“In This Together”: Diagnosis and the Imaginary Nation

“In This Together”

diagnosis and the imaginary nation

Annemarie Jutel

ABSTRACT In addition to the visible ways in which people have been united by COVID, there are also hidden structural and rhetorical links enabled by diagnosis. Diagnosis itself places the individual case into a generalized category, uniting the individual with many others so afflicted. In the case of COVID-19, diagnosis also creates new networks and relations by contact tracing. But diagnosis is also a measure of and technique for imaging the nation. Through multiple mechanisms, it constructs unifying concepts of nation, of citizen, and of class.

Appeals to solidarity have been a rallying cry during the COVID-19 pandemic. Political leaders and public health officials around the world have used metaphors of togetherness to entreat their citizenry, but also to celebrate their victories. In my home country of New Zealand, we’ve got the “team of five million,” and we’re admonished to “Unite against COVID-19” (Cheng 2020; NZ Government 2020b). In Ireland, citizens are invited to “Stay connected!” (Government of Ireland 2020; see Figure 1); in Canada, they’re asked to “Join the effort” (Government of Canada 2020); and in France, to “Tenir ensemble” (hold together) or “Faire bloc” (hold the line) (Gouvernement Français 2021).

Te Herenga Waka—Victoria University of Wellington, New Zealand. Email: annemarie.jutel@vuw.ac.nz.

Perspectives in Biology and Medicine, volume 64, number 3 (summer 2021): 339–351. © 2021 by Johns Hopkins University Press

Figure 1

The COVID slogan of togetherness from the Irish Government. “Whatever you are going through in isolation, let’s stay connected and make it through, together.” Source: https://www.gov.ie/en/campaigns/together/.

But this appeal for unity is more than a conscious project of unification, where people recognize their fellow citizens for having experienced the same thing as they and for acting in accord with public health recommendations, it is built into the fabric of diagnosis itself. Diagnosis connects people. It takes a set of symptoms, a history and some lab work—idiosyncratic characteristics of the individual “case”—and slots them into a category of disease to which many others belong. Diagnosis is, after all, a form of classification, putting together a number of disparate items—or in this case, individuals—which are more like one another than they are like some other set of items or individuals.

Diagnoses create order. They take the great continuum of function and dysfunction and break it into manageable chunks, providing us with “mental niches” for combining discrete objects (Zerubavel 1996). It is via this process of diagnostic classification that we make sense of health, illness, and disease. We sort through symptoms and presentations: place them together or apart and decide what needs to be done. One particular combination of symptoms—the runny nose, the hacking cough, and the fever—mean something totally different than the other—say, the same symptoms, with the addition of a positive PCR (polymerase chain reaction) coronavirus test.

Diagnoses are essential for developing evidence to determine the best practice: to decide the most effective treatment, the likely outcomes, the potential complications. Without diagnostic categories, generalization is not possible; without generalization, science cannot fulfil its roles. Statistical analysis is only possible with categories to represent outcomes and interventions, because we can’t count cases or outcomes if they aren’t in countable form.

How one is diagnosed reifies, provides heuristic and didactic structures, determines the treatment protocol, predicts the outcome, and, in the case of COVID-19 (as in the case of any diagnosed ailment) assigns a set of collective expectations which privileges the collective, if not the united.

In the pages that follow, after a review of how diagnosis enlists the sick person in a collective category, I will show how diagnosis and diagnostic systems bring individuals together, and how they help to create the nation.

From Case to Collective

The process of diagnosis in one in which (usually) an individual feels unwell and decides that their illness is one which is likely to be diagnosable—that is to say, explained by and captured in the medical taxonomy of disease categories.1 Not all cases of illness are thought to be medical by the person who experiences them or by the doctor who ultimately will determine the presence of a diagnosis or not. An upset stomach can just as easily be attributed to your sister’s cooking, a disease of some form or another (to be diagnosed by the doctor), or to fatigue.

The bringing of symptoms to the doctor is a request to join a collective: to be part of something bigger. The sick person presents a narrative that links events and creates a logic of disease, as opposed to a logic of, say, poor cooking and fatigue. Starting from this narrative, the doctor elicits further information, orders diagnostic testing, and creates their own logic, their own narrative (see, for example, Balint 1964; Frank 1995; Jutel 2019; Leder 1990). The ultimate aim of this encounter is to label the dysfunction, to diagnose. What Balint emphasized in the 1960s is possibly even more germane today: “the request for a name for the illness, for a diagnosis is the most pressing problem for the patient. It is only in the second instance that the patient asks for therapy . . . finding ‘nothing wrong’ is no answer to the patient’s most burning demand for a demand for a name for his illness” (25, original emphasis).

To be given a diagnosis is to be admitted into a community of individuals with legitimate complaints, to be provided access to the “sick role” and its concordant rights and responsibilities (Parsons 1958). Yes, the patient now has “permission” to stay in bed and forgo normal social duties. At the same time, they are expected to assume the “duties” of the sick person: follow medical instruction, commit to cure and to therapy.

But it’s more than just “sick,” it’s what kind of sick. The diagnosis provides an explanation for what ails the patient, a prognosis, a therapy, and social status. As Friedson (1972) explained, “Health and illness are not only ‘conditions’ or ‘states’ of the human individual . . . . They are also states evaluated and institutionally recognized in the culture and social structure of societies” (126).

To be diagnosed is to “become” and “to have” (Fleischman 1999). Some diseases are points of identification: one becomes diabetic, hypertensive, schizophrenic. Others are cumbersome and external, an albatross: one has cancer; one suffers from gout, and so on. In any event, to become diagnosed is for the individual case to give way to the collective.

Diagnosis is how medicine classifies human ailments which are in its purview. The very fact that diagnosis is a process of classification demonstrates how diag-

1By illness, I mean a feeling of dysfunction, in contradistinction to the term disease, which I use to denote a diagnosable ailment, recognized by medicine as having diagnostic status and recognized by the medical institution as being a legitimate ailment with a worthy label.

nosis brings us together. As a classification tool, diagnosis generalizes with all the benefits that this can bring to understanding a particular situation. Classifying is a means of summarizing many cases of disease to organize human illness in meaningful ways. As the introduction to the 1957 edition of the World Health Organization’s International Classification of Diseases (ICD) made clear, statistical classification in general, and the ICD in particular, furnishes “quantitative data that will answer questions about groups of cases” (vii).

This means that an individual patient assigned to a diagnostic category can ride on the benefit of the statistical power offered by similar cases. No longer an isolated individual for whom treatment is a best guess affair, the empirical power of previous groups of cases gives a better idea of what therapy is best, what outcome is expected. To make such comparisons or assertions requires the capacity to compare; in order to compare, idiosyncrasy must be obfuscated in favor of generalization.

The diagnosis is powerful unifier. By virtue of the label, the patient assumes a collective identity and joins new communities. As an example, the overwhelmingly successful Netflix series Diagnosis follows the trajectory of people without diagnoses for debilitating conditions, crowd-sourcing candidate diagnoses to help. One rapturous fan commented: “Dr Sanders—thank you with every fiber of my being—thank you for doing this. People like my daughter and the families need to know we aren’t alone” (“Sarah,” 14 Oct., commenting on Gardener 2019).

In relation to COVID, the diagnosis (or the risk of the diagnosis) appears to isolate the newly diagnosed patient to social isolation or quarantine: the opposite of togetherness. This is only part of what happens. At the same time that the individual goes into what we called, in New Zealand, a smaller “bubble” (the “Household Group” in Scotland, or the “Rule of 6” in England), the individual also is introduced into a new network, one which explores connections and contacts, casual and close.

As soon as a case is identified, a close analysis of where the person has been, who they have passed in the corridor, who they have embraced, and with whom they ate is triggered. The people thus revealed assume a shared identity, and in solidarity (albeit, usually imposed), they too go into isolation, have a test, become part of the network (Figure 2). So, it’s a situation of being simultaneously together and apart. During COVID times, illness is no longer a solitary burden to shoulder, it’s a sign to join the ranks and head to the local testing center. COVID is a national challenge, one which binds individuals to the spirit of the nation.

Statistics and the Birth of the State

Diagnosis and the national interest go hand in hand. The logic behind the earliest medical classification systems, such as John Graunt’s 1662 Natural and Political Observations, was to protect the kingdom. Graunt felt that by identifying and classifying causes of death, the king would become aware of preventable public

Figure 2

COVID-19 diagnosis creates new social networks via contact tracing. Screen capture from the NZ Tracer App Overview, Ministry of Health NZ. Source: https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novelcoronavirus/covid-19-resources-and-tools/nz-covid-tracer-app.

health scourges and “curiosities concerning the waxing and waning of diseases” (Graunt 1662b). In the 17th century, the plague was the dominant infectious disease, however, as Graunt maintained: “A true account of the plague cannot be kept without an account of other diseases.”

Every week, on a Tuesday, an account of every burial was brought to the Parish Clerk by “ancient Matrons sworn to that office” who, upon “touling and ringing of the bells, or the bespeaking of a grave” would go to “the place where the dead corpse lyeth, and upon their own view and others examination, make a judgement by what disease or causality the corpse died” (3).

Graunt was of the view that the plague was underacknowledged in the Bills of Mortality and surmised that “there were more that died of the plague than were accounted for under that name, as many as one to four.” He proposed that the truth could be discerned by comparing the number that died of other diseases and “in the weeks immediately before the Plague begun and the number reported to have been dead every week, of those diseases and casualties since, and observing that the surplusage that die now above what did then of those diseases, are indeed dead of the Plague, though returned under the notion of those other diseases” (Graunt 1662a, 2). Each of these individuals, by their posthumous classification, became united in a way that changed how Graunt, and subsequently the king, respectively explained and understood the health of the kingdom.

Centuries later, the rise of the medical classification in the modern era was similarly concerned with the state (Bowker 1996). Classification, and what was to become the classification of diseases as we know it today, was intimately con-

nected to the need of European states to be able to understand the health of their citizens. Like the Bills of Mortality, the ICD was originally intended as a means of recording causes of death; it rapidly became a way of tracking morbidity and contact with contagious individuals.

Indeed, one might argue that contagion actually created the ICD, or at least the need for its existence. The 1893 conference at which the ICD was conceived came on the heels of several individual conferences on cholera. The late-19th-century cholera epidemics were often contained by the death of their sufferers, but increasingly modern systems of transport allowed sick people—notably, pilgrims from Mecca—to act as vectors as they returned home from their pilgrimages, carrying disease still viable enough to spread. In order to monitor the progression of disease, it became important to have a consistent means for naming it (Bowker 1996). A stable diagnostic classification system is actually a prerequisite for a pandemic, since the very notion of pandemic is only possible if states recognize illnesses in the same way, and if the illnesses thus named can spread from one nation to another.

Not-So-Banal Nationalism

Nations are never natural divisions. Like diagnoses, they are a form of social categorization, where historical, cultural, traditional, political, and other forces break the natural continuum into chunks that can be understood, defended, and serve some sort of purpose. As Billig explains in Banal Nationalism (1995), nation-states are created, for the most part, not along natural boundaries, languages, or ethnicities, but rather by subtle gestures that enable us “to understand the assumptions of the daily news” (15). As Billig goes on to describe, little things create the nation: the use of words like here, us, and them. These words focus the attention on the imaginary thing that “we” are, and which allow “the media of mass communication [to bring] the flag across the contemporary hearth” (174). This “national first-person plural” serves as a continuous reminder of the nation-state, no matter which one we/you/they belong to, and diagnosis is one of the tools that serve as “daily, unmindful reminders of the nationhood in the contemporary, established nation-state” (174).

Be it influenza, SARS, HIV, or COVID, diagnoses punctuate nationhood when their causative agents disrespect the “invented permanency” of the nation (Billig 1995, 29). As I’ve written previously in the pages of this journal:

[viruses] ignore the invisible lines that define national boundaries, terrifying officials and citizens by the way [they slip] through border control: no passport, no visa. The theme of national boundary transgression is embedded in the notion of pandemic. After all, what is a pandemic but a “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people” [Nicoll 2011]? (Jutel 2013, 518)

These viral incursions compel the state to respond, to define itself as distinct and unified. While reminders such as the first-person plural may be banal in non-pandemic times, they become not-so-banal in times of viral threat. It is a unification borne of crisis and couched as such in metaphor and in description. The external threat of disease becomes affixed to other nation states. The H5N1 (bird flu) was referred to as being “like enemy troops moving into place for an attack” (Hanne and Hawken 2007, 95), and a favourite metaphor used by UK Ministers during the current COVID pandemic is of the population “being all in it together,” which hearkens to the repeated popular representation of WWII as shared experience of the civilian and the military (Lacey, Kelly, and Jutel 2020).

Imagining Unity: Who Are “We”? Not “Them”!

“We” aren’t really who we think we are, given, as Anderson (2006) has reminded us. Even in the smallest of nations it wouldn’t be possible for anyone to know all of its members. We are compelled to create ideas about who we are, or might be, and to impose those ideas on our sense of nation in what Anderson calls an “imagined” community. Disease and diagnosis play a role in the construction of this imaginary nation.

A rather quaint example of how diagnosis serves as a way of proving one’s affection for “the inventions of their imaginations” (Anderson 2006, 141) is captured in a 1916 advertisement for Bovril, a meat extract (Figure 3). Claiming that “It is unpatriotic to be ill in wartime,” the advertisement advocates consuming Bovril to ward off the risk of influenza. In COVID times, we see prompts for national identity in the daily media and in press conferences. Like sporting events, which every week remind us about our victories, our heroes, and our successes (Billig 1995), WHO situation reports provide a kind of score chart, where the numbers of new cases and of deaths, organized by region and by country, allow “us” to see how “we’re” doing compared to the rest of “them.” We may bask in the glory of low case numbers, or wallow in shame at high ones, depending on where we sit in the infectious disease league tables.

These victories (or failures) focus the public regard inward to something which is distinctly ours and most certainly not theirs, continually reinforcing the belief in the existence of a nation. In New Zealand, the sports metaphor—so successful in promoting patriotism—is embedded into the public rhetoric in order to further hone this sense of nation, and to supercharge its imaginary attributes as a collective. New Zealanders are part of a “team,” the so-called “team of five million.” The sporting metaphor provides a sense of comfort to a nation accustomed to rugby as a means of social identity, as well as a collective investment in success (Lacey, Kelly, and Jutel 2020). During lockdown, New Zealand’s Director-General of Health made extensive use of rugby metaphors during each alert level. He warned citizens not to become complacent, coaching us that “we’re at half time,

Figure 3

Illness as a flag for nationhood. Source: The Observer, Dec. 16, 1918.

but we can’t take our eye off the ball yet,” and he talked about not giving up “before the full-time whistle” and having a “game plan” (Bloomfield 2020; NZ Government 2020a).

The “us” and “we” presumes also a “them,” and the unification incurred by diagnosis in relation to the “not us” continues to be an important feature of New Zealand unity. Disgruntled and lockdown-weary citizens in the “team of five million” are quick to look askance at one another. In the early days of strict lockdown, the virtuous and vigilant reported their neighbors for what they perceived to be transgressions. By March 31, 2020, one week into the level 4 lockdown, New Zealanders had reportedly called in over 10,000 reports of lockdown breaches to the police (RNZ 2020); indeed, they were so eager to report that the police website set up for this purpose crashed under the load (Smith 2020). Later in the pandemic, when anxious Aucklanders faced a second lockdown as the result of an unexpected community cluster, othering those who were ill also brought New Zealanders together, albeit acrimoniously.

The question of citizenship is tightly linked, of course, to the question of nation, and particularly in New Zealand, in response to the returning citizen. States, worldwide, cling to an imagined purity, with the borders strengthened to prevent pollution (or in this case, contagion) from the alien “other.” Having an adversary produces class solidarity and imagined fellowships (Anderson 2006). For the “team of five million,” every potential assault on the disease-free status of their nation assembled (worthy) citizens more tightly. For example, for New Zealanders returning from other nations after the onset of the COVID-19 pandemic, homecoming was harsh (Graham-McLay 2020). Bitter social media and talk-back exchanges revealed New Zealand-based New Zealanders critical of what they saw as tainted citizens. They protested the return of the late returnees: the citizens who, like foreign invaders, could bring the virus back across the national boundaries, even if only to a quarantine center.

Typical of many, one contributor to the Ministry of Health’s Facebook page wrote “Let’s be real and remove emotional arguments. Most kiwis out of New Zealand right now made a choice to live elsewhere. . . . Why should this be our issue so far down the path?” (minhealthnz/posts 2020-174094737492652, emphasis added). Another chimed in: “I understand there was a full aircraft land [sic] from China last week not one person on the aircraft could speak English. You have to ask yourself are these people we are letting in really New Zealanders” (minhealthnz/posts 2020-?v=3691920004168655).

Also tainted, and adversarial, were Pacific Island neighbors, many of whom are either citizens by birth—if their island is part of the Realm of New Zealand—or by immigration. During the COVID-19 pandemic, travel between these islands and New Zealand was virtually shut down and restricted to repatriating citizens (and permanent residents) to either the islands or to New Zealand.

While, on the one hand, New Zealanders were disappointed that they could no longer fly to what they considered their tropical playgrounds—and many of the island nations were disappointed in the loss of economic benefit the absence of New Zealand tourists created—an abrupt about-face took place when a new cluster of community COVID-19 infection was identified in a small community of New Zealand-based Pacific Islanders after 102 days without a reported community case.

While many were hoping at the end of July to hear plans for the relaxation of border restrictions between New Zealand and the Cook Islands, instead they received news of a new cluster that included, ironically, the former Prime Minister of the Cook Islands, Dr. Joe Williams, among those infected.2 This news gave rise to further unification, both within the cluster itself via the contact tracing network described above, but also by casting the people diagnosed with COVID-19 or identified as close-COVID contacts as adversaries.

The initial flurry of social media responses to this cluster was so divisive as to generate a call from the Minister of Health for New Zealanders to stop spreading rumors. “Not only was it harmful and dangerous, it was totally and utterly wrong,” said the minister (Coughlan 2020). An early social media post on Facebook and Instagram, titled “News Flash,” incorrectly claimed that the cluster had started when a daughter in the family involved where the initial case occurred—“known to the police”—allegedly visited her supposed Australian-deported “boyfriend (or associate)” in a border isolation facility. This posting tarred the cluster members as having engaged in illegal activity both by allegedly entering a border isolation facility and being connected to someone “deported” from Australia.3 These were “bad” people who had, by virtue of their transgressions, brought disease back into the community (Bonnett 2020; Connor 2020). But the assumption of their badness was not just a matter of infection. They were Pacific Islanders, and the infection was deemed to be confirmation of their deviance. These racist insinuations were yet another form of generalization, both by and of the insulters. Again, following Anderson: “Racism dreams of eternal contaminations, transmitted from the origins of time through and endless sequence of loathsome copulations… the dreams of racism actually have their origin in ideologies of class” (149). Class, like diagnosis, is a category, one to which the inciters of the racist invectives assign themselves as they engage in their fictious tirades.

2Dr. Williams, known to his community and to this author as “Papa Joe,” would not recover from this infection, and would die on September 4 in an Auckland hospital. 3Australia deports New Zealanders who fail the “character test”; therefore, referring to someone as being deported from Australia implies a flawed and shady individual.

Conclusion

Togetherness was, and continues to be, visible in the ways in which nations, groups, and individuals approach the COVID-19 pandemic (Figure 4). Diagnosis is a generalizer; it is also a trigger for action. In the individual case, it is via the diagnosis that a treatment and a prognosis are established. In the case of pandemic, diagnosis confirms (or reassigns) boundaries, classes, and networks. It defines and links nations, as well as anchors patriotism.

But, ultimately, diagnosis also allows implementation of the force of the state, which in turn confirms its existence. Quarantine is mandated on those diagnosed; freedoms are curtailed under the guise of the diagnosis. When, the Prime Minister of New Zealand stands before the press corps with the Director General of the Ministry of Health at her side, and states that she “will let the Director General start,” as she typically does, she is ceding to the diagnosis count in order to buttress whatever action she will next order. In this context, diagnosis is no longer about the individual, it is about the rights and duties of citizenship, the declaration of patriotism, and governmental power.

Diagnosis offers a means by which an exercise of patriotism, a devotion to the collective occurs. “Be kind” admonished Jacinda Ardern; “We’ll make it through together” proclaimed the Irish COVID public health campaign. The terms of togetherness as created by the pandemic are terms that may be effective as a public health strategy, but they will require scrutiny once the dust settles. The collective identity may move from a team of five million to a herd, but with camaraderie may come enmity, censure, and reproach.

Figure 4

Togetherness as imagined nation and public health strategy. Screen capture from the NZ Tracer App Overview, Ministry of Health NZ. Source: https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novelcoronavirus/covid-19-resources-and-tools/nz-covid-tracer-app.

References

Anderson, B. R. 2006. Imagined Communities: Reflections on the Origin and Spread of Nationalism. Rev. ed. New York: Verso. Balint, M. 1964. The Doctor, His Patient and the Illness. Kent: Pitman Medical. Billig, M. 1995. Banal Nationalism. Thousand Oaks, CA: Sage. Bloomfield, A. 2020. The Breakdown. Sky Sport Auckland, May 19. Bonnett, G. 2020. “Family at Centre of Rumours Struggling with Online Abuse.” Radio

New Zealand, Aug. 18. Bowker, G. C. 1996. “The History of Information Infrastructures: The Case of the International Classification of Diseases.” Inf Process Manag 32: 49–61. Cheng, D. 2020. “COVID 19 Coronavirus: What Alert Level 3 and Other Levels Mean for You.” NZ Herald, April 16. Connor, F. 2020. “‘No Link’: MBIE Shuts Down Rumour Blaming Auckland’s

COVID-19 Outbreak on Girl Breaching Quarantine to Visit Man Deported from

Australia.” Newshub, Aug. 15. Coughlan, T. 2020. “Coronavirus: Chris Hipkins and Ashley Bloomfield Slam Spreading of ‘Vile’ Rumours About Latest COVID-19 Cluster.” Stuff, Aug. 16. Fleischman, S. 1999. “I Am . . . , I Have . . . , I Suffer from . . . A Linguist Reflects on the Language of Illness and Disease.” J Med Humanit 20: 1–31. Frank, A. W. 1995. The Wounded Storyteller: Body, Illness, and Ethics. Chicago: University of Chicago Press. Freidson, E. 1972. Profession of Medicine: A Study of the Sociology of Applied Knowledge. 4th ed. New York: Dodd, Mead. Gardener, A. 2019. “A Times Column, Now Streaming.” NY Times, April 16. Gouvernement Français. 2021. “COVID-19: La résilience des Français à l’honneur dans la campagne #TenirEnsemble.” Gouvernement Français, Aug. 2. https://www.gouvernement.fr/covid-19-la-resilience-des-francais-a-l-honneur-dans-la-campagne-tenirensemble. Government of Canada. 2020. “Coronavirus disease (COVID-19).” Government of

Canada. https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html. Government of Ireland. 2020. “In This Together.” Ireland Department of Health. https://www.gov.ie/en/campaigns/together/. Graham-Mclay, C. 2020. “‘Stay Away from Us’: New Zealanders Returning Home to

COVID ‘Lifeboat’ Face Backlash.” Guardian, June 25. Graunt, J. 1662a. Natural and Political Observations . . . Made Upon the Bills of Mortality.

London: John Martyn. Graunt, J. 1662b. Reflections on the Weekly Bills of Mortality for the Cities of London and

Westminster and the Places adjacent. London: Samuel Speed. Hanne, M., and S. J. Hawken. 2007. “Metaphors for Illness in Contemporary Media.”

Med Humanit 33 (2): 93–99. DOI: 10.1136/jmh.2006.000253. Jutel, A. 2013. “When Pigs Could Fly: Influenza and The Elusive Nature of Diagnosis.”

Perspect Biol Med 56 (4): 513–29. DOI: 10.1353/pbm.2013.0033. Jutel, A. 2019. Diagnosis, Truths, and Tales. Toronto: University of Toronto Press.

Lacey, C., M. P. Kelly, and A. Jutel. 2020. “Fighting Words in the Antipodes.” Perspect

Biol Med 63 (4): 669–82. Leder, D. 1990. “Clinical interpretation: The hermeneutics of medicine.” Theor Med 11: 9-24. New Zealand (NZ) Government. 2020a. “COVID-19 Updates.” Beehive.govt.nz. New Zealand (NZ) Government. 2020b. “Unite against COVID-19”. https://covid19. govt.nz/. Nicoll, A. 2011. “Planning for Uncertainty: A European Approach to Informing Responses to the Severity of Influenza Epidemics and Pandemics.” Bull WHO 89: 542–44. Parsons, T. 1958. “Definitions of Health and Illness in the Light of American Values and

Social Structure.” In Patients, Physicians and Illness: Behavioral Science and Medicine, ed.

E. G. Jaco, 120–44. Glencoe, IL: Free Press. Radio New Zealand (RNZ). 2020. “Nearly 10,000 Reports of Suspected Lockdown

Breaches Made.” Radio New Zealand, March 31. Smith, A. 2020. “COVID-19: Reports of Isolation Breaches Crash Website.” Radio New

Zealand, March 30. World Health Organization (WHO). 1957. Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death. Geneva: WHO. Zerubavel, E. 1996. “Lumping and Splitting: Notes on Social Classification.” Sociol Forum 11: 421–33.