Learning to Trust in a ‘Paracetamolocacy’: Studying the Taken-for-Granted Processes of Trusting in As These Become Exposed amid the Healthcare Experiences of Migrants

Trust theory has long noted the importance of systems and earlier work, especially that of Luhmann, sought to address the taken-for-granted role of systems by drawing on phenomenology. Yet Luhmann struggled to reconcile the lived experiences and understandings of individuals with an analysis of systems and ultimately the taken-for-granted features of trust were ‘abandoned’ in favour of a more risk-oriented analysis, as recent work by Frederiksen acknowledges. Trust theory has not progressed significantly in relation to systems and struggles to theorise trust amid multiple systems. Möllering, among others, has emphasised the missed potential of studying the taken-for-granted, with trust theory in this area suffering from a lack of empirical insights. Due to their very nature, these taken-for-granted roots of trust have remained overlooked in empirical studies – buried beneath the surface.

In this paper we draw on a pertinent case study to overcome this empirical-methodological problem. We analyse interview data with Italians who have recently migrated to the Netherlands and who have had a range of experiences with the Dutch healthcare system. Their implicit knowledge of Italian healthcare systems suddenly becomes explicit and illuminated when taken-for-granted assumptions no longer apply. Likewise, the unfamiliarity of the Dutch system(s) meant that system knowledge has had to be learned. By studying these participants’ narratives regarding experiences over several years, we develop a range of insights into: the nature of taken-for-granted system assumptions; the processes of uncertainty and risk by which system assumptions develop over time; and the powerful ways in which (mis)trust works to reorient practices – gradually reshaping these 'Italians' into ‘Dutch’ patients. We draw on Habermasian conceptions of lifeworld in developing this theorisation and conclude by relating our contribution to broader theories of trust. We also consider the importance of the taken-for-granted for wider theories of risk and uncertainty.