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Sociology

http://soc.sagepub.com Recognition and the Creation of Wellbeing


Eeva Sointu Sociology 2006; 40; 493 DOI: 10.1177/0038038506063671 The online version of this article can be found at: http://soc.sagepub.com/cgi/content/abstract/40/3/493

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Sociology
Copyright 2006 BSA Publications Ltd Volume 40(3): 493510 DOI: 10.1177/0038038506063671 SAGE Publications London,Thousand Oaks, New Delhi

Recognition and the Creation of Wellbeing


s

Eeva Sointu Smith College

ABSTRACT

Whilst much research into alternative and complementary medicine use indicates that these practices enable experiences of control, agency and empowerment, few theoretically informed answers have been given to why and how consultations with alternative and complementary health practitioners facilitate experiences that are felt to be healing.This article utilizes theories of recognition in order to reect on the healing experiences of women seeking health and wellbeing through varied forms of alternative and complementary medicine. I analyse the empowering and agency-giving aspects of alternative and complementary medicines, in particular in relation to wider societal conceptualizations of the self. This article is based on qualitative interviews with both practitioners and clients of varying alternative and complementary medicines.
KEY WORDS

alternative medicines / empowerment / identity / recognition / subjectivity

Introduction
he rise of alternative and complementary health practices is often seen to reect a sense of dissatisfaction many feel towards orthodox medical practice and the role traditionally ascribed to the biomedical patient (see for example, Astin, 1998; Furnham and Vincent, 2003; McGuire, 1988, 1996; Sharma, 1992; Stacey, 1997; Vincent and Furnham, 1996, 1997).1 In contrast with the passive, compliant and obedient character of the patient in biomedical encounters (Stacey, 1997: 205), alternative and complementary health practices are seen to allow the client a more active role in his or her health care (Furnham and Vincent, 2003; Hughes, 2004; Vincent and Furnham, 1996,

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1997), and to encourage people to conceptualize their illness experiences more holistically in relation to multiple aspects of life (Goldstein, 2003). Accordingly, the kind of self constructed in many alternative and complementary health practices has often been characterized as holistic, active and empowered. Conceptualizing health in terms of personal responsibility and agency is not limited to alternative and complementary health practices. Rather, the notion of self-responsibility has come to constitute an important part of the present day rhetoric of health maintenance and prevention of illness, also within biomedicine. Patients are increasingly identied and encouraged to act as responsible consumers, capable of actively maintaining health through lifestyle choices (Hughes, 2004; Powell and Hewitt, 2002). This active and informed individual citizen that has been emerging in health policy throughout the past two decades (Hogg, 1999; Hughes, 2004; Powell and Hewitt, 2002) can be seen as a part of wider social, political and cultural trends that involve specic understandings of selfhood: we have come to relate to ourselves as creatures of self-responsibility and self-mastery (Rose, 1999: 95). In this article, I relate experiences of healing that potentially emerge through involvement in alternative and complementary medicines to wider societal understandings and discourses of selfhood. However, I also reect on how and why alternative and complementary health practices may offer clients a sense of empowerment and control over experiences of unease, in particular, through utilizing different theories of recognition to analyse client accounts. It is important to note here that I did not have access to medical consultations alternative or otherwise. The following analysis is based on interview accounts that may or may not reect what goes on in different consultation rooms.

Methodology
This article is based on research into the ways in which alternative and complementary health practices are conceptualized, experienced and evaluated. The study involved 31 qualitative in-depth interviews with both users and practitioners of various forms of alternative and complementary health care (14 users and 17 practitioners; 27 women, 4 men) in north-west England. The sample reects general socio-economic and gender characteristics associated with the use of alternative and complementary medicines (Kelner and Wellman, 1997; Thomas et al., 2001; Vincent and Furnham, 1996; Wiles and Rosenberg, 2001). Most of the interviewees claimed a middle-class background, reected in many of the participants also having professional or semi-professional qualications. The average age of the interviewees was 50, with the youngest participant being 34 and the oldest 81. This article focuses exclusively on the interviews with women practitioners and users. This relates to ndings that the majority of people both practising and utilizing alternative and complementary health practices are women (Heelas and Woodhead, 2005; Thomas et al., 2001). However,

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highlighting womens experiences is also linked to a theoretical concern for conceptualizing health practices as utilized, assessed and experienced in relation to socially inscribed identities. The kinds of consultations focused on in this article take place outside the developing structures of referral through, for example, the National Health Service. Indeed, much of the use of these practices is private (Andrews, 2002; Thomas et al., 2001). However, I recognize that the character of consultations discussed here is a potential factor that inuences the ways the participants dene health and wellbeing. Similarly, an explicit focus on womens experiences potentially limits the wider applicability of the ndings and the analyses presented. Respondents for the study were recruited by snowballing through practitioner networks. Including a range of health related concerns and therapeutic approaches in the study was connected to a desire to throw light on varying kinds of experiences people gain through involvement. The interview questions focused on three principal areas: background of the user or the practitioner including information of how they came to turn to alternative and complementary medicines; questions about what constitutes a good practitioner or a good practice session; and understandings of the self, the body, health and illness. Initially, the interview themes were formulated on the basis of social scientic approaches to the use of alternative and complementary health practices, which identify these practices as enabling and enforcing experiences of agency, control and empowerment. Accordingly, the interviews sought to tease out what people felt they gained through being involved. The interviews also highlighted the norms and values underlying alternative and complementary discourses of health. The excerpts discussed and analysed in this article relate to the most signicant themes in the interview material around how clients experience and conceptualize good practice sessions and good practitioners.

Background: Health as Personal Fullment


On the surface, the reasons underlying the use of different alternative and complementary health practices vary enormously. Some seek relief for terminal illness, others utilize these practices for general health maintenance. Alternative and complementary medicines are consulted at times of physical unease, but also turned to in order to mend broken hearts. Some use of alternative and complementary medicines relates to serious spiritual seeking, other use relates to gullible consuming. Importantly, varied use-motivations often exist side by side as the hope to ease chronic pain can be fused with a feeling of delight in caring touch or in consuming something that is deemed good for you. Even though alternative and complementary health practices can be utilized in relation to very different types of unease, the kind of health that is sought through these practices often remains the same. Conceptualizing health in terms of personal fulfilment and wellbeing was frequent in the interview accounts:

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[Health means] that Ive got all of myself to bring to anything that I do. Whereas if youre not healthy, its like youre just bringing a part of yourself, not got everything right health is being fully me. (Sue, a client of a homeopath/bodywork practitioner) How would I dene health A person that is living their life to the full in whatever capacity the body is in. So even if theyre in a wheelchair, even if theyre not in our terms healthy, if they feel they are fullled with their life, that they can actually live Its the soul feeling its accomplishing whatever it came to life to do. (Jean, healer/reexologist)

Health has often come to imply a sense of personal fullment rather than just a body that functions well. In the above statements, every person is seen as capable of accomplishing a fullling life characterized by a sense of individualspecic holistic contentment. Importantly, it is not just the person, but their soul, that assesses what counts as a life that is both meaningful and healthy. The person-specic inner peace, harmony or balance often emphasized in alternative and complementary health practices relate to complex understandings about the self. It is the relationship between conceptualizations of the self and the contemporary understandings of health as over-arching wellbeing that I want to explore next.

Frameworks:The Age of Authenticity and the Desire for Recognition


Clearly the self and the body constructed in alternative and complementary health practices can be seen as projects displaying divergent identities and senses of belonging in the context of reexive modernization (Giddens, 1991). Conceptualizations of health as wellbeing and fullment relate to particular understandings of selfhood. According to Frank Furedi, [e]xploring and engaging with the inner-self has become an important constituent of contemporary identity (2004: 17). Similarly for Charles Taylor: We are creatures with inner depths; with partly unexplored and dark interiors (1989: 111). Thus, wellbeing can become something that is to be discovered through exploring and understanding ones inner core. Concern for the wellbeing of the self and the body also emerges in relation to a sense of individualized and internalized selfresponsibility; the self today is constructed as one that is ideally not only capable but obliged to be responsible and productive also in terms of personal health (Rose, 1999). This kind of responsible and inwardly reective self has a history. According to Charles Taylor (1991), modern Western individualism is related to the ideal of authenticity; being a full person is linked to the imperative of listening to ones self and following ones unique path, both which are to be individually discovered:

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I am called upon to live my life in this way, and not in imitation of anyone elses. But this gives a new importance to being true to myself. If I am not, I miss the point of my life, I miss what being human is for me. (1991: 29)

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Importantly, according to Taylor (1994),2 it is because of the hold of the ideal of authenticity over the contemporary self that gaining recognition for the unique individuality within has also become a key demand for having a fullling and true identity and, accordingly, for the experience of living a meaningful life. However, asserting ones personally discovered truth is also becoming increasingly problematic in the contemporary social climate. This is because a social context that emphasizes authenticity also undermines the social production and afrmation of the truths discovered from within. According to Taylor, the dwindling of social hierarchies that previously served as anchors for identication together with the ideal of authenticity result in the identity of the person being increasingly dependent on the recognition of the inner authenticity by others. The ideal of authenticity escalates the demand for recognition and simultaneously places the burden of self-responsible self-seeking upon the person. Yet, the ideal of authenticity also denies any apparent means of measuring and conrming ones success in being true to ones self: What has become about with modern age is not the need for recognition but the conditions in which the attempt to be recognised can fail (Taylor, 1991: 48, 1994: 345). Zygmunt Bauman makes a similar assessment about the effect of social change on subjectivity. According to Bauman, the contemporary individual who is fully at home only with himself [sic] (1991: 95) lives in a social context, which demands the establishment of a unique and stable identity, yet importantly, cannot collectively afrm this identity (p. 201). Identities that were previously more xed within social institutions are now spreading out and becoming more fragmented, with institutions serving as brief settings for the generation and corruption of subjectivity (Hardt and Negri, 2000: 197). Furthermore, as self-actualization becomes an important requirement for the subject obliged to display a choosing self (Rose, 1999), self-responsibility extends its grip over varied private concerns. In this context, the ideal of authenticity, and the processes of seeking recognition relate to concerns over the fragmentation of contemporary identities. However importantly, the notion of authenticity also constitutes a discursive ideal aspired to; authenticity is desired and displayed as part of being a normal subject across varying social contexts. However, processes of recognition that establish the self as appropriate according to the ideals of authenticity, self-fullment and self-responsibility, are also culturally and historically specic; what is recognized is subject to change in relation to wider social perceptions of value. Indeed, according to Axel Honneth, recognition implies not only the reciprocity of primary social relationships, but also a sense of the self as possessing the attributes of a morally competent actor within a given cultural context. As such, experiences of recognition result in the feeling of the person being both valued and understood

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(2001: 49). However, having a sense of the self as a competent actor who is esteemed by others is not distinct from what counts as valid or normal within the wider society. Whereas recognition implies the equal status of social actors with varying identities, misrecognition refers to the manner in which patterns of cultural value constitute some actors as inferior, excluded, wholly other or simply invisible (Fraser, 2001: 24). As such, recognition is not solely tied to the value of or the need for expressing ones authentic and true identity. Recognition is also a question of justice; mis-recognition is wrong because it constitutes a form of institutionalized subordination and thus, a serious violation of justice (Fraser, 2001: 26). How the dynamics of power to recognize and to be recognized are played out in health and health care, and potentially redressed through alternative and complementary medicine use, are discussed further in this article. However, before turning to the interview material, I want to think further about the ways in which health practices may come to endow a client with a sense of empowerment, control and even agency aspects often seen as an important part of the appeal of alternative and complementary medicines. In order to do this, I turn to theories or recognition in relation to subjectivity.

Recognition and Subjectivity


In order to understand healing and, in particular, the senses of control and agency many users report, a different kind of theoretical framework which may not t comfortably with the approach outlined earlier may be needed. Considering recognition in relation to the formation of the subject, and further, as a source of both interactive pleasure and vulnerability (Benjamin, 1988, 1995) provides another means of understanding therapeutic encounters and therapeutic effects. A brief outline of the role recognition is thought to play in the formation of subjectivity is important here. According to Majid Yar: the establishment of ones self-understanding (ones idea of self or subjective self-certainty) is inextricably dependent on recognition or afrmation on the part of the others (2001: 59). For Yar, dialogical recognition of the self and the other lie at the very core of being human (p. 58). This recognition involves a desire for realizing itself according to a particular perception, understanding or image of itself as a human being (p. 65, original emphasis). Recognition thus relates to subjective experiences that are also socially and culturally mediated and produced in relation to different discourses. Importantly, recognition that is valid for satisfying the desire for being seen by the other as a particular kind of being is only possible when the other doing the recognizing is also perceived as a full subject:
The afrmation-constitution of ourselves as the kinds of subjects we desire to be requires another consciousness (i.e. a subject) who will be aware of us and thus capable of conferring recognition upon us in the terms we wish to be taken. (Yar, 2001: 65, original emphasis)

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In other words, the perceived status of the other is the prerequisite of the recognition of the self as the kind of being one wishes to be, as a kind of self that is felt to be worthy in a particular social and cultural climate (Yar, 2001).3 Not only is recognition important in establishing the self as worthy in relation to internalized self understandings and wider social and cultural values. Experiences of recognition have also been related to the persons sense of agency. According to Jessica Benjamin:
A person comes to feel that I am the doer who does, I am the author of my acts, by being with another person who recognizes her acts, her feelings, her intentions, her existence, her independence. Recognition is the essential response, the constant companion of assertion. The subject declares, I am, I do, and then waits for the response, You are, you have done. (1988: 21)

Being recognized as an active being enables the person to develop into an active being (Benjamin, 1988, 1995). Furthermore, the developing capacity of recognition where the self comes to be known through intersubjective recognition granted also to the other as a being with its own subjective centre is also the source of understanding and empathy. Here, the ability to put oneself in the others place, to see the other as a being that is both intersubjectively related yet also independent, functions as the basis for a lifetime of intersubjective relationality. Becoming recognized is, however, an inherently precarious process: the other does not necessarily recognize the self. The uncertainty inhering in recognizing and seeking recognition is a source of vulnerability, but importantly, also a source of: pleasure of the evolving relationship with a partner whom one knows how to elicit a response but whose responses are not entirely predictable and assimilable to internal fantasy (Benjamin, 1995: 312). The pleasure of intersubjectivity emerges from the joys of feeling a shared mental state but also from the possibility of mis-recognition, which makes the recognition gained ever more signicant and afrming (Benjamin, 1988, 1995). I now move on to reect on the interview material in the light of the varying approaches on recognition outlined above.

Discussion:Wellbeing as Being Recognized


Many of the users and practitioners interviewed in this research were turning to alternative and complementary medicines because of the more empowering and agency-giving character of these practices. Sue is a client of a homeopath and bodywork practitioner. She describes her experiences within both the conventional and the alternative medical sectors in the following terms:
Id been to the doctor. I didnt feel I was getting anywhere. You know, I knew that what I was feeling was not how I normally felt. You know, that I was excessively tired. And the doctor was saying things like well, you are a single-parent, you are working, its understandable that youre tired. But I knew that I was more tired

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than I would normally be. And so, it felt um, that like somehow you had to prove something more for [the] doctor whereas the homeopath was more likely to take what you were saying seriously. (Sue, a client of a homeopath/bodywork practitioner)

In Sues experience, the doctor positioned Sue according to general, if not stereotypical characteristics pinned upon single mothers. A potentially stigmatizing label is being used to explain Sues feelings of tiredness. However, through being attributed an identity of a (tired) single mother, Sue is not being recognized in her particularity. She is being generalized and denied her experience of difference from social stereotypes. Sue is not being seen or heard as a subject she wishes to be. The denial of recognition for Sues unease is thus also denying Sue her own, real and authentic experience. Lack of recognition for Sues particularity is also connected to lack of recognition for Sues status as a rational agent. The biomedical discourse had no legitimate place for Sue and the complexity of her experience: Sues sense of tiredness was deemed medically decient and accorded little attention. As a response to the misrecognition of her own understanding of the feelings of unease, Sue turned to someone who would take her seriously. In Sues experience, the homeopath was willing to recognize Sue and her problem in their particularity. Time and explicit selfexploration allowed for Sue to feel she was being understood in her own terms, like she wished to be seen. Through the recognition given to Sue by the homeopath, Sues sense of agency was restored; the gap between how she felt as a person who deserved to be taken seriously and how the medical encounter had identied and treated her had, at least in part, been resolved. The kind of recognition for clients particularity offered by many alternative and complementary health practitioners can be seen as important for understanding the appeal of these practices: alternative and complementary medicines treat people desiring to be seen as authentic, knowledgeable and valid individuals as unique, empowered and informed agents whose experiences, interpretations and feelings matter. Sue is not alone in feeling that practitioners understand. Lesley had been suffering from alcoholism since the death of her partner. She turned to a healing practitioner in her quest for help for the deep feelings of loss that she felt remained under the surface and that in her eyes fuelled the alcoholism. This is how she described her feelings about the healing encounter:
Its a feeling of being understood and known Anther person being able to see exactly where youre coming form I think whats changed is at last somebody actually understands me. (Lesley, a client of a healing practitioner)

The therapeutic encounter is seen as characterized by experiences of acceptance and understanding, both of which Lesley contrasted with the experiences she had had in more conventional settings in relation to alcoholism:
I said, in one of the meetings, you know, its really needing to look at why you drink, you know, why you sort of hit the bottle. And the answer that was coming back not

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from just one counsellor, but from them all really was you would have become alcoholic anyway. Because, I mean, there is a big genetic inuence, you know, on that. I didnt see it that way, and neither did she [the healing practitioner] I mean, if you feel comfortable in yourself you wouldnt be drinking or people wouldnt be using drugs. I mean they use drugs, and people drink for reasons. (Lesley, a client of a healing practitioner)

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Instead of allowing the feelings inside Lesley to have a role in her alcoholism, Lesley experiences the conventional therapeutic encounters as denying her the possibility of having these emotions and perceptions heard. She feels labelled, not according to her own views or feelings, but according to her genes; a strategy that, furthermore, constructs her condition as inevitable. However, in the encounter with a healer, Lesleys feelings became the centre of her problem; she is reconstituted in terms of her emotions that need to be heard and then remedied. How Lesley herself experiences drinking becomes the key to addressing alcoholism. Through being heard, Lesley becomes a person whose perceptions and experiences count. However, through the recognition given to Lesleys feelings, she is also constituted as a person with a sense of agency. This experience of recognition helps in the construction of a new story in relation to drinking. Importantly, the recognition of a practitioner and the creation of a new account of drinking open up possibilities for healing that transcend the physiological body and relate rather to the persons subjective sense of the self. A similar account relating to experiences of recognition, or to the lack of them, was given by Jill. She had been suffering from severe pain in her knees for two years. After having her complaint diagnosed as severe arthritis, Jill opted for a privately paid for operation. The operation and the physiotherapy that followed, however, left Jill feeling disappointed. Her knees were still sore and stiff and the sense of losing her ability to live life like she used to was proving difcult to manage emotionally. In Jills case, a part of the complaint was offered the status of a legitimate afiction. However, how Jill was feeling with the loss of mobility she was experiencing was given little medical attention. Jills feelings of loss and disappointment were not recognized and Jill turned to different alternative and complementary practitioners. Here is how she described her experiences with one of them:
One day when she [June, the practitioner] said youre not really feeling any better are you? and I said well not in myself. Because I think it were because I was so used to being active. I was in a walking group, I was doing me gardening and you know, moving about and everything. And I just felt as if Id reached the end of the road if you know what I mean. I mean I was seventy-nine and I thought is this going be me life, just struggling to keep going? You know. And so June said, perhaps a bit, a course of homeopathy might help and I said do anything! (Jill, a client of a homeopath/bodywork practitioner)

Jills sense of unease did not t the ways she was identied by the doctors and physiotherapists. However, her sense of being unwell in herself was something that the practitioner recognized. Through this recognition, Jill also acquired a

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status of someone aficted not only because of her knees, but also as a person not feeling herself not being who she was or wanted to be. Illness is, in the above, characterized as physical at the same time as being unwell is also enmeshed with demands to be recognized as more than as a biomedical patient. By recognizing Jill and thus giving her sense of non-medical unease a degree of legitimacy, the practitioner also legitimates Jill and her experiences as authentic. Alternative and complementary health practices enable clients to feel like they are being understood and esteemed by others. Recognition that emerges through affective care combines with recognition that designates the person as valued and legitimate in the actual health care setting. The recognition of complaints establishes the subjectively felt unease as real and meaningful. Recognition of life-experiences, concerns and values is what practitioners and practices provide for many of the people involved. Alternative and complementary health practitioners are often experienced as seeing, feeling and hearing the client in more particular detail than is possible in biomedical encounters. Through this recognition, these practitioners help to counter experiences of misrecognition for some of those involved. Through recognition, practitioners also bestow and afrm identities, challenge biomedical categorizations and offer up other values for identication. There is often a sense of mis-t between personal experiences and the wider social context that has failed to appreciate or legitimate these experiences. This misrecognition also highlights a discrepancy between social norms around what constitutes ideal personhood and the actual experience of not being heard and recognized as, for example, a rational and an autonomous person on the part of many of the women interviewed. Jills story is interesting also for understanding how consulting a practitioner, and through this, developing a sense of self that is known and understood, can affect the life of a client. This is how Jill feels about the practice she is involved in:
Well I think it gives you a sense of wellbeing, restores your feeling of wellbeing. Restores your equilibrium. Is that what Im trying to say [yeah?]? Oh I know what it does as well, before June embarked on a homeopathy treatment, I was feeling very negative. Im not normally negative person. So I feel as though Ive gone back to being myself, cause now Im positive. And I can, I can up and go instead of waiting for things to happen, which is what youve got to be like So I just feel now as if Im back to what I was. You know, I can sort of bounce back. (Jill, a client of a homeopath/bodywork practitioner)

Wellbeing is identied as Jill stopping being negative; wellbeing entails the person positively conquering unease. Wellbeing also implies Jill being herself; wellbeing is characterized as one being true to ones self. At the same time, wellbeing denotes experiences of control and agency. A bodily sense of wellbeing explicitly enables Jill to be mobile. However, the restored equilibrium is emotional as well as practical and related also to Jills experiences of medical encounters and of the mainstream society as an 81-year-old woman. Jill

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describes restoring wellbeing as restoring equilibrium, yet this restoring of equilibrium could only take place when the loss of the equilibrium is recognized and validated.

Mutual Recognition from the Margins


Importantly, the recognition gained through alternative and complementary health practices is also often based on shared experiences of marginality. Therapeutic recognition also appears to be dependent on a sense of correlation between the one who recognizes and the person who is being recognized. This is what Louise said about her practitioner:
Shes a woman and we have other identities in common as well and that makes me feel safe with her So if I was going to see a man, I wouldnt be as relaxed [yeah]. You know, cause I often strip down to my pants, I wouldnt do, Id feel, you know, really uncomfortable doing that with a man. You know, and then theres the whole emotional stuff, of which Im way happier to talk to June. Its really hard to be clear about it [yeah] but I just know that, you know, she understands and even though life experiences are different, she has an empathy. (Louise, client of a homeopath/bodywork practitioner)

Louises practitioner understands, partly because in Louises eyes she too knows what being a woman is like. Here, as Nick Crossley points out: [t]he gesture of the other moves me as it does because we share collective habits of emotion (2001: 85). These collective habits of emotion pertain to recognition of the other as a being with a similar identity. There is a correlation between the practitioner and Louise not just in terms of shared life experiences, but potentially also in terms of shared experiences of misrecognition. A sense of sharing facilitates familiarity, which in turn reduces the possibility for Louise to feel objectied. The afrmation Louise feels is stronger because of the sensitive status of the issues that are being talked about. Louise strips down to her pants literally, but also metaphorically in the consultation room, and her vulnerability makes the experience of recognition more important, but also stronger. The afrming response expected and often granted by practitioners is not, however, only related to a sense of shared identities. Discourses of wellbeing form another backdrop for experiences of healing. Many go to consultations expecting and prepared to interpret their situation in terms of, for example, holistic connectedness between the mind, the body and the spirit. This shared context of knowledge also functions as a guarantee for recognition; concerns that are expected to matter, for example, in terms of holistic interpretation of unease get articulated, but also recognized. As such, the practitioner is a known and an unknown other, known to offer certain responses yet, other enough for the intersubjective interaction to potentially provide feelings of mutual recognition. This recognition that is emergent through interaction is often implicit and unconscious. This intersubjective recognition is uncertain in that it does

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not always take place, but also ever-more pleasant when it does take place precisely because of the precariousness of recognition relationships (Benjamin, 1988, 1995). This kind of affective recognition (Honneth, 2001), which functions partly on the level of unconscious subjectivity, may be experienced as particularly absent in encounters with biomedicine. The lack of affective recognition emerges in relation to the potential power imbalances inherent in traditional doctorpatient relationships, and also in relation to the biomedical discourse that conceptualizes disease in terms of visible physicality (Foucault, 1973). Biomedical discourse limits the possibilities for recognition through the ways in which it denes health and illness and through the ways in which it designates the expert as capable of discerning what might be wrong. Biomedical understandings of health and illness, embodied also in institutionalized structures, are problematical in terms of recognition because the reductionism of biomedicine can be felt to violate the particularity of the person desiring to assert and experience the self as authentic. This is not to say that alternative and complementary health consultations are void of questions pertaining to power. However, the potential imbalances of power inherent in therapeutic encounters can at least in part be seen as mediated by the role offered to the client as capable of personal interpretation and self-healing. Furthermore, the commercial character of the therapeutic exchange also places the client in a position where they often feel that they can expect more from the practitioner, including more in terms of respect and recognition. Importantly, questions of power are also implicitly negotiated in relation to a sense of shared gender identities:
Im happier seeing a female [yeah]. I wouldnt, and this is not his fault, that this was a man. Um, he was very pleasant, but it is very, very much hands-on. And I think that would have made me feel tense, which would counteract any benet from the session. Because Id be even more tense because of who, who it was [yeah] You need to able to feel comfortable with someone. (Bella, a client, the Alexander Technique, healing)

Sues views about her practitioner are very similar:


I dont think of myself as nding men harder to trust, but I think that at some level, maybe in terms of bodily contact with someone who is not a partner, I think Id nd that hard to do I enjoy that intimacy I suppose, I dont know. Its that kind of bodily thing that women can have together [that you cant have with a man?]. I dont know what it is, because its clearly not about sexuality. So it must be a gender thing rather than a sexuality thing. Yeah, just that ease about your body and your rolls of fat and your [yeah] you know Yes, I think it is a women thing because theyve had similar, shared life experiences I guess. Or you can assume certain things. (Sue, a client of a homeopath/bodywork practitioner)

Recognition that emerges from a sense of familiarity is particularly important because many alternative and complementary health practices involve physical contact. The touch of a female practitioner is experienced as non-objectifying

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and safe. This apparently non-objectifying character attributed to the touch of another woman enables experiences of recognition; the body may be the object to be touched, but the construction of the practitioner as someone seeing, hearing and feeling the client in their authenticity beyond the body, makes it possible for the client to feel recognized as a subject rather than as an object. Recognition through touch that is often gained through alternative and complementary health practices is in part facilitated through a sense of familiarity, but this familiarity also often relates to experiences of being a woman. With female practitioners, whether or not this actually is the case, many women can assume shared background knowledge and shared embodied experiences. Being able to assume things about the practitioner relates to the personal attributes of these people, but also to how, for example, female practitioners are seen as more caring and non-threatening to the bodies and identities of their clients. Why many might feel more comfortable with female practitioners is related to associations between femininity and care. Women have traditionally held the role of carers (Hochschild, 2003; Skeggs, 1997), which makes the experience of being cared for, especially through physical touch, by a female more natural and less objectifying. However, not all clients prefer female practitioners. Lillians practitioner, William, is a man. This is how Lillian describes what she likes about William:
Id say hes just a very, I would say gentle man ... Hes such a nice man, you feel that you can talk to him about anything. Whereas a lot of men you cant do that. And I think through this hes become a good friend. Hes just got this warmth about him, I think, and then you put faith into him. (Lillian, a member of a spiritual healing group)

It is gentle care and trust that Lillian values about the relationship she has with William. For Lillian, these characteristics make William different from most other men. These attributes also make William more attuned to Lillians feelings and experiences. A good practitioner, male or female, is someone clients trust as capable of recognizing the authenticity and knowledge of the self. Importantly, good therapeutic relationships, especially ones that have been established for a while, are frequently conceptualized in terms of friendship. It is the feeling of reciprocity that, at least in part, facilitates recognition. Yet, in this friendship, clients also put their faith into practitioners as people capable of conveying something beyond the person, as people with knowledge that does not need to be understood by the client. William is seen to possess or to be able to tap into knowledge that is beyond Lillian. However, the kind of care felt to be given by William mediates this imbalance of knowledge, making it possible for Lillian to both accept and value Williams insights. Being gentle is something that enables William to recognize, and for Lillian to feel recognized. Gentleness mitigates against experiences of misrecognition at the same time as Williams knowledge makes him another subject capable of conferring the kind of recognition desired for herself by Lillian. Recognition thus implies opening up. Recognition is based on care and attention given to vulnerabilities. It is not

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just a sense of equality or shared marginality that enables recognition (Yar, 2001). Recognition also emerges from processes of exposing the self to the other and experiencing that the feelings and concerns of the self are valid and accepted.

Recognition and Belonging


Here, I discuss recognition further, especially in terms of the role recognition plays in validating the person and her concerns in relation to wider social ideals and values. For Axel Honneth, recognition establishes the person as a morally competent actor living life in a way that is esteemed and accepted (2001: 50). Recognition is thus deeply cultural and social. Yet, this kind of recognition also enables experiences of belonging. Alice has consulted various practitioners throughout her adult life. Recently, she has been receiving spiritual healing, which she has experienced as helpful in easing the biomedically unidentied chronic pain she had been suffering from for the past eight years. Alice describes the easing of this pain in terms of wellbeing rather than in terms of physiological health. Alices mother was also present during the interview.
Alice: Even if the pain in my side hadnt changed at all [yeah], within myself the healing was making me feel better. Um, on a whole level. On a contentment level, on an acceptance level, on being one with the world level. Eeva: Yeah, what do you mean by that? How did healing make you feel one with the world? Alice: Because before healing, it was as if, I suppose I was an outsider, trying to nd a place, trying to sort of t in. Um, and I just felt much more in place, much more Alices mum: At peace with yourself Alice: Yeah, yeah, in the right place and all.

Healing encounters recognize Alices experiences and she emerges from them feeling better in herself. Importantly, feeling better is also associated with a sense of belonging. Alices experience of healing is linked to the recognition of her particularity within a wider framework. Authenticity as particularity melts with meaning-making that also appeals to a sense of universalism; wellbeing implies authenticity nding meaning from within that simultaneously designates and afrms the person as someone who belongs within a wider whole. It is the recognition of a problem within an explanatory frame that is deemed legitimate often outside meaning-making that resorts to discourses of science and rationality that can also be experienced as very therapeutic. Recognition through the healing encounter establishes Alices pain as legitimate in relation to this wider explanatory frame. Wellbeing comes also to signify a sense of rediscovered belonging, and even a sense of rediscovered identity as a full person.

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Conclusions
Because alternative and complementary health practices have often been seen as empowering those turning to these practices (Astin, 1998; Furnham and Vincent, 2003; McGuire, 1988, 1996; Sharma, 1992; Stacey, 1997; Vincent and Furnham, 1996, 1997), this article has turned to theories that offer a means of understanding how control, empowerment and agency may be produced through alternative and complementary medicine use. Alternative and complementary health consultations, which instil the client with the power of dening and even deciding what their unease consists of, are often characterized by recognition. The desire for being recognized relates to contemporary conceptualizations of selfhood (Taylor, 1989, 1991, 1994), yet, it is also emergent in the context of experiences of misrecognition. This misrecognition ultimately pertains to a struggle over the cultural denition of what it is that renders an activity socially necessary and valuable (Honneth, 2001: 54). Thus, the possibilities for healing through experiences of recognition also relate to the persons sense of self-worth and legitimacy within a particular social context. However, the self being recognized as an active being by the other is also a potential source for experiences of agency (Benjamin, 1988, 1995; Yar, 2001). For many of the women interviewed in this research, alternative and complementary health practices facilitate the recognition of personal, often emotional concerns. The demand to be recognized is particularly poignant when subjective experiences in relation to health and illness are accorded little legitimacy, especially within institutionalized settings. Indeed, the rise of alternative and complementary health practices, which explicitly seek to afrm and remedy a subjectively assessed lack of wellbeing, involves the misrecognized turning to discourses and practices that are capable of offering them a sense of self-worth, acceptance and understanding, often through an implicit sense of shared marginality. The lack of recognition for personal interpretations and experiences, which is often felt to characterize encounters with biomedicine, violates the particularity of the person and, through the denial of their inner truths, points to a discrepancy between discursive practices, such as biomedicine, and the desire for recognition on the part of many contemporary people. Those who experience misrecognition often turn to people who offer recognition for their particular experiences, knowledges and emotions. In the treatment rooms, different levels of recognition that pertain to afrming the self, as well as to legitimizing identities and complaints, often come together to endow the client with a sense of both empowerment and control.

Acknowledgement
I would like to thank Kevin Hetherington, Andrew Sayer, Jackie Stacey, Floris Tomasini, Linda Woodhead and the three anonymous Referees for insightful comments on earlier drafts of this article.

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Notes
1 Involvement in alternative and complementary health practices has also been interpreted as reecting lifestyle choices, and linked to consuming something seen and experienced as appropriate, desirable or fashionable (Andrews, 2002; Kelner and Wellman, 1997; McGregor and Peay, 1996). Alternatively, the rise of alternative and complementary health practices has been conceptualized as a response to uncertainties and risks posed by the advance of science and of medical technologies (House of Lords, 2000), or related to the rise of chronic illness (Furnham and Vincent, 2003). The way Taylor characterizes recognition assumes a subject who has the means to engage in quests for authenticity and who possesses an inner core that can be recognized. Furthermore, as Beverly Skeggs has pointed out, concern with the self for its own sake is a privilege those with the appropriate economic and cultural capital more readily possess (1997: 163). Many may also engage in self-practices as a means of representing themselves, to themselves and others, as persons with dignity and worth in relation to, for example, devalued gender or class identities (Skeggs, 1997). Not only do people desire recognition for their subjective, yet also culturally shaped self-understandings: We seek to distinguish and elevate ourselves, or at least keep others from elevating their self above us (Crossley, 2001: 87).

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Recognition and wellbeing Sointu Hochschild, A.R. (2003) The Commercialization of Intimate Life: Notes from Home and Work. Berkeley: University of California Press. Hogg, C. (1999) Patients, Power & Politics. London: Sage. Honneth, A. (2001) Recognition or Redistribution? Changing Perspectives on the Moral Order of Society, Theory, Culture and Society 18(23): 4355. House of Lords (2000) Complementary and Alternative Medicine: Select Committee on Science and Technology 6th Report. London: Stationery Ofce. Hughes, K. (2004) Health as Individual Responsibility. Possibilities and Personal Struggle, in P. Tovey, G. Easthope and J. Adams (eds) The Mainstreaming of Complementary and Alternative Medicine, Studies in Social Context, pp. 2546. London: Routledge. Kelner, M. and B. Wellman (1997) Health Care and Consumer Choice: Medical and Alternative Therapies, Social Science and Medicine 45(2): 20312. McGuire, M.B. (1988) Ritual Healing in Suburban America. New Brunswick, NJ: Rutgers University Press. McGuire, M.B. (1996) Religion and Healing the Mind/Body/Self, Social Compass 43(1): 10116. McGregor, K.J. and E.R. Peay (1996) The Choice of Alternative Health Therapy for Health Care: Testing Some Propositions, Social Science and Medicine 43(9): 131727. Powell, M. and M. Hewitt (2002) Welfare State and Welfare Change. Buckingham: Open University Press. Rose, N. (1999) Powers of Freedom. Cambridge: Cambridge University Press. Sharma, U. (1992) Complementary Medicine Today: Practitioners and Patients. London: Tavistock/Routledge. Skeggs, B. (1997) Formations of Class and Gender. London: Sage. Stacey, J. (1997) Teratologies: A Cultural Study of Cancer. London: Routledge. Taylor, C. (1989) Sources of the Self. Cambridge, MA: Harvard University Press. Taylor, C. (1991) The Ethics of Authenticity. Cambridge, MA: Harvard University Press. Taylor, C. (1994) The Politics of Recognition, in A. Gutmann (ed.) Multiculturalism, Examining the Politics of Recognition, pp. 2573. Princeton, NJ: Princeton University Press. Thomas, K.J., J.P. Nicholl and P. Coleman (2001) Use and Expenditure on Complementary Medicine in England: A Population Based Survey, Complementary Therapies in Medicine 9(1): 211. Vincent, C. and A. Furnham (1996) Why Do Patients Turn to Complementary Medicine? An Empirical Study, British Journal of Clinical Psychology 35(1): 3748. Vincent, C. and A. Furnham (1997) Complementary Medicine, a Research Perspective. Chichester, UK: John Wiley & Sons. Wiles, J. and M.W. Rosenberg (2001) Gentle Caring Experience: Seeking Alternative Health Care in Canada, Health and Place 7(3): 20924. Yar, M. (2001) Recognition and the Politics of Human(e) Desire, Theory, Culture & Society 18(23): 5776.

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Eeva Sointu
Is currently an assistant professor at Smith College, Massachusetts, USA (from July 2006). Previously she was a lecturer in the Department of Sociology at Lancaster University. Her PhD thesis, submitted in September 2004, was entitled In Search of Wellbeing: Reecting on the Use of Alternative and Complementary Health Practices. Her research interests include alternative and complementary health practices, social theory and embodiment and she has recently published The Rise of an Ideal: Tracing Changing Discourses of Wellbeing (2005) Sociological Review 52(2): 25574. Address: Sociology Department, Smith College, Northampton, Massachusetts, Northampton, MA 01063, USA. E-mail: e.sointu@lancaster.ac.uk

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