bluuebunny/crossref_metadata_2025 huggingface dataset:
Viewpoint Resurrecting the arena
Authors: Hunter T. D.
Published: February 2004

Abstract In this paper it is claimed that the 1974 reorganization of the British National Health Service was based on an inappropriate rational‐bureau‐cratic model. An alternative was the arena‐negotiation model, first proposed in 1967. It is argued that the adoption of the latter would have resulted in an organizational system congruent with the therapeutic goals of the contemporary health care system. Now that the 1974 structure of the NHS is in process of being modified there is a strong case for looking again at these arena concepts, which are, in any event, emerging in health care systems. It is argued that the bureaucratic model is also creating 'sick’organizations in other fields. Accordingly, it is not only the health of the health care system, but also the health of the larger society which compels us to envisage all human organizations as central conglomerates relating, on a basis of‘negotiated order,’ to a multiplicity of relatively small interdisciplinary project teams, overlapping with each other and linked directly to the central structure without Intermediate tiers.
Doctors and their spouses speak: stress in medical practice
Authors: Bates Erica
Published: February 2004

Abstract Many sociological articles assume that the patient‐doctor relationship is satisfactory for the doctor and unsatisfactory for the patient. This paper describes a research project on stress among doctors and their families. It seems that the stress the doctor feels may significantly contribute to the problems of the patient‐doctor relationship. For example, doctors who cannot cope with their own stress may find it difficult to help their patients cope with stress. The implications of these findings are discussed in the context of the social structure of medical practice and medical education.
Parsons's voluntarism and his analysis of ‘the case of modern medical practice’
Authors: Procter Ian
Published: February 2004

Abstract The paper presents an evaluation of Parsons's account of medical practice, through a critical analysis of the place of voluntarism in his work. Voluntarism is shown to be central to Parsons's theorizing, and is held to account for why certain problems are not perceived and elaborated on within the Parsonian framework.
Preserving the consultation: medical record cards and professional conduct1
Authors: Heath Christian
Published: February 2004

Abstract Professional medical practice in public institutions involves the systematic documentation of information concerning the transactions of organizational members and their clientele. In general practice (primary health care) as in other forms of medical work, record cards are maintained in which the details of patients’illness and its management are documented. These medical biographies provide the profession with a significant resource in their day‐to‐day dealings with their clients; the records inform decisions and generally play a crucial role in the organization of the consultations. To enable professional conduct to rely upon the records, a community of practices provides for the systematic documentation and comprehension of information. It is these practices which form the concern of the following brief essay.
Psychiatric emergency: concepts and problems of organizational structure
Authors: Clark Ian
Published: February 2004

Abstract The concepts and organizing principles underlying facilities for assessing psychiatric emergencies are discussed. It is argued that the analogy with medical/surgical emergencies is, in many cases, inappropriate. Where socially unacceptable behaviour is involved in generating a psychiatric referral, doctors working in hospital clinics are in a poor position to make informed assessments.
Kennedy's masked future
Authors: Freidson Eliot
Published: February 2004

Book review in this article:

I. Kennedy, The Unmasking of Medicine.
The process of problem (re)formulation in psychotherapy1
Authors: Davis Kathy
Published: February 2004

One frequently heard critique of psychotherapy, particularly in feminist circles, is that it individualizes client's problems, i.e. they are shorn of their social significance and reduced to personal (psychological) shortcomings of the client herself. The present paper attempts to demonstrate what this phenomenon might look like at the level of the actual conversational interaction between the client and her therapist. It will become clear that the (re)formulation of the client's initial version of her troubles is by no means a spontaneous artefact of the therapeutic interview, but the result of considerable interactional ‘work’ on the part of the therapist. The process of problem (re)formulation consists of three analytically distinct stages, which are accomplished primarily by means of the everyday conversational device of ‘formulations.’ By using formulations in a special way, the therapist is able to transform the client's difficulties in her situation as full‐time housewife and mother into a typical ‘therapy problem’.
Teamwork, information control and therapeutic effectiveness: a tale of two therapeutic communities
Authors: McKeganey N. P. , Bloor M. J.
Published: February 2004

Abstract This paper maps the differential distribution of therapeutic work within the programmes of two therapeutic communities found in psychiatric hospitals. It is shown that in one of the two communities, therapeutic work was largely restricted to the small groups and to those large groups attended by the psychiatrists. The other community displayed a distribution of therapeutic work which was spread across the whole formal weekly programme and into informal interaction outside the programme. These contrasting distributions are traced to differing patterns of internal communication which affected the ability of nurses and patients to work collaboratively with the psychiatrists.
Health care rationing: its effects on cardiologists in the United States and Britain
Authors: Gross Edith B.
Published: February 2004

Cardiologists practicing under contrasting types of health care rationing in the United States and Britain were found to differ significantly in the occupational stresses they experience, according to this exploratory study. In‐depth interviews revealed that the 24 American physicians complained most about increasing limits to their autonomy resulting from the intrusion of government, insurance companies and managed care agencies. Twenty‐one British cardiologists indicated greater concern about workloads and the lack of resources in the National Health Service. The stresses are associated with the different types of health care rationing in the two countries. In the United States, where explicit rationing exists, external controls are placed on length of hospital stays, tests and procedures, physicians' fees and the use of drugs. In Britain, implicit rationing is imposed by limiting overall funding of health care, leaving physicians free to make clinical decisions. However, the ethic of care for all and the limited funding create waiting lists and a lack of facilities.
Protesting patients: a study of complaints submitted to a Family Health Service Authority
Authors: Nettleton Sarah , Harding Geoff
Published: February 2004

The issue of complaints is a topical one. It is of interest to the Government who espouses a consumerist philosophy and to health care consumer groups who are keen to ensure that effective mechanisms for the redress of grievances are in place. The complaints machinery is currently being reviewed and debated by interested parties and the main suggestions for change are set out in this paper. It is suggested that the factors which impede reform are professional self regulation, which limits lay involvement in the assessment of matters complained about, and the new managerialism which, through its emphasis on consumerism, has the paradoxical effect of reinforcing the control of managers. If complaints procedures are to be reformed it is paramount that we have an insight into what people complain about. To this end this paper presents an analysis of the letters of complaint submitted to one Family Health Service Authority in the early 1990s.
Sex education and the AIDS epidemic in the Former Soviet Union
Authors: Williams Christopher
Published: February 2004

This paper describes the Russian response to sexuality, sex education and AIDS. Using primarily Russian language sources, it analyses the background to the current Russian debate on sex education since the 1960s. The nature of the government response – the introduction of a health education programme designed largely to combat specific sexual diseases such as syphilis and gonorrhoea – is also explored. It is suggested that the demise of the Communist edifice has not significantly altered official attitudes towards sex and sexuality. Particular attention is devoted to the impact of the AIDS epidemic on government and popular reaction to this sex education programme. Given the adverse effects which the breakup of the FSU, economic crisis and the disintegration of the USSR Ministry of Public Health in November 1991, have had on the possibility of launching a unified, co‐ordinated and systematically concerted sex education programme it is concluded that backward attitudes towards sexuality are likely to exist for many years to come and the same is true with regard to the widespread prejudices towards the victims of AIDS in the FSU.
The methodology of Focus Groups: the importance of interaction between research participants
Authors: Kitzinger Jenny
Published: February 2004

What are focus groups? How are they distinct from ordinary group discussions and what use are they anyway? This article introduces focus group methodology, explores ways of conducting such groups and examines what this technique of data collection can offer researchers in general and medical sociologists in particular. It concentrates on the one feature which inevitably distinguishes focus groups from one‐to‐one interviews or questionnaires – namely the interaction between research participants ‐ and argues for the overt exploration and exploitation of such interaction in the research process.
Epidemic psychology: a model
Authors: Strong Philip
Published: February 2004

When the conditions are right, epidemics can potentially create a medical version of the Hobbesian nightmare ‐ the war of all against all. A major outbreak of novel, fatal epidemic disease can quickly be followed both by plagues of fear, panic, suspicion and stigma; and by mass outbreaks of moral controversy, of potential solutions and of personal conversion to the many different causes which spring up. This distinctive collective social psychology has its own epidemic form, can be activated by other crises besides those of disease and is rooted in the fundamental properties of language and human interaction. It is thus a permanent part of the human condition ‐ and widely known to be such.
Women prostitutes in the AIDS era
Authors: Scambler Graham , Peswani Rita , Renton Adrian , Scambler Annette
Published: February 2004

The prevalence and nature of female prostitution in the west is considered, as are the main types of motivation for engaging in sex work. The variable tendency to define western prostitutes as causal agents in the transmission and spread of HIV/AIDS is noted, and the medical/epidemiological evidence against doing so briefly summarised. The impact of the AIDS pandemic on prostitutes and their work is discussed, as are a number of legal, ideological and representational issues relating to prostitution which have been given new salience by the AIDS debate. It is contended that the legal process continues to discriminate unjustly against women prostitutes; that a ‘double standard’ of sexual morality persists; and that prostitute groups have articulated a clear response to law and ideology, hinging on the de‐criminalisation of uncoerced adult prostitution. It is suggested that one likely consequence of decriminalisation would be improved access to health education and care facilities, as relevant for the general health status of women workers as for STDs, including AIDS.
A comparison of HIV‐related risk behaviour and risk reduction between female street working prostitutes and male rent boys in Glasgow
Authors: McKeganey Neil , Barnard Marina , Bloor Michael
Published: February 2004

In this paper we provide an early report of two continuing ethnographic studies of prostitution. We compare female streetworking prostitutes and male rent boys in Glasgow in terms of risks of HIV infection and practice of safer sex. It is shown that a considerable proportion of streetworking female prostitutes in Glasgow were injecting drug users but that drug use was much less common among rent boys. Although condom use appeared to be widespread amongst the women it was less common among the rent boys. We then examine the nature of the relationship established with clients. It is shown that the rent boys were much less directive in relation to clients ‐ much less likely to insist on safer sexual practices than were the female prostitutes. It is suggested that this lack of directiveness is associated with retrospective payment ‐ payment after the commercial sex act takes place. In a final section we look at the policy implications of our work.
AIDS counselling: the interactional organisation of talk about ‘delicate’ issues
Authors: Silverman David , Peräkylä Anssi
Published: February 2004

Although the AIDS pandemic has generated considerable social science research, the focus has almost entirely been on epidemiology and on survey research studies of health knowledge and behaviour. In contrast, this paper offers an early report on ongoing work into HIV and AIDS counselling as it occurs in practice in a number of English clinics. An analysis of transcripts of such naturally occurring encounters reveals how professionals and clients organise their talk in relation to the ‘delicate’ issues to be discussed. Particular attention is paid to the phenomenon of delay in the production of ‘delicate’ items and to the social organisation of the description of such items. Drawing, in part, on methods from conversation analysis, it is shown how a detailed analysis of how talk is produced in naturally occurring settings can generate findings relevant to professional practice.
Audience understandings of AIDS media messages: a discussion of methods
Authors: Kitzinger Jenny
Published: February 2004

What do people think of the media coverage of AIDS; how do they interpret what they hear and see? This article explores the methods used on the AIDS Media Research Project to examine audience ‘readings’ of AIDS media messages. It highlights the advantages of employing a combination of questionnaires, group discussion and different group exercises and presents some preliminary findings to show how these data collection techniques can throw light on audience understandings of AIDS and the media. In particular the focus is on how such methods help to explain two areas of apparent ‘misunderstanding’: the distinction between HIV and AIDS and the risks of blood donation and lesbian sex.
Women's socio‐economic status and self assessed health: identifying some disadvantaged groups
Authors: Macran Susan , Clarke Lynda , Sloggett Andrew , Bethune Ann
Published: February 2004

This paper uses data from the British Health and Lifestyle Survey to explore the relationship between women's overall assessment of their health and their occupation, employment status, household composition and household income. Logistic regression was used to predict the odds of assessing health as either ‘good’ or ‘less‐than‐good’. These findings suggest that after controlling for age and the presence of a long‐standing illness or disability, women's occupational group has the strongest influence on self‐assessed health. The re‐classification of certain occupational groups, in particular retail occupations, from their conventional socio‐economic categories is also vindicated in terms of their assessed health adding in line with the suggestion that, with respect to their income and terms of employment, retail workers are ‘misclassified’ as non‐manual. This analysis shows also that women who were economically inactive were more likely to evaluate their health as ‘less‐than good’ than women in paid work, after controlling for the presence of a long‐standing illness or disability. This is interpreted as evidence that not all of the poor health usually attached to the role of ‘housewife’ can be explained in terms of health selection out of the labour market.
Expert and lay participation in the construction of medical knowledge
Authors: Arksey Hilary
Published: February 2004

This paper examines the explanatory value of Fleck's conceptual analysis with regard to the development of medical knowledge. The discussion is illustrated by empirical data gathered as part of an on‐going study into Repetitive Strain Injury (RSI), a condition currently disputed within medical circles. Whilst there is empirical substantiation for some of Fleck's beliefs, the findings suggest his notion that general practitioners are educated and patients uneducated is too simplistic; in particular circumstances these attributes may be reversed. Furthermore, there is little evidence to show that ideas are circulated and exchanged between specialists, GPs and a lay audience; according to this revised view, medical knowledge is determined by experts alone. By invoking an extended version of Collins' notion of the ‘core‐set’, the paper considers how seemingly marginal actors can exploit their technical competence and thus play an influential role in medical debate.
A transformed pregnancy: the psychosocial consequences of gestational diabetes
Authors: Lawson Erma Jean , Rajaram Shireen
Published: February 2004

Gestational diabetes (i.e. diabetes diagnosed during pregnancy) has important implications for maternal and foetal well‐being. This paper presents an ethnographic study of gestational diabetes, an unexpected, potentially life‐threatening illness diagnosed during the second half of pregnancy. While previous research has conceptualised gestational diabetes as producing few consequences since it commonly disappears after delivery, this study explores the meaning women attach to the disorder. It found that gestational diabetes had a profound effect on the respondents, resulting in fear, depression and anxiety. The respondents' imagery of diabetes as a debilitating disease concomitant with blindness, amputations, and premature death generated increased anxiety throughout pregnancy and six‐weeks postpartum. The personal disruption in complying with the diabetic regimen as well as health care provider transactions exaggerated the unique stress of a ‘normal’ pregnancy. We suggest that a strictly medical view of gestational diabetes minimises its broader psychosocial significance and recommend effective provider‐patient interactions with ‘high‐risk’ pregnant women.
Beyond medicalisation‐demedicalisation: the case of holistic health
Authors: Lowenberg June S. , Davis Fred
Published: February 2004

Discourse relating to the dual processes of medicalisation and demedicalisation has become deeply embedded in the sociological literature and increasingly in the cultural fabric itself. This paper highlights several contradictory dimensions and discrepancies inherent in those notions of medicalisation and demedicalisation. Three key components of the conceptualisations of medicalisation are separated out for examination: the locus of causality, the purview of the pathogenic sphere, and status inequality or professionalisation. Data from the holistic health movement are utilised to illustrate more precisely those problematic and at times contradictory dimensions.
Embodied self‐identity, healthy lifestyles and school physical education
Authors: Kirk David , Tinning Richard
Published: February 2004

This paper draws on a study of female and male adolescents' social constructions of the body and self‐identity in and around physical education lessons. The concepts of the social construction of the body and embodied self‐identity are discussed and related to popular physical culture in Australia. Data from a two year study in Australian secondary schools is then used to illustrate the ways in which popular physical culture is appropriated, reconstructed and accommodated within adolescents' lifestyles. It is argued, on the basis of this data, that many girls and some boys experience degrees of disembodiment in physical education lessons as a strategy for the protection of self‐identity. As a result, many are hindered in appropriating the resources of popular physical culture to lead active or healthy lifestyles. The paper concludes by raising issues for the teaching of physical education and for health promotion more broadly.
Adolescent women, identity and smoking: leisure experience as resistance
Authors: Wearing Betsy , Wearing Stephen , Kelly Kathy
Published: February 2004

Recent theorising concerning leisure has suggested that this sphere, along with the family, the educational system and the occupation system, contributes to identity formation and more especially to gender identity. However, feminist analyses suggest that leisure can be both an area for the subordination and domination of women and an area of resistance to dominant ideologies and discourses. Questions are raised within this framework as to the need in late adolescence for girls, because of a lack of opportunity within their leisure experiences, to seek identity in other ways—smoking may be a form of resistance but also adopted because of a lack of leisure opportunities suitable for them. While males have role models and a culture that provides them with individual competitive pursuits which at least give them a perception of identity, women lack such a culture and are thus deprived of the opportunity to participate in leisure activities to the same extent as males. This paper argues that adventurous leisure which provides physical, mental and emotional challenge and satisfaction can provide a sound basis to resist gender stereotypes and provide alternatives to tobacco consumption.
Dying of awareness: the theory of awareness contexts revisited
Authors: Timmermans Stefan
Published: February 2004

In this paper, I employ a grounded theory approach to extend an existing theory. My starting point is the theory of awareness contexts, first formulated in 1965 by Strauss and Glaser. Using introspective ethnography, I illustrate that the way patients and relatives emotionally cope with terminal information defines the kind of awareness context. I therefore suggest 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.
Social inequalities in ill‐health: the significance of occupational status, education and income‐results from a Norwegian survey
Authors: Dahl Espen
Published: February 2004

The aim of the paper is to examine the interrelationships between socioeconomic indicators such as occupational status, education and income, and self‐reported ill‐health in a nationwide, representative sample of employed Norwegians aged 20–64 years. Three measures of ill‐health were selected for scrutiny: long‐standing somatic illness, reduced work potential due to longstanding somatic illness, and symptoms of nervous conditions. The relationships between the health outcomes and the socioeconomic variables were modelled by means of logistic regression while controlling for age, sex, marital status, and area of residence. The analyses show that occupational status stands out as the most important and most consistent predictor of ill‐ health, as it was significantly related to all three health outcomes. The pattern which appeared was a familiar one; the experience of ill‐health was more common among people in low status occupations, e.g. unskilled workers, compared with people in high status occupations, e.g. higher salaried employees. Education, on the other hand, was not significantly related to any of the three measures of ill‐health when other variables were controlled for. Disposable household income had an independent effect on longstanding somatic illness and symptoms of nervous conditions, while personal gross income had an independent effect on reduced work potential due to longstanding somatic illness. Personal income and occupational status also interacted with respect to work potential: Among unskilled workers, lower salaried employees, and ‘other’ self‐employed the odds ratios of experiencing reduced work potential increased with increasing income, while for the other occupational groups the trend was the opposite. In a closing section, possible interpretations of these patterns are discussed.
The potential social impact of predictive genetic testing for susceptibility to common chronic diseases: a review and proposed research agenda
Authors: Davison Charlie , Macintyre Sally , Smith George Davey
Published: February 2004

Recent advances in molecular genetics are making it increasingly feasible to construct individual genetic profiles predicting susceptibility to heart disease, cancer and respiratory disorders. This paper reviews current knowledge about the social and cultural impact of providing people with information relating to their risk for future disease, focusing not only on currently available predictive genetic testing but also on hypertension, hyperlipidaemia and cancer screening. We highlight the importance of issues of probability and uncertainty, and the tension between collective and individual goals in the assessment of medical risk. We conclude with a proposed research agenda for studies of the social and cultural impact of predictive genetic testing, and argue that there is a pressing need for rigorous, empirical, social research in this area.
An explication of treatment ideology among mental health care providers
Authors: Scheid Teresa Linnea
Published: February 2004

This paper presents an exploratory analysis of the treatment ideologies of mental health care providers who work with the chronically ‘mentally ill.’ Treatment ideology is understood as the complex set of beliefs providers hold about the aetiology of mental illness, the role of the client and the provider, and the efficacy of various treatments or interventions. A case study of a large, urban mental health care organisation providing care to the chronically‘mentally ill’was conducted in 1992. The author attended a series of staff retreats, administered a questionnaire, and completed in‐depth interviews with 22 providers. A typology reflecting two dimensions that juxtapose alternative treatment preferences was developed to represent the range of treatment ideologies uncovered. The first dimension reflects differing conceptions of the role of the provider (supportive or facilitative) and the second dimension reflects differing treatment goals (adjustment or autonomy). This typology was then theoretically extended to include a custodial role for the provider and a treatment goal oriented toward social control of clients. Further study of providers in differing organisation settings is needed to determine the salience of these typologies. Research must also investigate the development and consequences of treatment ideologies, with critical attention focused on the consistency (or inconsistency) of treatment ideologies within a given system, the professional and organisational sources of differing preferences for treatment, and the effect of various belief sets on health care services and outcomes.
‘An epidemic of good health’ at the workplace
Authors: Virtanen Pekka
Published: February 2004

Towards the end of 1986 a total of 32 workers who were frequently absent from work due to illness were made redundant at an engineering works. In 1987 sickness absences in the remaining work force were reduced by one third in comparison with the figures for the previous three years. In 1988 sickness absence figures started to climb again.

The events are described from the point of view of the local health centre physician. The clinical and epidemiological features of the ‘health epidemic’ are demonstrated. Two comments are presented. The first concerns the unspecificity of sickness absenteeism as a measure of illness. The second concerns the concept of ‘illness behaviour’ which should not be taken as a phenomenon determined by a set of causes, but as a human activity construed in interaction between the individual and significant others.
Attending to patients' stories: reframing the clinical task
Authors: Clark Jack A. , Mishler Elliot G.
Published: February 2004

Communication between patients and physicians is currently a significant topic in medical training programmes and in research on clinical practice. Physicians are encouraged, for example, to attend to patients' stories as ways of providing their concerns and understandings of their illnesses. However, there is little research on how storytelling is actually accomplished in the context of clinical encounters. Drawing on studies of medical discourse, conversational storytelling, and narrative, we present a comparative analysis of two encounters. Both revolve around the same clinical tasks, but in one the patient's story is prominent and in the other it is unheard. We follow the course of successful storytelling in one and its interruption in the other showing how the encounters unfold through patients' attempts to negotiate a story topic, set the scene, and clarify the action and its consequences. The physicians adopt distinctive alignments with respect to the emerging story. These differences appear to be related to the outcomes of the encounters, including the framing of clinical decisions and the maintenance of cooperative patient‐physician relationships. Focusing on the patients' attempts to tell a story illuminates the exercise of authority in clinical encounters, and the way in which clinical tasks are embedded in the social process of authoring the accounts of patients' illnesses.
Self, identity and radical surgery
Authors: Kelly Michael
Published: February 2004

Data are reported from interviews, analysed qualitatively, with persons who had had ulcerative colitis cured by radical surgery. The procedures performed on the subjects were total colectomy and ileostomy. The subjects were left permanently faecally incontinent by these procedures. Using concepts derived from the work of Mead, and developed in interactionist sociology, the consequences for self and identity of these operations are considered. The tension between the private self of the person with an ileostomy and their public social identity as an ileostomist is examined.
Sickness as a dominant symbol in life course transitions: an illustrated theoretical framework
Authors: Prout Alan
Published: February 2004

The paper examines how sickness as a cultural performance might be analysed as a dominant symbol within life course transitions. The concept of dominant symbol is taken from Victor Turner's framework for Symbolic Processual Analysis in ritual and pilgrimage and is used to interrogate data collected in an ethnographic study of sickness absence in an English primary school. It is suggested that sickness played a central part in the construction of meaning around the transition from primary to secondary school. The performance of sickness seemed to condense ideological features (especially those of gender and work discipline) and to express modulations in the meaning of the transition in its different phases. The concept of dominant symbol (and the related notion of liminality) illuminate these data but need modification to take account of the unritualised and fragmented character of many life course transitions in contemporary Western societies. It is suggested that with modification these concepts might be applied to the meaning of sickness in other life course transitions.
Knowledge of shadows: the introduction of X‐ray images in medicine
Authors: Pasveer Bernike
Published: February 2004

Abstract Ever since the discovery of X‐rays in 1895, X‐ray imaging has played a large role in the cognitive and practical organization of medicine. This article analyses the way X‐ray images were introduced and made sense of in medical thinking and acting around the turn of the century. The implicit assumption in many histories of radiology is that the specific (diagnostic) message of the X‐ray images resided inside them from the beginning, and that it is obscured either by technological or epistemological problems. These being solved, it would then be no problem to see directly what information the image contains.

In this article this assumption is contested. It is argued that the specific content of the images was shaped by the activities of X‐ray workers within the context of medical developments of the time. This shaping, as it is historically reconstructed here, consisted of four methods. X‐ray workers (be they physicians, technicians or scientists) experimented with the technology, the images, the photographic materials and the objects that were X‐rayed. They used X‐ray images of dead bodies to compare them with radiographs of living patients. Radiologists tried to‘translate’diagnostic information acquired with other methods into the shadows of the X‐ray images. And finally they compared images with images.

The process of shaping the content and use of X‐ray images, of making them represent reality, took place within specific institutions, and it took a different form in different countries, but also for different parts of the body. Developments of institutionalisation and professionalisation of radiology in England and the Netherlands are presented to provide a small part of the background of this shaping of knowledge of shadows.
The social construction of help among Danish children: the intentional act and the actual content
Authors: Christensen Pia Haudrup
Published: February 2004

This paper is based on an ethnographic study of younger Danish school children's actions and social relations during episodes of sickness and minor accidents. The focus is on how children as social actors give help to others. The main points concern first, the need for a cultural approach to distinguish between the intention and the motive of an action in order to understand children's evaluation of and communication about help. A second point concerns the recognition of children's individual actions as they combine in a collective strategy. Finally I discuss the relationship between children's cultural practices and constitutive elements of their everyday life. I specifically focus on ‘the act of looking’ and time and tempo as it relates to understanding childhood sickness and its relevance in social negotiation between children and adults.
Psychotropics, sociology and women: are the ‘halcyon days’ of the ‘malestream’ over?
Authors: Ettorre Elizabeth , Riska Elianne
Published: February 2004

The purpose of this paper is to lay the foundation for the development of a gender‐sensitive perspective on psychotropic drug use. This paper reviews existing research on psychotropic drug use and highlights gender biases in three ways. First, a review of the early work on gender differences in tranquilliser use reveals how ‘one‐dimensional’ accounts are offered by proponents who are either ‘no‐objections’, ‘cautious‐no‐ answer’, ‘women's‐role’ or ‘political’ advocates. Second, with special reference to women, a critical review of the two predominant discourses, the medical and the sociological, are outlined. It is argued that they have a common approach that makes women's drug use invisible. The paper concludes that the approach prevailing in current research is individualistic and gender blind and needs to be complemented with an analysis that problematises gender.
Paper and people: the work of the casualty reception clerk
Authors: Hughes David
Published: February 2004

This paper examines the exercise of discretion by casualty reception staff, focussing on the problems of accountability that arise when their judgements help shape the process of patient categorization that culminates in clinical diagnosis. Rules and guidelines which ostensibly relate to bureaucratic objectives, are applied in ways which reflect situational exigencies of reception work, and values embedded in organisational culture. But reception staff are reluctant to acknowledge the importance of their decisions, and, particularly where judgements relate to patient condition, present rule‐use as a straightforward and certain activity in which interpretation plays little part.
James Mackenzie, General Practitioner: a modest contribution to the archaeology of clinical reason
Authors: Osborne Thomas
Published: February 2004

This paper focuses on the work of the influential general practitioner and heart specialist, James Mackenzie (1853–1925), and seeks to reconstruct ‐ using some of the perspectives broadly associated with actor‐network theory as well as Michel Foucault's work on clinical medicine ‐ the epistemological rationality of his medical programme as a particular kind of network of knowledge. The paper concludes with a brief discussion of some of the implications of this analysis both for the sociological study of medical knowledge, and for our contemporary ideals of medical practice.
The dramatisation of emotions in practice and theory: emotion work and emotion roles in a therapeutic community.
Authors: Wiley Juniper
Published: February 2004

It is suggested that feelings, both as inner sensation and as external display, should be viewed as socially constructed objects. Just as reality and the self are constructed and reconstructed through a process of social interaction, so feelings are understood through interpretive frames, influenced by biography and cultural meaning systems, as well as situational and interactional factors. Therapeutic organisations, typically focused on emotions. provide a setting for the analysis of these processes. In particular, the concept of catharsis demonstrates the culturally constituted roles guiding the experience and the display of feeling, and the role of others in the construction of emotion. Three therapy sessions in a holistic therapeutic community for schizophrenics are examined, in which catharsis was expected yet different emotion performances were given. By combining a cultural and dramaturgical perspective, a typology of emotion roles is developed, and the way in which feelings create and maintain the social order is demonstrated.
Living the life: Explanations of infertility.
Authors: Sandelowski Margarete , Holditch‐Davis Diane , Harris Betty G.
Published: February 2004

This paper addresses the paradoxes of infertility and the explanatory models infertile couples construct to resolve them. The analysis is based on multiple interviews with 53 infertile couples and a comparison group of 10 couples with no fertility impairments in the process of achieving parenthood through pregnancy and adoption, and single interviews with three infertile couples one to two years after having their last child. Couples defined infertility functionally, behaviourally, empirically and phenomenologically to create explanatory models that had one of five organising principles at their core: a) once infertile, always infertile; b) once fertile, always fertile: c) fertile but infertile by prescription; d) pregnancy as cure for infertility; and d) infertile enough but not proven infertile. These models served to integrate and give purpose to infertile couples' experiences of pain and triumph.
Trends in socioeconomic mortality differentials in post‐war Norway: evidence and interpretations
Authors: Dahl Espen , Kjærsgaard Pål
Published: February 2004

The aim of the study was to describe changes in socioeconomic mortality differentials among adults in post‐war Norway and to examine some selected interpretations. Three separate data sets were obtained. In each set, census information on occupational class was linked to subsequent mortality during three five‐year periods, 1960–65, 1970–75 and 1980–85. The analysis showed a general decline in mortality but an increase in the socioeconomic mortality differentials among men, as measured by standardised mortality ratios (SMR). Women, however, displayed inconsistent SMR patterns and no clear trends. It is argued that this is due to an artefact, ie classification by women's own occupational class, and to health‐related exits from the labour market. Women were thus excluded from the analysis that followed. Over the years covered, socioeconomic age‐specific mortality differentials decreased among younger men and increased among older men. To mirror these changes, ‘potential years of life lost’ (PYLL) were calculated. Essentially, PYLL rendered the same picture as SMR did. The size of the increase in mortality differentials, as measured by SMR and PYLL, among men was somewhat underestimated due to health‐related exits from the work force, especially among unskilled workers, ie a ‘healthy worker effect’. A distinct change took place in the balance between the occupational groups at the extremes in the occupational structure over the years in question. This led to fewer deaths occurring among unskilled workers. Still, however, it seemed justified to state that social inequality in mortality remains a severe health problem. Little evidence was found of the hypothesised cohort effects.
Just the job? Is the relationship between health and domestic and paid work gender‐specific?
Authors: Hunt Kate , Annandale Ellen
Published: February 2004

Gendered assumptions about working lives are inherent in explanatory models and empirical analysis of the relationship between work and health. Although some of these assumptions reflect the reality of gender divisions of labour, they are rarely empirically tested and male and female samples are too often considered separately. Here we take a broader definition of work which includes aspects of paid work and domestic work, treating both domains as being relevant in principle to both men and women.

Using multivariate analysis and two measures of current health (malaise and physical symptoms), it was found that the association between domestic work (at least as measured here) and health is relatively small, and restricted to women's health. Paid work, in contrast, has much stronger associations with malaise for both men and women, and some indicators of specific aspects of work suggest that effects are not gender‐ specific. Taking account of both paid and domestic work together has an enhanced effect for women though not men, especially when indicators of conflict between paid work and other areas of life are taken into account. However, reports of work conflict are associated with more malaise in both men and women. Although the model is successful in explaining the variance in malaise symptoms this was not true for physical symptoms.
Fringe work: peripheral work in health visiting
Authors: de la Cuesta Carmen
Published: February 2004

Fringe work is a category developed in a grounded theory study into health visiting, accounting for a series of activities that health visitors were not expected or supposed to engage in. It is mainly a response to the deficiencies or gaps that health visitors encountered in both the health care and social systems, and operates by mobilising, developing and substituting resources. Fringe work highlights for the client the relevance of the health visitor's service, and contributes to the development of relationships with clients in two ways: it produces reciprocity and it enhances solidarity. While it may be said that fringe work represents a progressive form of work it can also be viewed as a paternalistic approach to health visiting.
Violence and vulnerability: conditions of work for streetworking prostitutes
Authors: Barnard Marina A.
Published: February 2004

This paper looks at the issue of violence in the context of streetworking prostitutes and their clients in Glasgow, Scotland. Street prostitutes routinely face the threat and reality of violence in their work which suggests that the health risks associated with prostitution need to be considered not only as public health issues but also in terms of occupational health. Using data derived from semi‐structured interviews as well as observation the paper focuses on the dynamics of the client/prostitute encounter. A particular focus is on the ways in which prostitutes try to establish and maintain client compliance throughout the commercial sex encounter. Prostitutes in this study framed control over the encounter as being a critical issue, particularly in terms of limiting the potential for violence to occur. Instances where prostitutes were unable to secure client compliance through intimidation on the part of the client are discussed. The strategies used by women to reduce the likelihood of client violence are considered. The paper ends with a reflection of possible policy initiatives to reduce the likelihood of client violence against prostitutes. The potential for change to take place is clearly limited by the illegalities surrounding prostitution and the highly stigmatised nature of the work.
Style, discourse and constraint in adjustment to chronic illness
Authors: Radley Alan
Published: February 2004

This paper discusses the problem of adjustment to chronic illness in terms of the demands of the patient's body and the constraints of culture. Criticism is offered of explanations which reduce such adjustment to a form of functional adaptation, either to symptoms or to social expectations taken separately. The argument is made that social constraints are embodied in everyday conduct, while bodily changes are made sensible through meanings engendered within discourse. Utilising findings from a study of coronary patients and their spouses the paper describes differences between the situations of those who confront and oppose illness and those who modify their lives as they accommodate to it. A discussion is offered of the different transformations of illness experience as these relate to the role‐settings of those concerned. This is used to set out a general thesis on style as a contextualisation of illness‐ experience, articulated in the co‐ordination of bodily action and social categories.
Ideology in the clinical context: chronic illness, ethnicity and the discourse on normalisation
Authors: Anderton Joan M. , Elfert Helen , Lai Magdalene
Published: February 2004

This paper is based on a comparative study examining how Chinese and white families manage the care of a chronically ill child. The circumstances of their lives that shape their experience of illness are explored. It is argued that the ideologies which underpin Western health care practices, in this case, the ‘ideology of normalisation’, often differ from the perspectives held by non‐Western immigrants, and others who do not have access to the ideology. The discrepancies in viewpoints between patients and practitioners can lead to a different set of goals in the treatment encounter, with the possibility of misunderstandings in the clinical context.

The ‘ideology of normalisation’ is used to show how professional ideologies serve as a means of separating out families into those who comply and those who do not. In other words, the ideology, and the moral discourse on normalisation, permit professionals to evaluate families and to categorise them. This categorisation has consequences for patient care, they might be refused treatment. Yet, this ideology is not based merely on ‘value‐free professional theories’, but is located within the moral order. The socio‐political, economic and historical factors that underpin the ideology are discussed.