Complex and dynamic times of being chronically ill: Beyond disease trajectories of patients with ulcerative colitis Sergei Shubin a, * , Frances Rapport b , Anne Seagrove c a Geography, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK b Centre for Healthcare Resilience & Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, NSW, 2113, Australia c College of Medicine, Swansea University, Singleton Park, Swansea, SA2 8PP, UK article info Article history: Received 28 July 2015 Received in revised form 6 October 2015 Accepted 27 October 2015 Available online 31 October 2015 Keywords: United Kingdom Time Chronic illness Temporality Heidegger Ulcerative colitis abstract This article contributes to health research literature by problematizing the linear, sequential and intel- ligible understanding of time in the studies of illness. Drawing on the work of Martin Heidegger, it at- tempts to overcome the problem of considering the time of illness as either a framework controlling patients' experiences or a mind-dependent feature of their lives. The paper offers a conceptual analysis of the stories of ulcerative colitis patients from a recent clinical trial to present temporalities of illness as both objective and subjective, relational and dynamic. We attend to a combination of temporalities related to the ambiguous unfolding of illness and patients' relationships with such an unpredictable world of changing bodies, medical practices and temporal norms. Furthermore, our analysis reveals openness of times and considers ulcerative colitis patients as constantly evolving beings, with multiple possibilities brought about by illness. The paper highlights co-existence of times and considers patients' lives as incorporating a multiplicity of futures, presents and pasts. It concludes with conceptual obser- vations about the consequences of developing complex approaches to illness in health research, which can better highlight the situatedness of patients and their multi-dimensional temporal foundations. © 2015 Elsevier Ltd. All rights reserved. 1. Introduction This paper presents a new perspective on the concept of ‘time’ in health and illness. It aims to address a number of important limi- tations in the interpretation of time that the current health services literature reveals in its presentation of patients' health concerns, and their views on healthcare professionals' practices in the sup- portive role. In order to achieve this, the paper uses interview data collected during a recent clinical trial (CONSTRUCT) with ulcerative colitis patients discussing their health and illness stories, in order to respond to the following limitations in the health and illness literature. Firstly, researchers often present patient's life trajectories, or changes to their health and wellbeing over the course of an illness linearly, as a succession of instants along an imaginary line (which we shall call in this paper a patient's ‘career’, Murray et al., 2005; Robinson, 1990). In so doing they tend to focus on static medical outcomes such as functioning and treatment adherence, and on temporal sequences of interventions that fail to express the very movement of time (Gergel, 2013). Within such flat temporalities, priority is often accorded to synchronising individuals' activities in a healthcare context with externally imposed temporal frameworks (such as a patient's history taking, medical progression, or the “controllable time” of consultation reporting, cf. Richardson et al., 2008) to the exclusion of a patient's surprisingly divergent expe- riences, as described by them. As a result, temporal experience is often explored within a binary framework that is pre-defined by the healthcare professional e such as temporary or permanent illness, available or ideal treatment options, “reclaimed” or “consumed” time (Seymour, 2002). These are perceived to be logically distinct, clearly separate dimensions, that relate to a pa- tient's past, present and future whereas we would argue for a more nuanced, overlapping, and less distinct approach to understanding the complex dimensions of health and illness. Secondly, the existing literature often presents time as an entity both consciously intelligible and easily manipulated by patients and healthcare professionals, in order to achieve specific goals such as ‘planned’ drug treatments (Grant et al., 2003; Hjelmblink and * Corresponding author. E-mail address: s.v.shubin@swansea.ac.uk (S. Shubin). Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed http://dx.doi.org/10.1016/j.socscimed.2015.10.065 0277-9536/© 2015 Elsevier Ltd. All rights reserved. Social Science & Medicine 147 (2015) 105e112