Всего публикаций в данном разделе: 319
"The Illness is Part of the Person": Discourses of Blame, Individual Responsibility and Individuation at a Centre for Spiritual Healing in the North of England [статья]
Опубликовано на портале: 23-03-2007Stuart McClean Sociology of Health and Illness. 2005. Vol. 27. No. 5. P. 628-648.
While the growth in usage and practice of varying forms of complementary and alternative medicine (CAM) continues apace, social science has increasingly turned to CAM's often individualistic approach to health and illness. CAM has been perceived as both partly a cause of and a response to the well-documented ideology in modern healthcare of "individual responsibility for health". This occasionally manifests in a 'victim-blaming' ideology amongst both orthodox and CAM practitioners alike. These issues emerged as key themes in an ethnographic study of a Centre for spiritual healing in the North of England. By drawing upon a range of qualitative data gained through the researcher's participation at this healing centre, author argues that the healers' focus on individual responsibility for health is not so much a part of the current socio-political health ideology of "victim-blaming", rather, it is illustrative of an important contemporary social phenomenon: the movement towards the subjectification and personalisation of public life.
Опубликовано на портале: 23-03-2007Chris Shilling British Journal of Sociology. 2002. Vol. 53. No. 4. P. 621-638.
This paper revisits Parsons's conception of the 'sick role' and examines the relevance of his writings on the cultural understanding of sickness to the consumption of health in the contemporary era. In terms of current developments, the author focuses on the development of pro-active approaches towards the healthy body, and the growth of "information rich" consumers of health care. These have become prominent themes in sociology, and while Parsons's writings are usually viewed as anachronistic he argues they remain highly pertinent to understanding the emergence of informed, body conscious lay people. If Parsons's analysis of health is more relevant to current circumstances than many critics assume, however, it is not unproblematic. The residual categories associated with the sick role obscure the continued utility of his work on the general cultural values informing health care. It is Parsons's analysis of these values, Chris Shilling suggests, that needs rescuing from restricted understandings of the sick role and highlighting as an important resource for contemporary theorists.
Managerialism in the Australian Public Health Sector: Towards the Hyper-Rationalisation of Professional Bureaucracies [статья]
Опубликовано на портале: 23-03-2007John Germov Sociology of Health and Illness. 2005. Vol. 27. No. 6. P. 738-758.
This paper draws on qualitative case-study research to discuss the impact of managerialism on the work organisation of public sector health professionals in Australia. The case studies included 71 semi-structured interviews with a broad range of public sector health professionals (predominantly nursing and allied health professionals, with some doctors and managers). The data are used to examine the implications of managerialism for the organisation of professional (public) bureaucracies. The findings show that while health professionals were able to exert their agency to influence managerial processes, the incorporation of managerial strategies into professional practice placed constraints upon professional autonomy. The impact of managerialism on professional bureaucracies is examined using the neo-Weberian framework of hyper-rationality, an ideal type derived from a combination of four forms of rationality identified in Weber's work: practical, formal, substantive and theoretical rationality. Applied to the social organisation of health-care work, this paper critically examines the utility of the hyper-rationality ideal type, noting its limitations and the insights it provides in conceptualising the impact of managerialism on professional (public) bureaucracies.
Опубликовано на портале: 23-03-2007Alisa Lincoln Sociology of Health and Illness. 2006. Vol. 28. No. 1. P. 54-75.
The influence of social factors on involuntary hospitalisation has been an important and controversial area of sociological focus for many years. Traditionally, social control theory has been used to understand disproportionate rates of involuntary hospitalisation among marginalised and powerless groups. However, dramatic changes in the social context of mental healthcare have necessitated a re-examination of the role of social factors in involuntary hospitalisation. In this study 287 psychiatric emergency room visits were examined in order to test hypotheses for understanding social influences on disposition. Little support for the traditional social control hypothesis was found. People from marginalised groups were not disproportionately involuntarily hospitalised, but instead were disproportionately treated and released from the hospital as people's social resources were used to access care rather than to prevent hospitalisation. This study highlights the importance of the historical relevance of our theoretical understanding of the relationship between social factors and involuntary commitment.
The Promotion of Private Health Insurance and Its Implications for the Social Organisation of Healthcare: a Case Study of Private Sector Obstetric Practice in Chile [статья]
Опубликовано на портале: 23-03-2007Susan F. Murray, Mary Ann Elston Sociology of Health and Illness. 2005. Vol. 27. No. 6. P. 701-721.
This paper examines some of the implications of the process of privatisation of a national healthcare system for the delivery, organisation and, ultimately, the outcome of services. Through a case study of obstetric care in Chile, authors illuminate the relationships between the macro-level of political decisions, the meso-level of the organisations through which government reforms were enacted, and the micro-level of clinical practice. Authors show that, for a significant proportion of Chilean women seeking maternity care, privatisation has led to expanded access and to ostensibly highly-personalised relationships with specialists. However, because of the fragmentation of maternity services, the altered work patterns for obstetricians occasioned by changes in healthcare financing and the relatively weak market position of most obstetricians, this personalised care is dependent on highly technologised obstetric practices. By examining the specific organisational arrangements under which private maternity care is conducted in Chile authors shed light on the connection between privately-funded maternity care and high caesarean section rates in this setting.
The Emergence of a Health Insurance System in a Developing Country: The Case of South Korea [статья]
Опубликовано на портале: 23-03-2007Sungnam Cho Journal of Health and Social Behavior. 1989. Vol. 30. No. 4. P. 467-471.
In an attempt to understand the social forces and the economic and political conditions under which new social policies emerge in developing countries, this study outlines factors affecting the introduction of the health insurance system in South Korea. The emergence of the South Korean health insurance system was influenced by changing labor needs of the industrial sector, increasing social expectations, external and international pressures, increasing medical costs, and class conflict. These pressures compelled the South Korean government to respond to demands for the introduction of new social welfare policies in the 1970s. In the case of South Korea, the new health insurance system resulted from the government's attempts to cope with political, economic, and social pressures rather than from an ideological commitment to the well-being of the population. The resulting insurance system was a way to maintain the social order and legitimacy of the regime, and a means to promote the health of groups important to defense or production.
On Practices of 'Good Doctoring': Reconsidering the Relationship between Provider Roles and Patient Adherence [статья]
Опубликовано на портале: 23-03-2007Karen Lutfey Sociology of health and illness. 2005. Vol. 27. No. 4. P. 421-447.
Questions pertaining to patient adherence and provider roles are part of the classical repertoires in sociological and health services research. While extensive research programmes consider why patients do not follow medical advice, less is known about how practitioners assess patient adherence. Similarly, there has been much work on provider roles changing with the organisation of healthcare, but less attention to the ways providers conceptualise, choose and strategically enact practices in the course of their work. Using data from a year-long ethnographic study of two diabetes clinics, the author examines some of the stances medical practitioners actively choose and enact in their treatment of diabetes patients – educators, detectives, negotiators, salesmen, cheerleaders and policemen – and how they tailor their actions to specific patients in order to maximise their adherence to treatment regimens. Findings suggest that the notions of 'patient adherence' and 'physician roles' are conceptually broader and more fluid than what is captured in existing literature, and this rigidity potentially impairs our ability to learn more about the everyday practices of medical work.
Опубликовано на портале: 23-03-2007Виталий Михайлович Нилов Журнал социологии и социальной антропологии. 2005. Т. VIII. № 3. С. 34-46.
Статья представляет некоторые результаты социологического проекта «Здоровье и благосостояние в трансформирующихся обществах» в Петрозаводском государственном университете. Одна из частей исследования была посвящена проблемам влияния жизненных событий на здоровье населения в переходных обществах. Анализ открытых вопросов позволил получить данные о разнообразных семейных событиях, включая как удачи в карьере, образовании, семейные праздники, так и экономические проблемы, безработицу, банкротства, смерть близких и т. д. Сведения о «социальном комфорте» (или «социальных настроениях») позволяют достаточно точно диагностировать как степень адаптации людей к социальному кризису, так и стратегии совладания с жизненными трудностями, которые они используют.
Опубликовано на портале: 22-03-2007Cleave Seale, Julia Addington-Hall, Mark McCarthy Social science and medicine. 1997. Vol. 45. No. 3. P. 477-484.
Analysis of a subset of data from a survey of 3696 relatives, friends and others who knew a sample of people dying in 1990 who lived in 20 areas of the United Kingdom (the Regional Study of Care for the Dying) is reported. Using the typology of awareness contexts developed by Glaser and Strauss [(1965) Awareness of Dying, Aldine, Chicago], the prevalence of different awareness contexts is described and compared with an earlier survey done in 1969. Open awareness of dying, where both the dying person and the respondent knew that the person was dying, is the most prevalent awareness context. This is particularly so in cancer and represents a change since 1969 when closed awareness (where the respondent knows, but the dying person does not) was more common. The characteristics of those dying in open and closed awareness contexts are then compared, suggesting that having cancer, not being mentally confused, having a respondent who knew for some time that the person was dying, and being of higher social class are independently predictive of full open awareness, a condition marked both by knowledge of dying, and a value commitment towards openness. Compared with people in closed awareness, people dying in full awareness are more able to plan their dying careers, so that they and their respondents are more satisfied with the degree of choice over the place of death, they are less likely to die alone, and are more likely to die in their own homes. Additionally, these individuals are more likely to have spoken of their wishes for euthanasia, another indicator of their desire to control the manner and timing of death. If dying from cancer, people in full open awareness are more likely to have received hospice care. It is suggested that underlying these patterns, and in contrast with some other cultures where awareness of dying is seen as less desirable, people dying in Anglophone countries are particularly concerned to maintain control over projects of self-identity. Their approach to death is a reflection of this individualism.
Опубликовано на портале: 22-03-2007Emma Rich Sociology of Health and Illness. 2006. Vol. 28. No. 3. P. 284-306.
This paper explores the ways in which young women 'manage' the complexities of the presentation of an anorexic identity, the stigma attached to it, and the relationships that are developed with fellow sufferers. A range of ethnographic data and 'voices' are drawn upon, including a small qualitative study within a leading centre in the UK for the treatment of eating disorders. The paper begins by outlining the ways in which for many young women, anorexia is a stigmatised identity which in various contexts comes to be perceived as an irrational and self-inflicted condition. It was reported by the young women in our study that many of their peers, families and teachers made sense of their eating disorder through a medicalised discourse which focused on visual aspects of weight gain/loss and often stigmatised the condition, reducing it to a position of pathology or irrationality. It is argued that these experiences form a type of 'discursive constraint' (Ronai 1994) which many of the young women attempt to resist by engaging with alternative contexts and relationships through which they can construct more positive self-representations of anorexia or anorexic identities. As is revealed through the various data sources, as these young women negotiate the various discourses which offer them alternative subjectivities, they come to manage anorexia as both an illness and an identity.
Опубликовано на портале: 22-03-2007Cleave Seale Social science and Medicine. 1991. Vol. 32. No. 8. P. 943-952.
The literature suggests that doctors' and nurses' openness about communicating with the terminally ill and their families has increased in the past two or three decades, partly influenced by the hospice movement. The present study reports the perceptions of relatives, hospital doctors, general practitioners and nurses who knew a random sample of 639 adults dying in England in 1987. The results from professionals suggest a general preference for openness about illness and death, tempered by the consideration that bad news needs to be broken slowly, in a context of support, while recognising that not everyone wishes to know all. In practice people dying from cancer were more likely to be reported as knowing what their illness was and that they would die than were people dying from other conditions. This difference held when controlling for the fact that death was more likely to be medically expected in cancer. Comparisons with 1969 show that the increases were due largely to cancer patients being told the truth more frequently by hospital doctors. This may be due to changed practices, or to the increase in the number of hospital episodes in the last year of life. Nevertheless, situations of 'closed awareness' where relatives were told and patients were not, and situations where patients were left to guess the likely outcome for themselves, were still quite common in 1987. Nurses and hospice practitioners were only marginally involved in breaking bad news, this remaining the province of hospital doctors and general practitioners. Relatives in general praised the manner in which they and patients were told, although a small proportion reported insensitive practice. In retrospect a high proportion of both relatives and professionals felt that the levels of awareness were best as they were, although this preference may have been influenced by a desire to see things in a good light. Most relatives reported adequate support and information being given by professionals to them during the patient's illness. On the whole, doctors provided information, and friends and family provided emotional support to relatives. Again, hospital doctors played an increasingly important role compared to 1969 in providing information, with general practitioners' role decreasing in this area. Gaps in information included not being told enough about what was wrong with the patient, not being told the reasons for decisions about treatment and, to a lesser extent, not being given information about how to care for the patient.
Опубликовано на портале: 22-03-2007Carl May Sociology of Health and Illness. 2006. Vol. 28. No. 5. P. 513-533.
Conventional models of 'evidence' for clinical practice focus on the role of randomised controlled clinical trials and systematic reviews as technologies that promote a specific model of rigour and analytic accountability. The assumption that runs through the disciplinary field of health technology assessment (HTA), for example, is that the quantification of evidence about cost and clinical effectiveness is central to rational policy-making and healthcare provision. But what are the conditions in which such knowledge is mediated into decision-making contexts, and how is it understood and used when it gets there? This paper addresses these questions by examining a series of meetings and seminars attended by senior clinical researchers, social care and health service managers in the UK between 1998-2004, and sessions of the House of Commons Health Committee held in 2001 and 2005. These provide contexts in which questions about the value and utility of evidence produced within the frame of HTA were explored in relation to parallel questions about the design, evaluation and implementation of telemedicine and telecare systems. The paper points to the ways that evidence generated in the normative frame of HTA was increasingly seen as one-dimensional and medicalised knowledge that failed to respond to the contingencies of everyday practice in health and social care settings.
Опубликовано на портале: 22-03-2007Susie Scott Sociological Review. 1999. Vol. 47. No. 3. P. 432-460.
Sociological responses to the increase in recent years of psychiatric reports of multiple personality (latterly redefined as Dissociative Identity Disorder) have focused upon its discursive production as a diagnostic category. Drawing on life-history interviews with survivors of extreme childhood abuse - some of whom defined themselves as having 'multiple personalities' - this paper suggests that an adequate sociological account needs to combine analysis of the popular and clinical discourses of dissociation/multiplicity, with an understanding of the relationship between these and particular individual auto/biographies. The production of a narrative of fragmented subjectivity is considered as an active engagement with previously denied and silenced autobiographical experience and with the dominant contemporary discourse that allows for the episodic denial of self-reflexive selfhood. In the light of DID diagnoses being largely applied to/adopted by women, questions are raised concerning the possible impact of the adoption of a multiple identity on individual integrity and autonomy.
Опубликовано на портале: 22-03-2007Stefan Timmermans Sociology of Health and Illness. 1994. Vol. 16. No. 3. P. 322-339.
In this paper, the author employs a grounded theory approach to extend an existing theory. His starting point is the theory of awareness contexts, first formulated in 1965 by Strauss and Glaser. Using introspective ethnography, he illustrates that the way patients and relatives emotionally cope with terminal information defines the kind of awareness context. He therefore suggests that the open awareness context should be split into three different contexts. In the suspended open awareness context, the patient or kin ignores or disbelieves the message communicated by the physician. In the uncertain open awareness context, the patient or family member dismisses the bad parts of the message and hopes for the best outcome. In the active open awareness context, the patient or relative accepts the impending death and prepares for it. This revision reclaims the emotional power of terminal illness from the viewpoint of patients and relatives and adapts the theory to changed structural conditions.
Опубликовано на портале: 22-03-2007Michael Bury, David Taylor Sociology of Health and Illness. 2007. Vol. 29. No. 1. P. 27-45.
During the last century demographic and epidemiological transitions have had a radical impact upon health and health service provision. A considerable body of research on the sociological aspects of living with chronic illness has accumulated. Debate has focused on how social environments shape disability-related experiences, and the extent to which individual responses define health outcomes. Through the establishment of the Expert Patients Programme (EPP) in 2001, the Department of Health has sought to enhance NHS patients' self-management capacities. This paper discusses three areas relevant to this: the policy formation process leading up to the EPP's present stage of development; the evidence base supporting claims made for its effectiveness; and the significance of psychological concepts such as self-efficacy in approaches to improving public health. The conclusion discusses NHS developments in primary care and public involvement in health and healthcare, and the implications that initiatives such as the EPP carry for the future. It is argued that to facilitate a constructive process of 'care transition' in response to epidemiological and allied change, awareness of cognitive/psychological factors involved in illness behaviours should not draw attention away from the social determinants and contexts of health.
Опубликовано на портале: 04-03-2007Stefan Timmermans Sociology of Health and Illness. 2005. Vol. 27. No. 7. P. 993-1013.
Death brokering refers to the activities of medical authorities to render individual deaths culturally meaningful. Social scientists and others agree that mortality provokes existential ambiguity in modern life requiring cultural coping mechanisms. In contemporary Western societies, medical professionals have sequestered the dying in institutions, and have classified the causes of death to explain suspicious death. Over the last decades, the institutionalisation of the dying process has been challenged by social movements and the sudden onset of some deaths while forensic medicine has struggled for professional legitimacy in the borderland between mainstream medicine and the legal system. In this article it is argued that medical death brokering persists in spite of challenges because medical experts offer increasingly flexible cultural scripts to render the end-of-life socially meaningful while accentuating death's existential ambiguity. Medical professionals help create the ambiguity they promise to resolve, reinforcing the cultural need for more expert death brokering.
Опубликовано на портале: 04-03-2007Larissa Remennick Sociology of Health and Illness. 2006. Vol. 28. No. 1. P. 21-53.
Since the mid-1990s, the Israeli medical scene has witnessed a real boom in elective prenatal testing for inherited diseases that has spread beyond risk groups to the general Jewish population, especially of Ashkenazi (European) origin. This study tried to identify key social influences involved in the growing range and prevalence of prenatal genetic tests as they emerged from women's own perspective. Twenty-seven women having blood tests for genetic mutations were interviewed at two types of genetic clinics, and re-interviewed after getting test results. The names of 23 women who chose not to have elective tests were obtained from testers, and these non-testers were interviewed for comparison. Women's accounts suggest that elective genetic testing is more acceptable, if not normative, among educated middle class Ashkenazi women, and is more often questioned and refused by lower class Mizrahi women, as well as religious women of any ethnic origin. The key forces that drive women's choice of prenatal genetic diagnosis include the fear of having a sick and/or socially unfit child in an unsupportive environment; strong endorsement of testing by gynaecologists; popular and professional discourse on the common Ashkenazi mutations causing genetic anxiety in this ethnic group (i.e. apprehension of multiple known and unknown dangers hidden in its genetic makeup); and the emerging social pressure for comprehensive prenatal screening as an indispensable part of good motherhood. Many women described the experience of testing as frustrating because of the long wait for results and difficulty of their interpretation and subsequent decision-making. Women who rejected elective tests explained their decision by moral/religious objections to abortion and/or eugenic aspects of prenatal screening, as well as by prohibitive costs and poor understanding of the tests' meaning and implications. Yet, few informants voiced objections to the excessive medicalisation of pregnancy as such; ethno-national motives of reproductive decisions were also uncommon in this group. More critical reflection is clearly needed from both providers and users of elective genetic screening before the more widespread uptake of this practice.
Опубликовано на портале: 04-03-2007Susan A. Nancarrow, Alan M. Borthwick Sociology of Health and Illness. 2005. Vol. 27. No. 7. P. 897-919.
The healthcare professions have never been static in terms of their own disciplinary boundaries, nor in their role or status in society. Healthcare provision has been defined by changing societal expectations and beliefs, new ways of perceiving health and illness, the introduction of a range of technologies and, more recently, the formal recognition of particular groups through the introduction of education and regulation. It has also been shaped by both inter-professional and profession-state relationships forged over time. A number of factors have converged that place new pressures on workforce boundaries, including an unmet demand for some healthcare services; neo-liberal management philosophies and a greater emphasis on consumer preferences than professional-led services. To date, however, there has been little analysis of the evolution of the workforce as a whole. The discussion of workforce change that has taken place has largely been from the perspective of individual disciplines. Yet the dynamic boundaries of each discipline mean that there is an interrelationship between the components of the workforce that cannot be ignored. The purpose of this paper is to describe four directions in which the existing workforce can change: diversification; specialisation and vertical and horizontal substitution, and to discuss the implications of these changes for the workforce.
Dilemmas in Fetal Medicine: Premature Application of Technology or Responding to Women's Choice? [статья]
Опубликовано на портале: 04-03-2007Clare Williams Sociology of Health and Illness. 2006. Vol. 28. No. 1. P. 1-20.
It is argued that innovative health technologies (IHTs) may be changing the roles of both patients and health practitioners, and raising new issues, including ethical, legal and social dilemmas. This paper focuses on the innovative area of fetal medicine. All fetal treatment necessitates accessing the fetus through the pregnant woman's body, and non-surgical treatments have long been a part of pregnancy care. However, recent developments in this area, including the increasing routinisation of sophisticated antenatal ultrasound screening and the introduction of treatments including fetal surgery, may mark a shift in this specialty. The paper explores such shifts from the perspectives of medical and midwifery practitioners working in two Fetal Medicine Units. It examines the apparent effects of the orientation of fetal medicine on prevalent conceptualisations of the maternal-fetal relationship, and some of the consequences of this. It is argued that new forms of uncertainty, including complex risk and diagnostic information, and uncertain prognostic predictions set within the rhetoric of non-directive counselling and women's choice, are leading to unprecedented ethical dilemmas within this area. More widespread debate about such potential dilemmas needs to take place before, rather than following their introduction.
"Listen to My Madness": Understanding the Experiences of People with Serious Mental Illness [статья]
Опубликовано на портале: 04-03-2007Helen Lester, Jonathan Q. Tritter Sociology of Health and Illness. 2005. Vol. 27. No. 5. P. 649-669.
This article explores the salience of disability theory for understanding the experiences of people with serious mental illness. Drawing on data from a focus group study, authors suggest that users experience both impairment (as embodied irrationality) which can, in itself, be oppressive, and also have to manage their lives within a largely disabling society. They outline some of the strategies adopted by users to manage their situation and ensure they access and receive health services, and illustrate how these are a result of the complex relationship between disability and impairment. It is suggested that using a framework of the social model of disability provides a useful way of understanding and making sense of the experience of users with serious mental illness.