bluuebunny/crossref_metadata_2025 huggingface dataset:
Experiences of disabled health and caring professionals
Authors: French Sally
Published: February 2004

Abstract The widespread discrimination against disabled people in most types of employment is well known. It would seem likely, therefore, that disabled people would find it difficult to gain access to the health and caring professions, although many people have argued that their personal experience of disability would be an invaluable asset to the professions and patients alike. By means of semi‐structured interviews this study aimed to gain insight into the experiences of people who had been accepted into the health and caring professions despite having a substantial disability. Although most respondents reported either positive or neutral attitudes from colleagues, a sizeable minority had experienced negative attitudes, especially when trying to gain access to training and during training itself.

Negative attitudes from patients and clients were, in contrast, exceptionally rare. Most respondents viewed their disability as an advantage rather than a disadvantage in the work context, and although some people were restricted in the specialities they could follow, most could fulfil all of their work obligations.
Medicine and semantics
Authors: Manning Peter K.
Published: February 2004

Book review in this article:

Eisenberg and Kleinman (eds). The Relevance of Social Science for Medicine.
Sexism, feminism and medicalism: a decade review of literature on gender and illness
Authors: Clarke Juanne N.
Published: February 2004

Abstract Do we really have a dependent variable in our study of the sex differences in illness and sex differences in the explanations for illness? The purpose of this paper, which reviews the literature in this area over the past decade, is to argue that because of both conceptual and methodological difficulties in the definition of health/illness, there are serious problems in the available analyses to date. Confusions between medical and lay definitions, mental and physical illness, illness per se and illness behaviour are among the issues raised with respect to the first issue: conceptual and definitional incommensurability. Proxy respondents, distinctions between males and females in illness experience, and improper rate calculation are among the issues discussed in the section concerning methodology.
The Cocktail party syndrome
Authors: McKeganey Neil P.
Published: February 2004

Abstract In the medical literature on the‘cocktail party syndrome’very little attention has been directed towards contextual elements in evaluating children's behaviour. This research note reports upon how adults in one therapeutic community accounted the behaviour of Linda, identified as a cocktail party speaking hydrocephalic child. The descriptions of Linda as 'speaking like an adult’and of living in language’are examined in terms of their contextual constituents. Finally I examine briefly how adult staff members interact with Linda on a day‐to‐day basis and attempt to cope with the difficulties they see her as presenting.
Pharmacists and medical doctors in nineteenth‐century Belgium
Authors: Schepers R.
Published: February 2004

Abstract In this article the main areas of conflict between the medical and the pharmaceutical professions in Belgium in the 19th century are outlined. The medical profession was dominant in the division of labour and the pharmacists were not allowed to threaten its position. However, pharmacists were also able to achieve their objectives ‐ geographical expansion of their officially recognized monopoly and the safeguarding of the pharmacist's key role in the dispensing of drugs, including proprietary drugs. They also managed to push the less qualified druggists out of the officially recognized division of labour in medicine.
Social constructionism and medical sociology: a study of the vascular theory of multiple sclerosis
Authors: Nicolson Malcolm , McLaughlin Cathleen
Published: February 2004

Abstract M.R. Bury has radically questioned the value of social constructionism for medical sociology (1986). The present authors have already responded to this wide‐ranging critique (Nicolson and McLaughlin 1987). This article aims to complement our theoretical discussion by embodying its principles in empirical case study. A recent debate surrounding the pathogenesis of multiple sclerosis is analysed in terms of the skills, interests and backgrounds of the medical personnel involved. It is noted that the proponents of the vascular theory possess developed expertises in interpreting disease in structural, vascular terms, whereas their opponents' skills lie in immunology or neurology. Different observers have produced different conceptions of the disease because modes of observation, and the points from which observation takes place, differ. It is also noted that the debate over the causation and treatment of MS has occurred between a large and powerful social group and a weak and marginal one. The effects of this power inequality on the production and assessment of knowledge about MS are investigated. The significance of the case study for Bury's misgivings as to the value of social constructionism is discussed, particular concern being taken to clarify the notions of instrumental realism, of reflexivity, and of the alleged dispensability of medicine.
Hospital patients' responses to dissatisfaction
Authors: Carmel Sara
Published: February 2004

Abstract Hospitalized patients' responses to dissatisfaction in the provision of services are analysed as a function of their perceptions of the severity of the service failure and their relative social power. The analysis is based on the responses of 384 patients in a general hospital who reported experiencing at least one disturbing problem in the receipt of hospital services. Three binary dependent variables were constructed based on three dimensions of intensity of complaint behaviours: passive vs. active, non‐directed vs. directed, non‐formal vs. formal. The four possible response combinations created an ordinal scale of intensity of response. The set of independent variables included: perceived severity of the problem, general measures of satisfaction with services, structural power discrepancies, personal and situational resources of social power, and self perception of social power. The results of multivariate analyses indicate that the perceived severity of the problem best explains the intensity of response. Personal and situational social power resources and self perception of power add to the explanation. Structural power discrepancies, however, do not relate to the intensity of patients' responses to dissatisfaction.
Charisma, power and altruism: a discussion of research in a child development centre*
Authors: Stacey Margaret
Published: February 2004

Abstract This paper reports on a study of a multidisciplinary assessment centre for pre‐school handicapped children. The centre provides an opportunity for different categories of health professionals to explore the needs of a handicapped child over a ten‐day period and to offer help and advice. The research design was an unusual one in including an assessment of staff attitudes by the doctor involved in setting up the centre, an assessment of the parents’views by a sociologist, an exchange of reports and an assessment of subsequent staff reactions. The present paper offers a commentary on the whole of this process. Differences between lay and professional models of handicap are explored and data on the changes staff were prepared to make are taken into account. The paper stresses that perceptions of problems are affected by the social position of the actors involved and their different notions of normality. A power model can aid in explaining some of the actions of the staff, but it is argued that both charisma and altruism are relevant concepts, particularly perhaps in sectors of the health service where the dominant values of competitive industrial society do not apply.
Orchestrating an encounter: a note on the talk of mentally handicapped children
Authors: Brewer John D. , McBride Gill , Yearley Steven
Published: February 2004

Abstract Patterns of power, leadership, authority and status within a group are all displayed in interaction and materially affect the flow of natural conversation. Authority and status, often accorded by mentally handicapped children on the basis of self‐assessments of communicative competence, can constitute important local resources which enable one of the parties to assume the role of co‐ordinator of the conversational interaction. In this case the interaction comes to comprise a type of setting known as an ‘orchestrated encounter’, where the talk takes a particular form which deviates from mundane everyday conversations. We use the notion of'orchestrated encounter’ to demonstrate the communicative competence of some children with severe learning difficulties.
Wisdom, diligence and teeth: discursive practices and the creation of mothers
Authors: Nettleton Sarah
Published: February 2004

Abstract In his paper ‘Governmentality’ Foucault 1979 has described how the family, which prior to the eighteenth century had formed a model of the state, afterwards became an effective instrument for the art of government. The art of government relies on wisdom and diligence. This paper is concerned with those forms of wisdom and diligence that surrounded the mouth, teeth and the domestic environment. It analyses the moral discourse and practices that surrounded the mother. The dental discourse and practice of the twentieth century created a range of conceptualisations of the mother ‐ the ‘natural’, ‘ignorant’, ‘responsible’ and ‘caring’ mother are identified here. Today the dentist, and the sociologist, listen and talk to an active, capable and subjective mother. The empirical data that is presented in this paper was derived from interviews with dentists and mothers and from reading journals and texts. It is through the vocabulary of the ‘dental experts’ that the mothers and patients construct themselves.
Implications of mortality and morbidity for health care delivery in Ghana
Authors: Fosu Gabriel B.
Published: February 2004

Abstract The lack of adequate statistics makes it almost impossible to get an accurate picture of the health situation in developing countries. Based on the fragmentary data available, this paper examines the determinants and consequences of ‘unnecessary’ deaths and ill health in Ghana. Even though the main causes of death among the majority of the people are preventable, the health care delivery system emphasizes curative rather than preventive, and urban‐based instead of rural‐based practices. The current structural and institutional factors which sustain them are discussed. Suggestions are made towards the solutions of the seemingly intractable and complicated health problems.
Social class and the general practice consultation
Authors: Boulton Mary , Tuckett David , Olson Coral , Williams Anthony
Published: February 2004

Abstract After assessing the evidence on social class differences in the rates and nature of general practice consultations, the Black Report proposed that middle‐class patients receive a better service from GPs than do their working‐class contemporaries. This paper reviews the literature on which this suggestion is based and presents further evidence from a study of communication in general practice, as to the extent and nature of social class differences in consultations.

The results of the study suggest that middle‐class patients are more active than working‐class patients in presenting their ideas to the doctor and in seeking further explanation of his views from him or her. However, this greater activity does not necessarily mean that middle‐class patients get more benefit from the consultation, at least in terms of its cognitive outcomes: similar proportions of working‐class and middle‐class patients received explanations from the doctor and similar proportions misunderstood and rejected his views and advice. These findings point to the important distinction between ‘process’ and ‘outcome’ and underline the need for further research which assesses social class differences in the outcomes as well as the processes of consultations.
Social, developmental and health correlates of ‘attractiveness’ in adolescence
Authors: Macintyre Sally , West Patrick
Published: February 2004

Abstract This paper suggests a possible link between two different bodies of research. The first is sociological and social epidemiological research which has demonstrated associations between social circumstance and various indicators of health and development; the second is experimental social‐psychological research which has demonstrated that perceived physical attractiveness is associated with the attribution of socially desirable character traits. Multivariate analysis of data from a cohort of a thousand 15 year olds in the West of Scotland shows that physical attractiveness as rated by three independent interviewers was associated with higher household social class, owner occupied housing, physical maturity, height, clear speech, and not wearing glasses. Females who were relatively light for their height were rated more attractive; this was not the case for males. Sex of interviewer and of respondent was associated with attractiveness ratings. It is intended that future contacts with this cohort be used to examine whether attractiveness ratings at 15 predict trajectories through educational, employment, and marriage ‘markets’.
‘Falling out of culture’: the effects of repetition strain injury on sufferers’ roles and identity
Authors: Ewan Christine , Lowy Eva , Reid Janice
Published: February 2004

Abstract Repetition Strain Injury (RSI), a non‐specific and controversial constellation of work‐related hand, arm and neck symptoms, became endemic in Australian industry in the early 1980s. Fifty two women who worked in a telecommunications organisation and chicken processing factory and had been diagnosed as having Repetition Strain Injury were interviewed about their perceptions and experiences of the illness. Their accounts of the effects of the pain and limitation on their work, home lives and identity reveal pervasive and ramifying consequences, including unemployment, a reduced capacity to do housework, disruption to family relationships and plans for the future, financial hardship, emotional and mental distress, loss of sleep, and an erosion of self‐esteem and involvement in leisure activities. Dominant themes in the interviews are the ambiguity of the illness and uncertainty about the prognosis, the disbelief of others which marginalises sufferers and contributes to a sense of loss of 'self and integrity, and the emotive political climate in which the women are forced to renegotiate roles and adapt to the limitations which RSI places on their lives.
Review Article: Missing bodies – towards a sociology of embodiment
Authors: Turner Bryan S.
Published: February 2004

C. Herzlich and J. Pierret, Illness and Self in Society, Baltimore and London: The John Hopkins University Press, 1987, £20.50 (cloth), xvi + 271 pp., translated by E. Forster.

W. Laqueur, Making Sex: Body and gender from the Greeks to Freud, Cambridge, Mass, and London: Harvard University Press, 1990, £19.95 (cloth), x + 313 pp.

D. Leder, The Absent Body, Chicago and London: University of Chicago Press, 1990, £27.95 and £11.95, x + 218 pp.

I. Löwy, The Polish School of Philosophy of Medicine. From Tytus Chalubinski (1820–1889) to Ludwig Fleck (1896–1961), Dordrecht: Kluwer Academic publishers, 1990, $78.00 and £44.00, vii + 287 pp., translated by I. Löwy.

E. Martin, The Woman in the Body, a cultural analysis of reproduction, Milton Keynes, the Open University Press, 1989, £25.00 and £7.99, ix + 276 pp.

M‐C. Pouchelle, The Body and Surgery in the Middle Ages, New Brunswick, New Jersey: Rutgers University Press and Oxford: Polity Press, 1990, $40.00 and £35.00, vii + 276 pp., translated by R. Morris.
Psychiatry and medicine in the US: Interpreting trends in medical specialty choice
Authors: Neff James Alan , McFall Stephanie L. , Cleaveland Timothy D.
Published: February 2004

Abstract An integrated model of change in knowledge, highlighting the role of technologic and organisational paradigms and the activities of professional and extra‐professional groups, is used to clarify the historical development of psychiatry and to account for current specialty choice trends. American psychiatry and medicine stem from disparate scientific/philosophical roots. A review of events leading to the establishment of psychiatry as a medical specialty indicates that the merger of psychiatry and neurology may have stemmed as much from professional competition as from technological or paradigmatic convergence. Recent perceived declines in the choice of psychiatry as a medical specialty are examined in light of this sociology of knowledge perspective. Declining choice of psychiatry as a specialty reflects both underlying paradigmatic conflicts with medicine as well as declining federal support for psychiatric training. Solutions proposed for the perceived problem within psychiatry are designed to solidify ties with medicine, increase political power and prestige, and retain federal support.
Research note: Identifying ‘at risk’ persons in community based research1
Authors: Murphy John W. , Pilotta Joseph J.
Published: February 2004

Abstract Since the passage of the U.S. 1963 Community Mental Health Act, all social planning is supposed to be community based. This means that policy research should be guided by the principle of community sensitivity, and not merely technical or logistical concerns. In this article the general tenets of community based research are outlined and applied to analysing the currently controversial issue of what it means for a person or community to be clinically ‘at risk’. Normally this topic is addressed in a purely technical manner, yet this approach must be altered if need identification is to be consistent with a community's own self‐perception, thereby producing valid data.
Medical sociology and the politics of health
Authors: Carpenter Mick
Published: February 2004

David Widgery, Health in Danger.

Peter Draper et al. The NHS in the Next 30 Years: A New Perspective on the Health of the British.
‘Relapse’ to unsafe sexual behaviour among gay men: a critique of recent behavioural HIV/AIDS research
Authors: Hart Graham , Boulton Mary , Fitzpatrick Ray , McLean John , Dawson Jill
Published: February 2004

Recent studies of gay male sexual behaviour have employed a concept new to the literature in the area. Men who appeared to have adopted safer sex behaviours and are now having ‘unsafe’ sex in relation to possible infection with HIV are described as having ‘relapsed’. In this paper we critically evaluate this concept. Firstly we undertake a methodological critique, looking in some detail at studies which have used ‘relapse’. We then provide a conceptual critique, suggesting that the construction of human sexuality implicit in the use of this term is inappropriate to the study of sexual behaviour. Finally, we suggest why a concept such as relapse should appear in the literature on the HIV/AIDS epidemic at this time.
The Tromsø study: factors affecting patient‐initiated and provider‐initiated use of health care services
Authors: Fylkesnes Knut , Johnsen Roar , Førde Olav Helge
Published: February 2004

The aim of this study was to examine factors influencing decisions involved in i) patient‐intiated visits to general practitioners and ii) provider‐initiated use of referral services. The analyses were performed with regression models on a set of data from a comprehensive population study of 7369 men aged 20–61 and 6832 women aged 20–56. Marked gender differences appeared in both patient‐initiated and physician‐initiated health care use. Various health status dimensions were found to be important determinants of patient‐initiated use, in particular self‐rated health, physical distress and transitory morbidities. Further, having a primary provider was found to increase patient‐initated use strongly. Among the health status measures only self‐rated health and chronic disease appeared as important determinants of provider‐initiated use. Age and years of education were negatively associated with GP visits and positively associated with the use of referral services. The higher rate of referral of patients with higher educational achievement indicates a social status bias among general practitioners, creating considerably inequitable access to referral services. Further, the analyses indicate that positive lifestyles are associated with increased health care consumption among men.
All change in the NHS? Implications of the NHS reforms for primary care prevention
Authors: Williams Simon J. , Calnan Michael , Cant Sarah L. , Coyle Joanne
Published: February 2004

The paper provides a review of the implications of the recent NHS reforms ‐ i.e. the Griffiths Report (1983), Promoting Better Health (1987), Working for Patients (1989) and the new GP contract (1990) ‐ for primary care prevention. Three major themes are identified as the leitmotivs running through these reforms: first, the introduction of general management into the NHS; secondly, the introduction of market principles into the NHS, and; thirdly, the increasing emphasis upon health promotion and disease prevention. The first section of the paper offers a critical review of the Government's health promotion strategy, one in which, it is argued, the primary care sector will play a central role. Hence, taking the issue of primary care prevention as a case‐study, the paper then proceeds to discuss the implications of these recent reforms (i.e. managerialism and market principles) for primary care prevention at a number of different levels: namely, for FHSAs, DHAs, GPs, nurses, and consumers. The final section of the paper considers the potential impact of these reforms for the professional autonomy of GPs and nurses, particularly in relation to the proletarianisation and deprofessionalisation theses. The paper concludes with a theoretical discussion and interpretation of the themes and issues raised within the course of the paper.
Women and private medicine
Authors: Wiles Rose
Published: February 2004

Women are higher users of private sector in‐patient health care than men and the difference is more pronounced than in the NHS. This paper draws on data collected early in 1991 for a survey of private patients in one Regional Health Authority in England at a time when public health services were experiencing extensive reforms. Reasons for ‘going private’ identified by women centred around issues of privacy, level of care, and the ability to choose admission dates. While the reasons men gave were broadly similar, a closer examination revealed gender differences in their interpretations. These variations can be accounted for by the different socialisation, social roles and social position of men and women. It is concluded that health care needs and their interpretation are likely to be very different between groups of men and women, with divisions existing along lines of class, age and race as well as gender. Without an understanding of the differing health care needs and wants of these groups, the public sector will not be able to provide services that provide consumer satisfaction.
Perceptions of stigma: the parents of autistic children
Authors: Gray David E.
Published: February 2004

This paper reports the findings of a qualitative study of courtesy stigma among 32 parents of autistic children. The results indicate that autism has uniquely stigmatising aspects because of the extremely disruptive nature of autistic symptoms, the normal physical appearance of autistic children, and the lack of public knowledge and understanding regarding the nature of autism. Most parents perceived themselves to be stigmatised by their child's disorder. There was a strong tendency for mothers to feel more stigmatised than fathers. Parents with more severely disabled children and children who were under the age of twelve were also somewhat more likely to perceive themselves to be stigmatised.
Logical analysis as a qualitative method I: Themes in old age and chronic illness
Authors: Williams R. G. A.
Published: February 2004

Abstract Qualitative methods have been criticized for their lack of explicit procedures and weakness in explanation. The present paper draws attention to a qualitative approach with a clear procedure and wide explanatory scope — logical analysis. Logic has been neglected as a way of organizing informants’accounts because it has been identified with a procedure for organizing theory. In this paper, the attempt is to reverse the emphasis, and to demonstrate a way of working with informants rather than involving in theoretical prescriptions. The approach is illustrated by some themes arising in old age and chronic illness.

First, two conceptions of illness which have been distinguished in the work of Claudine Herzlich are analysed as systems of premises and consequences. Next, the procedures involved in logical analysis, and the explanations and practical uses which arise from it, are illustrated in two case studies. These cases are part of a larger body of data collected, amongst other things, for the purpose of eliciting the logic of old people's thinking.

The emphasis is on illustrating the method; and general issues which arise from it, including the analysis of people who entertain contradictory systems of thought, are postponed to a second paper.
Logical analysis as a qualitative method II: Conflict of ideas and the topic of illness
Authors: Williams R. G. A.
Published: February 2004

Abstract In the previous paper, a qualitative method was demonstrated which was based on logical analysis, and illustrated on themes arising in ill‐ness and old age. The emphasis was on revealing the deductions of informants, not on propounding a deductive theory about them. In the present paper general issues arising from the previous demonstration are considered. On issues of explanation and research design logical analysis is compared with statistical analysis. Then a crucial explanatory issue, concerning the person who combines conflicting ways of thinking, is worked through on a case study. Finally, the conclusions make further suggestions about the topics amenable to logical analysis, the contrast between logical and statistical explanation, the research methods appropriate to logical understanding, and the practical uses of the method.
Recent developments in the history of nursing
Authors: Rosenberg Charles
Published: February 2004

Book review in this article:

C. Davies, ed., Rewriting Nursing History.
The ‘natural’ control of fertility1
Authors: Basker Eileen
Published: February 2004

The analysis of the reproductive behaviour of married Jewish women seeking abortions in a hospital in Israel, summarized here, indicates that fertility and its control, for these women and their husbands, was often judged on a dimension of ‘natural’‐‘artificial,’ where ‘natural’ was the valued pole. Representatives of the medical profession, who de facto controlled access to effective contraceptives, often either intentionally or unintentionally undermined couples’ attempts to control their fertility effectively, and gave support to suspicions regarding the dangers in ‘artificial’ medical contraception. The result, for these women, was unwanted and intolerable pregnancy and request for abortion. Abortion, by medical intervention, reinforced the sense that complete control of fertility was impossible; by further contributing toward their feeling of helplessness, it may also have discouraged couples from changing their contraceptive behaviour.
Being epileptic: coming to terms with stigma
Authors: Scambler Graham , Hopkins Anthony
Published: February 2004

Most commentators on the stigma associated with epilepsy have assumed that the psycho‐social distress sufferers experience derives wholly or largely from the discriminatory attitudes and behaviour of normal people. This ‘orthodox viewpoint’ is assessed and found to be lacking in empirical support. A study of the impact of epilepsy upon the lives of sufferers is reported, special attention being paid to coping strategies developed in the family and at work. A distinction between ‘enacted’ and ‘felt’ stigma is introduced and utilized in the generation of a new model of people's responses to ‘being epileptic’ which appears to have more explanatory power than the orthodox viewpoint.
Constructing addiction as a moral failing
Authors: Harding Geoffrey
Published: February 2004

The medicinal value of opium as an analgesic has been known to humankind for centuries. In England during the nineteenth century it was regarded, especially among the labouring classes, as a popular panacea for a variety of ailments. However by the end of the century addiction emerged as an issue of public concern ‐ due largely to the ‘moral crusade’ launched by the Victorian anti‐opium movement against the non‐medical use of opium. Central to the movement's campaign was a certain model of addiction, promulgated by its most prominent organisation, the Society for the Suppression of the Opium Trade. This paper examines how this model was taken as an objective reality.
‘They're not the same as us’: midwives' stereotypes of South Asian descent maternity patients
Authors: Bowler Isobel
Published: February 2004

The paper examines the stereotypes of South Asian descent women held by midwives in a British hospital. The data are drawn from a small‐scale ethnographic study which investigated the women's maternity experiences. The midwives’ stereotype contained four main themes: the difficulty of communicating with the women; the women's lack of compliance with care and abuse of the service; their tendency to ‘make a fuss about nothing’; and their lack of ‘normal maternal instinct’. The creation, perpetuation and effects of this negative stereotyping are examined in the light of the wider sociological research on patient typification. Black and minority ethnic patients are particularly vulnerable to negative typification because of their visibility combined with the fact that crude racial stereotypes are common in wider society. Stereotyping reflected and reinforced the view that Asian women are ‘all the same’ but ‘not like us’. Midwives used stereotypes to help them to make judgements about the kind of care different women want, need and deserve. It is therefore argued that stereotyping is a factor in the creation of the inequality in health experiences of black and minority ethnic patients.
Controllers and controlled: an analysis of participant constructions of outpatient commitment
Authors: Scheid‐Cook Teresa L.
Published: February 2004

This paper utilises qualitative data to examine outpatient commitment from two points of view: clinicians (the controllers) and clients (the controlled). Outpatient commitment is a legal mechanism whereby ‘mentally ill’ individuals are court‐ordered to report to their community mental health centre for treatment. In this paper I provide the reader with an understanding of how outpatient commitment works by allowing clinicians and clients to describe the meaning outpatient commitment has for them. While the experience of outpatient commitment varies, and supports the contention that there are multiple definitions of reality, it is clear that in general clinicians favoured the greater control over clients’ outpatient commitment provided and clients were cognisant of the greater liberty it afforded them. This has important theoretical implications for research into medicalisation and social control, in that providers and clients interpret medical dominance and ideology differentially. Consequently I analyse the interpretations of controllers and controlled from those sociological perspectives relevant to the issues of ideology, power, and social control. I conclude by calling for further investigation of those agents who seek to engage in ‘heretical discourse’ (Bourdieu 1991) which challenge dominant medical constructions.
Patients with terminal cancer who use alternative therapies: their beliefs and practices
Authors: Yates Patsy M. , Beadle Geoffrey , Clavarino A. , Najman Jake M. , Thomson Damien , Williams Gail , Kenny Lisbeth , Roberts Sydney , Mason Bernard , Schlect David
Published: February 2004

This paper examines the extent to which patients who have been diagnosed as having terminal cancer choose to use non‐medical therapies. In particular it is concerned with the illness behaviour of patients who are receiving conventional cytotoxic drug and radiation treatments, who also decide to use a wide range of ‘alternative’ medications and therapies. The paper discusses the findings of a study of 152 patients with metastatic cancer that examined the extent to which they used alternative cancer therapies, as well as the beliefs and attitudes they have about their cancer, its treatment, and the practitioners providing that treatment. Four groups of users of alternative therapies, who differ according to their commitment to and the type of therapies they use, were identified. Results of logistic regression analyses indicate that those using alternative therapies were different in range of social attitudes. These differences were primarily their greater reported ‘will to live’ and desire for control over treatment decisions, and the differing beliefs they hold about their disease.
Reshaping of self: a pendular reconstruction of self and identity among adults with traumatic spinal cord injury
Authors: Yoshida Karen K.
Published: February 2004

This paper describes the impact of chronic illness on self and identity among 35 adults with traumatic spinal cord injury (paraplegic), living in the community. The reconstruction of self and identity post spinal cord injury is conceptualised as a pendulum. The pendulum of self represents a dynamic model of identity reconstruction. The pendulum suggests that identity reconstruction is a process that swings back and forth like a pendulum between the nondisabled and disabled aspects of self. The pendulum depicts five predominant identity views (outcomes). These are: 1) the former self; 2) the supernormal identity; 3) the disabled identity as total self; 4) the disabled identity as an aspect of the total self; and 5) the middle self. These identity views are influenced by five experiences (processes). These are: 1) loss; 2) sustainment; 3) integration; 4) continuity and 5) development of the self. It is suggested that frameworks of identity reconstruction or reconstitution which include both process and outcome components may elucidate more clearly the impact of chronic illness on self and identity. In addition, this pendulum model of identity reconstruction is an alternative approach to traditional sociological conceptions of identity reconstruction.
Illness as adjustment: a methodology and conceptual framework
Authors: Radley Alan , Green Ruth
Published: February 2004

Abstract This paper describes a method for studying individual adjustment to illness. The methodology draws upon the conceptual framework offered by Herzlich (1973) and defines four modalities of adjustment ‐ accommodation, active‐denial, secondary gain and resignation. The relevance of these modalities for understanding how people come to terms with illness is indicated with reference to a variety of studies of chronic illness describing such adjustments. The technique, which invites free responses to a series of questions, engages respondents on a number of issues which have been designated salient in the literature on illness behaviour and is intended to be used (a) to distinguish between individuals in their adaptation to their condition, and (b) to relate personal experience of illness to changing social situations and relationships. The methodology is offered as a way of describing, within a single conceptual scheme, the ways in which individuals resolve the dual demands of bodily change and of cultural constraint during chronic illness.
Liberation or oppression? radical feminism and in vitro fertilisation
Authors: Denny Elaine
Published: February 2004

Qualitative research was conducted to determine to what extent, if at all, the experience of in vitro fertilisation could be explained by radical feminist theories. Ten semi‐focused interviews were conducted, seven with women alone, and three with women and their partners.

Radical feminists emphasise the control of women's reproductive role by men as being the root of patriarchal oppression. The development of reproductive technology has been identified as working against the interests of women, and extending male control to the means of conception. Radical feminist literature in the area has taken mainly a theoretical approach to the exclusion of examining the role of women, while empirical research has often been a theoretical, and located within a biomedical framework.

Two main areas of interest are discussed here; pro‐natalism, and power and control, which are examined in the light of radical feminist theory. While this approach provides a partial explanation for the experience of some women, the main weakness in radical feminist thinking is to treat women as universally oppressed and passive. By failing to legitimate women's experiences, radical feminism, far from liberating women, provides an alternative form of oppression.
Sex, gender and power: young women's sexuality in the shadow of AIDS
Authors: Holland Janet , Ramazanoglu Caroline , Scott Sue , Sharpe Sue , Thomson Rachel
Published: February 2004

While the incidence of HIV infection and AIDS amongst non drug injecting heterosexuals is currently low in the UK, epidemiological evidence suggests that this situation may be short lived. The sexual practices of young heterosexuals will then be crucial in determining the extent of the epidemic. Drawing on feminist theory, we argue that if we are to understand young people's sexual relationships we must attend to the power relations within which sexual identities, beliefs and practices are embedded. The social pressures and constraints through which young women negotiate their sexual encounters impinge directly on their ability to make decisions about sexual safety and pleasure. The power of young women to control sexual practices can then play a key role in the transmission or limitation of sexually transmitted diseases. From preliminary analysis of data collected by the Women, Risk and AIDS Project, we argue that the risks young women take in sexual encounters with men arise within a nexus of contradictions through which women are expected to negotiate safer sex practices. However well intentioned, public health campaigns aimed at women cannot be effective unless they recognise that men and women begin their sexual encounters as unequal partners in the battle against the sexual transmission of HIV.
What is the relationship between drug taking and sexual risk? Social relations and social research
Authors: Rhodes Tim , Stimson Gerry V.
Published: February 2004

This paper examines the dynamics of the relationship between drug taking, sexual activity and sexual risk. While epidemiological research has provided essential indicators of levels of drug taking and sexual risk behaviour, the determinants of the relationship between drug‐taking and sexual risk remain unclear. A review of recent epidemiological research indicates two main contentions. First, that the use of certain drugs increases (or decreases) sexual desire and levels of sexual activity. Second, that the use of drugs (licit and illicit) has a disinhibitory effect on safer sex compliance. Critical examination of the literature shows that evidence in support for either of these contentions is both limited and variable. This paper argues that there is little empirical certainty about the causal determinants of the relationship between (a) the reputed pharmacological effects of drug use on sexual activity and (b) the social, situational and cultural factors which may influence sexual activity and safer sex compliance in drug use related encounters. The paper concludes that understandings of the relationship between drug‐taking and sexual risk rest as much upon commonsense understanding as on empirical evidence. In response, the paper outlines the needs and parameters of future social research, which as a primary focus aims to examine the social interaction and social relations of drug use and sexual activity.
The condom: why more people don't put it on
Authors: Browne Jan , Minichiello Victor
Published: February 2004

This study sheds light on an important topic emerging in the sexual health debate – identifying the interpersonal nature of sexual relationships which influence condom use. Using the principles of grounded theory, in‐depth interviews were conducted with heterosexual men and women to understand the impact of the dyadic context of ‘heterosex’ on decisions to use condoms, condom availability and partner support and receptivity to cooperate in safer sex practices. The study found that condom dialogues occur at two levels ‐ ‘the interpersonal condom dialogues’ and the ‘internal or discursive condom dialogues’. These dialogues shape condom use/non‐use negotiations and the sexual encounter. Individuals also enter into sexual relations with a dislike of condoms and a perception of condom sex as ‘other sex’, which sets the context for their sexual experiences. Gender constructions of socially ‘appropriate’ sexual behaviour for men and women are implicated in the decisions to use condoms. The study highlights the importance of promoting condom sex as good and pleasurable sex if education and public health intervention programmes are to be effective in changing attitudes towards safer sex practices.
The interactional form of professional dominance
Authors: Hak Tony
Published: February 2004

Studies of ‘the interactional form of professional dominance’ portray particular conversational phenomena, such as interruptions and specific types of questions, as effective means by which doctors inhibit patients from getting the floor. Such strategies, however, depend on the patient's cooperation and, hence, cannot assure the doctor's dominance. In this paper it is argued that the Freidsonian concept of ‘professional dominance’ does not in the first place refer to the asymmetrical distribution of interactional tasks but rather to the asymmetrical distribution of specialised professional knowledge. Hence an ‘interactional form of professional dominance’ should not be sought in the doctor's strategies for controlling turns but rather in the unequal distribution of the parties' access to each other's objectives. The question is then how this asymmetry of access can be ‘discovered’ in conversational data. It is argued that this can be done (only) by an analysis of how episodes of the interaction function in the process of professional assessment as a whole.
Expert medical decisions in occupational medicine: a sociological analysis of medical judgment
Authors: Dodier Nicolas
Published: February 2004

An ethnographic study of expert medical decisions in the field of occupational medicine explores the doctor's role in the attribution of rights to sick people. Two ‘frames’ are displayed: the ‘clinical frame’ and the ‘solicitude frame’. It is demonstrated how these correspond to the status of conditions in medical work doctrines. Then, it is shown how the ‘psychosomatic frame’ displaces the treatment of physical complaints, and how the clinical and solicitude frame exert their presence again in the psychic domain. The meaning of these results for expert medical judgments is discussed, considering comparable work in other areas of medicine.
Power and persons: on ethical stylisation and person‐centred medicine
Authors: Osborne Thomas
Published: February 2004

This paper focuses on the relation of systems of ethics to the fabrication of medical power. After a brief consideration of the role of ethical cultivation in clinical medicine, the main body of the paper presents a case‐study of the influential ‘person‐centred’ medical rationality developed at the Royal College of General Practitioners in the 1960s and 1970s, and concludes‐partially by way of a brief discussion of the work of David Armstrong – with some reflections on the nature of ethical problematisations and their relation to the constitution of authority in modern societies.
Coping with autism: stresses and strategies
Authors: Gray David E.
Published: February 2004

This paper presents the results of a qualitative study of coping stresses and strategies among a sample of parents with autistic children. The most serious stresses that parents faced included problems with the lack of normal language, disruptive and violent behaviour, inappropriate eating and toileting and inappropriate sexual expression. Most parents used a variety of coping strategies, the most common of which included the use of service agencies, family support, social withdrawal, religion, normalisation, individualism and activism. Although no single coping strategy seemed to provide a definitively better outcome for the parents' adjustment, the use of services and family support appeared to provide the most successful strategy of coping for a substantial number of parents.
Self‐representations and physical impairment: a social constructionist approach.
Authors: Ville Isabelle , Ravaud Jean‐François , Diard Catherine , Paicheler Henri
Published: February 2004

In this paper a social constructionist approach is used to frame an analysis of the effects of physical impairment on self‐perception. The results are reported of a recent study in which questionnaires were mailed to 314 people who were paraplegic and 284 who were post‐polio, as well as to a control group of 327 who had no visible physical impairments.

While the people who were paraplegic and those who made up the control group gave similar answers to most of the survey questions, those who were post‐polio displayed a consistent, but different, way of reporting on their self‐representations. Moreover, this discourse, which included such self‐described characteristics as self‐control, a sense of duty, and a concern for meticulousness, was consistent in the post‐polio group across sex and age.

It is concluded that the date of onset of physical impairment is significant in influencing the self‐representation of persons with physical impairments. The socio‐historical evolution of social practices and cultural expectations and norms with respect to persons with disabilities in Western cultures were taken into account in interpreting the results of this survey.