bluuebunny/crossref_metadata_2025 huggingface dataset:
Westminster Women: The Politics of Presence
Authors: Lovenduski Joni , Norris Pippa
Published: February 2004

The entry of the 1997 cohort of Labour women into public life offers a test case of whether, and under what conditions, women politicians have the capacity to ‘make a substantive difference’. We outlines the theory of the politics of presence and discuss how to operationalise this in a testable model. We, use the British Representation Study survey of 1,000 national politicians (including parliamentary candidates and elected Members of Parliament) conducted in the 2001 general election. The analysis centres on the impact of gender on five scales measuring attitudes and values on issues that commonly divide British party politics.

Once we control for party, there are no significant differences among women and men politicians across the value scales concerning the free market economy, Europe, and moral traditionalism. Yet on the values most directly related to women's interests – namely the affirmative action and the gender equality scales – women and men politicians differ significantly within each party, even after controlling for other common social background variables that explain attitudes, such as their age, education, and income. The conclusion considers why these findings matter for the composition of parliament, the public policy agenda and for women's roles as political leaders.
Understanding Dual Identities in Poland
Authors: McManus-Czubińska Clare , Miller William L. , Markowski Radosław , Wasilewski Jacek
Published: February 2004

‘Parallel’ divisions of identity in Poland are a thing of the past – and perhaps the future – but not the present. Yet contemporary Poles are still politically divided by identities – albeit by ‘nested’ Polish/European identities rather than by ‘parallel’ ethnic identities. They are not divided between Polish and European identities, however, but between exclusive and dual identities – in essence a division between parochial and cosmopolitan identities. Contrary to fears that Europeanism in Poland especially might be narrow, culturally restrictive, or even racist, our data show that dual identities reflect broader cosmopolitan perspectives as well as specifically European or Western sympathies. There is a real significant difference of values between exclusive and dual identifiers which extends well beyond attitudes to Europe – and far beyond attitudes to the EU in particular. To a considerable degree this is a difference – some have argued a conflict – between traditional and modern Poland, between secular and devout Poland, between educated and ignorant Poland, between young and old Poland, and between hopeful and fearful Poland.
Alienation in the patient role: source of ambivalence and humor in comic get well cards
Authors: Bologh Roslyn Wallach
Published: February 2004

Summary The humorous themes of over 300 comic get well cards are analyzed to reveal sources of tension or strain in the patient role. The author uses a model of alienation as a way of categorizing these themes. Corresponding to the four aspects of alienated labor as specified by Marx, alienation in the patient role is divided into the following four aspects: alienation from medical providers (domination and indifference), alienation of self from body (powerlessness or impotence), alienation from treatment (meaninglessness), alienation from responsibilities (self‐estrangement). Each of these categories gets further broken down into sub‐categories reflecting the specific sources of ambivalence and humor expressed in the comic get well cards.

Using Merton's scheme of social structure and anomie, the author develops the logical possibilities in the patient role: compliant patient,‘problem’patient, malingerer, fatalist and rebel. These categories refer to the consequences of either accepting or rejecting the goal of getting well and the (alienating) means as indicated above required by the American system of medical care. Most of the humor of the get well cards falls primarily under the category that characterizes the‘problem’patient: accepting the goal of getting well but rejecting or ridiculing the alienating means.
Anticipatory problem solving: models for clinical practice and research
Authors: Pridham Karen F. , Hansen Marc F. , Conrad Helen H.
Published: February 2004

Summary Problem solving that anticipates a client's future is a fundamental component of primary care. However, adequate models for clinical practice and for research are needed. A paradigm of anticipatory care conceptualized as an interpersonal problem solving process is used as a framework for critical analysis of existing models and for the specification of conceptual and practical bases of new models of anticipatory care. The paper addresses questions concerning problem solving for the model of anticipatory guidance presented by the American Public Health Association and the model developed by Caplan, and the models of preparatory communication developed by Janis and by Leventhal and Johnson. The questions that are used to critique existing models and to specify new ones deal with identification and specification of issues for anticipatory care; its goals, functions, and intended outcomes; appraisal of readiness to participate in and worthwhileness of anticipatory care; the characteristic features of a model's solution phases and strategies of preparation; and the evaluation of the adequacy of anticipatory care.
Sexual pollution in the New Guinea Highlands
Authors: Mandeville Elizabeth
Published: February 2004

Summary Like members of other societies in the New Guinea Highlands, the Kamano of the Eastern Highlands believe that a man's health can be seriously undermined by the polluting power of female sexuality and that, though not directly fatal, this power can permanently stunt the growth of a youth and so weaken an adult that he becomes vulnerable to the sorcery and arrows of an enemy. In expounding their views, men and women emphasise the impact of female sexuality on males. They say that the harmful effects are automatic and that it is rare for a woman to employ her power deliberately against a man. The example most frequently offered is that of a man becoming thin and weak after eating food given to him by a woman who is menstruating or has recently had sexual intercourse with someone else. Yet this is by no means the whole of the matter, for not only do men regard certain women as more dangerous than others, but they also believe the health of women and children can be damaged by the sexual activities of men and women. We are concerned not simply with an automatic, one‐way transmission of sexual pollution but with an area of life which carries danger of different degrees to individuals in various relationships. I shall show in this paper that, while certain aspects of female sexuality are harmful in themselves, fear of sexual pollution is most likely to be felt where a person is intimate with someone who is, or may be, hostile and alien, and that this applies to women, and even children, as well as men. I shall suggest that the variation in the degree of danger apprehended is associated with the opportunities a wife has for establishing herself as a full member of her husband's village.
Chancers, pests and poor wee souls: problems of legitimation in psychiatric nursing
Authors: May David , Kelly Michael P.
Published: February 2004

Abstract This paper explores the relationship between psychiatric nurses and‘problem’patients as a means of commenting on the occupation of psychiatric nursing. Proceeding from a detailed examination of the case of one particularly problematic female patient, and drawing on a body of observational and interview data relating mainly, though not exclusively, to nursing activity on two very different psychiatric wards, we argue that what is critical in determining nurses’categorization of some patients as‘problems’is not so much the level or nature of patients’demands, as much previous work has suggested, but rather the patient's willingness to legitimate the nurses’therapeutic aspirations. Possessing neither readily identifiable technical skills nor unambiguous authority, the psychiatric nurse must look to her dealings with patients to sustain a viable professional identity.‘Problem’patients are those who call attention to the fragility of nursing authority by rejecting, implicitly or explicitly, the special services that the psychiatric nurse stands ready to provide.
Categorization in accident departments: ‘good’ patients, ‘bad’ patients and ‘children’
Authors: Dingwall Robert , Murray Topsy
Published: February 2004

Children form a significant proportion of accident services’ clientele but have received relatively little attention in the growing ethnographic literature on such organizations. This paper uses data from observation and interviews in four English accident departments to review Jeffery's influential analysis of medical staffs categorization of patients. After pointing to certain logical difficulties with this account, it is argued that an analysis of the way children are treated allows for these to be remedied by the development of a more sophisticated model of professional decision‐making. The paper concludes with a discussion of the way in which the categorization rests on the practical contingencies of accident work and the social organization of emergency work. Attention is drawn to the variation between high‐prestige units in teaching hosp pitals and lower‐status units in general hospitals and the way this limits the ability of the former to identify conditions like child abuse or neglect.
Problems in the conceptual framework of patient satisfaction research: an empirical exploration
Authors: Fitzpatrick Ray , Hopkins Anthony
Published: February 2004

Survey research into patient satisfaction has been responsible for developing a number of related concepts concerning the ways in which patients evaluate the health care that they receive. Recently doubts have been expressed as to the adequacy of this approach for understanding how patients anticipate and respond to medical encounters. This paper reports a study of patients attending neurological outpatient clinics. The results suggest that the conceptual framework deriving from patient satisfaction research provides only partial and sometimes misleading insights into the perspectives of the patients studied. The paper concludes that patients’ varying concerns with regard to their illness need to be more directly considered in explaining different responses to medical consultations. This approach enables a more sensitive evaluation of health care from the patient's point of view.
The identification and provision of care for the terminally ill at home by ‘family’ members
Authors: Hunt Maura
Published: February 2004

Audio‐recordings of naturally occurring conversations over a three‐month period between five nurses in a Symptom Control Team and fifty four terminally ill cancer patients and their relatives in their own homes form the focus of this study. The SCT nurses specialised in the care of the dying but did not carry out ‘hands on’ nursing which was given by community nurses. The SCT nurses carried out their work through ‘talk’. The main aim of the study is therefore, through analysis of the audio‐recordings, to determine how conversational interactions are used by nurses, patients and relatives in dealing with the process of dying. The aspect of the study discussed in this paper deals with the process at first home visits whereby the nurses, patients and relatives establish ‘family’ memberships and determine eligible sources of help in relation to expected sets of rights and obligations.
Social interaction and the cognitive organisation of health‐relevant knowledge
Authors: Morgan David L. , Spanish Margaret T.
Published: February 2004

Abstract Relying on recent work in social cognition, we introduce the term health belief schema to summarize how an individual organises knowledge about health issues, in this case, knowledge about ‘who has heart attacks and why’. Using data from group discussions of this topic, we show several ways that social interaction influences the formation of an individual's health belief schema for heart attacks, and demonstrate that these schemata typically consist of differentially weighted risk factors. Lay knowledge and use of risk factors does not, however, mirror medical knowledge of risk factors, and we offer suggestions as to how health practitioners can benefit from an accurate perception of lay‐knowledge about heart attacks.
An assessment of the Black Report's explanations of health inequalities
Authors: Blane David
Published: February 2004

Abstract The Black Report identifies four types of possible explanation for social class differences in health, and judges one of these (‘materialist’) to be the most important. This paper seeks to support this assessment with additional evidence from the literatures of sociology and medicine. In the process it suggests questions which could usefully be the subject of future research.
Social characteristics, the diagnosis of mental disorders, and the change from DSM II to DSM III
Authors: Schulman Gary I. , Hammer Joseph
Published: February 2004

Abstract Multivariate analyses are used to examine stability and changes in the predictors of mental illness diagnoses with the introduction of a revised diagnostic system in the U.S. The impact of the shift from DSM II to DSM III is studied in three outpatient clinics. Among our findings is support for the relationship of income and gender to receiving the diagnosis of schizophrenia. This is found both under DSM II and the more behaviorally‐based DSM III system. However, minority status, low education, and low income are predictors of the diagnosis of personality disorder under DSM II, but not with the shift to DSM III. These and other similarities and differences in the relationship between classic sociological variables and diagnosis that occur in the comparison of DSM III with DSM II are discussed. Particular attention is given the issue of‘bias’ in the diagnostic process.
Side effects of psychiatric treatment: a qualitative study of issues associated with a random allocation research study
Authors: Anthony Philip , Lancashire Stuart , Creed Francis
Published: February 2004

A random allocation study of the effectiveness of day hospital treatment for acute psychiatric illness was carried out in two district general hospitals. During the study it became apparent that in one hospital numerous patients being randomised to the day hospital failed to become established in treatment. In depth interviews were carried out with the day hospital staff in an attempt to elicit the reasons for this. It became clear that staff perceptions of the role of the day hospital is a potential source of bias in this type of study. A case study of one patient who was transferred from day to inpatient treatment during the study illustrates the dynamics of this bias. The paper demonstrates, once again, the value of concurrent qualitative research while performing a randomised controlled trial. In this particular case the qualitative interview indicates the reasons why the results of randomised controlled trials at one centre cannot necessarily be generalised to other centres.
Possibly abusive, often benign, and always necessary. On power and domination in medical practice
Authors: Måseide Per
Published: February 2004

In the medical sociological literature that focuses on medical practice, the doctor‐patient relationship is usually described in terms such as relationship asymmetry, cognitive conflicts and professional dominance. The unfortunate consequences of the doctor's power over the patient are stressed in a common criticism of the dominating biomedical perspective of modern medicine. As an alternative, more social psychological models have been promoted. In this paper it is argued that these social psychological perspectives represent an understanding of the nature and role of power in medicine that is insufficient and inadequate; an alternative perspective is therefore supported which conceives of power as necessary and constitutive for adequate medical practice.
On the analysis of medical work: general practitioners, opiate abusing patients and medical sociology
Authors: McKeganey Neil
Published: February 2004

Abstract Although general practice has provided the setting for a wide range of medical sociological analyses, those analyses have rarely focussed upon the care of specific patient groups or illness conditions. In the main, medical sociologists have chosen to portray general practice more in terms of their own secular interests in the processes of, for example, power, domination and communication ‐ processes which although evident within the consultation are not unique to it. This topical neglect of the care of specific patient groups within general practice is, I argue, part of a broader neglect of the topic of medical work as conceived by practitioners, which arises at least in part from a combination of methodological, theoretical, ideological and attitudinal factors. This paper uses the opportunity of a study focussing upon general practitioners' treatment of opiate abusing patients to explore these and related issues and concludes with a call for an applied sociology of medical practice.
Social research in stressful settings: difficulties for the sociologist studying the treatment of breast cancer
Authors: Cannon Sue
Published: February 2004

Abstract The paper examines some of the methodological and ethical issues which have arisen during the course of a three‐year study of breast cancer patients. It focuses particularly on some of the problems which may be encountered by medical sociologists working in settings which are stressful. The questions of involvement, detachment and personal responsibility, which generally need to be addressed in sociological research, have had an added significance because of the emotive nature of the subject matter and the method adopted to conduct the research.
Review Essay: Voices from the past: a historical note on the discourse of medical instruction
Authors: Atkinson Paul
Published: February 2004

H.W. Davenport, Doctor Dock: Teaching and Learning Medicine at the Turn of the Century
Coping with parents
Authors: Brossat Sylvia , Pinell Patrice
Published: February 2004

This paper accounts for the birth of a disease‐related consumers’ association, bringing together parents of children who are patients on a specialist paediatric ward and are subjected to parenteral nutrition at home. We attempt to show how the analysis of the production of technological‐medical innovation permitting the transfer of care from hospital to home elucidates the process leading up to the birth of the group. We interpret this process as a two‐phase development in the ward: the introductory stage, in which social innovations go hand in hand with the technological invention, bringing about a reshuffling of layman‐professional relationships; and the restructuring stage, starting when the former phase is re‐defined and designated as anarchic, and in which the old structure re‐emerges. We argue that the setting up of a parents’ association is a reaction to the re‐establishment of order following a period of order undone.
The uneasy fate of nursing home residents: an organisational‐interaction perspective
Authors: Wiener Carolyn L. , Kayser‐Jones Jeanie
Published: February 2004

This paper examines the macrosociological and organisational conditions which impinge on those who are most directly involved in decisions about nursing home patients: kin, physicians and nursing staff. Focus is on the organisational‐interaction interplay, through use of an ‘illness trajectory’ framework. This analysis sheds light on the differing effect of external and internal conditions on members of each group and on the work they are called upon to do in the care of nursing home patients. All of the actors are caught in a downward spiral: under the impact of the conditions described in this paper, kin, physicians and nursing staff come to accept their powerlessness to affect change; gradual diminution of expectations ensues, leading to an acceptance of a lower standard of care. This, in turn, has serious implications when patients develop an acute illness.
Theorising class, health and lifestyles: can Bourdieu help us?
Authors: Williams Simon J.
Published: February 2004

What is the relationship between class, health and life‐styles, and to what extent does health‐related knowledge influence subsequent behaviour? These issues have been a source of considerable debate for medical sociologists and others concerned with promoting ‘healthier’ life‐styles over the years. Yet despite a wealth of empirical material, there has been little attempt to theorise this relationship between class, health and lifestyles and the associated issues of structure and agency, accounts and action it raises. This paper attempts to rectify this lacuna through a critical discussion of the work of Pierre Bourdieu, and its relevance to the class, health and life‐styles debate. In particular, attention is paid to Bourdieu's analysis of the logic of practice, his concepts of habitus and bodily hexis, and the search for social distinction in the construction of (health‐related) life‐styles. The paper concludes with a critical commentary on these issues and the relative merits of Bourdieu's analysis for the sociology of health and illness. It is argued that despite certain limitations regarding issues of agency and ‘choice’, Bourdieu's analysis does indeed shed important light on the health and lifestyles debate, and that further bridge‐building exercises of this nature between mainstream theory and the sociology of health and illness are both necessary and fruitful.
Bringing back the body without the blame?: the experience of ill and disabled people at work
Authors: Pinder Ruth
Published: February 2004

This paper tussles with the policy question, that of integrating people with arthritis into employment, in terras of a dialectic between trouble and trust. It suggests that disability theorists' emphasis on the ‘social model of disability’ as the definitive explanation for disabled people's unfavourable position in the labour market is limited without an understanding of the body as a set of relationships linking self and outer world together. For disabled people, longterm illness in a public domain such as work may profoundly disrupt expectations about biographical and social integrity, and normative order. Using an indepth qualitative approach, this paper focuses on the differing employment experiences of two informants disabled by rheumatoid arthritis. Their accounts illustrate some tensions between the breakdown of trust, its constitution as trouble, and attempts to restore ‘business as usual’ in the workplace. The wider social and cultural significance of illness in the workplace, and the need to adopt a more discriminating approach to ‘discrimination’ are discussed.
The social‐interactional organisation of narrative and narrating among stroke patients and their spouses
Authors: Manzo John F. , Blonder Lee X. , Bums Allan F.
Published: February 2004

This study examines interviews with men who have experienced strokes.‘Control interviews' with persons who had experienced health problems not related to stroke were also conducted, and they are considered here as well. Unlike most studies of stroke patients' linguistic competence, which examine subjects in isolation and in clinical settings, these interviews were conducted in the patients' homes, with the patients' spouses present in all of the interviews. The analysis concerns the ways in which the spouses participate in the telling of narratives that describe the unfolding of the stroke event as such. At the beginning of every interview with stroke patients the interviewers asked what happened during the stroke proper. The spouses' participation in these stories is significant and sustained, whereas the patients' own mastery of such narratives is meagre although the narratives comprise details from their personal somatic experience. We specify several discreet interactional patterns that make up the stroke patients' dearth of agency in these tellings, compare the interactional dynamics in the interviews with ‘control’ patients, and discuss the significance of these interactional minutiae for the patients' well‐being and also for sociological investigations of ‘the brain’ and related issues.
Dying alone
Authors: Seale Clive
Published: February 2004

This paper draws on the accounts given by 149 relatives, friends and others who knew people who died alone. These are a subset of data from a larger national survey of a random sample of adult deaths. A critical assessment is made of the argument that in late modem society death is denied, ‘sequestrated’ or hidden away in hospitals and that community practices for containing the threat of death have atrophied. The accounts analysed here suggest that, in contrast, speakers are actively concerned to sustain an ideal of a caring community, seeking to locate people who die within its embrace. Speakers sought to preserve their moral reputations and ontological security by claiming membership of a community of care and concern. The accounts were also used to resurrect the hopes of speakers for the orderly continuation of social life in the face of the threat of death. Parallels to this are identified in the death rites of traditional societies. Professional (and governmental) interest in sustaining ‘community care’ is also analysed in relation to the treatment of death. Professional discourse commonly emphasises the benefits of a ‘natural’ death at home, away from what is depicted as the alienating environment of the hospital. However, both home and hospital contain possibilities of deaths alone, threatening the ideal of emotional accompaniment necessary to sustain the image of a caring community. While entry to hospital is often understood to be a placement beyond accompaniment it is by no means as great a threat as a death alone at home, which confronts speakers with a fantasy of abandonment that is difficult to repair.
The rise of surveillance medicine
Authors: Armstrong David
Published: February 2004

Despite the obvious triumph of a medical theory and practice grounded in the hospital, a new medicine based on the surveillance of normal populations can be identified as emerging in the twentieth century. This new Surveillance Medicine involves a fundamental remapping of the spaces of illness. This includes the problematisation of normality, the redrawing of the relationship between symptom, sign and illness, and the localisation of illness outside the corporal space of the body. It is argued that this new medicine has important implications for the constitution of identity in the late twentieth century.
Appraisal of health risks: the roles of masculinity, femininity, and sex
Authors: Kaplan Mark S. , Marks Gary
Published: February 2004

The study examined the relationship between gender role orientation and appraisals of health risks. A random sample of college students from a U.S. university responded to the Bem Sex Role Inventory (BSRI). Subjects also were presented with sets of scenarios that depicted health‐threatening events. They rated the extent to which different environmental events and the degree to which immediate illness symptoms posed a threat to their health. The ratings did not differ significantly between men and women or between individuals who were above versus below the median on the masculinity dimension. The one consistent result was an interaction between femininity and sex of subject ‐ highly feminine men exhibited the highest health concern ratings compared to the other subgroups. Additional analyses ruled out potential confounding variables. The findings suggest that the extent to which males are socialised toward greater femininity appears to lead to a heightened sense of awareness and concern about health compromising circumstances. Our results are consistent with a growing body of psychosocial literature showing the beneficial effects of femininity on health and illness outcomes.
Threats to the good death: the cultural context of stress and coping among hospice nurses
Authors: McNamara Beverley , Waddell Charles , Colvin Margaret
Published: February 2004

This study uses Australian data based on interviews with nurses and participant observation in an in‐patient hospice and a community based hospice service to demonstrate how hospice nurses perceive stress in their work environment and cope with caring for dying patients. Stressors are discussed within a cultural context and are viewed as threats to the nurses' shared system of values which centres on the Good Death. The Good Death is conceptualised as a series of social events that involve the dying person as well as the other interactants who may include family, friends and health professionals. The death is defined as ‘good’ if there is an awareness, acceptance and preparation for death by all those concerned. The nurses' coping strategies and social supports are negotiated within the context of the hospice environment, and relate directly to the protection and affirmation of the nurses' shared value system.
Giving patients a future: the constituting of classes in an acute medical unit
Authors: Latimer J.
Published: February 2004

Drawing on an ethnography of conduct within an acute medical unit, the paper explores how nurses and doctors constitute classes of patient to help accomplish their ordering work. For example, patients such as older people and those who are chronically sick are figured as having only limited medical futures. The current analysis suggests that staff deploy patients’ (perceived) social identities to help (re)figure them in particular ways to organise disposal. However, disposalemerges not so much as an effect of staffs moves, but as a mode of ordering in a world of multiple domains.
The politics of occupational ill‐health in late nineteenth century Britain: the case of the match making industry
Authors: Harrison Barbara
Published: February 2004

Using the match making industry as a case study, this paper examines the politics of occupational health in late nineteenth century Britain. It argues that this industry had a high profile within the wider political struggle around the question of working conditions and their effect on workers' health. This was due to the identification of match making with a specific and particularly disfiguring industrial disease, phosphorous necrosis, and that one firm, Bryant and May, featured prominently in the struggles around health and safety. This paper examines the role of employers, the state, and those demanding reform. It suggests that medical and dental ‘experts’ were important both in relation to their ‘official’ role with respect to factory regulation, and also because industrial ill health was a site of professional politics. The extent to which gender issues entered into the politics of occupational health at this time is considered. It concludes that mediation, compromise and the different priorities of the various interests involved prevented the dangers to health in matchmaking as in other industries from being controlled and eliminated in this period.
Reasons for consultation and explanations of illness among Finnish primary‐care patients
Authors: Punamaki Raija‐Leena , Kokko Simo J.
Published: February 2004

The aim of this study is to describe triggers to consultation, and to further understanding of how patients construct explanations for what is wrong with them. Patients consulting a general practitioner were interviewed about the process that had led to their consultation and explanations for the causes of their illness. The results show that the factors which trigger professional consultation are related to the everyday demands of work, home and other people on the one hand, and to the interpretation of bodily symptoms on the other. Characteristically, symptom interpretation often involves a veiled dialogue with the tax‐funded municipal health care system about a justification for the lay diagnosis. The results further show a domination of biomedical illness explanations among the patients studied. A third of the explanations concerned infectious, toxic and noxious agents, and a quarter constitutional defects in the body. Ten per cent were philosophical and metaphysical, and 16 per cent psychosocial in nature. The remainder were based on life style and risk behaviour, and on problems of medical care. The results are discussed from the standpoint of lay and professional models of explanation for illness.
‘Panic bodies’: discourses on risk and HIV antibody testing
Authors: Lupton Deborah , McCarthy Sophie , Chapman Simon
Published: February 2004

While several recent sociological studies have sought to examine the reasons why people tend not to perceive themselves at personal threat of HIV infection, few have been explicitly directed at understanding the reasoning behind the decision to seek HIV antibody testing. This paper presents the findings from semi‐structured interviews carried out with adults living in Sydney who had had one or more HIV tests. Aspects relating to the socio‐cultural dimensions of the HIV test for those who have experienced it are discussed, including representations of HIV/AIDS in mass media education campaigns, assessment of partners and notions of HIV risk and contagion in the context of embodiment in the age of epidemic.
The Ethnic Patterning of Health: New Directions for Theory and Research
Authors: Smaje Chris
Published: February 2004

This paper argues that analysis of the ethnic patterning of health has failed adequately to examine the social meaning of ethnicity, while too often becoming enmeshed in unhelpful dualities which counterpose material to cultural explanations, multiculturalism to anti‐racism, and sociology to epidemiology. Against the background of anthropological, objectivist and postmodern theories in the broader sociology of ‘race’ and ethnicity, the paper develops a concept of ethnicity for the purposes of health research. This is used to evaluate biological, migration‐based, material, cultural and racism‐based explanations for the ethnic patterning of health. It is argued that these types of explanation are best understood within an interactive framework. The methodological implications of this for future research are discussed.
Doctor‐patient relationships in the private sector: patients’ perceptions
Authors: Wiles Rose , Higgins Joan
Published: February 2004

Recent challenges to medical authority have been viewed as having an impact on relationships between doctors and patients. It is argued that these challenges have resulted in moves away from traditional paternalistic relationships. As a result of their market position, private patients as a group might be expected to be most advanced in bringing about change in the doctor‐patient relationship. Using data collected from a study of private patients, an analysis of patients' interpretations of their relationships with their doctors was undertaken. The patients' accounts indicated that relationships contained elements of both mutuality and consumerism. The features of the interaction, the organisation of health care in the private sector and the power of the medical profession are used to explain how these relationships develop. It is argued that there are tensions that exist in reality between the principles underlying each model which constrain relationships between doctors and patients moving too far in the direction of either consumerism or mutuality.
Condemned to be meaningful: Non‐response in studies of men and infertility
Authors: Lloyd Mike
Published: February 2004

Male infertility has been under‐researched, and in part this seems due to a strong reticence by men to talk to researchers about infertility. Rather than suggest possible features of male infertility that might lead to this reticence, this paper explores how researchers have themselves accounted for the high non‐ response rates. The analysis details the way in which social scientific reasoning about non‐response incorporates both existing knowledge about infertility and everyday reasoning about health and illness. It is suggested that this process is a variant of a pervasive form of commonsense reasoning ‐ the documentary method of interpretation. The interesting upshot of applying this method to non‐response, is that an absence of information is ‘condemned to be meaningful’.
Managing social change: a process‐sociological approach to understanding organisational change within the National Health Service
Authors: Dopson Sue , Waddington Ivan
Published: February 2004

Using the implementation of the Griffiths Report as an example, this paper examines the way in which sociologists and others have examined the process of managing change within the NHS. Several studies of Griffiths have documented a number of unintended consequences of its implementation but it is argued that none of these have adequately theorised these unintended outcomes of the policy implementation process. It is suggested that the process‐sociological approach of Norbert Elias, and in particular his game models, enable us better to understand the complex interweaving of planned and unplanned processes which is involved in all processes of managed change.
Private medicine:‘you pay your money and you gets your treatment’
Authors: Thorogood Nicki
Published: February 2004

This paper looks at the issue of private health care from the perspective of black (Afro‐Caribbean) women in Britain. The research on which it is based (Thorogood 1988) indicates that these women have a particular relationship to health care, one aspect of which is their use of private consultations with General Practitioners. This is, I suggest, a consequence of their historical and contemporary experiences.
Recent developments in professional control: the impaired physician movement in the USA
Authors: Stimson Gerry V.
Published: February 2004

Abstract Many sociological commentators have noted the reluctance of the professions to engage in active self‐regulation. However, in the last ten years in the USA a new form of professional control has emerged that encourages active intervention. This focusses on the issue of the ‘impaired physician’ and is concerned with physician ill‐health and its effects on medical practice, and is manifested in medical programmes for the identification, treatment and rehabilitation of impaired physicians. This interest in physician behaviour and its consequences for medical practice has developed and is contained mainly within the medical profession and tempers external surveillance and control. The success of the impaired physician movement rests on the ability to take certain areas of conduct such as alcoholism and drug abuse (which are formally disciplinary issues) and handle them as diseases.
Models and management: the case of ‘cystitis’ in women
Authors: Pill Roisin
Published: February 2004

Abstract Both patients and doctors use explanatory models to manage episodes of sickness. The symptoms of lower urinary tract infections (cystitis) are used (i) to explore lay aetiological theories and the way they are modified through interaction with health professionals; (ii) to consider the range of professional explanatory models. Typically the explanatory models used by doctors have received less attention than those of patients since they are assumed to be derived from homogeneous, internally consistent and rationally scientific bodies of knowledge. Cystitis is used as an illustration of the way theoretical/scientific models which have been developed in a research context are applied in everyday practice. It is argued that the biomedical approach to diagnosis leads to the creation of a puesdo‐disease, the urethral syndrome, and that apparent rationalisation of the diagnostic process by the use of clinical tests can lead to problems in the long‐term management of these patients. Such problems occur, not because patients have different explanatory models from doctors but because both doctors and patients become committed to the same explanatory model of underlying organic pathology and thus unable to consider other potential causes or address the wider question of coping with the patients ‘illness’.
Viewpoint: Things to come: the NHS in the next decade
Authors: Davies Celia
Published: February 2004

Abstract This paper offers an interpretation of contemporary developments in Britain's National Health Service which suggests that a major transformation is under way, the contours of which, while visible, are not yet fully appreciated or understood. The analysis is in sharp contrast with that recently proposed by Klein and deliberate comparisons are drawn. The paper is in three main sections. The first briefly summarises Klein's position. The second takes issue with certain of his views, notably those on structural change, but also to some extent those on the relevance of the private sector. Welfare pluralism is posited as the most plausible future for health care and as a phenomenon as yet not well understood in Britain's health care sector.
Boundary encroachment: pharmacists in the clinical setting
Authors: Eaton Gail , Webb Barbara
Published: February 2004

Summary This paper discusses the relationship between pharmacy and medicine in the light of recent claims that occupations such as pharmacy, whose central tasks arc organised around those of medicine, have gained increasing control over their sphere of work, thus contributing to a decline in medical hegemony. We discuss the process by which on the one hand, para‐medical groups may extend their boundaries into areas officially the responsibility of the medical profession, and on the other, the medical profession may willingly delegate or indeed relinquish control over certain tasks. However, we argue from data collected from those groups in medicine and pharmacy concerned with the problems of drug use, that this does not necessarily indicate a decline in medical hegemony.
Socioeconomic class, classification of ‘abnormal’ behavior and perceptions of mental health care
Authors: Heller Peter L. , del Carmen Rivera‐Worley Maria , Chalfant H. Paul
Published: February 2004

Summary The oft‐cited relationship between socioeconomic status and rates of mental illness was investigated in terms of lower‐class perceptions of certain‘disordered’behaviors and the sources of help, if any, thought relevant to these behaviors. It was hypothesised that certain types of behavior and perceptions of the environment which might be abnormal in middle‐class society are perceived as quite normal in the lower‐class world, and that lower‐class respondents will tend to describe such behaviors and perceptions as normal or only slightly extreme. It was further hypothesized that lower‐class living conditions lead to the development of an informal network of mutual aid relationships and a tendency to seek formal, professional mental health care facilities only for concrete and extreme examples of abnormal behavior.

Data were taken from interviews with working‐ and middle‐class female respondents residing in two small West Texas towns. Perceptions of mental illness and care for such illness were elicited by seeking response to five examples of behavior patterns considered indicative of mental disorder by mental health professionals. Two other questions dealt with source of treatment respondent would use if she developed an emotional problem, and the source of information respondent would use to decide where to find help for an emotional problem. It was found that lower‐class respondents, more frequently than middle‐class respondents: tend not to define certain forms of deviant behavior as mental or emotional incapacities; tend to suggest informal rather than formal sources of help for these deviant behaviors; tend not to suggest using professional mental health specialists for treatment of emotional disorders; and use informal sources for information concerning treatment of emotional problems.
Strategies against time
Authors: Last Murray
Published: February 2004

Summary This paper considers the development of one stereotyped illness in Maguzawa (non‐Muslim Hausa) culture of northern Nigeria, and suggests some reasons for its prevalence. The central argument is that the use of stereotyped illness in this case is a strategy (if it is a strategy at all) principally against the process of time and only secondarily against men or kin; but that perhaps most important of all is its use as a cognitive catch‐all, particularly in conditions of uncertainty, to save further thought and discussion. In putting this argument forward we hope to draw attention again to the range of various meanings a stereotyped illness can have for the person concerned and not merely to its strategic use for getting at people.
Review article
Authors: Goldie Nigel
Published: February 2004

Review in this Article:

George W. Brown and Tirril Harris, The Social Origins of Depression.
A question of balance: health behaviour and work context among male Glaswegians
Authors: Mullen Kenneth
Published: February 2004

Discussion of the persistence of social class inequalities in health has led to greater interest being paid to differences between the classes in lay health beliefs. Recent work on lay health beliefs, however, has mainly viewed social class as a proxy for wider aspects of lifestyle and paid less attention to its occupational component. Part of this can be explained by its predominant focus on the health beliefs of women. This paper remedies this imbalance by focusing on male Glaswegians' perceptions of the health effects of their occupations. It shows that not only were respondents very aware of the influence their jobs had on their health but that they also took action to redress the balance, either by compensating for such effects or controlling their work environment to minimise their influence. Respondents' degree of commitment to their work also had a direct bearing on their coping styles. Although traditional occupational class measures were found to obscure much of how occupation influences health, unskilled and semi‐skilled workers did suffer the greatest limitations in coping with the health effects of work.
The new reproductive technology: problem or solution?
Authors: Strickler Jennifer
Published: February 2004

New reproductive technologies, such as in vitro fertilisation, have been the subject of heated debate among academics, medical ethicists and policy makers. This paper examines the literature of physicians, infertile consumers of the technology and feminist critics, and argues that differences in the meaning of procreation are at the root of the debate. Physicians see it as a sphere of professional intervention; consumers focus on genetic transmission; and feminist critics see procreation as a locus for struggle over women's autonomy. Given these different meanings of procreation, empirical data and logical arguments will not resolve the conflict over reproductive technology.
Myth and the menopause
Authors: Kaufert Patricia A.
Published: February 2004

Abstract This paper examines two competing descriptions of the menopausal experience, the one proffered by the medical profession and the other by the women's health movement. These different interpretations of the menopause are each treated as myths in the sense in which that term is used by Barthes. In his definition, myths are social products and the modern myth reflects the values of the bourgeoisie. Through an examination of these myths, the paper discusses the view of women, particularly ageing women, taken by the medical profession and by the feminist health movement.
Chronic illness as biographical disruption
Authors: Bury Michael
Published: February 2004

Abstract The paper is based on semi‐structured interviews with a series of rheumatoid arthritis patients. Chronic illness is conceptualised as a particular type of disruptive event. This disruption highlights the resources (cognitive and material) available to individuals, modes of explanation for pain and suffering, continuities and discontinuities between professional and lay thought, and sources of variation in experience.