bluuebunny/crossref_metadata_2025 huggingface dataset:
Boundary encroachment and task delegation: clinical pharmacists on the medical team
Authors: Mesler Mark A.
Published: February 2004

The sociological literature on pharmacy is sparse, relative to that on physicians and nurses, especially in light of recent changes in the nature of health care and pharmacy's expanded ‘clinical’ role. Moreover, some of this literature presents contradictory perceptions of the clinical pharmacy role; some are perceiving it as encroaching on physicians' role boundaries, while others perceive its few new tasks to be delegated. This article is based on extended participant observation of clinical pharmacists in two northeastern teaching hospitals in the U.S. Data are presented on the clinical tasks the pharmacists performed, the potential boundary conflicts they posed for other members of the medical team, the resolutions of these conflicts, and the role boundaries perceived by relevant participants. From this analysis it is argued that the literature on pharmacy's boundary encroachment is not so much contradictory as incomplete. Implications for pharmacy and the analysis of role boundaries is discussed in conclusion.
Mediating illness: newspaper coverage of tranquilliser dependence
Authors: Gabe Jonathan , Gustafsson Ulla , Bury Michael
Published: February 2004

The purpose of this paper is to illustrate the value of insights from media studies for medical sociology by focusing on the cultural and ideological messages transmitted in newspaper coverage of tranquilliser dependence. An analysis of 62 stories recounting the experiences of individual tranquilliser users reveals that journalists concentrate on two kinds of person – the celebrity and the ordinary user‐ in their reports. The ways in which the press deploys these users' experiences of tranquilliser dependence and withdrawal and their relationship with the medical profession are then analysed, with particular attention being given to the cultural and ideological meanings embedded in its descriptions of such experiences and relations. The paper ends with a discussion of the reasons for the transmission of such meanings by the press and their possible effect on different audiences.
The social construction of noncompliance: a study of health care and social service providers in everyday practice
Authors: Fineman Norman
Published: February 2004

This study investigates the social construction of noncompliance by clinicians, social workers, and alcohol counsellors in a multiservice health care and social service agency. Based upon data from in‐depth interviews and long term observations, it is suggested that noncompliance, like other categories of deviance, is socially constructed and subjectively denned and interpreted. Staff members of this agency subjectively defined noncompliance as the extent to which clients' behaviours deviated from expectations of appropriate, proper and reasonable client behaviour. In addition, staff members interpreted the meanings of clients' noncompliance by subjectively assessing the intent underlying their clients' noncompliant acts. Their assessments, in turn, served to structure their subsequent interactions with clients and provided the rational and moral bases for constructing the strategies they used to manage clients' noncompliant behaviours and bring about compliance.
Husbands' participation in fertility treatment: they also serve who only stand and wait
Authors: Meerabeau Liz
Published: February 2004

The paper examines the participation of men in outpatient consultations at three fertility clinics, and draws comparisons with participation in pregnancy and childbirth, in which there are also diffuse statements about support, but little concrete activity. It is argued that the medical consultation has difficulty accommodating a triad, and assumes a commonality of aims which may not exist. The alternative, which would involve addressing the dynamics of the couple's relationship, may not be achievable within the confines of the outpatient setting.
Eager for medicalisation: the social production of infertility as a disease
Authors: Becker Gay , Nachtigall Robert D.
Published: February 2004

The social and cultural basis of medicalisation is explored through an examination of infertility, a social condition that has recently been recast as a disease. Infertility illustrates a basic dilemma of medicalisation: the health care system reflects the same value system at work throughout society. Placing social problems within a biomedical framework does not provide a satisfactory solution for conditions that deviate from cultural norms because those norms are replicated in biomedical ideologies about the nature and treatment of disease. We examine three phases of this dilemma through an analysis of data collected in in‐depth interviews with 43 American couples who were undergoing infertility treatment: 1) the disparity between initial expectations about ease and speed of treatment and its actual complexity, 2) the confrontation with medical definitions of abnormality, and 3) the cumulative effects of treatment, in which emotional exhaustion from infertility treatment vies with the continuing need to ‘fix’ the infertility and produce a pregnancy. We conclude that individuals' efforts to eradicate feelings of abnormality for their childlessness by lending medical legitimacy to their failure to conceive are undermined by entering a medical system in which concepts of disease and abnormality are implicit.
Nursing work, nurses' knowledge, and the subjectification of the patient
Authors: May Carl
Published: February 2004

Although sociologists interested in health and illness have extensively deployed the work of Michel Foucault in recent years, few studies have examined the ways in which this is of use in understanding nursing practice. This paper explores the ways in which nurses' accounts of their work and relationships with patients reflect a discourse of the social. While these accounts reflect a thoroughgoing accommodation of the importance of ‘knowing’ the patient as more than an object of clinical practice and procedure, they also reveal the practical problems that must be negotiated in attempting to do so. Foucault's notion of the clinical gaze is deployed in interpreting these accounts, and the question of power and resistance in nursing work is discussed.
Care = organisation + physical labour + emotional labour
Authors: James Nicky
Published: February 2004

The formula‘care = organisation + physical labour + emotional labour' identifies component parts of ‘carework’ as they were observed at a hospice. A comparison between women's domestic carework and that of the hospice nurses is made firstly to clarify the component elements of care and secondly to show how the interrelation and balance of the components differs in the two settings. It is argued that family care has been a model for hospice care but that division of labour in hospices, which replicates hospital labour‐divisions, results in an inflexibility in hospice care which is incompatible with the ‘family’ model. In the final section it is suggested that emotional labour is likely to be increasingly recognised as part of health care but that the concept of ‘total care’ needs to be questioned.
Women in a women's job: the gendered experience of nurses
Authors: Porter Sam
Published: February 2004

The aim of this paper is to examine how the structural influence of gender affects nurses in their working lives. Gender segregation exists both within and between the occupations of medicine and nursing. It is largely founded on the social construction of a skills/caring dichotomy. An analysis of how the gender of nurses and doctors affects their interactions with co‐workers reveals that the increasing proportion of female doctors has attenuated power differences between the two occupations. Examination of nurses' attitudes to gender demonstrates that they are very aware of the problem, despite a tendency to accept credentialist justifications of inequality. As a result of this they are becoming more assertive. The issue of sexual stereotyping is addressed and it is noted that popular mythology about sexual relations between doctor and nurses is highly misleading. Privatised aspirations are having a decreasing influence over nurses' working lives. In conclusion, while gender inequality is losing some of its power in nurse‐doctor relationships, it is becoming an increasingly significant factor in the relationship between male nurse managers and female workers.
The image of health: variations in perception by social class in a French population
Authors: D'Houtaud A. , Field Mark G.
Published: February 2004

In order to determine how a population defines the meaning of health, a study was made using a sample of 4,000 respondents from Lorraine, in the north‐eastern part of France. The respondents, all of whom were undergoing a health examination, were asked to respond to an open‐ended question on what health meant to them. A total of 6,172 replies were obtained whose contents were classified into 41 main themes themselves regrouped under 10 heading (or groups of themes).

The responses were clearly linked to the socio‐economic class position of the respondents, which was the most discriminating variable, and the one discussed here. There was a gradient from the higher, non‐manual classes to the lower manual classes, the former conceiving health more in personalized, positive and expressive terms, and the latter more in negative, socialized and instrumental terms, thus reflecting the complementary positions of social classes as mediated through the occupational structure.
Art, science, faith and medicine: the implications of the placebo effect
Authors: Price Linnie
Published: February 2004

The placebo effect has been shown to account for between 30 to 40 per cent of the efficacy of ‘active’ medication for a wide range of pathologies and is probably a powerful agent of cure in other therapies, for example surgery. Medicine has failed, at least explicitly, to confront the implications of this powerful effect, attending to it mainly as a nuisance variable to be controlled for in clinical trials. This paper argues that the existence and extent of the placebo effect represents a challenge to the assumptions behind much medical practice, and throws doubt on the validity of locating disease and healing within a paradigm of scientific rationality.
Clinical uncertainty: is it a problem in the doctor‐patient relationship?
Authors: Calnan Michael
Published: February 2004

There has been little consideration of the implications of clinical uncertainty about diagnosis, prognosis and treatment although these uncertainties might represent a real threat to professional autonomy. This paper, using evidence from a range of empirical studies, examines whether in the everyday practice of medicine clinical uncertainty is a real threat to professional autonomy. The evidence suggests that only rarely does clinical uncertainty present management problems for the doctor. The evidence also suggests that the image of the patient being duped by medical or bourgeois ideology, as presented in the work of some macro theorists, is inaccurate.
Student nurses’ construction of occupational socialisation1
Authors: Melia Kath M.
Published: February 2004

This paper examines the occupational socialisation of British nurses. It uses Bucher and Strauss's notion of segmentation and considers two major segments within nursing: the education segment which, through the colleges of nursing, promotes a ‘professional’ version of nursing, and the service segment which is concerned with getting nursing work done. Students’ accounts of their training were obtained by means of 40 informal interviews. On the basis of these accounts it is argued that the students learn neither the education nor the service segment's version of nursing, rather they learn to recognise when one version is appropriate and the other not and ‘fit in’ accordingly. The organisation of nurse training is based on a compromise between the two segments whereby the students move between clinical placements and the college of nursing; in this way both versions of nursing are enforceable on the students. The paper argues that nursing as an occupation, by its organisation and compromise solution to the training of its recruits, supports a transient approach to nursing work itself and so implicitly supports a lack of commitment to nursing as an occupation.
Social class and psychological ill‐health during unemployment
Authors: Payne Roy , Warr Peter , Hartley Jean
Published: February 2004

This study explores psychological health and the experience of being unemployed for between 6 and 11 months in two social class groups: unskilled and semi‐skilled workers v. white‐collar, managerial and professional workers. The respondents were British married men aged between 25 and 39. Information was obtained through interviews about financial and other problems, perceived threats associated with unemployment, anxiety, depression, general psychological distress and ratings of general health. It was expected that the working‐class sample would exhibit poorer psychological health than the middle‐class, but this was not confirmed. Medium‐term unemployment appeared to have a homogenizing effect, with similarly poor health in both social class samples, although working‐class respondents reported significantly greater financial problems and difficulties in filling the time.
The genesis of chronic illness: narrative re‐construction
Authors: Williams Gareth
Published: February 2004

In this paper I demonstrate the way in which people's beliefs about the aetiology of their particular affliction (arthritis) need to be understood as part of a more comprehensive imaginative enterprise which I refer to as narrative reconstruction. The intrinsically teleological form of this enterprise means that identified ‘causes’ represent r only putative efficient connexions between the disease and antecedent factors but also narrative reference points between the individual and society in an unfolding process which has become profoundly disrupted. Through the presentation of case material taken from lengthy interviews I illustrate the way in which my question to the subjects about the cause of their disease: ‘Why do you think you got arthritis?’ was translated by them into a narrative reconstruction of their changing relationship to the world in which they live and the genesis of illness within it.
Rudolf Virchow on the typhus epidemic in Upper Silesia: an introduction and translation
Authors: Taylor Rex , Rieger Annelie
Published: February 2004

Rudolf Virchow's Report on the 1848 typhus epidemic is one of the neglected classics of ‘social medicine’— a term he did much to popularise. His analysis of the epidemic emphasised the economic, social and cultural factors involved in its aetiology and clearly identified the contradictory social forces that prevented any simple solution. Instead of recommending medical changes like more doctors or hospitals, he outlined a revolutionary programme of social reconstruction; including full employment, higher wages, the establishment of agricultural co‐operatives, universal education and the disestablishment of the Catholic church. The present paper includes the first English translation of these long‐term recommendations. It also locates Virchow's Report within the context of the Medical Reform Movement of 1848 and traces his influence on the subsequent development of social medicine. Parallels are drawn between Virchow's attempts to reform health care and current developments in the political economy of health.
Negotiation of self and setting to advantage: an interactionist consideration of nursing home data
Authors: Hanson Barbara Gail
Published: February 2004

Abstract This paper examines the dynamics of the process of negotiation in a nursing home by focusing on the process of gaining advantage. The concepts of primary and secondary advantage are introduced in order to allow comparison and organization of the data. In the course of examining what rewards are possible and how they are achieved, we are able to see that the impetus to treat and the control of treatment action often lies with the staff of the home rather than the physician, that officially imposed definitions may be unfavourable to the persons they are imposed upon and that the process of deciding on everyday activities is often complex.
Licensed lay midwifery and the medical model of childbirth
Authors: Weitz Rose , Sullivan Deborah
Published: February 2004

Abstract Previous research has tended to equate lay midwifery with demedicalized care. This paper analyzes how licensed lay midwives in Arizona have been pressured towards a more medical model of childbirth. Licensing has affected midwives' beliefs and practices through increasing their exposure to medical definitions of childbirth and making them legally accountable to the medically dominated State Department of Health Services. The midwives' cumulative experience with handling obstetrical problems has also affected their definitions of childbirth. The midwives have maintained a commitment to holistic care, but have moved towards a more hierarchical style of practice due to changes in their clientele, the need for efficient bureaucratic arrangements, and the desire to earn a living at midwifery.
Health, health risks and inequalities: an exploratory study of women's perceptions
Authors: Calnan Michael , Johnson Barbara
Published: February 2004

Abstract Recent theoretical and empirical research has highlighted the importance of understanding the relationship between social structure and health beliefs. The empirical study described here explores the relationships between occupational social class and two dimensions of health beliefs which were concepts of health and perception of vulnerability to disease. Both the dimensions are claimed to be associated with decisions to carry out health behaviour and thus one of the aims was to shed some light on the social class gradient in patterns of preventive health behaviour and risk‐taking behaviour. The findings showed a more marked social class differentiation in concepts of health when they were defined in the abstract compared with when they were defined in relation to personal health. The concept of personal vulnerability itself was shown to be problematic and theories about vulnerability were similar for both classes. Explanations for the findings are discussed.
Medical dominance and the development of professional autonomy in physiotherapy
Authors: Øvretveit John
Published: February 2004

Abstract Has medical dominance declined as a result of the increasing autonomy of developing health professions? The paper argues that to answer this question it is first necessary to define medical dominance and professional autonomy. The paper outlines a categorisation of different types of professional autonomy, which correspond to different types of medical dominance. This categorisation is used to identify the particular aspects of professional autonomy in physiotherapy which have developed over recent years. It is concluded that whilst these changes correspond to a decline in aspects of medical dominance, there is no evidence of a significant decline in medical dominance in health services or that the changes which have taken place are solely a result of developing health professions' struggle for autonomy.
The legal and institutional development of the Belgian medical profession in the nineteenth century
Authors: Schepers Rita
Published: February 2004

Abstract The Belgian medical profession clearly suffered from a lack of internal coherence in the nineteenth century. The interests and objectives of, for example, the Royal Academy of Medicine, the provincial medical boards and the Fédération Médicale Beige, were by no means homogeneous. And even within the Federation itself, there tended to be a split on every question of tactics. In this article, two general trends will be described: the legal unification of the profession and its institutional development. In the third section, attention will be focused on the impact of the professional associations on medical education and on the control of medical practice. Each section begins with a survey of the state of the Belgian medical profession prior to the Belgian independence in 1830. Finally, some concluding comments are given.
Doctor‐patient negotiation of cultural assumptions
Authors: Fisher Sue , Groce Stephen B.
Published: February 2004

Abstract This paper simultaneously examines the relationship between norms as features of the social structure and norms as interactional accomplishments. Doctors as cultural members share a set of social facts about women as part of their common stock of knowledge. By posing these facts in a reflexive relationship with the interactional work participants do in specific settings we are able to display how doctors acting as ‘secret apprentices’ ferret cultural assumptions from medical interactions. A detailed comparison of two cases with the same doctor provide the data to examine the ways norms about patients qua women emerged and were negotiated against a background of cultural expectations or assumptions about women. This comparison reveals how divergent assumptions about women emerge, structure the discourse and influence the delivery of health care.
Paid employment and women's health: a benefit or a source of role strain?
Authors: Arber Sara , Gilbert G. Nigel , Dale Angela
Published: February 2004

Abstract Two contrasting theories of the relationship between paid employment and women's health are examined using data from the 1975 and 1976 General Household Survey. The ‘role accumulation’ hypothesis, which proposes that paid employment has beneficial effects on health, was supported for women without children, and for women over 40 with children. However, the causal ordering is unclear, for there is evidence that ill‐health reduces the likelihood of labour‐force participation especially among women over 40. When those reporting chronic illness are excluded, the association between being a housewife and short‐term illness largely disappears.

The contrasting hypothesis, that for married women with children the strain of occupying multiple roles leads to poorer health, was also supported, but only for women under 40 who work full‐time and have children. These women reported higher levels of illness, although this was less clear among women working in professional and managerial jobs. It is concluded that full‐time work for young mothers may be detrimental for their health unless there are adquate financial resources to help with the burden of maintaining the multiple roles of housewife, mother and employee, or until the sexual division of labour in the home changes.
Managing hypertension: beliefs and responses to medication among cultural groups
Authors: Morgan Myfanwy , Watkins C.J.
Published: February 2004

Abstract Lay beliefs and responses to antihypertensive therapy were examined through tape recorded interviews held with European respondents, who were predominately English and referred to as ‘white’, and people born in the West Indies. Respondents were aged 35–55 years, of manual social class and currently being treated for hypertension by their general practitioner. Nearly one‐half of the respondents identified stress or worry as a cause of their high blood pressure. Possible reasons for this are considered, including their doctors’ explanation of the causes and respondents own understanding of the term ‘hypertension’. Respondents were all aware of the importance of controlling their blood pressure. However, whereas the level of adherence to the prescribed medication was high among white patients, less than half of the West Indians were classified as compliers, with many regularly ‘leaving off’ the drugs. This reflected their particular beliefs and concerns, and was often associated with the use of herbal remedies, forming a continuation of traditional cultural patterns.
The birth of cancer policies in France
Authors: Pinell Patrice , Brossat Sylvia
Published: February 2004

Abstract This paper analyses the social conditions of emergence of cancer politics in France in the inter‐war period. It examines the historical circumstances whereby various segments of the dominant class‐surgeons, 'scientist’ doctors, philanthropists ‐ and 'society ladies’ concurred to create an ‘anti‐cancer movement’ and to found a new discipline, i.e., cancerology, as well as a novel form of organizing medical care, i.e., cancer centres. It then examines the process of construction of a representation of cancer as a scourge disease, combining elements of medical, scientific and lay discourses.
Women's health or social control? the role of the medical profession in relation to factory legislation in late nineteenth century Britain
Authors: Harrison Barbara
Published: February 2004

Based on an analysis of primary and secondary documentary sources this paper examines the relationship of medical men to state intervention in women's labour. Focusing on factory legislation it explores the extent to which this intervention may be seen as an attempt to alleviate the health consequences of industrial work or as a means of social control, which is defined here in terms of actual restrictions on women's participation in the paid labour market and of the assertion of their primary role within the private domain. The involvement of medical practitioners in such questions is also assessed in terms of the consequences for industrial medicine. The paper argues that factory legislation failed to meet either its social purpose, or the health needs of working women, while reinforcing the ideology of 'separate spheres’and the moral and social responsibilities of the state
Inequality in health and the class position of women ‐ the Norwegian experience
Authors: Dahl Espen
Published: February 2004

The paper examines whether different ways of classifying women in the socioeconomic hierarchy make a difference with regard to health. Among sociologists there has been much dispute on how to classify women in the class structure. The insights from this debate, however, have attracted negligible attention in contemporary research on social inequalities in health. Four ways of classifying women are identified and operationalized: the conventional, the individual the cross‐class, and the pre‐war generational approach. Using a nation‐wide representative data set, their associations with a dichotomous measure of self‐reported health are investigated. Logistic regression analyses show that only one approach yields significant results (p<0.05): the conventional. In this model, health is inversely associated with socioeconomic status. Possible interpretations of these results are discussed. The findings imply that the conclusions drawn in Norwegian studies of social inequalities in health and in use of health services must be questioned and should be reconsidered.
Style of life and the salience of health: an exploratory study of health related practices in households from differing socio‐economic circumstances
Authors: Calnan Michael , Williams Simon
Published: February 2004

This paper describes results from a small scale study, using qualitative interview methods, which attempts to explain variations in health‐related practices between households living in contrasting social and economic circumstances. The approach and methodology adopted put an emphasis on spontaneous, unprompted discourse, in an attempt to discover how ideas about matters of health and health‐related practices are integrated into routine daily life, and how this routine daily life is shaped by social and economic circumstances. The evidence from this study shows that irrespective of social and economic circumstances, matters of health rarely surfaced in people's descriptions of their lives and neither did health concerns in the context of behaviour. The implications of these and other findings are discussed in an attempt to explain the link between social structure and behaviour.
Potency: a readjustment‐promoting link in the rehabilitation of disabled persons
Authors: Ben‐Sira Zeev
Published: February 2004

Abstract A study among a stratified sample of Israeli disabled war veterans ascertained the contribution of ‘potency’ ‐ a recently discerned stress‐moderating link in the coping process ‐ in promoting the readaptation to social life of traumatically disabled persons. Potency reflects a combination of self‐confidence and commitment to and trust in society. The data suggest that potency is likely to weaken the deleterious impact of inadequate coping with the unprecedented demands inherent in disability. Disabled army veterans with strong potency are less likely than those with weak potency to be affected by occasional coping failures, by subjectively perceived ‘demands’, or by occasional resource deficiencies. The evident instrumentality of potency for readjustment suggests that societal and personal factors simultaneously play a significant role in readjustment.

The contribution of this study is in its illumination of the importance of the disabled person's perception of society, in addition to his/her individual resources, for successful reintegration into social life.
Appealing to the ‘experience’ of the patient in the care of the dying
Authors: Peräkylä Anssi
Published: February 2004

Abstract The care of dying patients in hospital is characterized by the co‐presence of four different frames: practical, medical, lay and psychological. Within the psychological frame, the staff define the patient as an experiencing subject, exposed to the staff members' knowledge and involvement.

The psychological frame is used in two different circumstances. First, it is used by the staff members when the patient deviates from an expected identity within some other frame. The deviation creates a threat to the working conditions and moral order at the ward. The threat is managed through a shift into the psychological frame. Second, the psychological frame is used spontaneously in the accounts of their work given by staff members to the sociological field researcher. The image of care associated with the field researcher is characterized by a special awareness of the psychological issues. Thus the field researcher is inevitably a part of the functioning of the new kind of surveillance working through the psychological frame.
Hope for the humblest? The role of self‐help in chronic illness: the case of ankylosing spondylitis
Authors: Williams Gareth H.
Published: February 2004

Abstract This paper puts forward the proposition that modern self‐help organizations are the progeny of an uneasy relationship between two ideologies: individualism and collectivism. Within this relationship individualism is the dominant partner. Using a case‐study I examine the way in which these ideological influences can be seen to take concrete form in the history and activities of the National Ankylosing Spondylitis Society. I argue that certain characteristics of ankylosing spondylitis itself make it particularly amenable to self‐help, but that under pressure from various social and cultural forces this tends to take the form of an emphasis on individual self‐reliance rather than mutual aid. This tendency makes it difficult for the Society to respond in a meaningful way to social aspects of disablement. Although these interpretations are necessarily provisional, the paper concludes by suggesting that the tensions and equivocations revealed by the analysis have more general relevance to self‐help groups, particularly those which are condition‐specific and rely, to some extent, on the patronage of doctors and other health professionals.
The professional socialisation of midwives: Balancing art and science
Authors: Benoit Cecilia
Published: February 2004

Abstract Mastery of esoteric knowledge is one of the central features assigned by sociologists to fully professionalised service occupations, together with an orientation towards public service. There are, nevertheless, different views about the best way in which this education and socialisation can be provided for new recruits for practitioner roles. Some maintain that the university provides an ideal training ground. Critics of this view, however, call for a rejection of ‘university diploma mills’ and a return to the type of apprenticeship socialisation common during the premodern era. This paper tests the usefulness of these perspectives in understanding the occupational socialisation of Newfoundland and Labrador midwives. Three major styles of training ‐ traditional apprenticeship, vocational schooling and university education ‐ can be discerned. In comparison to both apprenticeship and academic styles of occupational socialisation, only vocational training nicely blended the art and science of midwifery to produce competent and committed professionals.
Masculinity, femininity and sex: an exploration of their relative contribution to explaining gender differences in health
Authors: Annandale Ellen , Hunt Kate
Published: February 2004

The emergence of gender as a major area of interest in medical sociology in the 1970s set an exciting agenda for future research. However, despite a growing literature, our understanding of the mechanisms linking gender and health has advanced little in recent years. This may, in part, be due to problems in conceptualising gender. In particular, despite theoretical advances, biological sex and sociological gender continue to be conflated in empirical research. In this paper we argue that sex and gender are not necessarily coincidental and that gender roles and gender role orientations may cross‐cut sex. We draw upon a recent tradition of research on gender role orientation in psychology which assesses the level of ‘bmasculinity’ and ‘femininity’ in an individual's self‐concept through identification with traditionally ‘masculine’ and ‘feminine’ characteristics. Considering a range of health measures we conclude that the sex (male‐female) differences that are traditionally found in research on gender and health may mask an association of ‘femininity’ with relatively poor health and ‘masculinity’ with relatively good health in both men and women.
What is genuine sickness? The relation between work‐discipline and the sick role in a pottery factory
Authors: Bellaby Paul
Published: February 2004

From material gathered in the author's study of sickness and absence in a pottery factory, it is shown that genuine sickness is routinely problematic, and must be negotiated between the claimant and others in the work‐group, sometimes also management and medical practitioners. Resolutions of the problem are practical and contingent, rarely based on medical proof, actual or imagined. It transpires that gender, age and class relations in the workplace have a bearing on whether and in what terms sickness and/or absence is acceptable. The ambiguities contained in these relations and existing between discourses and techniques of power associated with work‐discipline, worker resistance and medical practice, are reproduced in the negotiation of genuine sickness.
Patient responses to benzodiazepine medication: a typology of adaptive repertoires developed by long‐term users
Authors: North Diana , Davis Peter , Powell Anne
Published: February 2004

Since the late 1970s there has been a marked decline in the prescribing of the benzodiazepines. Yet long‐term use of this drug persists despite widespread media condemnation and growing professional concern. The study seeks to illuminate this phenomenon by deploying qualitative methods to investigate the meaning that such medication has for the users themselves and their styles of management. In‐depth interviews were conducted with fifteen community‐based users and seven members of a self‐help group. From this material a typology was developed that reflected the relationship users had formed with their medication. The key dimensions in this typology were the degree of dependency on the drug, the perceived level of risk associated with it, and underlying attitude. The relationships to the drug reflected in the typology were suggestive of a pattern of self‐regulation and active management by users, rather than dominance and control by practitioners. Furthermore, the investigation indicated that characteristics of the medication regime itself—such as type of drug and dose exert an influence on the attribution of meaning and the place of the drug in users' lives. While a characterisation of patient subculture has real potential for application in clinical practice, there are also implications within medical sociology for theories of medicalisation and social control.
Surviving psychiatric insritutionalisation: a case study
Authors: Prior Pauline M.
Published: February 2004

This paper looks at the impact of psychiatric hospital treatment on the life of a man who spent almost forty years in a large mental hospital in Northern Ireland. Patient behaviour and staff experience of this behaviour are examined within the conceptual framework proposed by Erving Goffman. This man's story once again challenges the notion of the all‐pervading power of the institution, and affirms the ability of some individuals to maintain a strong personal identity in spite of being officially labelled as deviants and separated from society because of this label. It also challenges the assumption that institutional living in itself, stigmatises and therefore isolates an individual from normal social networks. It is argued that in order to predict the impact of voluntary or compulsory institutionalisation, not only must the identity‐construct of the individual be considered, but also the social position of the institution within the community.
Going against the grain: smoking and ‘heavy’ drinking amongst the British middle classes
Authors: Burrows Roger , Nettleton Sarah
Published: February 2004

This paper examines the characteristics of those members of the British middle classes who ‘go against the grain’ of healthy living by both smoking and drinking alcohol over recommended levels. Using logistic regression procedures on GHS data, it concludes that there are significant gender differences, with men being much more likely to adopt such risky health behaviours than women. Further, the social correlates of such behaviours differ for men and women. For men, such behaviours are significantly associated with marital status, the experience of social mobility and region. For women, such behaviours are associated with the presence of dependent children, educational level and the number of hours worked in paid employment. The paper attempts some tentative interpretations of these results by drawing upon the available sociological literature.
Reneotiating identity: cancer narratives
Authors: Mathieson Cynthia M. , Stam Hendaikns J.
Published: February 2004

We frame the work of living with cancer as one which is identity‐altering. Interviews with a heterogeneous group of cancer patients of varying sites and stages were used to conceptualise the identity work as involving disrupted feelings of fit, renegotiating identity, and biographical work. Patient narratives reflect these categories depending on their stage of illness and their experiences in medical institutions.‘Identity work’ is used to describe the process of patients' evaluations of the meaning of their illness within the actual context of ongoing, organised social relationships, including the medical system. We discuss the implications for narrative analyses in the social sciences.
Domestic labour and health: bringing it all back home
Authors: Thomas Carol
Published: February 2004

This paper explores the relationship between unpaid domestic labour and health. Although the ‘informal care’ literature touches on the connection between aspects of domestic labour and health, sociologists have not engaged in a systematic analysis of the nature of this relationship. In the following discussion I examine i) the reasons why this relationship has been obscured, ii) possible ways forward in theorising the link and, iii) the under‐recognised historical contribution made by domestic labourers to the improvement in the health status of the population in industrial Britain. In relation to the latter I critically examine the widely accepted ‘McKeown thesis’ (McKeown 1979) which postulates that falling mortality rates in late 19th and early 20th century Britain can be explained not by medical intervention but by rising standards of living and improved nutrition. I argue that in the McKeown thesis, and in the work of those like David Blane (1987) who have examined it, the explanation for falling mortality rates is incomplete because it has not accounted for a then developing and expanding area of social activity, namely, domestic labour.
Socioeconomic mortality differentials in men and women according to own and spouse's characteristics in Finland
Authors: Martikainen Pekka
Published: February 2004

This paper compares the magnitude of differences in mortality according to own and spouse's socioeconomic characteristics and assesses the importance of cross‐classifying these characteristics. The analysis covers all 35–64 year‐old married Finnish men and women in the period 1981–85. Relative mortality rates were obtained from Poisson regression models.

The analysis shows that socioeconomic mortality differentials within each sex are more or less equally large according to both own and spouse's education or occupational characteristics for a wide range of causes of death. Moreover, among both women and men cross‐classifications between own and spouse's socioeconomic status do not indicate important mortality differentials over and above those already displayed by its two separate parts, i.e. there were no important interactions between own and spouse's socioeconomic characteristics.

The results call into question the argument that the mortality of married women should be analysed on the basis of their husband's socioeconomic characteristics because these characteristics better describe both spouses' socioeconomic standing and are thus more powerful predictors of men's and women's mortality than women's socioeconomic characteristics. It is further concluded that the advantages of cross‐classifying both spouses' socioeconomic characteristics in mortality analysis are very limited when these characteristics do not interact with each other.

Moreover, cause‐specific comparisons between men and women showed that married women's mortality differentials by own educational as well as occupational status were roughly as large as those obtained for men. The larger total mortality differentials among men than women are mainly due to cause of death structure.
Ethnicity: not a black and white issue. A research note
Authors: Bradby Hannah
Published: February 2004

The dangers of using ‘race’ as an analytical concept in the sociology of health and illness are outlined, before examining how the terms ‘racism’, ‘racialisation’ and ‘ethnicity’ can be defined in order to distinguish between ethnic minorities, ethnic majorities and racialised minorities in contemporary Britain. It is argued that by using this terminology the implications for health differences between ethnic groups of racism, of cultural practices and of biological factors can be specified.
Musculoskeletal suffering: diagnosis and a variant view
Authors: Thornquist Eline
Published: February 2004

What acounts as relevant and valid information in a diagnostic context? A descriptive analysis of a first encounter from physiotherapy practice provides the background for a proposed response to this question. The encounter took place between a therapist and a patient suffering from muscular tension. It exemplifies the employment of dimensions of experience and knowledge other than those ordinarily accepted by scientific medicine. Prevailing notions of the body and the traditional distinction between ‘objective’ and ‘subjective’ knowledge are considered against this background. It is suggested that the tacitly accepted separation between the physical body and human experience be superseded by a new understanding. Conversely, the prevailing correlation between ‘patient/symptoms/subjectivity’ and less valid information on the one hand, and ‘clinician/signs/objectivity’ and valid information on the other, is shown to be counterproductive. Verbal and bodily information are not categorically different, belonging to the separate worlds of ‘res extensa’ and ‘res cogitans'. In real lives—and real bodies—they are complementary. It is argued that more complex interactional forms are better suited than standard diagnostic procedures to understand and deal adequately with patients’ often complex ailments.
Parkinson's Disease as a problem of shame in public appearance
Authors: Nijhof Gerhard
Published: February 2004

Using life stories as data, the research problem was to find patterns in the interpretations of Parkinson's Disease. In one of the patterns—found in 12 of the 23 life stories—Parkinson's Disease is interpreted as a problem of ‘shame’. The interpretation of shame could partly be explained by other elements of the pattern. Shame is said to arise from the assumed rule‐breaking character of the signs of the disease. Not all rule‐breaking behaviour, however, is said to be an explanation for shame. Three conditions are mentioned. The first is the social importance of the rules broken. The rules which are said to cause shame are considered as socially sensitive, as related to important social values. The value particularly pointed to is described as ‘social competence’. The second condition is the ‘visibility’ of the behaviour. Particularly, rule‐breaking in public is said to arouse shame. The third condition is the assumption of being labelled as a ‘deviant’ because of the rule‐breaking behaviour. In this pattern of interpretation two consequences are drawn. In the first the life world is divided into a ‘private’ and a ‘public’ domain. In the second, found in almost all the life stories in which shame is mentioned, the informants say they feel inclined to ‘retreat’ from the public domain.
The fracturing of medical dominance in British psychiatry?
Authors: Samson Colin
Published: February 2004

Medical dominance is not a transhistorical and invariant property of the medical profession. Rather it is a set of occupational privileges that can be invoked or revoked according to changing alignments of political, economic and cultural power. Using the example of British psychiatry in the context of the health service reforms of the 1980s, it is argued that medical dominance may be fracturing as a result of the policy switch towards community mental health care and the managerial reorganisation of the health services. Knowledge claims and medical procedures that have legitimated the dominant position of psychiatry within the mental health services ‐ a medico‐eclectic ideology, a view of doctor superiority over other mental health professionals and the extensive use of physical treatments—are outlined and contrasted with the conflicting ideas and authority structures of community care and health service management. Challenges to medical dominance in mental health, it is contended, are represented by the legislative empowerment of a range of previously subordinated groups of professionals and para professionals. This paper draws primarily upon two sources of data; an ethnography and in‐depth interview study of 40 psychiatrists and managers in the Bristol area in 1989–90 and an analysis of the writings of psychiatrists in the professional press.