Discourse, Materiality and Power: Dietary Supplements and their Users Susan Roberton Bidwell A thesis submitted for the degree of Doctor of Philosophy of the University of Otago, Dunedin March 2020 Abstract Throughout human existence people have used herbs and other medicinal substances to protect themselves against illness and treat their ailments. Gathering wild herbs has, however, been replaced today by the many products on the shelves of health stores and pharmacies in developed countries with health systems similar to New Zealand. Previous studies of supplements and their use have largely focused on how many people use them, or subsumed supplement use within wider studies of complementary and alternative medicine (CAM). Supplement use, however, has characteristics that make it different from CAM therapies more broadly. Yet there have been only a few investigations where supplement users have been asked directly about their practices, and those that have been done have tended to be under- theorised and so lack depth. This study used a constructionist approach, within which supplements and their users were examined from both humanist and post-humanist perspectives. I used semi-structured interviews to generate data with 36 participants who were regular users of supplements. The interviews were supplemented by observations of the displays of products that participants brought to my attention in the home and retail settings where the interviews took place. A critical theoretical analysis was undertaken, framed by Deleuze and Guattari’s concept of the rhizomatic assemblage of multiple, interconnected actants which are always in a process of change. Within this wider framework, aspects of the data were examined using other theoretical concepts including deconstruction, the agency of matter, and Foucault’s ideas of power and caring for the self. The study revealed that popular assumptions about supplements as being natural, holistic and risk free can be deconstructed to show a wide variety of nuances and competing interpretations. Material things are significant in supplement use; not only the products themselves but the non- human communication technologies that allow individuals and companies the means to research, promote, sell or buy supplements when and where they choose across the globe. Using the experience and new knowledge acquired through these non-human things, supplement users become confident in their ability to resist over-scrutiny of their practices by the orthodox health system and this confidence becomes woven in to how they present themselves and their life story. i I conclude the study by drawing on Barad’s work on intra-action and agential realism. These concepts show supplement practices to be a simultaneous production of human and non-human agency, with each affecting and being affected by the other. Each time a product is sold, bought or ingested can be understood as a temporary event that entangles meaning and matter at one moment in time. Yet within the passing event, enacted through the physical piece of matter, many social, cultural and economic effects are contained, as well as the personal meanings of the individual user and their hopes for the future. There is also a ritual element to these events, symbolising the user’s expectation that they can keep the disruption of ill health and injury away and so preserve their capacity to pursue the ongoing quest for what makes life meaningful for them. ii Table of contents Abstract 1 Table of contents 3 Acknowledgements 5 Preface 6 Chapter 1: Introduction 7 Scope of the study 7 Previous studies of supplements 9 Research gaps 15 Structure of the thesis 18 Chapter 2: Ingested substances: ancient and modern 20 Legends and literature 20 Traditional medicines 24 The beginnings of professional and ‘alternative’ health care 28 Informal home remedies in colonial New Zealand 29 The persistence of home remedies into the mid-20 th century 31 Chapter 3: Methodology and methods 33 Introduction 33 Epistemological approach 33 Reflexivity 36 Methods 38 The sample 40 Ethical approval and Māori consultation 43 The interview process 44 Analytical approach 45 Theoretical framing 48 Chapter 4: Natural, holistic and safe: deconstructing discourses about supplements 51 Introduction 51 Nature and naturalness 54 How natural is ‘natural’? 57 The evolving assemblage of the natural: traditional, exotic, novel, ethical 60 Holism and holistic health 68 Balance and uniqueness of the person 71 iii The desire for wholeness 75 Safety from risk: the body under siege 80 Repelling external invaders 83 The quiet invader within 87 Conclusion 94 Chapter 5: Supplements as lively matter: the importance of material things 96 Introduction 96 The power of the material product 100 Things for the body and mind 103 Things for the spirit 110 Things in the evolving assemblage 119 Interconnecting things 123 Marketing things 130 Conclusion 140 Chapter 6: Supplements: through responsibility and expertise to power 142 Introduction 142 Being a responsible citizen 145 Reconfiguring responsibility: supplement users 148 Reconfiguring responsibility: as a supplement seller 155 Becoming your own expert 157 Becoming expert enough to advise others 167 Supplements and evolving identity 173 Conclusion 179 Chapter 7: Discussion 181 Supplement practices: the intra-action of discourse, materiality and power 181 Supplement practices: entangled phenomena 185 Meaning, matter, ritual and symbolism 190 References 198 Appendices 265 Appendix A: Information sheet for supplement users 265 Appendix B: Consent form for supplement users to participate 268 Appendix C: Information sheet for supplement seller participants 270 Appendix D: Consent form for supplement sellers participants 273 Appendix E: interview guides 275 iv Acknowledgements My grateful thanks to all the participants without whom the study could never have taken place. All of them shared their experiences generously, allowing me insights into difficult times in their lives and how they had coped with them. Many of them welcomed me into their homes and treated me hospitably with warmth and openness. The insights they provided from their life stories will never leave me. I want to record my deep gratitude for the thorough, consistent and patient help I received throughout from my wonderful supervisors. They read through draft after draft and provided insightful comments every time, guiding me where I needed improvement, steering me through thickets of theory and preventing me from despair on the one hand, or enthusiastically setting off down irrelevant ‘rabbit holes’ on the other. I owe more than words can say to their mentoring. I also thank my family, especially my wonderful husband Vince Bidwell who, as ever, was a rock of stability and quiet support throughout, my four adult children and two grandchildren. Between them they variously provided encouragement, entertainment or diversions that kept me on track and allowed me to retain perspective about the most important things of life. Special thanks to go to Simon and Cecilia for reading and commenting on some of the draft chapters, to Vince for proof reading the final draft, to Alex for creating the word cloud in Chapter 5 and to my dear friend Chris for pointing me to the lesser known mythological sources in the background chapter. I also thank my good friends Kristi, Sarah, Chidimma, Sandra, Ann and Yvonne for sticking with me over all these years of study and always taking an interest in my progress. Thanks also to the other students and staff of the Department of Population Health University of Otago, Christchurch for all the useful conversations over encounters in the kitchen and to my lovely colleagues at Pegasus Health for their encouragement and support throughout. Special thanks to Jen Williams for her advice and assistance on the details of formatting. I also acknowledge the assistance of the administrative staff members of the Department of Population Health University of Otago, Christchurch including Katrina, Fran, Bernadette and Susannah and the IT assistance provided by Anna Young in sorting out time consuming issues related to systems and access of which there were many during the years the thesis was written. v Preface In 2013 I was a co-investigator in a piece of research where we were interviewing community pharmacists. For their convenience, most of the interviews took place in their pharmacies, and as we waited for them to become free to talk to us, I had more time than ever before to observe the pharmacy space. I could not help but notice the large displays of dietary supplements and herbal medicines that usually took up one whole wall of the pharmacy with the sign ‘Natural Health’ above them. Judging by the proportion of space they took up, it seemed that these products represented an important part of the business transacted in the pharmacy. Our research questions focused on the advice that pharmacists gave people about their prescribed medicines as well as other health advice they provided to general enquiries from the public who came to the pharmacy. In the course of our interview we would ask, gesturing at the wall of ‘Natural Health’, “What about these other things you sell?” My interest was sparked when we found the pharmacists seemed reluctant to discuss these products. They tended to give us a somewhat defensive standard answer, namely, that the products were not evidence-based, but ‘our customers’ ask for them, and as they needed to maintain a viable business, their role was to ensure they stocked high quality, safe products with accurate labelling. I became curious after hearing this response several times and decided to take a look at the literature for myself to see why they were so popular, yet the pharmacists treated them with such apparent caution. If they were not evidence-based, then why were so many of them for sale? What I found only made me more curious. Sales of such products had been increasing steadily over the years in all Western countries.