bluuebunny/crossref_metadata_2025_split huggingface dataset:
Parkinson's Disease as a problem of shame in public appearance
Authors: Nijhof Gerhard 
Published: February 2004

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

AbstractMedical dominance is not a transhistorical and invariant property of the medical profession. Rather it is a set of occupational privileges that can be invoked or revoked according to changing alignments of political, economic and cultural power. Using the example of British psychiatry in the context of the health service reforms of the 1980s, it is argued that medical dominance may be fracturing as a result of the policy switch towards community mental health care and the managerial reorganisation of the health services. Knowledge claims and medical procedures that have legitimated the dominant position of psychiatry within the mental health services ‐ a medico‐eclectic ideology, a view of doctor superiority over other mental health professionals and the extensive use of physical treatments—are outlined and contrasted with the conflicting ideas and authority structures of community care and health service management. Challenges to medical dominance in mental health, it is contended, are represented by the legislative empowerment of a range of previously subordinated groups of professionals and para professionals. This paper draws primarily upon two sources of data; an ethnography and in‐depth interview study of 40 psychiatrists and managers in the Bristol area in 1989–90 and an analysis of the writings of psychiatrists in the professional press.
Existential and clinical uncertainty in the medical encounter: an idiographic account of an illness trajectory defined by Inflammatory Bowel Disease and Avascular Necrosis
Authors: Adamson Christopher 
Published: February 2004

AbstractUncertainty has been a central theme in the sociology of medicine. Scholars have focused on the existential uncertainty which is an aspect of the illness experience, and on the clinical uncertainty which marks the diagnosis and treatment of disease. However, there are few intensive examinations of how existential and clinical forms of uncertainty mutually affect each other. This essay draws on a personal experience of illness with inflammatory bowel disease (IBD) and a vascular necrosis (AVN), and on the clinical record of how these diseases were diagnosed and treated, in order to demonstrate that these two forms of uncertainty, by continuously playing to and playing off each other, mutually shape the nature of the medical encounter.
Modern medicine and the civilising process
Authors: Pinell Patrice 
Published: February 2004

AbstractMedical sociology, mainly an Anglo‐Saxon invention, was developed almost without any theoretical reference to Norbert Elias’ work. One of the consequences of this ignorance was that a very challenging idea had been lost. This idea addressed the sociological problems associated with the historical changes that in turn affected the role played by hygiene in the normalisation of human behaviour. According to Elias’Civilizing Process, the progressive changes in human behaviour were part of global dynamics involving the transformation of both social structures and individuals’ habitus. In the construction of the ‘civilised behaviour’ characteristic of the dominant group, hygienic preoccupation played no role. The medical discoveries of the 19th century about the infectious diseases gave a posteriori an addition of legitimacy to this civilised behaviour. Adopting Elias’ perspective, I try to answer a question left unexplored in his work, i.e. the place of contemporary medical knowledge and practices within the ongoing civilising process. This question leads me to analyse:1 the role played by ‘Pasteurian hygiene in the policy of civilization’ of the lower classes in France2 the tendency towards the medicalisation of self‐control behaviour and the emergence of the patient as medical auxiliary involved in the division of medical works.
Myalgic Encephalomyelitis and the medical encounter1
Authors: Cooper Lesley 
Published: February 2004

AbstractIn the history of twentieth century western medicine several ‘syndromes’ have been denied the legitimate status of ‘organic disease’. Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS) are examples of such syndromes, in that their status within biomedicine as ‘real, organic’ diseases is still a matter of controversy. These ‘non‐diseases’ or ‘illegitimate illnesses’ are usually defined in terms of symptoms, with few consistent signs, and scientists and doctors have failed to agree on aetiology and pathogenesis. There are no obvious visible abnormalities present in sufferers, and ME cannot be diagnosed by standard medical tests. This paper explores the consequences of uncertainty and controversy for those who suffer from ME. It is based primarily on a series of ten life history interviews with sufferers of ME. These accounts of illness careers focus on the difficulties in obtaining a correct diagnosis and achieving legitimate sick role status, and on problems of miscommunication, dismissal and disbelief. As are sult, respondents changed their attitudes towards either particular doctors, or the medical profession. These altered perceptions are discussed in the context of the emergence of critical lay perspectives, and a growing public ambivalence towards biomedicine.
What is gender? Feminist theory and the sociology of human reproduction
Authors: Annandale Ellen , Clark Judith 
Published: February 2004

AbstractFeminist theory and research on the sociology of human reproduction have historically been bound together as each has developed. Yet recently sociologists of reproduction and ‘women's health’ have lost sight of core debates in feminist theory. They still tend to work with the assumption that feminism is an internally coherent body of thought, despite the emergence of significant internal divisions since the mid‐1980s. In this paper we evaluate the challenge that feminist post‐ structuralism poses to prior conceptualisations of gender in the context of reproductive health through a critique of sociological work in this area from the 1970s and 1980s. We conclude with a critical exploration of the new insights that might emerge from a post‐structuralist ‘deconstruction’ of gender in the context of human reproduction.
Risk theory in epidemic times: sex, drugs and the social organisation of ‘risk behaviour’
Authors: Rhodes Tim 
Published: February 2004

Abstract‘Risk’ and ‘risk behaviour’ have become keywords in discourses about AIDS. Notions of risk behaviour in the field of HIV prevention and the addictions largely derive from epidemiological categorisations which have had a key role in constructing lay and scientific understandings of the ‘problems’ of AIDS and injecting drug use. This has encouraged are stricted vision which inadequately captures risk as it is understood and experienced by drug users themselves. Drawingon case examples from qualitative research with illicit drug users, this paper explores the utility of current theories of risk behaviour in understanding how risk behaviour is socially organised. Two key developments in risk behaviour theory are examined. These are situated rationality and social action theories. Findings illustrate that situated rationality theoriestend to be conceptually limited to an analysis of individual rationality which fails to capture the distribution and influence of power in negotiated actions and the habituated nature of risk behaviour. In contrast, social action theories aim to understand the interplay of social factors which give rise to individuals’ situated risk perceptions and actions. Findings highlight the important role that qualitative research plays in questioning, as well as complementing, dominant scientific constructions of risk. Future theories of risk behaviour in the field of HIV prevention, as well as other health domains, need to consider risk as a socially organised rather than individual phenomenon. The paper concludes by asserting that understanding what risk actually means to participants themselves provides the necessary data for public health interventions to create the conditions where risk reduction becomes possible.
Pakistani women and maternity care: raising muted voices
Authors: Bowes A.M. , Domokos T. Meehan 
Published: February 2004

AbstractThe paper explores the potentiality of an empowering research strategy to raise the muted voices of Pakistani women, with particular reference to experiences of maternity care. It focuses on research carried out with Pakistani women in Glasgow in 1991. It is argued that issues of power negotiation need to be addressed at all stages of the research process, including the framing of research questions, during data collection through interviews, and in the analysis and presentation of results. Women's comments on maternity care were very varied, some being very satisfied, many not so. Three particular cases illustrate variation at the individual level, and muting interpretations are considered. In conclusion, it is suggested that an empowering research strategy may indeed raise muted voices, but that it can also give researchers more power. And the issue of the response to muted voices, a key aspect of the concept of muting, remains.
Control and condoms in commercial sex: client perspectives
Authors: Plumridge Elizabeth W. , Chetwynd S. Jane , Reed A. 
Published: February 2004

AbstractIndepth interviews were recorded with 24 clients of female sex workers to explore their perspectives on the control of commercial sex encounters. The men saw the encounter as falling into three phases, only the first of which ‐ the decision to have sex ‐ was under their control. Subsequent phases ‐ the negotiation of services and the performance of sex ‐ they argued to be under worker control. The men considered that they acquiesced in worker control because they saw themselves as respectful of a woman's right to control her body and because they considered themselves attentive to workers’ sexual pleasure. At the same time, this acquiescence was considered to exculpate them from any responsibility for safer sex practice. Thus while the men argued they were consistent condom users, they held their partners responsible for ensuring this consistent condom use: women supplied condoms, and were held accountable for any condom failures.The discourse of these men therefore functioned both to present clients benignly and to exculpate them from any responsibility for ensuring the safety of the commercial sex encounter.
Culture, relativism and the expression of mental distress: South Asian women in Britain
Authors: Fenton Steve , Sadiq‐Sangster Azra 
Published: February 2004

AbstractSocial anthropology and medical anthropology have presented a challenge to the belief that there are universal categories of mental illness. A relativist position would suggest that there are as many categories of mental health (or physical health) as there are languages and culture in which they are expressed. Intermediate arguments suggest that there may be common elements in ideas of mental illness but that cultural expression of syndromes may differ significantly, or that symptoms may cluster in different ways in different cultures. These arguments have been raised, as well as in cross national comparisons, in the context of minority groups (ethnic, cultural, language groups) in Britain. The research, reported here, on South Asian women in Bristol, shows that they have a clear conception of mental health and illness, a clear understanding of relationships between physical and mental health, and make important distinctions between types of mental ill‐health. They describe mental distress in a culturally specific set of language terms and their accounts differ from English speakers in important ways. At the same time they describe a syndrome of mental distress which corresponds in a number of features to the category ‘depression’.
An ethnography of risk management amongst illicit drug injectors and its implications for the development of community‐based interventions
Authors: Power Robert , Jones Steve , Kearns Gerry , Ward Jenni 
Published: February 2004

AbstractQualitative research which describes the social behaviour of illicit drug users has a key role to play in refining community‐ based interventions. Such research has been used for many years in drugs research, but during the AIDS epoch its practical application has been most fully realised. Data are presented to illustrate the way in which qualitative research can inform the development of outreach initiatives targeted towards illicit drug injectors, not in contact with treatment services. Social networks of injectors from three sites in England were studied and we describe the strategies they adopted to reduce the likelihood of viral infection. We show how informal coping strategies, such as personalising syringes and ensuring a supply of sterile injecting equipment through secondary distribution can be integrated into peer education outreach. We also examine the management of risk and the social meanings that perpetuate sharing of injecting equipment, describe situations and scenarios in which syringe sharing is likely to occur, and suggest how such research can assist the evaluation and evolution of relevant and targeted interventions.
Health inequalities as policy issues ‐ reflections on ethics, policy and public health
Authors: Vågerö Denny 
Published: February 2004

AbstractSocial class differences in health have been found in all societies that have looked for them. In spite of an apparently stable historical pattern of upper social classes living longer and faring better than lower ones, there is a certain amount of variation in the size, trends and nature, even the direction of such differences, indicating that they might be modified by policy and social change. Social class differences in health, as well as other health inequalities, have in fact become a part of the political agenda. But policymaking in this area is weak and unconvincing in most countries. There is little consensus as to why policies to reduce health inequalities are important. Should they be pursued for the reason that health is a ‘right’, as suggested by some writers, and often in the political rhetoric? Or because they are important for a country's level of health in general?The purpose of this article is firstly, to examine some of the moral justifications for the reduction of health inequalities and, secondly, to suggest that the public health policy agenda can be improved by focussing on the public health significance of health inequalities. It is argued that the reduction of health inequalities may represent a great potential for improving the health of the population, but there is a moral justification for equal distribution of health, risks and health resources even if this did not contribute greatly to improved general health.
From biographical disruption to biographical reinforcement: the case of HIV‐positive men
Authors: Carricaburu Danièle , Pierret Janine 
Published: February 2004

AbstractIn‐depth interviews were conducted with 44 asymptomatic HIV‐positive men infected through homosexual relations or medical treatment for haemophilia. The objective was to better understand interrelations between: the consequences of infection on everyday life; the meanings given to being HIV‐positive; and the reconstruction of identities. The consequences for everyday life are examined in relation to: the importance of keeping one's immune status secret; self‐imposed restraints and the constraints ensuing from the immune status; and the resources interviewees tapped to cope with their new situation. The meanings given to infection arose as these men reinterpreted their individual and collective pasts. This biographical reconstruction reinforced components of identity that, prior to HIV‐infection, had been built around haemophilia or homosexuality. This is what is called biographical reinforcement, a notion developed in relation to biographical disruption.
Research note: Decision‐making processes, ethical dilemmas and models of care in HIV/AIDS health care provision
Authors: Bennett Lydia , Duke Jan 
Published: February 2004

AbstractThe data reported heere is part of a larger study exploring the impact of HIV/AUDS on health care professionals. In this segment of the study, participants (16 nurses, 5 doctors and 3 social workers), from three hospital AIDS units were interviewed about the difficulties inherent in their work. Analysis of the transcript data indicated that the areas causing the greatest conflict and concern were thise surrounding the management of dying patients. A category identified in the data was the dis‐agreement about patient treatment. Non‐medical staf in one unit reported stress, frustration and conflicts about the discision‐making process with dying patients and expressed their discontent with the biomedical model of health care delivery. In contrast, staff in the other two inits, reported satisfaction with the management of patients and relief that patients were not ‘pushed’ to be treated. Accordingly, a model of care which focuses on the patient's needs and encourages a team approach to decision‐making, is recommended.
NHS managers as rhetoricians: a case of culture management?
Authors: Hughes David 
Published: February 2004

AbstractIn the wake of Peters and Waterman'sIn Search of Excellencefew NHS managers are unaware of culture management as a tool for shaping organisational change. Yet the first wave of post‐Griffiths studies found little evidence of ‘culture management’ in action. This paper draws on data from an ethnographic study carried out in 1988–90 to suggest that the symbolic facet of management action is an important, though neglected, element in the 1991 NHS reforms. It argues that rhetorical skills Iwere a valuable resource for general managers overseeing the change process, and explores some of the ways in which rhetoric may have influenced cultural adaptation. However, many of the specific claims of the ‘excellence genre’, including ideas about the importance of strong, homogeneous cultures, are rejected. Rhetoric is an aspect of micro‐political struggles over meaning, which rarely result in straightforward cultural ‘manipulation’, and are more likely to re‐shape organisations through pragmatic accommodation than to win the hearts and minds of members.
A literary approach to managerial discourse after the NHS reforms
Authors: Traynor Michael 
Published: February 2004

AbstractThe 1990 NHS and Community Care Act can be seen as the culmination of the importation into the UK National Health Service of ‘business’ language. This has entailed struggles between the values of new general managers and the traditional professions and unprecedented attention to issues of ‘measurement’. A recent study of NHS Trusts involved three yearly rounds of interviews with managers and the administration of questionnaires to the nursing workforce in the same areas. Although the main intentions of the research lay in gauging the job satisfaction of the workforce and describing the managers', approaches to organisational strategy, the way that each group used language soon emerged as an area of interest and as a pointer to the foundational values and epistemologies of each group. An approach to the texts of interviews and questionnaire responses was informed partly by an analysis of discourse, elaborated by Foucault and others and partly by deconstraction, an approach usually associated with literary texts. The approach to analysis is based on the realisation that language is structured in a way that reflects existing power relations and that attention to metaphor and other rhetorical devices can give insight into these discourses. After briefly introducing the policy context and a particular approach to literary texts, this paper offers analysis of how managers talked about measurement and financial constraints.
‘But if you look at the coronary anatomy …’: risk and rationing in cardiac surgery
Authors: Hughes David , Griffiths Lesley 
Published: February 2004

AbstractRecently there has been wide public debate in Britain about the denial of cardiac surgery to smokers and other patients possessing negative risk factors. While some senior medical practitioners have insisted that such decisions are based on objective clinical grounds linked to prognosis and effective use of resources, other commentators argue that doctors are policing lifestyle and making judgements about deservingness. One way of shedding light on this controversy is to examine how medical practitioners themselves talk about cases when consequential decisions must be made. This paper presents tape‐recorded data from cardiac catheterisation conferences in which cardiologists present cases to a cardiac surgeon, who must decide whether to accept them for surgery. For much of the time, decisions are linked to the technical feasibility of surgery and the details of coronary anatomy. However, in many conferences age, lifestyle, and wider social structural factors figure centrally in discussions and appear to influence outcomes. The analysis explores some of the tensions that occur as doctors move between ‘technical’ and ‘social’ discourse frames to make sense of patient histories. Far from remaining exclusively within a neutral medico‐technical discourse, doctors construct arguments and counterarguments that closely resemble the standpoints in the wider public debate on rationing and deservingness.