revise earlier, making his assignments and following the week planning, he believes he would not need to use Ritalin. It is only when he starts the weekend before, that he really uses Ritalin. He also tells me about one really nice course, which he thought was so interesting that he did not feel the need to use Ritalin.

When Lotte is asked what her world would look like she gives a really interesting answer:

‘Then I would never know how it feels not to be dreamy all the time. But I think there would be other solutions. Not with concentrating, but for example; I am with an ADHD talking group at the moment, about organizing your work, and that really helps. So that is another kind of solution. External, to get your life back on track.’

Mo sees this almost the same way:

‘If I had a month to learn for my exams, then I wouldn’t need Ritalin. Then there would be some days when I would be focused for half a day. But at the moment, now I’m probably going to use it, because I still did not learn for my exams.’

Lotte explains that she thinks schools are not adjusted to students with learning problems.

‘It would be ideal if schools would adjust to people who are not that quick with learning or who have focussing problems, instead of the other way around. Because at the moment it is like this: take a pill [gooi er maar een pil in] and then you’re good enough to fit into the oiled machine of education.‘
[Me: ‘So actually it would not have to be necessary?’]
‘Yes, that’s my opinion, but that’s just not possible in this society.’

This latter statement is really interesting. Respondents to some extent think that the educational system is the cause for their Ritalin use. Even students who are diagnosed with ADHD or ADD say that if they had other tools like coaching, more time, or alternative schedules, they would be able to succeed in college without the drug. Ritalin is just a tool to make things easier for them. The fact that Jasper does not take Ritalin for a course that he really likes, could also tell us something about the current educational system. If students would be motivated for all courses, maybe they would not need Ritalin after all.

Conclusion

All of the respondents are positive about the functional effects of Ritalin. They get more focused and concentrated, and they can empty their heads. However, almost all of the respondents are troubled by side effects. Some even altered their way of living and way of Ritalin use because of the side effects. Respondents mention both physical and mental side effects. Ritalin is not seen as a super drug, but as a tool that gives them support during studying. That is one of the reasons why Ritalin use is not considered cheating; when you take Ritalin it does not mean that the work is done automatically. Respondents emphasize the student’s own responsibility that is still needed to succeed in studying. It could be concluded that normalization of Ritalin is indeed occurring; respondents think that it should be a student’s own choice taking Ritalin or not. This could be interpreted as a sign of medicalization; if it is possible, why not take a pill to enhance your performance?

There is a contradiction in experiences and attitudes towards Ritalin: despite troubling side effects, respondents still feel the need to use Ritalin. When thinking about a life without Ritalin, however, they acknowledge that there are other ways to solve their learning problems. The fact that they feel the need to use Ritalin despite the side effects must mean that there is a pressing motivation to use it anyway. Respondents talk about the educational system as if it could be one of those pressing motivations. If they had more time, or started earlier, got coaching or alternative schedules, they think that they could still be successful in their studies. Because they do not experience these advantages at the moment, they feel the need to take Ritalin to be able to succeed. This is a really interesting finding, and more extensive research would be really valuable. To see if a ‘pharmaceuticalized culture’ is indeed arising in the Netherlands, more research is needed.

It is important to note that I certainly do not deny the existence of ADHD or ADD, or that I deny that students with learning or focusing problems do not need extra help and attention. But based on my research findings, solutions could be provided to give students the opportunity to function without Ritalin. If courses would be more interesting in the eyes of students, there would be less need among them to use Ritalin. Furthermore, more time and attention could be offered to students who have problems with concentrating. Moreover, students who have studying problems could use training to learn how they could study effectively and begin studying on time.

This study shows that studying students’ perceptions of Ritalin use is important if we want to understand its underlying reasons and mechanisms and comprehend it in the broader context of a pharmaceuticalized university culture. Ritalin should not be normalized, and we should make sure we remain critical of its use and associated practices.

(Written for Youth Cultures in a Transnational Context)

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