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302 James E. Katz, Ronald E. Rice, and Sophia K. Acordthe identified sites, but is characteristic of centralized e-health services generally,it is understandable (as the next section argues) that users have appliedand reinvented features of the Internet to try to resolve some of these problemsthemselves. That is, the Internet has provided the potential for self-organizationamong many kinds of social networks, especially along the lines ofpersonal and group identities.THEME 2: STRAIN TOWARD SELF-ORGANIZATIONOnline Support Group CommunitiesGroups and networks of interacting participants use technology to decentralizehealth information and unite global networking and information flow withthe human experience of their own illness or suffering (Izenberg andLieberman, 1998, cited in Napoli, 2001). The developing complex networksociety is one in which distant, global edges are combined with many local,organizational clusters (Castells, 2000: 369). Networking thus becomes a selforganizinghuman activity, as health seeking is based primarily upon informationsharing and development (Wellman, 1995).The Internet has the capabilities to support virtual health communities(Wynn and Katz, 1997; Patsos, 2001; Katz and Rice, 2002). Such communities(as well as mediated relationships between physicians and patients,discussed in the following section) possibly represent a transforming relationshipbetween lay and medical knowledge (Hardey, 2001, 2002; Loader et al.,2002). Such communities are particularly useful for patients with rarediseases, as these people are by definition relatively few in number; they areusually also dispersed geographically, lack specialized care or even acceptancein their local environment. Social distance offers the opportunity for havingexpertise available while (seeming) anonymity reduces the reluctance todiscuss sensitive topics; these, of course, are characteristics of the Internet,which enable users to manage their interactions with respect to expressivenessand stigma. Access is readily available at any time and from many places(Rice, 2001). As a quick illustration of these processes in action, we note thatindividuals with depression, diabetes mellitus (a gastrointestinal disorder), ora gynecological condition were more likely to use online groups than thosesuffering from other illnesses (Millard and Fintak, 2002).Centralized medicine typically works to treat the individual patient, oftenignoring the suffering or therapeutic contributions of their loved ones. Onlinewebsites and support groups provide information, support, acceptance, and asense of real-time understanding to patients and their families and friends(Wellman, 1995; Till, 2003), and, in conjunction with physical communities,