Showing papers in "Sociology of Health and Illness in 2011"
TL;DR: Pharmaceuticalisation, it is argued, is best viewed in terms of a number of heterogeneous socio-technical processes that operate at multiple macro-levels and micro-levels that are often only partial or incomplete.
Abstract: Drawing on insights from both medical sociology and science and technology studies this article provides a critical analysis of the nature and status of pharmaceuticalisation in terms of the following key dimensions and dynamics: (i) the redefinition or reconfiguration of health 'problems' as having a pharmaceutical solution; (ii) changing forms of governance; (iii) mediation; (iv) the creation of new techno-social identities and the mobilisation of patient or consumer groups around drugs; (v) the use of drugs for non-medical purposes and the creation of new consumer markets; and, finally, (vi) drug innovation and the colonisation of health futures. Pharmaceuticalisation, we argue, is therefore best viewed in terms of a number of heterogeneous socio-technical processes that operate at multiple macro-levels and micro-levels that are often only partial or incomplete. The article concludes by drawing out some broader conceptual and reflexive issues this raises as to how we might best understand pharmaceuticalisation, based on our analysis, as a framework for future sociological work in this field.
295 citations
TL;DR: The article shows how understanding work undertaken on the bodies of others as 'body work' provides a mechanism for relating work in the sphere of health and social care to that in other sectors, opening up new avenues for research.
Abstract: Body work is a central activity in the practice of many workers in the field of health and social care. This article provides an introduction to the concept of body work--paid work on the bodies of others--and demonstrates its importance for understanding the activities of health and social care workers. Providing an overview of existing research on body work, it shows the manifold ways in which this can inform the sociology of health and illness--whether through a micro-social focus on the inter-corporeal aspects of work in health and social care, or through elucidating our understanding of the times and spaces of work, or through highlighting the relationship between mundane body work and the increasingly global movements of bodies, workers and those worked-upon. The article shows how understanding work undertaken on the bodies of others as 'body work' provides a mechanism for relating work in the sphere of health and social care to that in other sectors, opening up new avenues for research.
203 citations
TL;DR: Primary findings include: left and egalitarian political traditions on population health are the most salutary, consistent, and substantial; the health impacts of advanced and liberal democracies are also positive and large; and globalisation defined as dependency indicators such as trade, foreign investment, and national debt is negatively associated with population health.
Abstract: In recent years, a research area has emerged within social determinants of health that examines the role of politics, expressed as political traditions/parties and welfare state characteristics, on population health. To better understand and synthesise this growing body of evidence, the present literature review, informed by a political economy of health and welfare regimes framework, located 73 empirical and comparative studies on politics and health, meeting our inclusion criteria in three databases: PubMed (1948-), Sociological Abstracts (1953-), and ISI Web of Science (1900-). We identified two major research programmes, welfare regimes and democracy, and two emerging programmes, political tradition and globalisation. Primary findings include: (1) left and egalitarian political traditions on population health are the most salutary, consistent, and substantial; (2) the health impacts of advanced and liberal democracies are also positive and large; (3) welfare regime studies, primarily conducted among wealthy countries, find that social democratic regimes tend to fare best with absolute health outcomes yet consistently in terms of relative health inequalities; and (4) globalisation defined as dependency indicators such as trade, foreign investment, and national debt is negatively associated with population health. We end by discussing epistemological, theoretical, and methodological issues for consideration for future research.
185 citations
TL;DR: The conclusion is that when innovative technologies such as telecare are actually put to work, 'the same' technology will perform differently, and the untenability of pre-given promises and the fluidity of locally evolving goals has important implications for the way in which innovations are promoted, as well as for the ways innovative technologies may be evaluated.
Abstract: Telecare is advocated in most European countries with great, if not grandiose, promises: improving healthcare, lowering costs, solving workforce shortage. This paper does not so much question these specific promises, but rather the 'register of promising' as such, by comparing the promises with actual processes of incorporating technologies in healthcare practices. The case we study is the use of webcams in follow-up care from a Dutch rehabilitation clinic for people with severe chronic obstructive pulmonary disease (COPD). This process shows many changes and contingencies, and corresponding shifts in goals and aims. The conclusion is that when innovative technologies such as telecare are actually put to work, 'the same' technology will perform differently. In order to function at all, technology has to be tamed, it has to be tinkered with to fit the practices of the users. The technology, however, is not meekly put to use (tamed), but is unleashed as well, affecting care practices in unforeseen ways. The untenability of pre-given promises and the fluidity of locally evolving goals has important implications for the way in which innovations are promoted, as well as for the way innovative technologies may be evaluated.
127 citations
TL;DR: It is argued in this paper that subjectivities and distress among men are an important area for critical sociological research, and the utility of gender relations, performativity,subjectivities and wellbeing for a better understanding of distress is considered.
Abstract: In line with the shift towards prioritising lay accounts and narratives of chronic illness in sociology, there is an emerging literature on men, their subjectivities and experiences of mental distress. We argue in this paper that subjectivities and distress among men are an important area for critical sociological research. Very little is known about men's subjectivities or the meanings they give to - and how they cope with or seek help for - distress. At the same time, current theories of gender relations, performativity and wellbeing as they pertain to men are likely to shed further light on subjectivity and distress. However, current theories (and qualitative research involving men and women) are pointing to considerable complexity. In this paper, we outline what is known about distress and men, and consider the utility of gender relations, performativity, subjectivities and wellbeing for a better understanding of distress. We also ask: What other factors influence distress, and how should these be considered in relation to men and masculinities? What are the implications for research and policy?
118 citations
TL;DR: It is concluded that violence experienced by disabled children and their families says more about the dominant culture of disablism than it does of the acts of a few seemingly irrational, unreasonable, mean or violent individuals, and that there is a need for extensive cultural deconstruction and reformation.
Abstract: This article addresses the multi-faceted nature of violence in the lives of disabled people, with a specific focus on the accounts of disabled children and their families. Traditionally, when violence and disability have been considered together, this has emphasised the disabled subject whom inevitably exhibits violent challenging behaviour. Recently, however, more attention has been paid to violence experienced by disabled people, most notably in relation to hate crime. This article embraces theories that do not put the problems of disablism or violence back onto disabled people but magnify and expose processes of disablism that are produced in the relationships between people, which sometimes involve violence. This, we argue, means taking seriously the role of social relationships, institutions and culture in the constitution of violence. Disabled children, we argue, are enculturated by the violence of disablism. We follow Žižek's advice to step back from the obvious signals of violence to 'perceive the contours of the background which generates such outbursts', and identify four elements of the violence of disablism which we define as real, psychoemotional, systemic and cultural. We come to the conclusion that violence experienced by disabled children and their families says more about the dominant culture of disablism than it does of the acts of a few seemingly irrational, unreasonable, mean or violent individuals. We conclude that there is a need for extensive cultural deconstruction and reformation.
113 citations
TL;DR: The results suggest that the risk of HIV infection among women across countries in sub-Saharan Africa is further aggravated among those who are younger, in female-headed households, not in stable unions or marital partnerships or had an earlier sexual debut.
Abstract: Women in sub-Saharan Africa bear a disproportionate burden of human immunodeficiency virus (HIV) infections, which is exacerbated by their role in society and biological vulnerability. The specific objectives of this article are to (i) determine the extent of gender disparity in HIV infection; (ii) examine the role of HIV/acquired immune deficiency syndrome (AIDS) awareness and sexual behaviour factors on the gender disparity and (iii) establish how the gender disparity varies between individuals of different characteristics and across countries. The analysis involves multilevel logistic regression analysis applied to pooled Demographic and Health Surveys data from 20 countries in sub-Saharan Africa conducted during 2003–2008. The findings suggest that women in sub-Saharan Africa have on average a 60% higher risk of HIV infection than their male counterparts. The risk for women is 70% higher than their male counterparts of similar sexual behaviour, suggesting that the observed gender disparity cannot be attributed to sexual behaviour. The results suggest that the risk of HIV infection among women (compared to men) across countries in sub-Saharan Africa is further aggravated among those who are younger, in female-headed households, not in stable unions or marital partnerships or had an earlier sexual debut.
106 citations
TL;DR: The concept of 'shifting normalities' is proposed, providing a dynamic explanatory model of chronic illness that captures the interaction of changing conceptions of a normal life and the normalisation of symptoms.
Abstract: Biographical disruption and related concepts have been widely applied in chronic illness. Different conceptualisations of normalisation have also been proposed in order to explain individuals’ diverse responses to illness on their biography, but as yet, not clearly related to changing bodily experience or normalisation of symptoms. This article aims to examine the relevance of these concepts in rheumatoid arthritis (RA), an unpredictable autoinflammatory disease characterised by painful and swollen joints, disability, fatigue and joint damage. Interviews were conducted with 23 people living with RA, and analysed using Framework, to enable people’s whole narratives and context to be considered. Six typologies of normality emerged from the data: disrupted; struggling to maintain; fluctuating; resetting; returning; and continuing normality. Multiple normalities were often present in individuals’ narratives, with one normality typology usually dominating at the time of the interview. The typologies connect to several biographical concepts, and instances of ‘biographical reinstatement’ were also found, where participants described returning to normal life, through perceived effective medication rather than reconceptualisation of health. The concept of ‘shifting normalities’ is proposed, providing a dynamic explanatory model of chronic illness that captures the interaction of changing conceptions of a normal life and the normalisation of symptoms.
106 citations
TL;DR: This paper highlights the difficulties involved in making teams of such heterogeneous members-and the paradoxes that arise when this task is achieved, and reveals how the tension between integration and specialisation of team members is especially acute for service users.
Abstract: Current healthcare policy emphasises the need for more collaborative, team-based approaches to providing care, and for a greater voice for service users in the management and delivery of care. Increasingly, policy encourages 'partnerships' between users and professionals so that users, too, effectively become team members. In examining this phenomenon, this paper draws on insights from the organisational-sociological literature on team work, which highlights the challenges of bringing together diverse professional groups, but which has not, to date, been applied in contexts where users, too, are included in teams. Using data from a qualitative study of five pilot cancer-genetics projects, in which service users were included in teams responsible for managing and developing new services, it highlights the difficulties involved in making teams of such heterogeneous members-and the paradoxes that arise when this task is achieved. It reveals how the tension between integration and specialisation of team members, highlighted in the literature on teams in general, is especially acute for service users, the distinctiveness of whose contribution is more fragile, and open to blurring.
106 citations
TL;DR: The paper demonstrates the ways in which men can find themselves marginalised within the context of pregnancy and childbirth, but are still able to draw on identifiable markers of masculine practice which enable them to enact a masculine form congruent with dominant masculinity.
Abstract: In recent years, fathers’ experiences during childbirth have attracted much research and policy interest. However, little of this work has been grounded in the first-hand accounts of men and there is a lack of theory-based research to help understand men’s thoughts and practices around childbirth. This paper is based on qualitative research undertaken with first-time fathers and healthcare professionals. It draws on Connell’s (1995) conceptualisation of hegemonic masculinity to explore how men construct masculine identities within the context of pregnancy and childbirth and also how healthcare professionals construct masculinity. The paper demonstrates the ways in which men can find themselves marginalised within the context of pregnancy and childbirth, but are still able to draw on identifiable markers of masculine practice which enable them to enact a masculine form congruent with dominant masculinity. It also illustrates how healthcare professionals’ constructions of masculinity enable them to predict how men will behave and allow them to position men in ways that involve minimum disruption to their own practice. The paper also highlights how men’s marginal status is embedded in the dynamics of the social structure, which produce and reproduce dominant masculine identities within the context of childbirth.
104 citations
TL;DR: It is argued that the practices of care are shaped by a complex interweaving of regulatory mechanisms associated with home care along with the physical and affective dimensions of intimate body work, suggesting the need for new ways of understanding body work in contemporary landscapes of care.
Abstract: Body work is a key element of home healthcare. Recent restructuring of health and social care services means the home is increasingly a key site of long-term care. While there is a growing literature on the social dynamics between care recipients and their family caregivers, less is known about the formal work dynamic between paid care workers and care recipients and family caregivers. Drawing on interview data from an Ontario-based study of long-term home care, we explore how body work is negotiated through the embodied practices of care in the home and through care relationships associated with home care. In particular we focus on how the practices of intimate body care (such as bathing, toileting, and catheter management) show the diverse dynamics of care work through which caregivers, care recipients and homespace are constituted. We argue that the practices of care are shaped by a complex interweaving of regulatory mechanisms associated with home care along with the physical and affective dimensions of intimate body work. In turn this suggests the need for new ways of understanding body work in contemporary landscapes of care.
TL;DR: It is shown that becoming knowledgeable about a child's condition is essential for gradually comprehending and managing a situation that initially seems unmanageable and distressful, and suggests that as parents adjust, so do the frequency and purpose of their internet searches.
Abstract: The internet has democratised access to health and diagnostic information, enabling patients to mobilise social support from peers and advocate their interests in encounters with medical personnel. Research has shown that these possibilities are particularly important for patients and caregivers confronting a rare medical condition. However, little research has focused on how the act of searching for and accumulating information via the internet can be important for coping emotionally with a situation characterised by uncertain prospects and inadequate information from health personnel. This paper explores the experiences of 10 Norwegian parents whose children have different rare genetic disorders and who used the internet as a resource. The analysis draws on the theoretical framework of the medical sociologist Aaron Antonovsky, who emphasises people's inherent ability to manage extremely stressful life experiences. Analysing the process of adjusting to and coping with life parenting a child suffering from a rare genetic disorder, this study shows that becoming knowledgeable about a child's condition is essential for gradually comprehending and managing a situation that initially seems unmanageable and distressful. It also suggests that as parents adjust, so do the frequency and purpose of their internet searches.
TL;DR: A wide-ranging analysis of body work in health and social care, as well as other sectors, shows that attempts to overcome them and reorganise the sector in pursuit of cost savings or 'efficiency', generate problems for workers and the patients, whose bodies they work upon.
Abstract: With ‘efficiency savings’ the watchword for health and social care services, reorganisation and labour rationalisation are the order of the day. This article examines the difficulties involved in (re)organising work which takes bodies as its object, or material of production. It shows that working on bodies (‘body work’) systematically delimits possibilities for labour process rationalisation which, in turn, constrains reorganisation of the health and social care sector. It does this in three main ways. First: rigidity in the ratio of workers to bodies-worked-upon limits the potential to increase capital-labour ratios or cut labour. Secondly: the requirement for co-presence and temporal unpredictability in demand for body work diminish the spatial and temporal malleability of the labour process. Thirdly: the nature of bodies as a material of production – complex, unitary and responsive – makes it difficult to standardise, reorganise or rationalise work. A wide-ranging analysis of body work in health and social care, as well as other sectors, fleshes out these three constraints and shows that attempts to overcome them and reorganise the sector in pursuit of cost savings or ‘efficiency’, generate problems for workers and the patients, whose bodies they work upon.
TL;DR: The article discusses the respondents' ambivalent expectations regarding the therapeutic promise of brain research, and shows how these are structured by understandings of the ontology of personality disorder.
Abstract: Neuroscientific research into mental health commands generous funding, suggesting neuroscience is understood by a variety of actors and institutions as having significant potential to enhance the therapeutic practices of psychiatrists. This article interrogates this ‘therapeutic promise’ of neuroscience through the case study of the psychiatric condition personality disorder. Specifically, the focus is on the promissory discourse of clinicians specialising in the management of two variants of personality disorder − antisocial personality disorder and psychopathy − and researchers investigating the neurobiology of these constructs. The article discusses the respondents’ ambivalent expectations regarding the therapeutic promise of brain research, and shows how these are structured by understandings of the ontology of personality disorder. In turn, these ambivalences direct our attention to practical issues surrounding the potential of neuroscience to translate into and enhance clinical practice, as well as theoretical concerns revolving around the place and role of the biological within contemporary neuroscience, psychiatry and psychology. In sum, the necessity of large material and symbolic investments in neuroscience should, perhaps, be reflected upon more critically, and analytic encounters with this discipline must keep in mind it's at times surprising commitment to the realms of the social and the psychological.
TL;DR: A study using a modified grounded theory approach to analyse a series of semi-structured interviews with 49 female sex workers in Hong Kong, in order to examine the ways in which this group experiences and negotiates the stigma which arises from their employment in the sex industry.
Abstract: While the stigma surrounding sex work is both well documented and easily recognised, few studies examine stigma in this context from the perspective of the sex workers themselves. In this article we report on a study using a modified grounded theory approach to analyse a series of semi-structured interviews with 49 female sex workers in Hong Kong, in order to examine the ways in which this group experiences and negotiates the stigma which arises from their employment in the sex industry. Sex workers in Hong Kong were subject to various stigmatising forces in their daily lives in their interactions with the public, the police and their families. These processes could have a negative impact on the sex workers' health, both through obvious manifestations such as physical or verbal abuse and through more subtle processes such as those which generated or perpetuated vulnerability and those which compelled the sex workers to conceal their identities and withdraw themselves from social networks. These findings are situated in the context of broader research surrounding sex work, drawing attention to the consequences of stigma on health and their interaction with health-service providers, before briefly discussing possible means of overcoming stigma-related barriers to providing adequate healthcare for this marginalised group.
TL;DR: How routine midwifery practice during labour can communicate certain understandings about birth is shown and attention is given to how midwives' activity during labour and birth implicitly introduces a sense of danger, an imagined risk that confines practice and operates to unsettle normality.
Abstract: Midwifery activity in the labour room coalesces around routine surveillance practices. When engaging in such practice, midwives have to cope with attempting to instil a sense of confidence in the mother's embodied ability to give birth to her baby spontaneously while concurrently attending to an array of risk-focused tests and measurements. Midwives are vigilant about the potential harm that may come to mother and baby while at the same time they are responsible for facilitating a normal birth. This article sets out to explore the tension between these two tasks and shows how routine midwifery practice during labour can communicate certain understandings about birth. Using empirical evidence taken from an ethnographic study of midwifery talk and practice, attention is given to how midwives' activity during labour and birth implicitly introduces a sense of danger, an imagined risk that confines practice and operates to unsettle normality.
TL;DR: Qualitative research shows that donation to biobanks is a complex process shaped by donors' embeddedness in a number of social contexts; by complex relations of trust in biomedicine; and by the ambiguous status of human tissue.
Abstract: Collections of human tissue (biobanks) are thought to be an essential resource for biomedical research. Biobanks have, however, been a source of debate in both bioethics and sociology. In recent years this theorising has been supplemented with empirical research, including a significant body of qualitative research, into donors' experiences and attitudes. To date, this literature has not been synthesised. We report the findings of a review of qualitative literature regarding the ways in which lay people construct and experience the process of donation to biobanks. Our aim was to determine what the qualitative research literature tells us about the process of donating to biobanks, and how this can enrich existing insights from quantitative research and from theoretical sociology and bioethics. Qualitative research shows that donation to biobanks is a complex process shaped by donors' embeddedness in a number of social contexts; by complex relations of trust in biomedicine; and by the ambiguous status of human tissue. While these findings are theoretically and practically useful, current sociological theorising is very general. A more detailed and nuanced 'sociology of biobanking' is needed, and this might be best achieved by exploring specific theoretical questions in a variety of biobanking settings.
TL;DR: In this paper, the authors investigated the association between subjective social status (SSS) and health, while controlling for own and familial SEP, and found that subjective assessment contributes to health inequalities in young people largely independent of objective SEP.
Abstract: Health inequalities according to objective socioeconomic position (SEP), have been well-documented. Yet, in young people the associations are negligible. Recently, research on the association of subjective social status (SSS), and adult health has begun to accumulate. Studies on young people are rare and describe societies with large income inequalities. Here, we investigated the association between SSS and health, while controlling for own and familial SEP. The study population consisted of 15-year-olds (N = 2369) who have grown up in a context of low social inequalities. Data were derived from surveys carried out in 2004 in 29 secondary schools in Helsinki. The SSS was measured with an indicator specific to and validated for adolescents (a societal ladder). Outcome measures were self-rated health, health complaints, presence of limiting longstanding illness (LLI) and GHQ-12 caseness (indicating psychiatric morbidity). The SSS associated strongly with all health measures. Adjusting for objective socioeconomic measures attenuated the associations; although they all remained statistically significant apart from LLI among girls. The subjective assessment contributes to health inequalities in young people largely independent of objective SEP. Subjective ratings most probably capture aspects of social hierarchy that are more subtle and less well represented than in conventional measures.
TL;DR: This study highlights how men's conceptualisations of masculinity coupled with their class position informed their understanding of male roles and the expectations that flow from this and shows how certain risky practices are firmly rooted in the material reality of men's lives, not simply in their gender.
Abstract: In recent years, much research concerning men's health has focused on men's health-related practices While this body of research has often sought to contextualise men's health practice it has done so primarily in terms of gender not social class The need remains therefore to link theories of masculinity and health to broader theories regarding social class and health which highlight the social and economic context of people's lives, in order to develop more complex understandings regarding the interactions between social class, gender and men's health practices The aim of this article is to explore these interactions via a qualitative examination of the ways in which two groups of working class men living in two contrasting socio-economic areas construct masculinity and how this intertwines with their class position to impact on their health practices This study highlights how men's conceptualisations of masculinity coupled with their class position informed their understanding of male roles and the expectations that flow from this It shows how certain risky practices are firmly rooted in the material reality of men's lives, not simply in their gender, and how aspects of masculinity and class position intimately entwine to structure men's health seeking behaviour
TL;DR: It is argued that the 23andMe model promotes the idea that curiosity about one's genome on the one hand, and participation in research on the other, are not only compatible but complementary aspects of being an entrepreneurial subject of contemporary health and medicine framed by the technologies of web 2.0.
Abstract: The emergence of direct-to-consumer (DTC) personal genomics companies in 2007 was accompanied by considerable media attention and criticism from clinical geneticists and other health professionals, regulators, policy advisors, and ethicists. As well as offering genetic testing services, some firms are also engaged in building their own databases and conducting research with the data obtained from their customers. In this paper, we examine how one of these companies, 23andMe, is creating a certain kind of 'research subject' in opposition to that constituted in conventional forms of disease research. Drawing on debates about neoliberalism, contemporary health discourses and subjectivity, we consider two kinds of subjectivities produced through the discursive and material practices of 23andMe and UK Biobank, namely, 'enterprising' and 'altruistic' selves. We argue that the 23andMe model promotes the idea that curiosity about one's genome on the one hand, and participation in research on the other, are not only compatible but complementary aspects of being an entrepreneurial subject of contemporary health and medicine framed by the technologies of web 2.0.
TL;DR: The ebook of Pink Ribbon Blues How Breast Cancer Culture Undermines Women S Health is available at mn-dc.org hosted in 3rd party web for no fee.
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TL;DR: Qualitative data from semi-structured interviews with cervical cancer patients is drawn on, finding that body work was crucial in corroborating and validating beliefs pertaining to the ability and willingness of the professional to deliver this agenda in the future.
Abstract: Trust is vital for quality healthcare outcomes, yet existing research neglects the 'embodiedness' of the interactions on which trust is based This article draws on qualitative data from semi-structured interviews with cervical cancer patients The significance of body work in winning or, on occasions, undermining trust emerged as a key theme within the responses Interpretations of professionals' verbal and non-verbal presentations-of-self were often mutually reinforcing and intrinsically linked--forming a more general locus of meaning from which assumptions of competence and care were drawn Yet it also became apparent that, whilst verbal communication was useful in establishing the agenda of the professional in relation to that of the patient, it was body work which was crucial in corroborating and validating beliefs pertaining to the ability and willingness of the professional to deliver this agenda in the future The multi-temporal nature of trust makes apparent how certain seemingly distinct forms of body work--as presentation-of-self versus more hands-on modes--are inherently intertwined Trust, and the affective relationship in which it is rooted, bridges the present with the future and thus makes apparent how seemingly 'detached' forms of body work are connected to the emotion-work of the caring role and the craftwork of body work as touch
TL;DR: It is argued that the discourse of wellbeing--captured in many alternative and complementary health practices--is congruent with culturally prevalent ideals of self-fulfilling, authentic, unique and self-responsible subjectivity.
Abstract: This article is premised on the importance of locating the appeal and meaning of alternative and complementary medicines in the context of gendered identities. I argue that the discourse of wellbeing � captured in many alternative and complementary health practices � is congruent with culturally prevalent ideals of self-fulfilling, authentic, unique and self-responsible subjectivity. The discourse of wellbeing places the self at the centre, thus providing a contrast with traditional ideas of other-directed and caring femininity. As such, involvement in alternative and complementary medicines is entwined with a negotiation of shifting femininities in detraditionalising societies. Simultaneously, many alternative and complementary health practices readily tap into and reproduce traditional representations of caring femininity. It is through an emphasis on emotional honesty and intimacy that the discourse of wellbeing also captures a challenge to traditional ideas of masculinity. Expectations and experiences relating to gender add a further level of complexity to the meaningfulness and therapeutic value of alternative and complementary medicines and underlie the gender difference in the utilisation of holistic health practices. I draw on data from a qualitative study with 44, primarily white, middle-class users and practitioners of varied alternative and complementary medicines in the UK.
TL;DR: This paper examines specific instances and consequences of 'ambiguous gain', defined as 'a putative or demonstrated benefit that, as an unintended outcome, results in increased uncertainty and a consequent reduction of agency or wellbeing at the level of individual or collective identity'.
Abstract: Community services for carers of people with dementia can assist in relieving
caregiver burden and delay the institutionalisation of the person with dementia.
Under some conditions, however, engagement with dementia services may
produce unintended negative consequences, resulting in increased confusion and
a reduction of agency for carers. Drawing on an analysis of three salient aspects
of caregiver identities, this paper examines specific instances and consequences of
‘ambiguous gain’, defined as ‘a putative or demonstrated benefit that, as an
unintended outcome, results in increased uncertainty and a consequent reduction
of agency or wellbeing at the level of individual or collective identity’. The paper
concludes with a discussion of implications for policy and practice.
TL;DR: It is argued that the clinic functions as a containment for legal as well as practical and bodily dimensions of donor conception, and this in turn shapes practices and perceptions of self-arranged conception.
Abstract: A growing body of literature investigates heterosexual donor conception and there is now also a small body of work which investigates the experiences of single women and lesbian couples. Both of these focus on a clinical setting. Women, notably single and lesbians, also undertake non-clinical donor conception, and insufficient consideration has been paid to these self-arranged reproductive practices, and how they may compare with the clinical ones. Seeking to fill this gap, this paper explores women's experiences of accessing donor sperm inside and outside reproductive health clinics by drawing on a qualitative interview study with 25 lesbian couples in England and Wales with experiences of jointly pursuing donor conception. The paper explores the differences embedded in the two conception routes with regard to donor recruitment, access to donor sperm over time, space and the management of sperm as a bodily fluid. Utilising the framework of 'ontological choreography' developed by Thompson (2005), as well as Douglas's (1966) work around bodies, dirt and disgust, the paper argues that the clinic functions as a containment for legal as well as practical and bodily dimensions of donor conception, and this in turn shapes practices and perceptions of self-arranged conception.
TL;DR: This paper analyses a change to the system of uniforms in one UK hospital, where management have required all professions to wear the same 'corporate' uniform, seeking to create a new 'cor corporate' worker whose allegiance is principally to the organisation, rather than a profession.
Abstract: Despite their comparative neglect analytically, uniforms play a key role in the delineation of occupational boundaries and the formation of professional identity in healthcare This paper analyses a change to the system of uniforms in one UK hospital, where management have required all professions (with the exception of doctors) to wear the same 'corporate' uniform Focus groups were conducted with the professionals and patients We analyse this initiative as a kind of McDonaldisation, seeking to create a new 'corporate' worker whose allegiance is principally to the organisation, rather than a profession Our findings show how important uniforms are to their wearers, both in terms of the defence of professional boundaries and status, as well as the construction of professional identity
TL;DR: A model containing six career contingencies relevant for young people's progress from recreational to regular drug use is presented, showing that the closing of social networks, changes in forms of parties, intoxication becoming a goal in itself, easier access to drugs, learning to recognise alternative effects of drugs and experiences of loss of control are at play.
Abstract: This article analyses the process of going from recreational use to regular and problematic use of illegal drugs. We present a model containing six career contingencies relevant for young people's progress from recreational to regular drug use: the closing of social networks, changes in forms of parties, intoxication becoming a goal in itself, easier access to drugs, learning to recognise alternative effects of drugs and experiences of loss of control. The analysis shows that these dimensions are at play not only when young people develop a regular drug use pattern but also when they attempt to extricate themselves from this pattern. Hence, when regular drug users talk about their future, it is not a future characterised by total abstinence from illegal drugs but a future where they have rolled back their drug use career to the recreational drug use pattern they started out with. Empirically, the article is based on qualitative interviews with young drug users contacted at nightclubs in Denmark.
TL;DR: Interview data from mothers who are carriers of the FX gene, and who have at least one child with FXS, is analysed to examine how their understandings and enactments of reproductive options, obligations, and responsibilities support an expanded notion of genetic responsibility.
Abstract: A woman who carries the gene for fragile X syndrome (FXS) has a 50 per cent chance per pregnancy of passing the gene to her sons and daughters. In this paper we analyse interview data from mothers who are carriers of the FX gene, and who have at least one child with FXS, to examine how their understandings and enactments of reproductive options, obligations, and responsibilities support an expanded notion of genetic responsibility. Accounts of 108 women from across the United States show that the majority of mothers chose not to have another biological child once they learned their carrier status. They discussed genetic responsibility and reproductive agency in terms of an obligation not to risk having another child who carried the gene, although their accounts reflected the tensions that arose from managing oneself as a genetically at-risk actor. Another 22 mothers either purposely became pregnant or continued an unplanned pregnancy after finding out their carrier status. These mothers' accounts reflect an expanded version of genetic responsibility that incorporates ideas and values beyond managing risk in what it means to act responsibly in light of genetic knowledge.