Heteronormativity in Action:
Reproducing the Heterosexual Nuclear
Family in After-hours Medical Calls
CELIA KITZINGER, University of York
Heterosexism has become a recognized social problem since the rise of lesbian, gay, bisexual, and transgen-
dered (LGBT) activism in the 1970s. One of its manifestations is heteronormativity: the mundane production ofheterosexuality as the normal, natural, taken-for-granted sexuality. My research uses conversation analysis toexplore heteronormativity as an ongoing, situated, practical accomplishment by people oriented to other actionsentirely. I show that family reference terms—across a dataset of 59 after-hours calls to the doctor—are deployedso as to construct a normative version of the heterosexual nuclear family: a married couple, co-resident with theirbiological, dependent children. I examine the inferences normatively attached to family reference terms, considerhow these inferences are used interactionally, and document how this everyday talk-in-interaction both reflectsand reconstitutes the culturally normative definition of the family. This research advances our understanding ofnormativity by showing how a social problem can exist even when there is no orientation to "trouble" in inter-action. Here, the persistent and untroubled reproduction of a taken-for-granted heteronormative world bothreflects heterosexual privilege and (by extrapolation) perpetuates the oppression of non-heterosexual people,denied access to key social institutions such as marriage and unable to take for granted access to their culture'sfamily reference terms. The article shows how the heteronormative social order is reproduced at the level of mun-dane social interaction, through the everyday conversational practices of ordinary folk.
One of the major achievements of the lesbian, gay, bisexual and transgender (LGBT)
movements of the last 30 years has been to transform—at least in many quarters—"the prob-lem of homosexuality" into "the problem of heterosexism." So, for example, the focus ofsocial scientific research has shifted from a focus on LGBT people per se
(e.g., assessing theirmental health or their parenting capacities) to the multiple oppressions to which they aresubjected—ranging from state-sanctioned execution, torture, and enforced psychiatric treat-ment (Amnesty International 2001), to institutional discrimination and hate crimes (Herekand Berrill 1991), to the mundane oppressions of everyday life, such as anti-gay jokes andthe social gaffes made by well-meaning heterosexuals in talking to, or about, LGBT people(Conley et al. 2002).
Just as "homosexuality" is a social construction invented to diagnose, circumscribe, and
control certain kinds of behavior (same-sex sexual relationships) treated as social problems(Kitzinger 1987), so too is "heterosexism" such a social construction. The term represents asecond attempt by the LGBT movement (the first was "homophobia"; see Kitzinger 1987) tolabel certain kinds of behavior (e.g., discrimination, prejudice, and violence against LGBTpeople) as social problems. Insofar as the social construction of "heterosexism" is successful, it
The author wishes to thank John Heritage for encouraging her to pursue the ideas on which this article is based and
the audiences at the University of California at Santa Barbara and the University of Madison–Wisconsin for very useful dis-cussions following presentations of earlier versions of this article. Helpful feedback on earlier drafts was provided by PaulDrew, Gene Lerner, Douglas Maynard, Geoffrey Raymond, Emanuel Schegloff, Jack Sidnell, and Sue Wilkinson. JamesHolstein was a thoughtful, thorough editor. Direct correspondence to: Celia Kitzinger, Department of Sociology, Universityof York, Heslington, York YO10 5DD, UK. E-mail: [email protected]
Social Problems, Vol. 52, Issue 4, pp. 477–498, ISSN 0037-7791, electronic ISSN 1533-8533.
2005 by Society for the Study of Social Problems, Inc. All rights reserved. Please direct all requests for permission to photo-
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is the behavior of heterosexual people in discriminating against LGBT people that is the legit-imate target of social reform. As a social constructionist, one approach I might take to "het-erosexism" as a topic (not the one pursued here) would be to investigate how (i.e., throughwhat claims-making actions, with what degree of success, and against what contestations)the LGBT movements have struggled to promote heterosexism as a social problem. An alter-native approach—the one exemplified here—is to explore how everyday heterosexist realityis constructed: that is, how does it come about that people in ordinary interactions (not moti-vated by heterosexist prejudice or discriminatory intent) commonly invoke and produce anormative heterosexual world as a taken-for-granted reality?
As a lesbian-feminist activist and scholar, I am concerned about the full spectrum of het-
erosexist oppression—from the deportation of homosexual asylum seekers to countries inwhich they are tortured and imprisoned, to the denial of equal marriage rights to same-sexcouples, to the minor indignities and exclusions of everyday life. The analysis presented hereaims to gain purchase on the latter phenomenon. It is motivated by my strong sense thatwhile LGBT activists are campaigning against blatant oppression and overt discrimination, atthe same time all around us a heteronormative social fabric is unobtrusively rewoven, threadby thread, persistently, without fuss or fanfare, without oppressive intent or conscious design.
My current research program uses conversation analysis to explore how that is done andaims to understand what strong threads constitute and bind together a normative heterosex-ist culture that make it so impervious to challenge and so slow to change. In this study, myaim is to make visible (and thereby to enable us all to challenge) some of the mundane quo-tidian actions that result in the routine achievement of a taken-for-granted world thatsocially excludes or marginalizes non-heterosexuals.
The term "heteronormativity" is widely used in contemporary political, social, and criti-
cal theory to describe socio-legal (e.g., Phelan 2001), cultural (e.g., Lancaster 2003), organi-zational (e.g., Grace 1999), and interpersonal (e.g., Blasius 2000) practices that derive fromand reinforce a set of taken-for-granted presumptions relating to sex and gender. Theseinclude the presumptions that there are only two sexes; that it is "normal" or "natural" forpeople of different sexes to be attracted to one another; that these attractions may be publiclydisplayed and celebrated; that social institutions such as marriage and the family are appro-priately organized around different-sex pairings; that same-sex couples are (if not "deviant")a "variation on" or an "alternative to" the heterosexual couple. Heteronormativity refers, insum, to the myriad ways in which heterosexuality is produced as a natural, unproblematic,taken-for-granted, ordinary phenomenon.
In contrast with what John Heritage (1984) calls the "normative determinism" (p. 16) of
theorists such as Durkheim, Freud, and Parsons, the conversation analytic approach pursuedhere (like ethnomethodology more generally; Garfinkel 1967) does not depend upon an un-derstanding of actors as the bearers of internalized, culturally transmitted norms that guide ordetermine their conduct. Heteronormativity is embodied in what people do rather than intheir beliefs, values, ideologies, or faiths. Complicity with heteronormativity does not neces-sarily imply prejudiced attitudes or beliefs (e.g., as these are usually conceptualized by ho-mophobia scales; see Kitzinger 1987) or any deliberate intent to discriminate against LGBTpeople (Kitzinger forthcoming). Rather, heteronormativity—like other social norms—is em-bodied and displayed endogenously, in the details of conduct, and may be studied empiricallyas such.
My empirical investigation of heteronormativity builds on Harvey Sacks's (1995a) analy-
sis of norms,1 most especially in relation to membership categorization as outlined in his
1. As Sacks (1995a) points out, his is "a different sense of ‘norms regulating activities' than one might usually use
in doing sociology or anthropology, where it would be said by and large that the norms are followed by those personswho do the things—or ought to be" (p. 253). Although norms and normativity (as here defined) are central to conver-sation analysis as a field, few conversation analysts since Sacks have used this terminology in their work; but see
Heteronormativity in Action
classic lecture "The Baby Cried. The Mommy Picked It Up." Norms, according to Sacks(1995a), provide rules of relevance for selecting categories ("viewers use norms to providethe relevant membership categories in terms of which they formulate identifications of thedoers of those activities for which the norms are appropriate"; p. 260), and people "usenorms to provide some orderliness, and proper orderliness of the activities they observe" (p.
260). According to Sacks, norms are used to "see a family" when observers see a man beatingup a woman and do nothing because "we thought you were married and it wasn't any of ourbusiness" (p. 91). Also according to Sacks, people can "pass" as members of categories towhich they do not in fact belong simply by virtue of the norm that leads them to be seen thatway, as when "a woman walks away from a supermarket with the baby carriage filled with ababy that's not hers" (p. 254). Norms might also occlude families as when older parentsobserved caring for their child are taken to be the child's grandparents (p. 226), or as in thefollowing account from the mother of two-year old Nathaniel, describing what happenedwhen they were referred to a new doctor: "After I had introduced her to Nathaniel andexplained his symptoms she responded by looking at me and asking, ‘And who are you?'Since parents do not need to legitimate their right to discuss their own children's illnesseswith a doctor, I inferred from this that she did not think I could be his mother" (Liladhar1999:240). Janine Liladhar (1999) understands the doctor's displayed inference that she isnot the mother of her child with reference to race: she is white and her son is black. Observ-ers apparently did not see a family when a white mother playing race-you-to-the-car withher 20-year-old black son was taken to be pursuing a thief (Rosenblum and Travis 2000:169)or when two lesbian parents were asked, "which one of you is the mother" (Dalton andBielby 2000). In such instances, other cultural norms (about "age," "race," and the propergender constitution of family members) overturn inferences that could or should be madenormatively on the basis of category-bound activities. Through the displayed assumptions ofthe interactants in such situations, analysts can begin to understand the constitution of thenormative concept of the family as, for example, "private," mono-racial, and bi-gendered.
The research reported here develops the Sacksian notion of norms with specific reference
to the heterosexual nuclear family. It puts conduct in interaction at the center of theorizingabout the social world, and shows how norms and normativity can be grounded and elabo-rated in detailed empirical analysis of their deployment in action. As such, it is part of theethnomethodological tradition that aims to "treat the obvious as a phenomenon" (Zimmer-man and Pollner 1970:80) and to explicate the seen-but-unnoticed tacit presuppositions (or"norms") of everyday life and contributes thereby to the "sociology of the unmarked" (Brekhus1998) an understanding of the practices that produce ordinary mundane heterosexism.
Insofar as conversation analysis has focused on social problems—and certainly in rela-
tion to the social problems highlighted in the 1988 special issue of Social Problems
on "Lan-guage, Interaction, and Social Problems"—these have been treated in the form of "trouble" asoriented to by participants in interaction (Maynard 1988:325). However, from the point ofview of many social activists, and others concerned with social problems—indeed, includingSacks, the founder of conversation analysis himself, in his early lectures (Sacks 1995b:175–87)—social problems can also be produced, and reproduced, by social actors who are not ori-ented to any trouble in their interactions. A social problem exists only for us, as analystseavesdropping on their talk, who see in it the untroubled reproduction of a heterosexist (orracist or classist or otherwise oppressive) world. One important theoretical goal of this article,then, is to highlight the value of conversation analysis in analyzing interactions in which, byand large (and with orderly exceptions), the taken-for-granted, ordinary world is reproduced
Schegloff's analysis of sotte voce
improprieties as episodes in which "formal notice is . . taken of the cultural norms appli-cable here, in the very course of showing a lack of commitment to abide by them" (Schegloff 2003:63). Rather thanabandoning important sociological notions such as norms and normativity, I am here respecifying them in terms used byethnomethodologists and conversation analysts.
and reconstituted with no trouble at all—because it is precisely the assumptions with whichthis taken-for-granted world is imbued that cause "trouble" or "problems" (at best), andoppression and discrimination (at worst), for those who do not conform to its cultural norms.
Family as a Categorization Device
This article focuses on person reference terms drawn from the category of the "family" as
these are deployed by interactants in after-hours calls to a doctor. Previous analyses haveshown that social participants readily produce family terminology that displays their hetero-sexuality without being heard thereby as doing anything out of the ordinary (Kitzinger 2005),whereas when people make it apparent in the course of ordinary activities (such as making adentist appointment or taking out car insurance) that they have same-sex partners there arerecurrent interactional problems (Land and Kitzinger 2005). The analysis presented here isparticularly germane, then, to the sociological tradition of work on the family—long-con-sidered a social problem, especially in its "deviant" forms: for example, black families (e.g.,Stack 1974), or working-class families (e.g., Rubin 1976; compare to Smith 1993). LGBT fam-ilies, in particular, are at the forefront of contemporary debates about marriage and the fam-ily (e.g., Bernstein and Reimann 2001; Weston 1998).
Family researchers have been preoccupied by issues of definition. As James A. Holstein
and Jaber F. Gubrium (1999) argue, however, "family is not objectively meaningful . . it isconstantly under construction, obtaining its defining characteristics somewhere, somehow, inreal time and place, through interpretive practice" (p. 4). This, they suggest, mandates anempirical focus on "the myriad social processes through which persons in the course ofeveryday life produce and organize ‘family' as a meaningful designation for social relations"(p. 4). In common with their innovative empirical research program analyzing discourseabout the family across a range of organizational contexts (e.g., Gubrium and Holstein 1990;Holstein 1993), the work to be reported here explores how "family" is constructed in interaction.
The production of the heteronormative family is understood as an ongoing, locally managedaccomplishment, and the analysis focuses on one of the key practices through which family isconstituted in these calls: the use of person references and the inferences that attach to these.
Person references drawn from the category of "family"—such as "wife," "husband,"
"daughter," "brother-in-law," and so on—are common non-recognitional person references(Sacks 1963, 1972a; Sacks and Schegloff 1979; Schegloff 1996). That is, they are terms rou-tinely deployed as references to third parties in talk-in-interaction where the speaker is treat-ing their co-conversationalist as someone who does not know the person being referred toand/or would not recognize them by name. (Other examples of typical non-recognitionalperson references include categorical or role references such as "a doctor," "an African-American," "a diabetic," "a woman.") Family reference terms are among the categorieswhose deployment Sacks began to explore—most famously in "the baby cried, the mommypicked it up" discussion (Sacks 1972b, 1995a), but also at various points scattered throughouthis work, including an interrogation of the use of inferences attached to "wife," "sister," and"child" in a counseling call (Sacks 1995a:116) and the (hypothetical) deployment of "hetero-sexual couple" inferences to disguise otherwise stigmatized identities (Sacks 1995a:593). Thepresent research, then, builds on the early work by Sacks both on norms and on membershipcategories, and contributes to conversation analysis a more systematic and data-drivenapproach to the selection and deployment of non-recognitional person reference forms. Itexplores—in a single corpus of calls—the difference the selected person reference term makesto the sequence that subsequently unfolds, due to the inferences that, thereby, can be seen toattach to the term selected. I begin with a description of the dataset and then consider theway in which the talk produces a heteronormative version of family.
Heteronormativity in Action
The data corpus comprises recordings of 59 after-hours calls made to a medical practice
in a large town in the English Midlands.2 In 50 of the 59 calls, the caller is someone otherthan the patient; these calls are the focus of analysis here. According to the terms of referenceof the British National Health Service, general practitioners—physicians with no particularclinical specialization—have 24-hour responsibility for the medical care of their patients. Thisincludes the condition that they should visit patients in their own homes if necessary, eitherbecause the patient cannot travel to the surgery or because the surgery is closed. The norma-tive purpose of these after-hours calls is to request such a home visit (Drew forthcoming).
This data corpus cannot be treated as representative (as Drew forthcoming points out),
either in terms of the kinds of after-hours calls made generally or in terms of the manner inwhich doctors manage such calls. Moreover, it is likely that definitions of "the family" vary—for the participants in these calls and for people generally—across their occasions of use.
Analysis of these calls begins to chart the deployment of family reference terms in one suchspecific context.
In all of these calls, the doctor is a "locum" (a stand-in for the doctor with whom the
patient is registered), such that he knows neither the caller nor the patient, nor does he knowanything about their family circumstances. Interactions between the patients and their usualphysicians would be conducted very differently because most references to nuclear familymembers could be done by using recognitional forms of reference (i.e., their names). How-ever, the range of recurrent occasions in modern societies in which recognitionals cannot beused is vast, and the use of family reference terms is a potent resource in all such contexts.
The data were transcribed according to the system devised by Gail Jefferson (see Atkin-
son and Heritage 1984) and subsequently developed by other conversation analysts, designedto preserve those small but significant features of talk (cut-offs, silences, etc.) that interactantsuse in systematic and orderly ways, many of which turn out to be essential to the analysespresented here. Non-recognitional person reference forms—in particular, person referenceforms drawn from the category set of the family—were very common across these calls, and Icollected and analyzed them in their sequential context. I examined, in particular, initial
per-son references—and the inferences associated with them—for what they show about norma-tive understandings of the family and the interactional uses these understandings are put to.
Reproducing the Heteronormative Family
Of the 50 calls in the corpus where the patient is not the person calling, 33 are calls on
behalf of people referred to as family members (e.g., spouses, children and grandchildren, sib-lings, and in-laws), and 17 are on behalf of non-family members (e.g., friends, neighbors, andpeople for whom the callers have an institutional responsibility). Extracts 1 and 2 are exam-ples of openings of calls on behalf of family members:
(1) [DEC 1-2-12 BREATHLESS]
Hel:lo, is tha' du- doctor¿
Yes, Doctor ((deleted)) speaki:ng,
i: i: (Yeah) Couldja's call an' see my wife
2. The calls were recorded by the doctor, and many of the names (of people and places) and other identifying
information were deleted by him, at his discretion and before the tapes were released. This appears to have involvedrecording silence over identifying information. Deletions have been indicated as such; those names that were notdeleted (presumably in error) have been pseudonymized.
(2) [DEC 1-1-10 ASTHMA]
Hello, I'm sorry tuh trouble yuh,
Ventolin:e::hm one spoonful at night,.hh I gave
her some about an hour ago I kept (it late) with it
being so hot but sh[e st]ill can't brea:the very
Extracts 3 and 4 are examples of the openings of calls on behalf of people who are not familymembers.
(3) [DEC 1-2-6 DISCLOCATION]
Hello:, eh. hhh I've got a friend here (.) an' ‘e
dislocated ‘is shoulder
(4) [DEC 1-2-13 SICK I]
.h Ah good evenin', um: .hh this is a relief warden
Ehm- I'm ringing you up regarding one of our
tenants here. A Misses ((deleted))
((some talk from tape deleted here))
Clr: That's right dear.
.hh U:m:- the lady is a diabetic.
In each Extract 1 to 4, the caller makes an initial reference to the patient using a term whichdisplays a relationship between the patient and the caller—either a family relationship (as in1 and 2) or not (as in 3 and 4). The analysis presented here focuses on the inferences mobi-lized by these initial person references and on the difference they make to the sequentialunfolding of the call. It pays particular attention to the understandings of family thereby dis-played and to how these understandings are deployed.
The fact that family reference terms are used at all in these calls is a contingent finding—
they need not have been used. It is not sufficient to say of the speakers in Extracts 1 and 2that they refer to the patient as their "wife" or "daughter" because that is who the patient is.
There are alternative, equally "accurate" ways of referring to these persons: "a seventy fiveyear old woman" (Extract 1), "an asthmatic" (Extract 2), and so on. The availability of personreference forms from a number of different category sets (e.g., age, diagnosis) means thatperson reference in terms of the category set of family can be understood as the consequenceof a speaker making a selection from amongst a range of possible alternatives: so in Extract 4the same person is variously referred to as "one of our tenants" (lines 4–5), "A Misses((deleted))" (line 5), and "the lady" (line 8). In Extract 5—which I will later analyze in itsbroader conversational context—there are also two different person references to the samepatient. This extract is notable in that it is the only instance in the dataset in which a familyreference term is used after some other form of person reference not indexing family. Thepatient is referred to initially as "a patient of Doctor ((deleted))" (line 5) and only then—albeit immediately afterwards—as "my husband" (line 6):
(5) [DEC 2-1-15 FOOD POISONING]
.hh Hello:, um: I'm: ph- (.) phoning up fer:
Heteronormativity in Action
I have a:b- a: patient of:h:: Doctor ((deleted))
This initial person reference locates the patient in relation to the doctor rather than, as in allother instances, in relation to the caller. Note that this form of person reference, in principle,could have been used in any and all of the other calls in the corpus—in many of which thedoctor subsequently asks for just this information (e.g., see Extracts 20 and 21).
Across these calls, then, family reference terms displaying the relationship between caller
and patient are systematically selected as initial person references, where there are equallyaccurate alternatives drawn from non-relational category sets (diagnostic category, age, sex,occupation, etc.), as well as an alternative type of person reference designed to display therelationship between the doctor and the patient.
In the following sections I explore how the deployment of these initial person references
relies on and constructs a normative understanding of family: as related by law and by blood;as co-resident; and as an intimate, caring (gendered) social unit. In an intersection betweenthe family and the institution of medicine as it is organized in England, members of a familyare also understood to share the same family doctor.
Code of Law and Bond of Blood
The definition of family employed here is indigenous to the interaction in the sense that
person references like "daughter" and "son" are used by the participants and are treated bythe interactants themselves—and not just by the analyst—as indexing family relationships.
This is most blatantly the case when the term "family" is used as a collective term for thecaller, the patient, and any other actual or potential members. So, for example, in Extract 6the caller refers to her "daughter" (line 1), on the basis of which—and without any interven-ing talk to warrant it—the doctor later generates a "family" (line 63):
(6) [DEC 1-1-1 DIARRHEA]
My daughter's: uh Melanie she's age four:,
((61 lines of diagnostic questioning omitted))
Anyone else:: in the family with: (.) tummy bug
Likewise, in Extract 7 the caller refers to her "son" (line 5), on the basis of which the doctorlater asks about "family" composition (line 75):
(7) [DEC 1-1-11 MEASLES]
Hello, can I speak to the doctor on call please,
Yes, Doctor ((deleted)) speaking,
Hello, ehm (0.5) I was wonderin', I think my
son's got measles, an':
((69 lines of diagnostic questioning omitted))
[.hh Fine,Any other children in your family?
By contrast, there are other kinds of relationships which are not
treated as familial. In
Extract 8 the caller refers to the patient as her "boyfriend"—a term that, in contrast with"husband" does not imply a marital relationship. In the course of this call the doctor begins toask (at line 3) whether "anybody else in the fa-[mily]" has the same symptoms as the patient,but cuts off the word "family" after the first syllable and replaces it with "house". (The war-rant for hearing "fa-" as the first syllable of "family" comes from empirical conversation ana-lytic research on the technology of repair: this is an instance of [pre-framed] replacementrepair; Schegloff, Jefferson, and Sacks 1977:370).
(8) [DEC 2-1-16 STOMACH]
Um my boyfriend's uhm: really ill at the moment.
‘E's got really bad stomach pains. An' fever.
Can anyone: come out tuhnight to look at im?
((sniff)) Welb- uh:m: u-sorry who's ‘is doctor?
‘is doctor's ((deleted))
R:ight. hh Wull what's actually been happening
((32 lines of diagnostic questioning omitted))
Anybody else in the fa- the house got a fu- o:-
In abandoning "family" as the reference term for this unmarried couple, the doctor displaysthat marriage is integral to his definition of "family." In selecting "house" as an alternative, hedisplays that his intention in initially selecting "family" was to ask about the health status ofother people with whom the patient is co-resident, thereby also displaying an understandingof "family" members as co-resident (see next section). In this call, as in virtually all others inthis corpus, it seems from the caller's description of the patient's symptoms that caller andpatient are co-present; this is reinforced by the caller's selection of "come" (in her request online 5), rather than, for example, "go." In virtually all the calls in which the names of femalecallers have not been deleted from the audiotape, the title "Mrs." is used: callers thereby dis-play themselves as married and this may contribute to their relationship with the patientbeing treated as "familial," in ways that the caller's in Extract 8 is not.
Marriage—code of law—is one key way in which, according to David M. Schneider
(1968), Euro-Americans define kin; biological relatedness—bond of blood—is the other. InExtract 9 below (an extension of Extract 7), the doctor displays an implicit understanding (at lines79 and 81–82) that children in a "family" are all the biological offspring of the same mother.
(9) [DEC 1-1-11 MEASLES]
Hello, can I speak to the doctor on call please,
Yes, Doctor ((deleted)) speaking,
Hello, ehm (0.5) I was wonderin', I think my
son's got measles,an': (what I should give it to
‘im) or anythin',
[(and that) whether I should give ‘im anything
.hhh Oh right, ew: how old is your son?
Ah he was one last week, .hh[h
[B:right, an' an'
what's actually been happening to ‘im
((61 lines of diagnostic questioning omitted))
[.hh Fine,Any other children in your family?
Yeah, I've got another boy,
Ha- older or younger?
[Well, must be older, mustn't he?
[ .hhhh ] ehhehm! Well, unless you're very
ah:m yeah has he had measles?
The inference that the caller's sons are both biologically hers—that she bore and gave birthto them—is displayed through the doctor's assertion (made without waiting for the caller to
Heteronormativity in Action
answer his question) that the other boy "must be" older (line 79). It makes sense only asindexing his recollection that the patient is 12 months old and his knowledge that pregnancylasts 9 months. This analysis of "must be" is reinforced by the doctor's subsequent acknowl-edgement, at lines 81–82, that a younger child would be possible
if the caller had been"quick." The laughter (at line 81) and the apology (at line 82) are oriented to the sexualimplications of a "quick" second conception.
Circumstances other than a "quick" second conception under which a woman could
have two sons in her family with less than a year's difference in age include (in addition totwins): the adoption of one or both children; the caller and her partner both bringing infantsfrom prior relationships into their "blended" family; and the caller being in a lesbian relation-ship in which both partners had conceived and given birth within a few months of eachother. These alternatives do not involve a biogenetic link between mother and son, and arenot oriented to as possibilities by the doctor. His assertion that the second son "must be" olderis based on, and thereby reproduces (without any orientation to so doing), the concept of themother/son relationship as normatively biological.
People who are not biologically related to their child (adoptive parents, step-parents,
lesbian/gay co-parents) construct (sometimes precarious) claims to parenthood in the contextof this assumption (e.g., the lesbian mother quoted in Hayden 1995 who describes feeling likea fraud "if I act like he's my baby. I'm afraid someone will ask me about labor [. .] I have tokeep telling myself he is
my baby" [p. 49]). The dependence of kinship on biology is alsomanifested when the families of origin of non-biological parents refuse kinship roles with achild (e.g., the mother of a lesbian who referred to the child she was asked to treat as her"granddaughter" as "my daughter's friend's daughter"; Epstein 1994:83).
The Nuclear Family as Co-residential Unit
When the doctor offers a home visit, he routinely asks the caller for a home address, and
sometimes also for a home telephone number. In designing his request, he displays certaininferences about the residential arrangements between caller and patient. With only twoexceptions in the dataset (a working mother calling about a child at home with his father[DEC 2-1-2] and an adult sister calling about a suicidal brother [DEC 2-1-13]), callers and thepatients about whom they are calling generally seem to be co-present, as displayed through:
(a) the formulation of the description of current symptoms (e.g., a knock to a pregnant
sister's stomach that happened "bout five minutes ago" [DEC 2-1-3], a wife who has"just fainted" [DEC 1-1-13]);
(b) audible patients off-line (e.g., a crying child [DEC 1-2-14], an adult sister who an-
swers a question about symptoms relayed to her from the doctor by the caller [DEC1-1-14]);
(c) explicit statements of co-presence; these are made only by distant relatives and non-
relatives and function as accounts for the presence of the patient in their homes (e.g.,"I have my brother in law staying with me" [DEC 2-1-18], "I've got an old friendstayin' with me down on- from Scotland on holiday" [DEC 1-1-4]). As the analysisbelow displays, parents of young children, and husbands and wives, treat their co-presence as a taken-for-granted, tacit assumption and instead treat not being co-present as accountable (see [DEC 2-1-2]);
(d) the formulation of the request to the doctor to visit the patient using the term "come"
(e.g., "Can anyone come out tonight to look at him?" [DEC 2-1-16] in Extract 8,which invites the inference that caller and patient are co-present [whereas "Can any-one go out tonight to look at him?" would invite the inference that they were not]).
The inference that the patient and the caller are co-present applies across the dataset to both"family" and "non-family" callers. However, when callers are identified as spouses or parents,
the doctor makes an assumption of co-residence, whereas when they are otherwise identified,he does not. So, for example, in Extract 10 the caller asks the doctor to "call an' see my wifeplease" (line 4) and the doctor asks "where do you live" (line 10)—as opposed to "where doesshe live"—thus displaying an inference that the caller lives with his wife, such that to call andsee one is to call and see the other, with the pro-term "you" being understood as plural.
(10) [DEC 1-2-12 BREATHLESS]
Hel:lo, is tha' do- doctor¿
Yes, Doctor ((deleted)) speaki:ng,
i:i:Couldja's call an' see my wife please, .h[h
She's breathless.She can't .hh get ‘er
breath.hh! .h[hhh ]
[What]'s: her name?
Ru-an' where do you live.
In Extract 11, the caller announces that his "wife" has fainted and, after some diagnosticquestioning, the doctor asks "What's your address" (line 40) in order that he might "popround and see her" (lines 40–41), thereby again displaying the inference that the caller'saddress is also the wife's address.3
(11) [DEC 1-1-13 FAINTED]
Eh: my wife has uh: just fai:nted, .hh She:'s
(0.7) been to:: the doctor's a:nd eh: our doctor
at ((deleted)) gave ‘er: .hh some painkillers
because ‘‘e said she had a: um a virus in the bowel,
Eh: she's been in be:d, and she had a sort've
((18 lines omitted – describing lead up to
. she just slumped and banged her head on the bed
and fell on the floo:r,
So she's lyin' there now till she recovers,
((11 lines of diagnostic questioning omitted))
What's your address, and I'll pop ‘rou
.hh Oh-kay; I'll be about twenty minutes.
The assumption of co-residence displays that it is normative, in these conversationalists' cul-ture, for husbands and wives to live together. As Kath Weston (1998:74) points out, the nor-mative power of co-residence as part of the definition of a family is also evident in the factthat lesbian/gay organizations in the United States have helped to frame domestic partner-ship legislation that stipulates co-residence for a specified period—anything from threemonths to a year—before an unmarried couple can register to achieve the legal standing en-titling them to benefits available to married couples (see also Kitzinger and Wilkinson 2004a).
3. Although the use of "call" in Extract 10 (line 4) may invite the inference that the parties are co-present, at least
in British English a request to "call" on someone does not necessarily imply either the co-presence of the speaker andthe person to be called upon, or their cohabitation—as is instantiated by this example from a telephone conversation inwhich Lesley (who, as is clear from other calls in the corpus, does not live with her mother-in-law) asks a plumber'swife: "Could you:r husband call on my mother in law please" [Holt 1–6].
Heteronormativity in Action
The assumption of co-residence is also routinely displayed when parents phone on behalf
of children. Following the reference to a patient as "my daug:hter, Jean" (and subsequent talkduring which the daughter is said to be two years old), the doctor asks simply "where d'youlive" [DEC 1-2-9]; when the patient is "my daughter who's uh:: .hh just coming fuh nineteenmonths old" [DEC 2-1-7 SICK], the caller later says, "my address is." An assumption is therebydisplayed that the doctor will understand that she and her daughter share the same homeaddress, such that the caller's address is what is needed for the doctor to visit the patient.
By contrast, family members who are not children or spouses are not unproblematically
treated as co-resident. In the calls from which Extracts 12 and 13 are taken, the callers show,through their description of the patient's current symptoms and their own attempts to relievethem, that they currently must be at the same location. However, the doctor displays prob-lems with treating these callers and patients as co-resident. In Extract 12, after a caller'saccount of his adult daughter's medical problems (adult, as the problems are related to thetermination of a pregnancy), the doctor does not (as in Extracts 10 and 11) ask some variantof "where do you live?" or "what's your address?" Instead, he designs his question in such away as to display his inference that caller and patient are only temporarily ("at the moment")in the same home, and that the address he needs is the patient's current location, whetherat the home of caller or patient. The inference that the patient might be at either of twopossible locations is premised on an inference that patient and caller are not—or may notbe—normally co-resident.4
(12) [DEC 1-2-11 DAUGHTER]
Clr: I'm ringing about my daughter. She's doubled up
in pain ( ) t! stomach
((64 lines of problem description and diagnostic
67 Doc: An:'whe-whe:re
are you at the moment. mhh What's
In Extract 13, the doctor launches his question in such a way as to display an inference thatthe caller and her daughter do not live together, and then repairs this to display an awarenessthat, whatever their living arrangements more generally, mother and daughter are currentlyat the same location.
(13) [DEC 1-2-7 CONTRACTIONS]
I'm phonin' for my daughter, e:hm (0.7) she's due
‘er baby the twenty fourth u' this month
((56 lines of diagnostic questioning omitted))
Where does she li-where are you, What's your
Likewise, callers display what they take to be normative living arrangements in first referringto the patient. No caller in the data corpus ever says that a spouse or child lives with them—that is something which, they take it, goes without saying (despite the number of divorcedand separated couples now parenting from separate households; Jacobson et al. 2001).
Instead, they use a family reference term and then immediately describe the patient's symp-toms (as in Extracts 10 and 11), and it is on the basis of this family reference term that thedoctor then displays an inference of co-residence.
4. Here, as elsewhere in this article, space constraints preclude inclusion of the conversations in their entirety;
however, in neither of these extracts could anything in the omitted material reasonably underwrite the doctor's reluc-tance to ascribe co-residence to these callers and patients. In fact, the situation is rather the reverse in Extract 12 wherebetween lines 2 and 67 the caller reports on a range of different remedies attempted with a daughter who "had a opera-tion to terminate a pregnancy on Tuesday"—three or four days before the call—none of which has been successful inalleviating her pain. This invites an understanding that caller and patient have been co-present at least sometimes overthe course of the last three or four days, and hence might make possible the inference of co-residence, here withheld.
Through the normative treatment of some person reference terms as implicative of co-
residence, and others as not, the traditional nuclear family of co-resident parents and chil-dren is reproduced. The non-normativity of all alternative arrangements is constituted in partby precisely the normative assumptions displayed here. In these calls, the interactants drawon what they take to be normative about kinship and living arrangements in their culture,and use it as a resource in negotiating medical care. Without being oriented to doing any suchthing, they are reflecting and reproducing their normative culture.
Intimate Caring, Gender, and Family Designations
The doctor in these calls routinely displays an assumption that any adult calling for a
child, thereby demonstrably engaged in an act of caring on her or his behalf, is that child'sparent. So, for example, the "little girl" of Extract 14 is subsequently referred to by the doctoras the caller's "daughter" and "the baby" of Extract 15 as "your first," although in neither casedo these callers specify that the children about whom they are calling are their own.
(14) [DEC 1-2-3 ULCERS]
Clr: I've got a little gi:rl of nineteen months.
Clr: An' I've just noticed in ‘er mouth. that she's
got .hhhh at least three: quite bad ulcers on ‘er
((13 lines describing symptoms omitted))
Doc: Ri:ght, sorry. hh So- so how old didju' say-
you say your daughter was,
(15) [DEC 1-1-5 COLIC]
It's thee: (0.4) the baby, she's: (0.4) just
comin' up on four weeks old,
((107 lines of diagnostic questioning omitted))
[h Is she] the second baby? or (.) your first, yeah
Thus, when callers say they "have" children or babies, this is treated as claiming a kinshiprelationship. By contrast, the caller who says "I have a gentleman that's in a very bad way"[DEC 1-2-17] is not treated as claiming a kinship relationship. The assumption that an adultcalling on behalf of a child is (unless otherwise specified) the parent of that child reflects, andreproduces, cultural understandings that parents (especially mothers) are responsible for thecare of their children.
The analysis of Extracts 14 and 15 goes some way towards offering empirical support for
Sacks's (1972b; 1995a) famous claim that when we hear "The baby cried. The mommypicked it up," what we hear is that the "mommy" who picks the "baby" up is the mommy ofthat baby. Apparently the doctor hears, and is intended to hear, "I've got a little gi:rl" and "it'sthe baby" as indexing familial relations between speaker and child. However, whereas Sackssimply claims that "baby" is a family reference term, the data presented here show that theterms "baby" and "girl" are, in the context of these calls, treated and understood by these socialparticipants themselves as family reference terms, even though (unlike "daughter") they arenot specific to familial relationships and can be used in other contexts to refer to non-kin.
The social norm that parents care for their sick children is apparent in this dataset in that,
in fact, it is indeed overwhelmingly a parent, and more specifically a mother, who performsthe action of calling the doctor on behalf of a sick child. More importantly from the conversa-tion analytic perspective on normativity advanced here, the activity of calling the doctor isunderstood by social participants with reference to the social norm that makes caring for chil-dren a category-bound activity, such that those who make such calls on behalf of their
Heteronormativity in Action
children overwhelmingly select person reference terms that display the parent/child relation-ship (e.g., "son," "daughter," etc., as in Extracts 2, 6, 7, and 9). Moreover, as we have seen,those who do not select such person references nonetheless have their more ambiguous—and not, strictly speaking, familial—terminology ("baby," "girl," "boy") treated with referenceto this social norm, and are identified as mothers on the basis of the category-bound activitythey are performing (caring for children, as in Extracts 14 and 15). These data also, thereby,provide evidence for Sacks's (1995a) claim that "for an observer of a category bound activity,the category to which the activity is bound has a special relevance for formulating an identifi-cation of its doer" (p. 259). In sum, the family is produced as a locus of caring not simplybecause it is, in fact, overwhelmingly parents who do call the doctor on behalf of their chil-dren, but also because those who care for children produce themselves, through their selec-tion of familial terminology, as the parents of their children, and not as members of whateverother category sets they can also claim to be members of.
The inference that people calling on behalf of children are their parents can be so strong
as to override even clear statements to the contrary, as in Extract 16 in which the caller iden-tifies the patient as a baby who is not her own (lines 1–2). This statement is ostensibly notheard, or not understood, by the doctor. He subsequently queries her identity (line 21), suchthat she finds herself explaining (in lines 24–25) why it is she, and not the mother, who iscalling.
(16) [DEC 1-2-16 BABY I]
I've got u:m .h my next door neighbor's baby's
not very well.She keeps losin' ‘er breath an' .hh
um (.) bringin' up sick and everything an' she
keeps cryin'. She's been cryin' for about four
hours,.hhh They don't know what's wrong with ‘er.
((15 lines of diagnostic questioning omitted))
Are you the mother.
No, I'm the next door neighbor.h .h
The mother's lookin' after the baby at the
An' she's- I see. Okay doke.
In this dataset, no parent provides an account for why he or she, as opposed to another, ismaking the call.
Evidence that, as feminists claim, women's caring role is not just statistically more com-
mon, but also socially normative is also displayed in these calls. First, more women call onbehalf of others than do men (only 11 of the 50 such calls are from men). Second, the trendin the data is that if a male calls on behalf of a patient (of either sex), he is more likely to beoffered a home visit than is a female caller.5 One reason for this may be the doctor's expecta-tion—displayed to female callers, and never to males—that women will be free to bring thepatient to see him the following day: as in Extracts 17 (a mother calling about her child) and18 (a wife calling about her husband):
(17) [DEC 1-1-9 CONJUNCTIVITIS]
An' if you're worried in the morning, bring ‘im
along to the morning surgery,
(18) [DEC 2-1-15 FOOD POISONING]
If you wanted to bring ‘im along in the morning
I'll have a loo[k at ‘im.]
5. The sample of male callers is small, and this finding does not quite reach significance at the p 0.05 level (2
3.57, df 1, p 0.10, critical value 3.84).
Family carers are often (though, according to Gubrium and Holstein 1990:95–112, notalways) expected to have intimate personal knowledge about the patient's personal circum-stances, previous medical history, and current medical needs. In history-taking from callersidentified as "mothers" and "wives," the doctor displays through question design his expecta-tion that callers will be able to provide him with personal medical information. Of wives heasks: "what treatment did he put your husband on?" [DEC 2-1-4]; "Has he had any problemsin the past, with 'is stomach," [DEC 2-2-2]; and "Has he ever had anything like this befo:re?"[DEC 2-2-4]; and of a mother: "has she had any illnesses in the past of any note?" [DEC 1-1-1].
Husbands are asked: "She ever had those [codeine phosphate tablets] befo:re," [DEC 1-1-13];and "Does she have a problem with 'er chest normally," [DEC 1-2-12]. The doctor displays ononly one occasion an orientation to the possibility of a spouse not having the informationrequested: he asks a husband, "When was her last period. D' you know?" [DEC 1-2-15].
By contrast, non-familial callers are not expected to have intimate knowledge of the
patient. When a caller identifies herself as an institutional representative (Warden Services),the doctor asks, "does she have any past history that you know about
" [DEC 2-1-5, my empha-sis], thereby displaying an expectation that she may not know.
Non-familial callers are unapologetic about their lack of knowledge of the patient's med-
(19) [DEC 1-2-17 BREATHING]
All he needs is a bit of a Nebulizer, .hh [Diyih]
Diyiknow how to use that?
No but he knows how to use it, doesn't he!
((18 lines omitted, in which doctor advises on
Is ‘e also: got some steroids with ‘‘im.
Oh I don't know a damn! I don'know what ‘e's got,
No such blithe confessions of ignorance are ever produced by husbands and wives, or by par-ents of children. Instead, close family members treat themselves (and are treated by the doc-tor) as accountable for not having this kind of information: "I don't know what it was earlieron - I wasn't here you know," says Melanie's mother [DEC 1-1-1], who has alreadyexplained that she was at work when her daughter's illness started; "It's hard trying to remem-ber everything" says a wife [DEC 2-1-4]. Callers treat themselves as accountable for having inti-mate knowledge about their children, husbands, and wives (as the caller in Extract 19 doesnot), thereby re-inscribing the taken-for-granted inference that "close" kin—which they arethereby displayed to be—normatively have this kind of knowledge about each other.
In sum, unless otherwise accounted for (e.g., by the institutional relationship displayed
in the caller's self-identification as a "relief warden" in Extract 6 above), making a call to adoctor on behalf of another implies that the caller is in an intimate caring relationship withthe patient. The deployment of family reference terms to refer to the patient, and the infer-ences which demonstrably attach to these, both display and reconstitute the family as theculturally privileged site of intimate caring it is already understood to be.
The Family Doctor
The analysis in this section shows how co-interactants display the inference that in the
culture of which they are co-members all family members (parents and children alike) sharethe same family doctor. This arrangement is, of course, culturally specific and may differenti-ate U.K. from U.S. (and other) medical cultures. However, the general argument advancedhere is generalizable to every culture—that cultural norms (including those associated with
Heteronormativity in Action
heteronormativity) are displayed in talk, and that analysts can read from participants' talk-in-interaction whatever practices are normative in their particular culture.6
As noted, the doctor in these calls is a "locum" taking sole temporary responsibility for a
multi-doctor practice, and he routinely asks for the name of the doctor with whom thepatient is registered. In designing this question, he displays his inference that those calling onbehalf of family members are registered with the same doctor as the patient, whereas othercallers are not. For example, in Extract 20 a woman calling about her husband's swollen tes-ticles is asked, "have you seen your own doctor at all"—a question which makes sense only ifthe pro-term is understood as plural, such that the woman's doctor is also her husband's:
(20) [DEC 2-2-4 SWOLLEN TESTICLES]
.hh How can I help. hh
.hhh U::m well my husband's- he's been quite
poorly for about the last two or three da:ys,
a:nd u:m (.) he's passing water a lot an' ‘is
testicles are swollen an' ‘e's rea- lotta pain in
the bottom of ‘is body like. (.hhhhh)
[(Um)] hmm hmm! ((throat clear))
(.hh) An:d: sorry how long's that-
[b]een going on for.
Aw, two days. But it's just gettin' wo:rse,
Has- Have you: seen: (.) your own doctor at all¿7
Similarly, in Extract 21 a mother calling about a child's sickness is asked, "who's your doc-tor," thereby displaying the assumption that mother and child share the same doctor:
(21) [DEC 2-1-7 SICK III]
. my daughter who's uh:: just coming fuh nineteen
months old, um: .thh yesterday she was feelin' very
((74 lines omitted, of problem presentation,
diagnostic questioning, and diagnosis))
Who's your doctor,
By contrast, non-family members are assumed not to share a doctor, with the question
formulated as "Who'[s his doctor?" [DEC 2-1-16 ] or "Who is his doctor actually" [DEC 1-2-17]. A caller on behalf of an adult son is asked, "Who- who's her doc- your: t! his doctor¿"[DEC 1-2-19]. Likewise, the caller who identified herself as "only 'is grandma" (i.e., kin, butnot close kin) is asked, "O:kay, an' who's your doctor normally, or his doctor." [DEC 2-1-9]:in the original formulation the doctor displays an orientation to the caller as family; in hisrepair, he treats her as distant kin, unlikely to share with a grandson a family doctor.
Callers—especially spouses—also make available in their talk the inference that nuclear
family members have the same doctor and that others do not. A husband of a wife who hasjust fainted explains that "She's been to the doctor's and our doctor at ((deleted)) gave hersome painkillers" [DEC 1-1-13]; a husband of a couple not registered with the practice asks,
6. The norms identified in earlier sections of this article are also culturally specific: the norm of cohabitation is not
displayed in those cultures in which husband and wife live separately, either in their natal homes or in men's orwomen's houses (Barnard and Good 1984:78–83) or in cultures in which children do not normatively live with theirparents (Ingoldsby 1995:119); the norm of "caring" between spouses is not displayed in cultures in which husband andwife are neither intimate with nor care for one another, and indeed never meet after their ritual ceremony (Gough1968).
7. As is evident from the repair, this turn was initially designed to be "Has he seen his own doctor" and was specif-
ically altered to display an inference that the woman would share the same doctor as her husband, and would haveaccompanied him to the surgery.
"Did you want to know where our doctor was?" [DEC 1-1-6]; and a wife of a husband withpossible food poisoning reports unproblematically the advice of a previous doctor to "contactour own doctor" [DEC 2-1-15]. What is interesting about this latter case is that it turns outthat husband and wife do not, in fact, have the same doctor. The exchange in which thisstatement is made is reproduced in Extract 22 (an extension of Extract 5), described earlier asunique in the corpus for the deployment of a non-familial person reference (line 5)—typicalof institutional calls—followed by a familial person reference (line 6):
(22) [DEC 2-1-15 FOOD POISONING]
.hh Hello:, um: I'm: ph- (.) phoning up fer:
I have a:b- a: patient of:h:: Doctor ((deleted))
Ahm: we've just come back from:: holiday, from
Wales We'[ve h]ad to call the doctor out
[Mm hm] .mhh[ h h
[this morning in Wales,]
[ for my husband ]
Um:: I think it could be: food poisonin'.‘E's
been given: ((swallow)) t! tablets: .hh ta take,
to stop the diarrhea, .h[h]
Um:: hh (0.5) but um:: .hh it hasn't actually
stopped it ‘n h- he's still sort'uv li:ke losing a
lot of li:quid. hh Still very very feverish.
((11 lines of diagnostic questioning omitted))
.hhh An::d uh what- you saw the doctor this
Yes. [But] the doctor advi:sed us if it got any
worse to contact [our ] own doctor.
((65 lines of diagnostic questioning and diagnosis
If you wanted to bring ‘im along in the morning
I'll have a loo[k at ‘im.]
[Well, we ] actually live the other
side of ((deleted)) (.hhh) but- we've: u:m we live
at now. So it's quite a struggle tuh get ‘im all
the way up tuh ((deleted))
I see.Well so, have you changed your: doctor.
M- u- u:hm: no, ‘e hasn't changed ‘is doctor
because he likes- ‘e used to live up by there.
t.hh An::d because ‘e likes bok- Doctor
((deleted)) ‘e ne- ‘e decided not tuh change it.
Over the course of this call, a hypothetical family doctor is first conjured into being and
then dissolved. This person is first invoked by the caller in seeking to justify the need for ahome visit: she reports having been advised by a holiday doctor to contact "our" own doctor
Heteronormativity in Action
(line 37). Later, in response to the caller's account of the difficulties of visiting a surgery somedistance from home, the doctor invokes this same person: "Well, so have you changed your:doctor" (line 109, with "you" and "your" here treated as plural). The hypothetical family doc-tor finally dissolves in lines 110–14 where "his doctor" makes an appearance instead—and itbecomes apparent that husband and wife have different doctors, with this accounted for interms of "his" previous residence, "his" preferences, and "his" decisions. The way in which anormative inference (here, that spouses share a doctor) acts to shape the interaction is pow-erfully apparent in this call.
In sum, I have shown that the heteronormative definition of the family reflected and
constructed by these social participants in the course of their everyday lives comprises wifeand husband, co-resident with their biologically related, dependent children, with the wife/mother taking primary responsibility for caring for sick family members and for contactingthe (shared) family doctor. The normative construction of the family is invoked, deployed,negotiated—and occasionally resisted—by social participants for whom the business at handis caring for a sick person and trying to secure a home visit from a doctor. However, in con-ducting the business of their everyday lives, without conscious design or oppressive intent,they reproduce their society's heteronormative social order.
In this analysis, I have sought to excavate what Euro-American readers—as cultural
members—already "know" and take for granted: that families normatively live together andcare for one another. I have analyzed the mundane understandings of family embedded inthese calls to show what these understandings are, and how they are displayed by peoplewho are not simply describing, but are actively deploying family reference terms for interac-tional purposes. In conclusion, I will: (a) examine some of the interactional uses to which thesefamily reference terms are put; and (b) extrapolate from these findings the implications ofthis quotidian reproduction of heteronormativity for the problem of heterosexism more broadly.
Interactional Uses of Family Reference Terms
The use of heteronormative terms and inferences in these calls is not designed to display
anti-gay prejudice or to discriminate against non-heterosexual people. Rather, speakers aredeploying person reference terms that they treat as ordinary and natural in pursuit of theinteractional goals related to their medical concerns. A key interactional use of referenceterms relating to the traditional nuclear family is to render ordinary and natural the actionbeing performed by callers in contacting the doctor on behalf of these particular patients.
Calling the doctor is—along with other actions described in the calls (such as sponging downa feverish child, helping a spouse to the toilet, preparing special foods or drinks)—demonstrablyan act of caring. Caring activities are, as has been shown in the preceding analysis, category-bound to the particular categories of people who constitute the nuclear family, especially thewife/mother. This means that callers who contact the doctor and report, "My husband isn'tvery well," or, "I think my son's got measles," constitute themselves as ordinary people doingan ordinary and natural thing in calling on behalf of these patients in particular—becausethese patients, referred to by terms which display them as members of the caller's nuclearfamily, are precisely the people for whom "caring" is an ordinary and natural activity. Asdemonstrated above, a wife/mother is culturally understood to be bound to her "husband" bymarriage and to her "son" by blood, to live with them, to care for them, to have intimateknowledge of their medical needs, and to share with them a family doctor. Calling on theirbehalf is rendered thereby a wholly non-accountable activity: nothing special is happening interms of the relationships displayed. Whatever other interactional hurdles the caller has to
negotiate (conveying the nature of the medical problem, describing the symptoms as suffi-ciently severe to merit a home visit, and so on; Drew forthcoming) she does not have to dealwith the issue of why she rather than some other person is calling on behalf of the patient.
The fact that she is the one calling is rendered ordinary and natural.
Here, nuclear family reference terms are being used, as Donna J. Haraway (1997:53) has
theorized, as a technology for producing the effect of "natural" relationships. The use of thesereference terms mobilizes the inferences which attach to such relationships, obviating theneed for the caller to account for her caring activities and facilitating a smooth and unprob-lematic doctor/caller interaction. The sheer ordinariness of a parent calling on behalf of achild, or one spouse on behalf of another, makes the use of these terms a powerful resourcefor "doing being ordinary" (Sacks 1984), with all the interactional benefits (of not having toprovide accounts, explanations, justifications, etc.) that attach to being an "ordinary" persondoing a "natural" activity.
Nuclear family terms also are used to co-implicate a third party in the decision to call the
doctor. Callers frequently display an orientation to their call as constituting a demand onthe doctor's time and energy (e.g., via expressions of regret for the necessity of making thecall or requesting a home visit: "I'm afraid I'm- I'm sorry, but I've gon' t'av to call ya out"[DEC 1-2-15]). They reduce their own culpability in this respect by allocating some of theresponsibility for the call to other family members—in this dataset, always spouses—whohave either allegedly requested that the call be made, or whose purported anxieties for thepatient have prompted the call. For example, when one caller's suggestion that her daughtermay have mumps meets with some skepticism from the doctor, she says, "My husband justsaid ta phone ya" [DEC 1-2-8]. Another caller, having described how his pregnant daughter isvomiting and has a slight discharge, co-implicates his "wife" in the anxieties this is causing:"It won't stop at the moment, e- which is obviously: (.) worrying me, an:d my wife" [DEC 1-1-7]. Patients who call on their own behalves also occasionally claim that they are doing so inresponse to the promptings of a spouse, thereby displaying what John Heritage and JeffreyRobinson (forthcoming), drawing on Jefferson (1984:351), call "troubles resistance"—thatis, that they are not calling the doctor lightly and have tried to deal with the problemthemselves. The marital unit terminology of "husband" and "wife" offers a resource for co-implicating other people whose involvement with caller and patient is treated as self-evident.
Implications for the Problem of Heterosexism
The mundane, everyday use of family reference terms in these calls constitutes a major
resource for ordinary folk who are not oriented in any way to LGBT concerns but who aresimply getting on with the business of their lives. In so doing, the social order they reproduceis profoundly heteronormative: in these calls the nuclear family is always a heterosexual one,individuals are (apparently) universally heterosexual; sexual orientation—of any kind—issimply not an issue. It is precisely this untroubled reproduction of a heteronormative worldthat—from an analyst's point of view—contributes to the problem of heterosexism.
These casual displays of heterosexuality in the service of local interactional goals consti-
tute a mundane instance of heterosexual privilege by those who take for granted, as otherscannot, their access to their culture's family reference terms. Such terms are not available—inany unproblematic way—to lesbian or gay couples in England, where (as in most other coun-tries) same-sex marriage is not permitted under law (see Kitzinger and Wilkinson 2004a). Astudy in which gay men were asked about their lexical choices in referring to their "lover"/"partner"/"friend"/"boyfriend" points to a plethora of self-consciously articulated difficultiesand concerns (Harvey 1997; see also Land and Kitzinger 2005 for an analysis of lesbiansattempting to deploy the terminology of "wife" and referring to a female "partner" in thecourse of everyday activities). The normative understanding is that a family unit properlycomprises one (and only one) mother and father—what Sacks (1972b) refers to as the
Heteronormativity in Action
"proper number of incumbents for certain categories of any unit . . a nation-state may havebut one president, a family but one father, a baseball team but one shortstop on the field,etc." (p. 221).
Family researchers have emphasized the range and diversity of "emergent and reconfig-
ured forms of family life" (Lempert and DeVault 2000) in contemporary modern societies.
According to the 1991 Census, only 14.6 percent of UK households contained one adult maleand one adult female, with between 1 and 3 dependent children, where only one of theadults was in employment (Bernardes 1999). The acknowledged existence of family diversitydoes not, however, necessarily map onto social members' displayed understandings of thefamily as a normative concept. It is not necessarily the case that the families of which thesecallers are members are as rigidly traditional as their displayed understanding of "the family"implies: they include several mothers who work outside the home, fathers/husbands whocall on behalf of sick family members, an unmarried couple, a family dealing with a daugh-ter's abortion, the couple who do not share a normative "family doctor"—and presumablyother kinds of non-conformity which were not revealed in these calls. If these callers hadbeen interviewed on the topic, they may well have produced more nuanced and complicatedaccounts of family life; however, what I have shown in their daily interactions, when familyterminology is a resource not a topic, is their deployment of the traditional normative con-struction of "the family" as a distinct, co-residential, heterosexual marital unit. This common-sense understanding is produced by callers and doctor in interaction and is oriented to as nor-mative even when it is breached, as when accounts are offered for the presence of others(such as friends) in the home (Extract 3) or when non-normative medical arrangements areglossed as normative (Extract 23).
The interactional trouble that arises in these calls when normative understandings are
breached enables us to extrapolate the problems that might confront a lesbian or a gay mancontacting a doctor on behalf of partner or child (especially any child of whom she or he isneither a biological nor a legally appointed adoptive parent). Such a caller lacks as a resourcethe culture's family reference terms, and the inferences associated with such a resource, usedso smoothly by most of these (apparently) heterosexual callers. Research (based on self-reported data) on lesbians' and gay men's experience of the physician-patient relationshiphas found that 17 percent report having avoided or delayed seeking health care for reasons todo with their sexual orientation (Stein and Bonuck 2001) while 27 percent report negative orproblematic experiences with their children's health care related to sexual orientation or fam-ily constellation (Mikhailovich, Martin, and Lawton 2001; see also Riordan 2004, for theexperience of lesbian and gay physicians). Although some of these negative interactions arethe product of explicitly homophobic behavior including intimidation and humiliation fromhealth care professionals (e.g., Stevens 1992), many must derive from the underlyingassumptions of universal heterosexuality incorporated into the culture's family referenceterms and the mundane heterosexism (Peel 2001) to which that gives rise. Research on les-bian and gay families more generally (e.g., Stacey 1998; Weston 1991), like the medicalresearch cited above, has used self-report data to highlight the heteronormative context forsame-sex couples and their children. The analysis presented here contributes to that litera-ture a detailed analysis of how heteronormativity is grounded in the empirical details of talk-in-interaction (see also Kitzinger 2000, 2005; Land and Kitzinger 2005).
In conclusion, analysis of these family reference terms, the inferences normatively asso-
ciated with them, and the interactional uses to which they may be put in the context of after-hours medical calls have shown that (and how) tacit, taken-for-granted concepts of "thefamily" are reflected in, and reproduced by, the talk of social participants. Through theirdeployment of family reference terms in conducting the business of their ordinary lives, thespeakers in this dataset both reflect and (re)construct their society's normative definition offamily as composed of a co-residential married heterosexual couple and their biological chil-dren. This analysis has also demonstrated that heterosexism can be produced and reproduced,
even—and perhaps especially—where there is no sign of trouble in social interactions. It maybe particularly important to target for analysis precisely those everyday interactions whichseem unremarkable, where nothing special appears to be happening, because what is alwayshappening on such occasions is the reproduction of the normal, taken-for-granted world,invisible because it is too familiar. Here, in the specific context of requesting a home visitfrom a doctor, we see heteronormativity in action. In unravelling the social fabric of ordinary,everyday life, LGBT activists and researchers can make visible and challenge the mundaneways in which people—without deliberate intent—reproduce a world that socially excludesor marginalizes non-heterosexuals.
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U.S. Postage Twin Cities, MN 200 University Ave. E. Permit No. 5388 St. Paul, MN 55101 Angela Sinner, D.O. Pediatric Rehabilitation A Pediatric Perspective focuses on specialized topics in pediatrics, orthopedics, neurology, neurosurgery and rehabilitation A Range of Treatment Options
By Xiaoni Zhang and Victor R. Prybutok MARKETS DIFFER IN CHINA, THE U.S., AND EUROPE Market differences include communications standards, price structures, government regulations, customer demographics, usage patterns, business potential, and technology adoption strategies. Despite the 2001 downturn in the global telecommunica-tions market, the mobile penetration rate in China is increas-ing due to the elimination or reduction of mobileconnection fees. The mobile market worldwide is dynamicin terms of technology development, and competition isaggressive. The potential size and growth rate of the Chinese,U.S., and European mobile markets warrant examination ofthe state of their wireless development. Here, we explore thatgrowth by examining the differences among the threeregions, especially those in mobile consumer demographics,Short Message Service (SMS) usage, and 3G technology.