Showing papers in "Sociology of Health and Illness in 1998"
TL;DR: In this article, the authors consider the value of vignettes together with the difficulties associated with the technique and introduce the technique in a study that explores drug injectors' perceptions of human immunodeficiency virus (HIV) risk and safer behaviour inside and outside the prison system.
Abstract: Vignettes are stories generated from a range of sources including previous research findings. They make reference to important factors in the study of perceptions, beliefs and attitudes. Vignettes have primarily been used by psychologists in North America and used in quantitative surveys but more recently they have been used in a small number of qualitative studies. Drawing from a range of studies in the social sciences this paper considers the value of vignettes together with the difficulties associated with the technique. It introduces the technique in a study that explores drug injectors’ perceptions of human immunodeficiency virus (HIV) risk and safer behaviour inside and outside the prison system.
548 citations
TL;DR: In this article, the authors consider how ideas and evidence concerning geographical health variation are used in discourses relating to health inequalities and conclude that while individual characteristics are very important for the health inequalities which are observed between people, their geographical setting also has some significance.
Abstract: This paper considers how ideas and evidence concerning geographical health variation are used in discourses relating to health inequalities. We consider the different concepts of space and place which are employed in these debates. Much of the discussion in the literature focuses on the relative importance of compositional and contextual effects in determining health variation between different geographical areas. We discuss some of the theory which might illuminate the possible impact of place on health inequalities. In the light of this theoretical debate, and focusing mainly on research from Britain, we review the empirical evidence concerning place as a contributor to health inequalities. It is concluded that while individual characteristics are very important for the health inequalities which are observed between people, their geographical setting also has some significance. This has implications for policies aiming to reduce health inequalities.
350 citations
TL;DR: In this paper, the authors argue for a re-conceptualisation of lay knowledge about everyday life in general and the nature and causes of health and illness in particular, as narratives which have embedded within them explanations for what people do and why.
Abstract: This paper contributes to the development of theory and research on inequalities in health. Our central premise is that these are currently limited because they fail adequately to address the relationship between agency and structure, and that lay knowledge in the form of narrative has a significant contribution to make to this endeavour. The paper is divided into three sections. In the first section we briefly review the existing, largely quantitative research on inequalities in health. We then move on to consider some of the most significant critiques of this body of work highlighting three issues: the pursuit of overly simple unidimensional explanations within 'risk factor' epidemiology and the (probably inevitable) inability of this research tradition to encompass the full complexity of social processes; the failure to consider the social context of individual behaviour and, in particular, the possibility for, and determinants of, creative human agency; and, thirdly, the need for 'place' and 'time' (both historical and biographical) to be given greater theoretical prominence. In the final section of the paper the potential theoretical significance of 'place' and 'lay knowledge', and the relationship between these concepts, in inequalities research is explored. Here we suggest three developments as a necessary condition for a more adequate theoretical framework in this field. We consider first the need for the conceptualisation and measurement of 'place' within a historical context, as the location in which macro social structures impact on people's lives. Second, we argue for a re-conceptualisation of lay knowledge about everyday life in general and the nature and causes of health and illness in particular, as narratives which have embedded within them explanations for what people do and why – and which, in turn, shape social action. Finally, we suggest that this narrative knowledge is also the medium through which people locate themselves within the places they inhabit and determine how to act within and upon them. Lay knowledge therefore offers a vitally important but neglected perspective on the relationship between social context and the experience of health and illness at the individual and population level.
336 citations
TL;DR: This article used data from the Fourth National Survey of Ethnic Minorities to examine three alternative approaches to ethnic inequalities in health, including genetic and cultural differences, while acknowledging the contingent and contextual nature of ethnicity.
Abstract: Most work on ethnic inequalities in health in the UK has focused on genetic and cultural difference, ignoring issues relating to class disadvantage. However, more recent work, and that conducted in the US, suggests that material disadvantage might be crucial. Nevertheless, the wider sociological literature illustrates that ethnicity and ‘race’ cannot simply be reduced to class.
This paper uses data from the Fourth National Survey of Ethnic Minorities to examine three alternative approaches to ethnic inequalities in health. Epidemiological approaches are driven by empirical findings and make little explicit acknowledgement of theoretical understandings of ethnicity, but they carry the assumption that ethnicity provides a natural and fixed division between population groups. Consequently, explanations for differences tend to be reduced to ahistoric and de-contextualised genetic and cultural factors. Structural approaches generally focus on material explanations for inequalities, but there are important methodological difficulties in assessing these. We also need to consider other elements of the structural disadvantage faced by ethnic minority groups, such as their experiences of racism or concentration in particular geographical locations. Approaches that focus on ethnic identity emphasise the importance of group affiliation and culture, while acknowledging the contingent and contextual nature of ethnicity. However, despite the promise carried by identity based approaches, there has been little empirical work undertaken.
These varying approaches illustrate how important ethnic inequalities in health might be to a wider understanding of mechanisms producing inequalities in health. However, a concern with mechanisms in health inequalities research can lead to a focus on technical interventions along causal pathways, with the roots of health inequalities, wider social inequalities, being ignored.
289 citations
TL;DR: In this article, the authors explore the interviewees' responses to the stroke as something which was "not that bad" and examine the place of the stroke within the context of these peoples' lives.
Abstract: Stroke is popularly conceived of as an illness which shatters lives. The discourse of shattered lives, articulated more generally within the sociological literature on chronic illness as ‘biographical disruption’, is examined with reference to the experience of a sample of predominantly elderly, working class people living in the East End of London. We begin by exploring the interviewees’ responses to the stroke as something which was ‘not that bad’, before going on to examine the place of the stroke within the context of these peoples’ lives. Particular attention is paid to the ways in which age may mediate illness experience.
284 citations
TL;DR: This article examined the relationship between various categories of income inequality, median state income, social trust and mortality and found that violent crime, but not property crime, is closely related to income inequality.
Abstract: Starting out from the relationship between income equality and indicators of social cohesion and social trust, this paper explores the social processes which might account for the relationship between greater income equality and lower population mortality rates. We note that: homicide shows an even closer relationship to income inequality than does mortality from all other causes combined; there are several reports that homicide rates are particularly closely related to all cause mortality; and that there is a growing body of research on crime in relation to social disorganisation.
We use US state level data to examine the relationships between various categories of income inequality, median state income, social trust and mortality. The data suggest that violent crime, but not property crime, is closely related to income inequality, social trust and mortality rates, excluding homicide. The second half of the paper is devoted to literature on the antecedents of violence. Feeling shamed, humiliated and disrespected seem to be central to the picture and are plausibly related to the way in which wider income differences are likely to mean more people are denied access to traditional sources of status and respect. We suggest that these aspects of low social status may be central to the psychosocial processes linking inequality, violence, social cohesion and mortality.
272 citations
TL;DR: In this article, the authors explore the consequences of mortgage arrears for both the health of indebted home owners and their use of primary health care services, and demonstrate that the experience of mortgage indebtedness has an independent effect on the subjective well being of men and women, and increase the likelihood that men will visit their general practitioners.
Abstract: This paper is a direct response to Wilkinson’s (1996) call for more research into housing insecurity and health. It explores the consequences of mortgage arrears for both the health of indebted home owners and their use of primary health care services. It is based on the results of a secondary analysis of the British Household Panel Survey. It demonstrates that the experience of mortgage indebtedness has an independent effect on the subjective well being of men and women, and that it increases the likelihood that men will visit their general practitioners. The paper draws upon the sociological notions of ‘ontological security’ and ‘individualisation’ to make sense of these empirical findings. It suggests that policies which have encouraged the growth of home ownership are premised on the idea of individual responsibility, a notion which underpins other spheres of contemporary welfare policies. Within this context, the consequences of mortgage indebtedness are likely to have profound psychosocial consequences for those who have direct experience of it. The spectre of mortgage debt may also contribute to the insecurity which has come to form a feature of our contemporary social and cultural life.
253 citations
TL;DR: It is suggested that conceptualising a hospice as a ‘no place’ allows it to be understood as a central part of contemporary Western culture and enables certain ideas about ‘living’, personhood and the hygienic, sanitised, bounded body to be symbolically enforced and maintained.
Abstract: This paper is based on a 10-month participant observation study within an inpatient hospice in Southern England. I highlight the difficulties of using homogenous categories such as ‘the dying patient’ and ‘the dying process’ in exploring the marginalisation of patients within the physical space of contemporary hospices and similar institutions. In opposition to such categories, my findings indicate the importance of focusing upon the body of the patient, and the disease processes taking place within it and upon its surfaces, in understanding why some patients are now sequestered within hospices whereas others are not. I argue that a significant proportion of patients are admitted to hospices because of the way in which their disease spread and subsequent deterioration affects the boundedness of their bodies and undermines their identities as persons. I suggest that conceptualising a hospice as a ‘no place’–i.e. a space within which the taboo processes of bodily deformation and decay are sequestered – allows it to be understood as a central part of contemporary Western culture. Setting the disintegrating body apart from mainstream society, as hospices appear to do, enables certain ideas about ‘living’, personhood and the hygienic, sanitised, bounded body to be symbolically enforced and maintained.
234 citations
TL;DR: In this article, a comprehensive understanding of health inequalities can be constructed from a social stress model, the self-efficacy approach, the sociology emotions, and the social cohesion approach, and a striking attempt to deal with health inequalities as it seems to solve some of the difficulties that other perspectives have had in accounting for existing empirical patterns.
Abstract: Doubts about the viability of material explanations of social inequalities in health have led to a renewed focus on the aetiological role of psychological stress, and, moreover, on how psychological stress is generated by society’s inequality structures. Some researchers maintain that the emerging psychosocial perspective will become the dominant paradigm in research on health inequalities. After commenting on some aetiological topics, the paper outlines how a comprehensive understanding of health inequalities can be constructed from a social stress model, the self-efficacy approach, the sociology emotions, and the social cohesion approach. The emerging perspective is a striking attempt to deal with health inequalities as it seems to solve some of the difficulties that other perspectives have had in accounting for existing empirical patterns. Nevertheless, it is perhaps too much to claim that it signifies a paradigm shift. It should rather be considered as an enrichment of the social causation explanation. The latter, when studying health inequalities, should be developed further by considering both material and psycho-social environments, and their mutual interaction.
215 citations
TL;DR: It was found that many women who were presented with the choice to undergo some form of adjuvant treatment versus no treatment felt that ‘doing nothing was no choice’ and retained the idea of probability but thought that they personally would beat the odds.
Abstract: Open-ended personal interviews were conducted with 20 women with early stage breast cancer attending a regional cancer centre in Southwestern Ontario. We explored three related issues: (1) the extent to which these women perceived that they had treatment options; (2) their understanding of treatment benefits and risks; and (3) the role they wanted for themselves and their oncologists in treatment decision-making.
We found, first, that many women who were presented with the choice to undergo some form of adjuvant treatment versus no treatment felt that ‘doing nothing was no choice’. Second, when interpreting probabilistic information on treatment benefits and risks, some women retained the idea of probability but thought that they personally would beat the odds. Others transformed the information to make it more personally meaningful, and still others assessed their risk status by comparing themselves with friends or relatives having the same disease. Third, many women preferred some form of shared treatment decision-making process with their oncologists. Women perceived treatment decisions as either ‘right’ or ‘wrong’ which raised the issue of blame for a ‘bad’ decision should the cancer return. Implications of these findings for clinical practice and for models of treatment decision-making are discussed.
183 citations
TL;DR: The complexities of the workings of gender in relation to health are explored, using current theorising around masculinities, hegemonic masculinity, negotiated gender and the disaggregation of gender from sex to inform health policy and practice.
Abstract: Women, typically, have been the focus for discussions of health inequalities in relation to gender. Now research on prostate illhealth turns attention to the neglected area of men’s health and to men’s disadvantage in health. Drawing on evidence of men’s experiences and perspectives of their health, the complexities of the workings of gender in relation to health are explored, using current theorising around masculinities, hegemonic masculinity, negotiated gender and the disaggregation of gender from sex. Touching also on a range of other related issues including methodological ones, the discussion offers ideas towards better understanding of gender in relation to health disadvantage. In the context of the continuing concern about health inequalities, there is scope not only for documenting ‘hidden’ health disadvantage among men, but also for reviewing how health disadvantage by gender is framed and analysed; both are useful to inform health policy and practice.
TL;DR: In this paper, a qualitative study of health in small enterprises is presented, where the authors theorize the social production of illness and injury in the workplace and argue that health and injury can become mediators of broader social tensions.
Abstract: On the basis of a qualitative study of health in small enterprises, this paper attempts to theorise the social production of illness and injury in the workplace. Particular features of working life in small workplaces, especially their personalised social relations and low polarisation of employer-employee interests, shape workers’ perceptions of the employment relationship and of health in relation to work. Strained authority relations at work can form a key social context in which health and injury are constructed. In situations of conflictful supervisory relations, bodily experiences can become ‘problematised’. Meanings attributed to health conditions and the quality of the employment relationship are transformed and merged, prompting a questioning of the legitimacy of power asymmetries in the workplace and recognition of the conflicting interests of labour and capital. Bodily experiences and ill-health offer possibilities for resistance and become mediators of broader social tensions. Unheeded illness claims deepen feelings of distrust and blame, further causing labour relations to deteriorate, and re-producing the social conditions for illness.
TL;DR: In this paper, the authors address the relevance of T. Parsons' concept of the "sick role" to the experience of illness in contemporary society by building on recent research, which suggests that the increasing predominance of chronic disease changes the temporal structure of the experiences of illness.
Abstract: This paper addresses the relevance of T. Parsons' concept of the «sick role» to the experience of illness in contemporary society by building on recent research, which suggests that the increasing predominance of chronic disease changes the temporal structure of the experience of illness. This has important implications for the structure of social expectations and obligations associated with the «sick role». In particular, recent advocates of «insider»' views of illness and the related promotion of ideologies of «patient empowerment» have contested assumptions of dependency implicit within the concept of the «sick role», presenting a far more «independent» and «proactive» vision of the sick individual. With specific application to a group of people living relatively long term with an HIV positive diagnosis, this paper addresses some of the implicit ambiguities manifest in the self-empowerment ethos, highlighting some implicit dependencies underlying the rhetoric of empowerment and concluding that a more structural analysis of illness experiences, such as that proposed by Parsons, may be apposite
TL;DR: The lack of shared meanings results in alienation from work and teamwork for staff in lower structural positions which, in turn, has considerable implications for team functioning.
Abstract: The purpose of this study was to examine the relationship between structure and meaning in multidisciplinary long-term care teams. In-depth semi-structured interviews were conducted with 26 staff working on five multidisciplinary teams in the same long-term care facility in Metropolitan Toronto. Staff in different structural locations have differing meanings of work and teamwork. Direct caregiving nursing staff have simple role-sets, minimal involvement in team decision-making and ritualistic orientations towards their work and teamwork.
Multidisciplinary professionals have complex role-sets, greater involvement in team decision-making and organic orientations towards their work and teamwork. Supervisory nurses are in a contradictory structural location and shared aspects of both orientations to teamwork. The lack of shared meanings results in alienation from work and teamwork for staff in lower structural positions which, in turn, has considerable implications for team functioning.
TL;DR: In this article, the authors report the findings of a study of satisfaction, dissatisfaction and complaining, funded by the National Health Service Executive (NHSE), and suggest that satisfaction and dissatisfaction are linked but are essentially discrete constructs.
Abstract: In this article the authors report the findings of a study of satisfaction, dissatisfaction and complaining, funded by the National Health Service Executive (NHSE). Although interest in these issues has increased with the introduction of the Citizen's Charter Initiative and the continued growth of consumerism, few scholars have looked at the relationships between them. Satisfaction and dissatisfaction are commonly viewed as different facets of the same phenomenon. In turn, dissatisfaction is often understood to be a precursor to a complaint, or an embryonic one. The findings presented here suggest that satisfaction and dissatisfaction are linked but are essentially discrete constructs. The authors plot a variety of reactions to dissatisfaction and show that although excessive use is made of formal professional networks, few instances of dissatisfaction emerge as formal complaints. The article concludes that insufficient attention has been paid to understanding the everyday ways in which people cope with dissatisfaction and decisions not to voice a grievance.
TL;DR: Men were not more likely to develop alternative, externalising, disorders to depression than women as mentioned in this paper, and women were more likely than men to experience and express anger about the life event.
Abstract: Women’s greater risk of depression is one of the most consistent findings in psychiatric epidemiology. However, the explanation for this difference remains contested. Here possible explanations were tested using a sample of couples where, because they had experienced a life event that was severe for both members, both the woman and man were at risk of depression. There was no evidence to suggest that the higher range of depression among women in this sample was the result of a measurement artefact. In addition, men were not more likely to develop alternative, externalising, disorders to depression. If anything, women were more likely to experience and express anger about the life event. Consistent with an explanation based on gender differences in roles, women were only at greater risk of depression following an event involving children, housing and reproduction, and then only when there were clear gender differences in associated roles. Such a specific difference cannot be explained easily as a result of biological differences, particularly as among women rates of depression did not vary by parity. In conclusion it seems likely that women’s greater risk of depression is a consequence of gender differences in roles, which lead to differences in the experience of life events.
TL;DR: It is argued that children, as an important social group, repay study in connection with the sociology of health and illness and make a clear case for considering people as embodied health care actors.
Abstract: This paper argues that children, as an important social group, repay study in connection with the sociology of health and illness. The paper outlines the neglect of children within medical sociology and goes on to open up a discussion towards a sociology of child health. The paper makes three main points. First, consideration of the case of health and illness helps understanding of children’s social positioning as a minority group. Secondly, children present a clear case for considering people as embodied health care actors. Thirdly, taking account of children in the sociology of health requires rethinking the division of labour and inter-generational relationships within it.
TL;DR: The paper draws on tape-recorded data from meetings of community mental health teams and describes the ways in which humour is used by participants to subvert or challenge existing occupational hierarchies.
Abstract: This paper contributes to the sociological study of humour in health care settings by analysing its use by community mental health team members dealing with referrals made by consultant psychiatrists. It is about humour and hierarchy, and specifically about humour as a strategy used by rank and file team members to resist or attenuate instructions coming from powerful professionals. The paper draws on tape-recorded data from meetings of community mental health teams and describes the ways in which humour is used by participants to subvert or challenge existing occupational hierarchies.
TL;DR: In a lifecourse perspective, cumulation of adverse socio-economic circumstances and selection are important mechanisms, which successively may cause a downward spiral, which is likely to be significant during the period of childhood and youth.
Abstract: In this article a lifecourse perspective on socio-economic inequalities in health is presented. In a lifecourse perspective, cumulation of adverse socio-economic circumstances and selection are important mechanisms, which successively may cause a downward spiral. A conceptual model is examined with empirical data. Three processes in the explanation of socio-economic health inequalities are emphasised: the contribution of childhood socio-economic conditions, the contribution of childhood health and the contribution of health selection. Data were used from the longitudinal Study of Socio-Economic Health Differences (LS-SEHD) in the Netherlands.
It was found that the relation between adult socio-economic status and adult health is influenced by childhood socio-economic conditions. An independent effect of childhood socio-economic conditions on adult health was partly explained by unhealthy behaviour and personality characteristics and cultural factors. Also, childhood health was found to play a role in the explanation of socio-economic health differences in early adult life. Health selection in childhood seems the most important mechanism in this process. With respect to health selection in adult life no effect of health problems on downward social mobility was apparent. Our results indicate that the occurrence of a downward spiral is likely to be significant during the period of childhood and youth.
TL;DR: To what extent pharmacists in the clinic constitute their clients as people with expertise and/or knowledge, what difficulties client knowledgeability can create, and how this is managed or pre-empted within the interaction is examined.
Abstract: The existence of asymmetry in medical encounters has been discussed many times in previous research, beginning with Parsons' influential functionalist view of socially prescribed roles for physician and patient. Both theory and research have undergone many transformations since, creating a general agreement amongst conversation analysts that asymmetry is 'interactively achieved' rather than imposed (Maynard 1991). However, most of the 'micro' sociological literature dealing with asymmetry in doctor/patient consultations is based on episodic encounters, as opposed to long term relationships. Conversation analysts in particular have not tended to focus on long term inter- actional sequences. The data presented here are drawn from a paediatric oncology clinic, which deals with long term cancer and leukaemia patients. These patients make regular visits to the clinic, often over a period of several years, and as such are an unusual group with respect to their knowledge of their conditions and treatment. This paper considers the implications of this with respect to the 'knowledge-based asymmetry' which has been documented in a range of lay-professional encounters. In so doing, it examines to what extent pharmacists in the clinic constitute their clients as people with expertise and/or knowledge, what difficulties client knowledgeability can create, and how this is managed or pre-empted within the interaction. In many cases, the knowledge of the patient does appear to 'diminish' the inter- actional symmetry commonly seen in lay/professional encounters to some extent. However, there are still observable incidences of what is termed 'interactional submission' by apparently know- ledgeable patients or carers during the course of the encounters.
TL;DR: This paper found that doctors respond to complaints with a range of negative emotions, and interpreted complaints as a challenge to their competence and expertise as professionals, not as issues troubling the complainant or as legitimate grievances.
Abstract: This paper reports on the findings of three empirical studies, conducted by the authors, of how doctors respond to complaints about medical care. The authors found that doctors respond to complaints with a range of negative emotions, and interpreted complaints as a challenge to their competence and expertise as professionals, not as issues troubling the complainant or as legitimate grievances. The interview data show that the way in which doctors talked about complaints and accounted for them drew on their understandings of their work world. They suggest that this helped them maintain a sense of control, and argue that this not only sustains individual security but also reinforces professional identity and serves the interests of professional politics. However, they conclude that this reaction to complaints goes against the spirit of resolving complaints to the satisfaction of the complainant which is currently the aim of systems for quality assurance.
TL;DR: The author analyses how resuscitation technology shapes sudden death in emergency departments and examines the extent to which the course of resuscitative efforts is a consequence of technological factors or of health care system characteristics.
Abstract: Social scientists and ethicists often blame the increased use of advanced medical technologies for the undignified character of contemporary dying. Based on ethnographic material and in-depth interviews with health-care providers, the author analyses how resuscitation technology shapes sudden death in emergency departments. First, he examines the extent to which the course of resuscitative efforts is a consequence of technological factors or of health care system characteristics. Second, he looks at how resuscitation technologies indirectly offer an opportunity to face pending death. In the last part, he investigates how this opportunity can be fostered when the emergency department staff takes the needs of relatives and friends in consideration
TL;DR: This article found that traditional family hospitality meals play a more important part in the life of migrant South Asians and Italians than they do in the majority culture, and British-born South Asians maintain this pattern more than Britishborn Italians.
Abstract: South Asians have a high risk of heart disease in Britain and Italians low, and there are corresponding differences in total energy and total fat intake. The present paper explores how far obligatory patterns of food intake exist in either group and are reflected in conventions of hospitality. Both groups are from peasant-based economies, where, despite the common pattern of low fat intake, food occupies a high proportion of family income, and is correspondingly important as a part of gift exchange in marriage, and as a bearer of collective meanings.
Open-ended questions on meals suitable for family hospitality were asked of South Asian women (63 born abroad, 56 in Britain), and Italian women (39 abroad, 51 in Britain) together with 50 women from the general population, all aged 20–40 and resident in the West of Scotland urban area. The traditional family meal of the Glasgow general population corresponds to the cooked dinner described in South Wales, and suggests a pan-British cultural symbol. However traditional family hospitality meals play a more important part in the life of migrant South Asians and Italians than they do in the majority culture, and British-born South Asians maintain this pattern more than British-born Italians. This pattern of hospitality, in an economy where energy-dense foods are readily available, may result in high energy intake and increased coronary risk. However realisation of these implications, and increased weight consciousness, can lead to restoration of the traditional cardioprotective diet.
TL;DR: In this article, the authors discuss the reinforcement offered to ontological dualism by biomedicine and discuss the parallels between the development of feminist health activism and that of professional, non-medically qualified homoeopathy.
Abstract: In this paper the author begins by discussing the reinforcement offered to ontological dualism by biomedicine. It then describes some parallels between the development of feminist health activism and that of professional, non-medically qualified homoeopathy, going on to ask whether alternative medicine can offer a political challenge to ontological dualism. Three aspects of the feminist critique of biomedicine are discussed in relation to contemporary, feminist, homoeopathy. They include the power dynamics within the clinical encounter, the degree to which social and environmental issues are incorporated within medical diagnosis and treatment, and the manner in which the patient's subjective experience is used during case-taking. He concludes that contemporary feminist homoeopathy does address the concerns relating to dualism and power raised by the health activists of second wave feminism; it therefore must be considered a feminist form of medicine. However, its very success in this regard raises a new set of difficulties and tensions. Although holistic forms of medicine do have the potential to address the ontological dualism which is inherent to biomedicine, they may also increase the capacity practitioners have to construct and enforce normative forms of behaviour through their clinical practice. In addressing one set of feminist concerns relating to biomedicine, homoeopathic practice may actually intensify the dangers relating to a second set of feminist concerns
TL;DR: The term medicalisation is considered in the light of an empirical study on menstruation as discussed in medical advisory columns, and the letters sent to the magazines do not lend support to the idea of medicalisation as an endeavor pursued by the medical profession alone.
Abstract: The term medicalisation is considered in the light of an empirical study on menstruation as discussed in medical advisory columns. The focus is on how the medical profession responds to young women’s questions about their maturing bodies. The questions are seldom of a medical nature; rather, they are concerned with normality and coping with menstruation in everyday life. The doctors’ response is clear: the patient need not worry, the medical profession is both willing and able to take over the responsibility for, and control over, the body. The medicalisation of menstruation that can be found in advisory columns strengthens the position of the medical establishment as the legitimate authority on the body. Nevertheless, the letters sent to the magazines do not lend support to the idea of medicalisation as an endeavor pursued by the medical profession alone. The letters are also a means whereby young women try to establish standards for proper female gender behaviour in an areas where lay society remains silent.
TL;DR: The article shows the main dimensions that go to make up the patient's mobilizing worth : closeness to the core of real emergencies; social demands; the intellectual interest of the case; questions raised by transfers of responsibility between doctors; and some indications about their complexity.
Abstract: The hospital is characterized by a dual orientation : being open to the heterogenous demands for medical care that are spontaneously directed to it, and selecting patients in terms of their match with medical specialties represented in its different services. This tension is at the heart of the functioning of emergency services. Based on ethnographic fieldwork in a French teaching hospital, the article examines the consequences of this duality on the concrete organisation of work. It shows the main dimensions that go to make up the patient's mobilizing worth : closeness to the core of real emergencies; social demands; the intellectual interest of the case; questions raised by transfers of responsibility between doctors. For each dimension, it studies staff reactions and gives some indications about their complexity. Finally it suggests some comparisons between these results and the observations made by several studies conducted in American and UK hospitals since the 1970s
TL;DR: In this article, a three-phase model for periodising the activity of the groups and movements of the post-war era is proposed, with the largest part devoted to an examination of one particular aspect of the first phase: the birth of the National Association For Mental Health and their activities in their first ten years of life.
Abstract: The paper begins by noting the absence of any sustained analysis of post-war mental health pressure groups and movements. This is deemed problematic because such movements and groups have had a strong presence during this period and because movements, as such, are afforded a central role in much contemporary sociology on account of their role in the process of social change. Next the paper considers how such analysis should be conducted, and suggests a three-phase model for periodising the activity of the groups and movements of the post-war era. The largest part of the paper is then devoted to an examination of one particular aspect of the first phase: the birth of the National Association For Mental Health and their activities in their first ten years of life. Much can be learned from the study of this group.
TL;DR: In this paper, the authors look at the deployment of a medical technique, reflex anal dilatation, and contrast the way in which its deployment was a subject of enormous controversy in the Cleveland child sexual abuse affair with its comparatively unproblematic previous use to identify homosexuality.
Abstract: This paper looks at the deployment of a medical technique, reflex anal dilatation and contrasts the way in which its deployment was a subject of enormous controversy in the Cleveland child sexual abuse affair with its comparatively unproblematic previous use to identify homosexuality. We interpret this contrast using two general frameworks: recent work in the sociology of scientific knowledge, particularly actor-network theory, and Foucauldian work on dangerousness and visibility. We argue that the specific historical conditions surrounding the two different deployments allow an understanding of why the deployment of the technique was resisted in one case but not in the other. While Foucault helps us to understand the potential for contestation between the proponents of RAD in Cleveland and actors such as families and politicians, actor-network theory enables us to examine how such conflict actually arose through tracing the sorts of resources that could be mobilised in problematising RAD. In particular, we note that the antagonists of RAD had available a 'practice of rights' towards which they could orient themselves in their contestation of the 'practice of care' that informed the activities of the RAD proponents.
TL;DR: The ways in which homeopathic medicine accords with an expansive view of the consultation in general practice, and offers doctors a means of avoiding the iatrogenic effects of modern drug treatments are explored.
Abstract: Sociological studies of complementary and alternative therapies have largely focused on the activities and experiences of lay practitioners and users. In contrast, this paper explores some of the ways that a group of medically qualified general practitioners employ homeopathic treatments in their everyday work within the NHS. We explore the ways in which homeopathic medicine accords with an expansive view of the consultation in general practice, and offers doctors a means of avoiding the iatrogenic effects of modern drug treatments. We also point to the ways that this involves practitioners in engaging with contests about the utility of treatments that are rejected by contemporary bioscience.