Showing papers in "Sociology of Health and Illness in 2002"
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TL;DR: In this article, the authors report the results of a study of felt and enacted stigma among a sample of parents of children with high functioning autism, finding that a majority of the parents experienced both types of stigma, but that mothers were more likely to do so than fathers.
Abstract: This paper reports the results of a study of felt and enacted stigma among a sample of parents of children with high functioning autism. The results indicate that a majority of the parents experienced both types of stigma, but that mothers were more likely to do so than fathers. This was especially true in the case of enacted stigma, where a majority of mothers, but only a minority of fathers, encountered avoidance, hostile staring and rude comments from others. The child's type of autistic symptoms was also related to the stigmatisation of their parents, with parents of aggressive children more likely to experience stigma than the parents of passive children. The study also found that the distinction between felt and enacted stigma was more distinct analytically than it was in practice, as many parents tended to conflate the different types of stigma. The results of the study are considered in the context of the changing conceptualisations of, and treatments for, high functioning autism and their implications for the stigmatisation of parents.
474 citations
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TL;DR: In this paper, the potential for a visual approach is analysed drawing on a range of studies, broadly within the sociology of health and illness, which have used visual approaches, highlighting the value of visual methodology projects within qualitative approaches to research more generally.
Abstract: This review starts from the premise that the visual has been, until recently, a neglected dimension in our understanding of social life, despite the role of vision in other disciplines, including medicine itself. The potential for a visual approach will be analysed drawing on a range of studies, broadly within the sociology of health and illness, which have used visual approaches. I highlight the value of visual methodology projects within qualitative approaches to research more generally, and assess the difficulties as well as the advantages. It is suggested that using visual methodologies does not necessarily lead to greater reactivity in the research process as has sometimes been proposed; and that visual worlds are themselves unique topics of sociological study which may be enhanced by using visual techniques rather than written and spoken language. A combination of visual and traditional methods can also be fruitful. Painting and drawing, video, film, and still photography are included as examples which researchers have used and can use.
276 citations
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TL;DR: It was found that older respondents portrayed their symptoms as a normal and integral part of their biography, but they also talked about the highly disruptive impact of symptoms on their daily lives.
Abstract: This paper examines the meanings of symptoms for people with osteoarthritis. The study comprised 27 in-depth interviews with men and women aged between 51 and 91 years (median age = 76) and draws on previous sociological work about experiences of chronic illness, disability and ageing. In particular, the distinction proposed by Bury between ‘meaning as significance’ (the significance and connotations associated with illness) and ‘meaning as consequence’ (problems created for the individual by activity restriction and social disadvantage), provides a useful framework to examine the biographical aspects of symptoms. We found that older respondents portrayed their symptoms as a normal and integral part of their biography, but they also talked about the highly disruptive impact of symptoms on their daily lives. We consider how these co-existing accounts of meaning make sense in the context of cultural connotations of ageing and the implications for meeting health care needs of older people with osteoarthritis.
275 citations
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TL;DR: The authors found that men are reluctant to consult their doctors, because "men don't cry", thus reinforcing the notion that "masculinity" is a social construction, and that side effects of surgical and radiotherapy treatments sometimes led to impotence and incontinence, while the treatments that involved hormones were reported to have an additional, sometimes profound effect on libido, energy, ability to work, body shape and competitiveness.
Abstract: While some argue that gender differences, which refer to the social classification into 'masculine' and 'feminine', have their source in 'culture', others argue there is no need to have an absolute dichotomy between culture and nature, or between constructionist and anti-constructionist epistemologies. Although there has been much theorising about the body, until recently little attention has been paid to empirical evidence. This paper looks at the way in which prostate cancer and its treatment affects men's bodies, their roles and sense of masculinity. Interviews were conducted with 52 men, exploring their experiences of prostate cancer. Findings suggest that many men are reluctant to consult their doctors, because 'men don't cry', thus reinforcing the notion that 'masculinity' is a social construction. However, while the illness and the side effects of surgical and radiotherapy treatments sometimes led to impotence and incontinence, the treatments that involved hormones were reported to have an additional, sometimes profound effect on libido, energy, ability to work, body shape and competitiveness. These side effects reduced some men's sense of masculinity. We conclude that the physical body as well as culture should be considered when trying to explain what it means to be masculine, and how illness may affect men's sense of masculinity.
268 citations
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TL;DR: This article found strong independent relationships between health and experiences of racism, perceived racial discrimination and class, and found that ethnic identity is not related to health rather, the multivariate analyses presented in this paper showed strong independent relationship between ethnicity and health.
Abstract: To understand ethnic inequalities in health, we must take account of the relationship between ethnic minority status, structural disadvantage and agency So far, the direct effects of racial oppression on health, and the role of ethnicity as identity, which is in part a product of agency, have been ignored We set out to redress this balance using data from the Fourth National Survey of Ethnic Minorities Factor analysis suggested that dimensions of ethnic identity were consistent across the various ethnic minority groups Initially some of these dimensions of ethnic identity appeared to be related to health, but in a multivariate model the factor relating to a racialised identity was the only one that exhibited any relationship with health These findings suggest that ethnic identity is not related to health Rather, the multivariate analyses presented here showed strong independent relationships between health and experiences of racism, perceived racial discrimination and class
247 citations
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TL;DR: Men's experiences of the ultrasound scan have been studied in this paper, where the authors provide a theoretical analysis of men's empirical accounts of seeing the baby during an ultrasound scan and discuss how ultrasound can be constructed as simultaneously both a medical and a social event with the potential to generate epistemological conflicts.
Abstract: Drawing on an ethnographic study of the transition to contemporary British fatherhood, this paper discusses men's experiences of the ultrasound scan. Seeing the baby on the screen seemed to herald an escalation of their awareness of the baby, reinforcing its reality. Visual knowledge, as opposed to other forms of knowledge, therefore became a primary means of knowing the baby. In this paper I provide a theoretical analysis of men's empirical accounts of seeing the baby during the ultrasound scan. After a description of method, I set the context by presenting data to illustrate the significance of the ultrasound within men's pregnancy experience. The paper then sets up the theoretical foundations for an analysis of these accounts by first, examining the development of the primacy of vision within medicine and secondly, discussing the illumination of the body interior, initially by dissection but now via contemporary technologies of vision including ultrasound. The final section, draws upon further data and discusses how ultrasound can be constructed as simultaneously both a medical and a social event with the potential to generate epistemological conflicts.
148 citations
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TL;DR: It is shown how the professional role and status of the community pharmacist (chemist) in the context of consumerist health care is challenged by the consumer’s power in the commercial transaction and perceived expertise in the management of minor illness.
Abstract: In this paper we consider the professional role and status of the community pharmacist (chemist) in the context of consumerist health care. The sociological perspective of pharmacy as an incomplete or marginal profession has been challenged in more recent work, which describes how pharmacists act to ‘transform’natural objects (drugs) into more valued social objects (medicines). We consider this process as it applies to the everyday and ‘taken-for-granted’ act of buying medicines in the pharmacy. We draw on focus group and interview data from a study involving consumers and pharmacy staff in the North West of England. The consumers had purchased one of a group of ‘deregulated’ medicines, which were previously available only with a doctor’s prescription. One way in which pharmacists have sought to develop their professional role is by trying to formalise their involvement in the surveillance of medicine sales. We show how this professionalising strategy is challenged by the consumer’s power in the commercial transaction and perceived expertise in the management of minor illness. This challenge forms a boundary to the pharmacists’‘transformatory’ work, and forms part of an ongoing negotiation of the meaning and relevance of their expertise. We present the strategies adopted by consumers and pharmacy staff to (respectively) obtain the desired medicines and fulfil professional responsibilities against a background of differing and contested assessments of the risks associated with medicines use.
122 citations
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TL;DR: GPs’ perceptions of how current government policies, and the new institutions and governance arrangements that they have created impact on physicians’ ability to set their own limits and to judge their own work are investigated.
Abstract: Clinical autonomy has long been seen as conceptually central to the analysis of the occupational status of the medical profession, though the implications for this of recent developments in health care managerialism have been disputed by theorists. In particular, the question has arisen as to whether ‘restratification’, that is, the active involvement of physicians in this process, should be construed as medical elites exerting control over the rank and file in order to protect the profession as a whole, or as an incursion from outside it. This paper uses interview data from 49 general medical practitioners in Northern England. It investigates their perceptions of how current government policies, and the new institutions and governance arrangements that they have created impact on physicians’ ability to set their own limits and to judge their own work. We found a clear acceptance by GPs of the need to discharge ‘bureaucratic accountability’, in particular to maintain records of their clinical decisions. This provides the possibility of external surveillance of medical work, and thus implies a clear reduction in autonomy over the content of medical work on the part of rank-and-file GPs, who may regret this situation but offer little resistance to it. Our findings illustrate a form of restratification; the most frequently reported immediate source of pressure to modify casenote recording was the Primary Care Group (PCG), an organisation constitutionally dominated by physicians acting in a managerial capacity. Nevertheless, the agendas of PCGs are largely driven by central government and our study thus provides further evidence of the intermediary or contingent (rather than independent) character of professional autonomy.
110 citations
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TL;DR: A content analysis of a series of medical textbook entries found that throughout this period the text consistently maintains that obesity results from a simple excess of caloric intake over expenditure, and demonstrates that medical conceptualisation of a presumably cohesive object of knowledge can undergo transformation quite independently of definitive experimental evidence.
Abstract: Obesity is now the focus of considerable attention in the medical profession, and many have noted that obesity has been progressively medicalised. The subjection of phenomena to medical explanation, however, has been associated with both the potential to relieve and also to exacerbate the attribution of individual responsibility. In order to understand the ways in which a particular phenomenon, obesity, can be variously conceptualised at different time-points within a medical framework, we conducted a content analysis of a series of medical textbook entries. Using the widely-consulted Cecil Textbook of Medicine, we reviewed entries on obesity from 1927 to 2000 and found that throughout this period the text consistently maintains that obesity results from a simple excess of caloric intake over expenditure. Despite the unwavering nature of this basic model, an evolving set of causal factors is superimposed. Early models invoke aberrant individual activities, such as habitual overeating, while later editions drop these factors in favour of genetic and, paradoxically, environmental effects. Obesity shifts in ontological status, as it is transformed from being the product of something that individuals do to something that they experience. Concurrent with these changes, we find a change in the social appraisal of obesity. In each edition there is a narrative regarding the cost/benefit relationship between obese persons and society, as well as a construction of accountability for obesity as an outcome. Obese individuals are progressively held less responsible for their condition in successive editions of the text. Initially cast as societal parasites, they are later transformed into societal victims. Using these texts and obesity as a case-example, we demonstrate that medical conceptualisation of a presumably cohesive object of knowledge can undergo transformation quite independently of definitive experimental evidence, with a persistent dialectic between etiological configuration and formulations of social culpability and remediation. We situate our findings with respect to ongoing debates concerning the nature and implications of medicalisation. This case effectively highlights a more general epidemiological tension between an individual level of focus on risk behaviours and a population level of focus that contexualises behaviours within a social and material framework.
97 citations
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TL;DR: Previous ethnographic work on the classification in medical work of children and adults as good or bad, appropriate or inappropriate, culpable or blameless is developed, and a repertoire of moral formulations about childhood and child care is rendered visible.
Abstract: This paper presents data from a recently completed ESRC funded ethnography of social relations and case formulation in an integrated child health service, comprising paediatric inpatient and outpatient, child and adolescent mental health and child development services. Children present to the services with symptoms or troubles for which there are often competing biological, neurological, genetic and/or psychosocial models of causation. As a consequence, clinicians’ talk is oriented to deciding between three main potential types of case formulation – medical, psychosocial and not just medical. These three formulations are not static ideal-types. They are highly contestable and require complex practical and rhetorical work, through which facts and evidence are selectively invoked and different parties to the case are granted attributes which construct and reconstruct past events to render ambiguous symptoms or events understandable. In particular, moral judgements and complex characterizations about the child’s parents, or significant others, often form an indispensable warrant for these formulations. By analysing professional narratives about cases, this paper develops previous ethnographic work on the classification in medical work of children and adults as good or bad, appropriate or inappropriate, culpable or blameless, and renders visible a repertoire of moral formulations about childhood and child care. In particular, judgements about the adequacy of parental love are central to clinical reasoning.
92 citations
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TL;DR: It is argued that so-called ‘family-friendly’ policies must target both sexes and that the underlying attitudes of men to childcare and the domestic division of labour must change before the sexes can compete on equal terms in the workplace.
Abstract: With the Government promoting flexible and ‘family-friendly’ policies within the NHS, an increase in the number of part-time nurses is imminent, particularly in view of current pro-active recruitment drives in this area. Research, however, indicates that it is mainly female employees who continue to utilise such policies with few male nurses employed on a part-time or flexible basis. Working part-time and taking career breaks, usually because of caring commitments, results in female nurses falling behind male colleagues in terms of career development and promotion prospects, with managers selecting males over females (particularly those who work part-time) regarding functional role allocation in the hospital setting. Based on a recent study of full-time and part-time nurses and their managers in three Outer London NHS Trusts, this paper argues that so-called ‘family-friendly’ policies must target both sexes and that the underlying attitudes of men to childcare and the domestic division of labour must change before the sexes can compete on equal terms in the workplace. Until this happens men will continue to advance the development of their nursing careers more rapidly than women. Already, in a female-dominated area of employment, male nurses form a disproportionate percentage of those in higher grades and management posts.
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TL;DR: In this paper, the authors employ three concepts from the field of technoscience studies to elucidate how epidemiological constructions about bodily differences are infused with authority and legitimacy: race, social class and gender.
Abstract: The multifactorial model of disease causation constitutes the dominant conceptual framework underwriting the epidemiology of chronic illness. Under this rubric, factors correlated with disease are analysed at the individual level; accordingly, race, social class and gender are routinely conceptualised and incorporated into epidemiological research as individualised measures of racial category, socioeconomic status and sex. This paper employs three concepts from the field of technoscience studies to elucidate how epidemiological constructions about bodily ‘differences’ are infused with authority and legitimacy. The multifactorial model and accompanying representations of race, class and gender can be usefully conceptualised as a black box (Latour 1987, Latour and Woolgar 1986), in which individualised inputs to epidemiological studies are routinised while the interior workings of the black box – how exactly ‘differences’ come to affect health – are taken for granted. Second, processes of triangulation (Star 1985, 1986) are evident, as results from multiple lines of research on an array of different diseases are used to enhance the stability of the multifactorial model and associated constructions of ‘difference’. A final illuminating technoscience concept is that of the boundary object (Star and Griesemer 1989), whose dual properties of conceptual flexibility and integrity help in understanding the proliferation and institutionalisation of epidemiological methods of studying race, class and sex/gender in chronic disease.
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TL;DR: This paper found that the linkages between criminality and mental illness are achieved through the use of ideological, polarised talk that creates distinctions between Us and Them, as well as through a hierarchy of mental illnesses.
Abstract: Researchers have identified that portrayals of mentally ill people as violent and criminal are among the most common depictions of mental illness in the popular media (Nunnally 1961, Wahl and Roth 1982, Day and Page 1986). Little attention, however, has been paid to assessing the textual strategies whereby such representations gain currency. This research is interested in investigating the reporting techniques utilised by the popular press including the ways in which power, knowledge and ideology articulates in and through media reports about mental illness. This study draws on Foucault (1972) and van Dijk (1998), to assess data generated out of a discourse analysis of 195 articles from two major Canadian newspapers over the past decade (1990–1999). Findings suggest that the linkages between criminality and mental illness are achieved through the use of ideological, polarised talk that creates distinctions between Us and Them, as well as through a hierarchy of mental illness. Within the hierarchy of illness, three portrayals are explored including the mentally ill criminal, the passive patient and class based illness depiction. A major finding reveals that, throughout the various representations, a central reporting feature is of mentally ill people as simultaneously rational and irrational. Furthermore, varying degrees of agency are afforded mentally ill subjects on class lines, which has implications for the substantiation of responsibility and blame.
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TL;DR: This article found that the complex and strategic blending and switching of vocabulary, tone and accent is one means through which identities and support networks are negotiated and affirmed among Glasgow Punjabis, and the hybrid use of language can and should be reflected in the way that research is conducted with multilingual communities and some preliminary suggestions are made.
Abstract: Language and translation are not treated as part of the problematic in sociological research when compared with that of social anthropology, and this relative inattention can be related to the parallel development of the two disciplines. Ethnographic evidence from studies of identity, social support and wellbeing among Glasgow Punjabis suggests that the complex and strategic blending and switching of vocabulary, tone and accent is one means through which identities and support networks are negotiated and affirmed. The hybrid use of language can and should be reflected in the way that research is conducted with multilingual communities and some preliminary suggestions are made.
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TL;DR: Survey of young temporary workers employed in Australian outlets of a well-known multinational fast food chain found the Fordist regimes of fast food chains may still constitute a less hazardous working environment for temporary workers than more disorganised work settings.
Abstract: A growing body of international research points to an association between precarious employment or contingent work arrangements and a higher incidence of injury, disease and psychological distress as well as inferior knowledge/compliance with occupational health and safety (OHS) standards Despite this, published research on the OHS problems of young workers in hospitality and other service industries largely ignores the fact that many are engaged on a temporary basis To address this gap we surveyed 304 young temporary workers employed in Australian outlets of a well-known multinational fast food chain Indices assessed included work-related injuries, exposure to occupational violence, and knowledge of OHS practices and legislative rights In trying to explain the adverse OHS outcomes associated with contingent work, researchers have repeatedly identified three sets of factors; economic and reward pressures, work disorganisation and regulatory failure Like most other multinational fast food companies, this firm adopted a Fordist production system Given suggestions that Fordist systems adversely affect worker health and wellbeing, it seemed plausible that the combination of Fordism with reliance on a young casualised workforce would result in markedly inferior OHS outcomes Contrary to this expectation, workers surveyed had an incidence of injury around the norm for full-time permanent workers, and an excellent knowledge of risk control measures and OHS legislation On the other hand, they had limited knowledge of their workers’ compensation entitlements and faced an elevated risk of low-level occupational violence
Far from exacerbating the situation, the primary reason for the positive injury and knowledge outcomes was the Fordist system that tightly specified tasks and incorporated detailed risk assessment and control procedures This system was shaped by an overriding concern for the company’s bottom line (hence the worker’s poor knowledge of worker’s compensation – a result more typical of contingent workers) but pervasive controls had benefits for an otherwise vulnerable workforce Ritzer (2000) and others have portrayed the Fordist regimes of fast food chains as integral to a system where workers are indoctrinated, class relations obfuscated and covert threats to continued employment used to undermine solidarity Without denying this, these systems may still constitute a less hazardous working environment for temporary workers than more disorganised work settings Further research is needed to determine whether the study findings can be generalised or are restricted to this chain or its Australian outlets
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TL;DR: In this paper, an original variation is added to the anthology of relations between care and coercion, inspired by ANT, which seeks to participate in a criticism of the liberal definition of the human agent.
Abstract: Is the addict a criminal or a patient? Should addicts be approached with coercive means or in such a way that his/her individual freedom is protected? This way of framing the problem of addiction opposes freedom and coercion, care and constraint, activity and subjugation. These dualisms have structured the French medical and legal debates until recently. At the beginning of the 1990s, however, the evident opposition between freedom and coercion was problematised. The critics tentatively designed a new form of substitution treatment. With methadone and other constraints, this treatment was a search for ‘generous constraint’, that is, for the conditions under which coercion might do a little more than oppress the user. Through a detailed description of several techniques of this experimental treatment, an original variation is added to the anthology of relations between care and coercion. Moreover, this contribution, inspired by ANT, seeks to participate in a criticism of the liberal definition of the human agent.
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TL;DR: This research finds that the actions of consumers and health care administrators, coupled with state policy evolutions and the expansion of managed care, work together, as a system, to intensify interprofessional competition between certified nurse-midwives and physicians, further undermining that dominance.
Abstract: The growth of managed care in the United States is altering the shape of the system of professions and is accelerating an overall decline of physician professional dominance in that system. An adequate understanding of the changing character of the system of professions demands a consideration of the interacting roles of ‘competing’ health care providers, the state, corporate and consumer forces; however, past research addressing one or more of these forces has not explicitly examined their interrelation. The countervailing powers framework provides a starting point for articulating precisely this sort of interrelation. Using data from a comparative case study of interprofessional competition between certified nurse-midwives (CNMs) and physicians within select state policy and managed care contexts, this article extends the countervailing powers framework, illustrating how the relationships among relevant parties in the health care system can be understood as a system of alignments challenging physician professional dominance in a complex manner. Specifically, this research finds that the actions of consumers and health care administrators, coupled with state policy evolutions and the expansion of managed care, not only separately challenge physician professional dominance but also work together, as a system, to intensify interprofessional competition between certified nurse-midwives and physicians, further undermining that dominance.
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TL;DR: One of three papers (others in Social Science & Medicine and Disability & Society), ESRC funded (£93K), builds on WA's work funded by DH and JRF.
Abstract: One of three papers (others in Social Science & Medicine and Disability & Society), ESRC funded (£93K). WA was PI. Builds on WA's work funded by DH and JRF. Led to interviews on BBC, including See Hear and Asian Network. WA invited to become Trustee of a major Deaf organisation.
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TL;DR: This paper concerns a qualitative study exploring the nature of surgical work with a group of 34 surgeons involved in treating urinary incontinence, and a typology of contingency was found in this area of everyday surgical work.
Abstract: This paper concerns a qualitative study exploring the nature of surgical work with a group of 34 surgeons involved in treating urinary incontinence. Sources of surgical variation are identified from surgeons' own accounts of their work as well as observation of the selection of patients and operative procedures, and the operative process itself. A typology of contingency, consisting of three categories of contingency (case, surgeon and external), was found in this area of everyday surgical work. In developing this typology, theoretical and philosophical ideas about habitus and disposition, and practical and technical knowledge, are considered and extended to help to understand the nature of surgical practice. These ideas may also be useful in explaining some of the apparent tensions between evidence-based surgery and everyday surgical work.
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TL;DR: In this article, the authors present extracts from a body of data collected at a regional genetic counselling centre, and analyse using a conversation analytic approach, focusing on the communication of genetic information by counsellors and the ways in which this is received by clients, and how this impacts upon the way in which topics for discussion are arrived at.
Abstract: The rapid scientific and technological advances in the field of human genetics have created an ever-widening gap in knowledge and understanding between those specialists who are involved with them and the general public who are the intended beneficiaries. Genetic counselling is seen as an important way of addressing this gap. Whilst there is a growing literature on genetic counselling, this has tended to focus on quantitative measures of outcome. However, there is a growing recognition that genetic counselling is a communicative process, and needs to be studied as such. This paper presents extracts from a body of data collected at a regional genetic counselling centre, and analysed using a conversation analytic approach. A particular emphasis is placed upon the communication of genetic information by counsellors and the ways in which this is received by clients, and how this impacts upon the ways in which topics for discussion are arrived at. Four areas around which interactional difficulties arise are identified: achieving a client-led agenda; knowing what is relevant for a particular client; managing different activities within counselling; and managing the multiple perspectives of clients.
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TL;DR: The embodied experience of ill-health is an important, underlying prerequisite for perceiving a future in which (further) ill- health is anticipated, and this pivotal finding will be used to illuminate the observation that, when lifestyles are changed to concur with professional recommendations, these changes tend to be reactive in nature.
Abstract: Health promotion is premised upon a proactive approach to health and its management, one that requires a future-orientated outlook, in which the threats of (future) ill-health can be anticipated and thereby mitigated. Despite this, little is known about the extent to which concerns about morbidity and mortality actually feature in people's present and future perceptions of self, and whether such perceptions have any influence upon their present health-relevant behaviours. By drawing upon interviews with 55 people aged 26–81, this article highlights the central role that embodiment plays in the mediation of health promotion messages. The embodied experience of ill-health, it will be shown, is an important, underlying prerequisite for perceiving a future in which (further) ill-health is anticipated. This pivotal finding will be used to illuminate the observation that, when lifestyles are changed to concur with professional recommendations, these changes tend to be reactive in nature.
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TL;DR: The paper argues that this policy frame is consistent with recent claims from criminologists that there is a new 'turn' in penal policy, away from rehabilitation and addressing the needs of individual offenders, and that doctors are not 'zero tolerant' in responding to attacks.
Abstract: Violence against doctors provides an illuminating context for studying medicalisation and its limits in the management of deviance. The paper examines the emergence of such violence as a policy issue in England, with particular reference to general practitioners (GPs) in the National Health Service. Recent guidance exhorts doctors to exercise 'zero tolerance' with respect to acts of violence. The emphasis is on risk management and protecting victims rather than on resolving the perpetrators' problems. The paper argues that this policy frame is consistent with recent claims from criminologists that there is a new 'turn' in penal policy, away from rehabilitation and addressing the needs of individual offenders. However, responses of individual GPs, obtained through a postal questionnaire sent to c.1000 GPs and in-depth interviews with a sub-sample, suggest that doctors are not 'zero tolerant' in responding to attacks. But nor are they medical imperialists seeking to include all perpetrators within their professional jurisdiction. Rather, they exercise professional discretion about behaviours which often fall into a 'grey area' between 'illness' and 'crime', and about individuals who are not clearly categorisable as either 'sick' or 'bad'.
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TL;DR: In this article, two disparate areas of social science theory, actor-network theory and policy networks, are brought to bear on the problem of explaining the rapid development of an area of medical science and health policy in the UK.
Abstract: In this paper two disparate areas of social science theory, actor-network theory and policy networks, will be brought to bear on the problem of explaining the rapid development of an area of medical science and health policy in the UK. There has been a surge of interest in the treatment and management of personality disorder from within both the psychiatric profession and government ministries, and particularly those personality disorders deemed to be severe or dangerous. This has resulted in the development of a new psychiatric classification, the ‘dangerous and severe personality disorder’ (DSPD), and the funding and development of a new service to deal with it. Major new mental health legislation has been set in train to provide legal backing for the pre-emptive detention of patients with such a diagnosis, despite widespread uncertainty over its status, reliability or predictive capability. In the process of presenting and analysing this development, actor-network theory and policy networks will themselves be reviewed and compared, and common and incompatible elements, foci and mechanisms identified.
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TL;DR: It becomes evident that German homeopathic physicians do not sacrifice central aspects of homeopathic concepts in order to gain legitimacy and is argued that complementary medicine and alternative medicine are both rather unfortunate terms for studying homeopathy in micro-sociological settings.
Abstract: The purpose of this study is to assess the ways in which homeopathic physicians deal with the conceptual tensions between homeopathy and biomedicine The data-collection included twenty semi-structured interviews which were conducted with homeopathic physicians in Berlin Three distinct patterns of homeopathic practice emerged from the data: a) segregating the patients into categories of homeopathic and biomedical patients; b) complementing a predominantly homeopathic practice with a few biomedical strategies for diagnostics; c) focusing on homeopathy and condemning biomedicine with the exception of emergency medicine and surgery
On the level of medical knowledge the physicians’ perspectives on the efficacy of homeopathy and some of its controversial concepts (opposition to vaccinations, miasm, vital force) are examined It also becomes evident that German homeopathic physicians do not sacrifice central aspects of homeopathic concepts in order to gain legitimacy
Finally, it is argued that complementary medicine and alternative medicine are both rather unfortunate terms for studying homeopathy in micro-sociological settings Heterodox medicine is favoured
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TL;DR: A comparison of risk assessment practices of contraceptives for women and men shows how the evaluation of health risks does not simply reflect the specific effects of chemical compounds in the human body, but also how side-effects were rated differently according to the risk model that was adopted.
Abstract: This paper concerns a comparison of risk assessment practices of contraceptives for women and men. Our analysis shows how the evaluation of health risks of contraceptives does not simply reflect the specific effects of chemical compounds in the human body. Rather, we show how side-effects were rated differently according to the risk model that was adopted. Our analysis shows an important new aspect of risk assessment: lay perspectives of men are taken more seriously by experts and policymakers than those of women. In the case of male contraceptives, men’s wellbeing when using contraceptives was a central issue from the very beginning. Men’s emotional wellbeing and sexuality has been put on the international research agenda by the reproductive scientists themselves, and the need for long-term data about male contraceptives has been emphasised by the pharmaceutical industry. In the case of female contraceptives, the concern for the long-term effects of contraceptives was put forward by women’s health movements, and research into women’s mental health and libido when using hormonal contraceptives was initiated only at the instigation of women’s health advocates. We therefore conclude that the incorporation of lay interests in the experts’ methods of risk assessment shows a clear gender pattern. Whereas the perspectives of male contraceptive users have been emphasised and negotiated by authoritative spokespersons within the medical establishment, the incorporation of the interests and needs of female contraceptives users depended on women’s health advocates.
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TL;DR: It is shown that the construction of Type A man rested on the medicalisation of the core values of traditional masculinity, while the term ‘hardy man’ demedicalised and legitimised these values.
Abstract: This article describes the transition in American ‘stress’ literature from a focus on ‘Type A man’ to the ‘hardy man’. These two diagnostic categories were constructed in medical discourse and entailed certain notions of masculinity, class and health. The constructs explained the rise of unhealthy (coronary-prone) American middle-class white men in the 1950s and the emergence of healthy men in the same class, race and gender order in the 1970s. I show that the construction of Type A man rested on the medicalisation of the core values of traditional masculinity, while the term ‘hardy man’ demedicalised and legitimised these values.
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TL;DR: In this paper, the authors investigated three different conflictual jurisdictional relationships between professions: a subordinated, a standardised and a commodified relationship, and evaluated the extent that they are able to preserve the mission of death investigators.
Abstract: In late modernity, conflicts about professional jurisdiction have gained in intensity because the emergence of new technologies can drastically alter the grounds for expertise. In the United States, medical examiners have the legal mandate to investigate and certify suspicious deaths, straddling the disparate worlds of public health and criminal justice. Over the last decade, procurement organisations fuelled by advances in immunology and surgical techniques have challenged medical examiners’ jurisdiction, requesting access to the corpse for organ and tissue transplantation purposes. Building further on Andrew Abbott's The System of Professions (1988), this article investigates jurisdictional relationships between professions when an emerging profession makes inroads on the jurisdiction of an established profession. Taking the vantage point of the established profession, I have distinguished three different conflictual jurisdictional relationships: a subordinated, a standardised and a commodified jurisdictional relationship. These relationships will be evaluated for the extent that they are able to preserve the mission of death investigators.
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TL;DR: In this article, the authors explored the social construction of suicide stories in Scottish newspapers and found that visualising, locating, social impacting and causal searching were key concepts in the construction of a suicide story, and that these were connected through the core explanatory category of "morality".
Abstract: Suicide stories in newspapers have been identified as an important risk factor for individual suicide because they provide real-life models for vulnerable individuals. The link between suicide ‘stories’ and suicide rates, however, is not clearly understood. One problem is the lack of detailed analysis of how suicide stories are constructed. Yet this is important because it would enable researchers to comprehend more fully how newspaper reports shape and structure ‘reality’. It is argued that the suicide story is a way of mapping out reality and that by de-constructing we can learn how this shapes and constrains our understanding of suicide and the actions adopted in response to it. The aim of this study, therefore, is to explore the social construction of suicide stories in Scottish newspapers. Two broad sheet and two tabloid newspapers were scanned for suicide stories for the year 1999. One hundred and ninety-one articles reporting suicide were identified and analysed using grounded theory. This generated a set of conceptual categories, which formed the basis of a framework. The study found that visualising, locating, social impacting and causal searching were key concepts in the construction of a suicide story, and that these were connected through the core explanatory category of ‘morality’. The study also showed how suicide was rendered explicable through the concepts of deviancy, dysfunction and moral weakness.
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TL;DR: This Finnish study conducted five focus group discussions with a total of 34 participants whose ages ranged from 65 to 85 and analysis of the data employed the concepts developed by Pierre Bourdieu.
Abstract: This paper focuses on how older people construct themselves as users of medical drugs, and on what factors are important in medication from the user’s point of view. The data of the study consist of focus group discussions about medication with people aged over 65 years. The analysis was based upon Pierre Bourdieu’s concepts of social field and habitus. The main actors appearing in the discussions were users and doctors. Pharmacists had only a marginal role as suppliers of medical drugs. It was clearly important for the participants to express their appreciation towards doctors, the dominant actors in the field of medication. The most important theme in the discussions, however, was the independence of the users themselves. By assuming responsibility for the use of their medication and by applying their own initiative, these older people were able to gain a meaningful position in the field of medication. The habitus of a patient in the health care setting is a compliant patient. The habitus outside health care, on the other hand, requires that people are active and reasonable users. In individual practices it is possible to detect logics of both sides of habitus.
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TL;DR: The Blackwell Publishers Ltd/Editorial Board 2002 Blackwell Science Ltd Oxford, UK SHIL ociology of Health & Illness 0141–9889.
Abstract: © Blackwell Publishers Ltd/Editorial Board 2002. Published by Blackwell Publishers, 108 Cowley Road, Oxford OX4 1JF, UK and 350 Main Street, Malden MA 02148, USA Blackwell Science Ltd Oxford, UK SHIL ociology of Health & Illness 0141–9889 © Blackwell Publis ers Ltd/Editorial Board 2001 2002 4 51 riginal Article C nnecting riminology and sociology of health and illness tef T mmer ans and Jonathan Gabe