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Social Theory & Health
Journal Prestige (SJR): 0.554  Citation Impact (citeScore): 1 Number of Followers: 3  Hybrid journal (It can contain Open Access articles)ISSN (Print) 1477-8211 - ISSN (Online) 1477-822X Published by Springer-Verlag  [2468 journals]
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- Extending Durkheim’s sociology of suicide to healthcare decision-making:
towards a sociology of choice as a social phenomenon of integration and
regulation-
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Abstract: Abstract The study of the social dimensions of healthcare (decision-making) behaviour lacks a foundational theory. Using extant studies, this paper argues and demonstrates that their results can be placed on the social manifold that is spanned by the four idealistic poles described by Durkheim’s (On Suicide, 1897) work ‘On Suicide’ and that these poles can therefore be extended to theoretically represent four ideal types (meanings) of healthcare choice: altruistic choice (excessive integration), egoistic choice (absence of integration), fatalistic choice (excessive regulation), and anomic choice (absence of regulation). By using Bearman’s (Sociological Forum 6(3): 501–524, 1991) structural model of suicide, this social manifold is theoretically unfolded by representing all possible tangible (network) structures as a function of integration and regulation, which additionally amplifies and extends Durkheim’s theory. This approach builds upon Pescosolido’s (Advances in Medical Sociology 3(1):161–184, 1991) Network Episode Model and provides opportunity to connect it further to the Social Symbiome.
PubDate: 2024-08-05
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- Confiding in strangers: trust and mental health service use in China
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Abstract: Abstract Research on trust has formed a dichotomous conceptualization of trust as established through either institutional support or relational norms, neglecting other possibilities. Drawing on Simmel’s theorization of the Stranger and Zelizer’s relational perspective, I argue that “stranger trust” is another mode of trust that frames the trusted person as a Simmelian stranger through interactional negotiations. Using interviews with mental health service consumers in China, I address the question: how do participants of therapeutic relationships form trust under the unfavorable institutional environments for mental health services in China' My findings show that participants in therapeutic relationships create trust by framing the service provider as a “Stranger.” This mode of trust-building consists of three components: (1) a moderate interpersonal social distance, (2) differentiation from other types of relations, usually through monetary payment, and (3) a depersonalized discourse of emotions. From the client’s perspective, the establishment of stranger trust mitigates the risk posed by a lack of institutional regulation for mental health service provision. This study calls attention to how relational practices create and maintain trust in settings with weak institutional support for trust.
PubDate: 2024-08-01
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- Doing physical activity or not: an ethnographic study of the reasoning of
healthcare workers and people with type 2 diabetes-
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Abstract: Abstract According to biomedical notions, physical activity (PA) is an integral part of treatment for several non-communicable diseases, Type 2 diabetes (T2D) among them. Adapting one’s life in accordance with such notions, however, involves considerations that reach beyond what can be confined to treatment decisions. Thus, we aim to explore the various reasons for doing PA or not among healthcare workers and people with T2D taking part in programs that promote PA. We do so based on ethnographic fieldwork that includes observations and focus group interviews in two programs in a Danish municipality, and with inspiration drawn from Habermas’ theory of communicative action. Our results show that healthcare workers emphasize primarily health-related reasons for doing PA, including a moral imperative to be healthy, while people with T2D have a slew of other reasons for doing PA or not. These reasons together illustrate that for participants with T2D, long-term concerns for health and disease take a backseat to more immediate concerns for enjoyment, pain, and family, and that the participants generally reject the normative health imperative. We suggest that healthcare workers and participants with T2D engage in dialogue about their normative assumptions with the purpose of reaching a mutual understanding.
PubDate: 2024-07-24
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- Negative health classifications: understanding avoidance and social
exclusion during a pandemic-
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Abstract: Abstract During a pandemic, there is a fine line between distancing and avoiding other people, with stigmatizing classifications sometimes transforming social distance into social exclusion. Drawing on Bourdieu's under-utilised theory of classification struggles, this paper conceptualises schemes of pandemic Othering in terms of Negative Health Classifications. Complementing the interactionist approach in pandemic stigma research, classification struggles are a social practice that denote a conceptual link between the individual and social structures of inequality. When social structures are unstable, as was the case during the pandemic, an established common sense can become questionable. Based on the analysis of survey data from 2606 respondents collected during one of the peaks of COVID-19 in Austria and Germany, the paper explores two struggles over health classifications, (1) social cleavages created and exacerbated by individuals who strive to tackle medical crises by avoiding the 'disease carriers', and (2) conflict over illegitimate pandemic practices resulting in the loss of social capital and a polarization of social groups. The findings offer evidence of widespread negative health classifications emerging during the COVID-19 pandemic that future research should explore in their implications for inequalities in other health policy contexts.
PubDate: 2024-06-05
DOI: 10.1057/s41285-024-00207-4
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- Beyond experiential knowledge: a classification of patient knowledge
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Abstract: Abstract Patients’ experiential knowledge is increasingly documented as a valid form of knowledge in the health sector and is often said to be a source of valuable information to complement the knowledge of health professionals. Although this increased recognition is outlined in the health science literature and formalized in certain organizational and clinical contexts, it remains difficult for various actors of the health ecosystem to contour the different forms of knowledge patients acquire through their experience as well as to consider them as essential in co-building care plans and as an asset to build care relationships. The aim of this review is twofold: (1) to challenge the dominant model of knowledge in medicine and healthcare by making the various forms of patient knowledge more explicit and tangible and (2) to provide a better understanding of what experiential knowledge consists of by classifying the various forms of knowledge patient acquire, develop, and mobilize throughout their care journey. A narrative review allows to classify six types of patient knowledge according to their source of learning: embodied, monitoring, navigation, medical, relational, and cultural knowledge. The three main sources of learning, namely the self, the system, and the community grounds patients’ learning process in their health journey.
PubDate: 2024-06-04
DOI: 10.1057/s41285-024-00208-3
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- In the absence of meaning: care practices and environmental factors behind
the multiple selves of the digital psychiatry participant-
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Abstract: Abstract This paper compares formal accounts that laboratory members use to describe a digital psychiatry intervention with lab practices as they were observed ethnographically. The intervention uses correlations between wearable data and self-reports of mood to produce behavior change recommendations, which participants then implement with the help of a guide. In formal accounts, the trial is described as the accomplishment of the individual participant who is empowered by data-driven insights. Formal accounts from the lab present this participant as multi-layered. In observation, however, participants do not seem multiple. Instead, the contingencies of living and working environments come to the fore. Observations of open-ended interactions in guidance sessions, which are minimized in formal accounts, are particularly powerful in capturing these contingencies. The critique of representation from philosophical pragmatism shows how the multi-layered participant is similar to the multiple representational meanings entities take on according to theories common in twentieth-century psychiatry, and supports the ethnographic approach as a way out of these paradoxical formulations. The paper, thus, explains the role of otherwise underspecified human labor involved in the trial, while demonstrating ethnography’s ability to account for interactions with participants, through which we gain insights into the contingent, emplaced process of implementing the trial.
PubDate: 2024-06-04
DOI: 10.1057/s41285-024-00206-5
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- Fragmentation in One Health policy and practice responses to antimicrobial
resistance and the salutary value of collaborative humility-
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Abstract: Abstract This paper investigates One Health (OH) applied to antimicrobial resistance (AMR) to deepen and nuance its conceptual underpinnings and inform effective implementation. We consider how models of OH and AMR wedded to bioscience assumptions of life obscure biosocial complexity and reinforce the misleading assumption that scientific knowledge of AMR is generated outside social systems. With reference to in-depth interviews with medical practitioners, scientists and policy-makers working on AMR in Australia and the UK, we explore accounts of OH action on AMR. We show that the implementation of OH is subject to some fragmentation due to workforce organisation, funding arrangements and the absence of detailed guidance for translating OH into practice. Despite OH aspirations for transdisciplinary cooperation and innovation, human-centrism and somewhat incommensurable professional and scientific views on OH constrain trust in the policy approach and limit effective action. We discuss how, in some settings, OH action on AMR does resemble policy aspirations when emphasis is placed on collaborative humility, a finding that underlines OH’s biosocial character. We argue for the development of more robust biosocial models of OH to guide its application to AMR in real world settings.
PubDate: 2024-05-28
DOI: 10.1057/s41285-024-00209-2
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- Disability and social trust: a comparison of people with a spinal cord
injury and the general population in Norway, the Netherlands, and
South-Africa-
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Abstract: Abstract Is it the case that social trust is significantly different for people with a disability compared to people without a disability' Or is it the case that disabled people's perception of social trust is country-specific and/or socio-demographic specific' This article analyses how people with spinal cord injuries (SCI) compare with the general population’s perceptions of social trust in Norway, The Netherlands, and South Africa. The study is based on survey data for people with an SCI and the general population. Contrary to our expectations, we find that people with an SCI tend to have a social trust on a par with or somewhat higher than the general population. The low levels of social trust in South Africa are striking compared to levels in Norway and The Netherlands. Those with higher education and those having paid work show higher levels of trust than those who are less educated or those who are unemployed; women have somewhat higher levels of trust than men, and that the mean level of social trust increases with each age group. The findings illustrate a need for more critical empirically oriented research on social trust as well the value of exploring the research object beyond conventional understandings.
PubDate: 2024-04-15
DOI: 10.1057/s41285-024-00205-6
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- “Different names for the same thing”' Novelty, expectations, and
performative nominalism in personalized and precision medicine-
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Abstract: Abstract This paper explores the complementary and contrasting uses of the terms ‘personalized medicine’ and ‘precision medicine’ in denotations of a biomedical approach attentive to individual specificities that harnesses genomics and other data-intensive profiling technologies. Drawing on qualitative interviews conducted with biomedical experts in the context of the Precision Medicine Initiative in the United States and the 100,000 Genomes project in the United Kingdom, we read definitional reflection and debate through the lens of the sociologies of expectations and novelty. We observed two key aspects in the shift from ‘personalized medicine’ to ‘precision medicine’ that has been especially prevalent in the United States. First, the term ‘precision medicine’ enables its proponents to rhetorically depart from the idea that this approach to medicine can be expected to deliver individually personalized treatments—an expectation that is seen as unrealistic by many. Second, it enables its proponents to assert that personalization, when understood as caring about the patient as an individual person, is not a new approach to medicine but rather something that many medical professionals have always aimed to do (eliding in the process other experiences of US healthcare as, for instance, alienating and discriminatory). We argue that the shift from ‘personalized’ to ‘precision’ medicine can be regarded as a manifestation of performative nominalism: an attribution of ‘newness’ that contributes to performing and propelling innovation, rather than solely reflecting it. In so doing, rhetorical demarcations between personalized and precision medicine emerge as performatively contributing to the production of different biomedical ontologies.
PubDate: 2024-03-14
DOI: 10.1057/s41285-024-00203-8
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- Categorising and cohabiting: practices as the site of biosocial becoming
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Abstract: Abstract In this article we argue that social practices, which consist of sayings and doings that extend across space and time, generate and sustain distinctive patterns of microbial interaction. In taking this approach, we position practice theory within and not outside the realm of contemporary biological processes, including processes that matter for human health. In working towards this conclusion, we show how categories and distinctions (e.g. between communicable and non-communicable disease) are embedded in medical responses and in the lives of potentially harmful bacteria like Helicobacter Pylori. Our next step is to explain how social practices engender patterns of cohabitation, interaction and mutual adaptation between microbes within and beyond the body, processes we illustrate with reference to anti-microbial resistance. The conclusion that human and microbial coexistence is, in various ways, defined by the lives of social practices provides an important bridge between the social and natural sciences and a starting point from which to approach fundamental questions about the dynamics of biosocial becoming, and the part that public policies play in these processes.
PubDate: 2024-02-27
DOI: 10.1057/s41285-024-00204-7
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- Aging in light of digitalization of healthcare
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Abstract: Abstract With the advancements in digital technologies, notions such as aging in place have gained currency. But, next to technical issues concerning the extent to which full-blown aging in place is possible, philosophical and ethical questions have been also raised. An important dimension of the digitalization of healthcare is how would aging look to both older adults and the public in the wake of such systems. In this article, I will suggest integrating postphenomenology into Age Studies to explore how aging comes to be conceptualized. An advantage of postphenomenology is that it is anchored in a first-person perspective, and in this sense, it may be a perfect fit to enhance our awareness about the impacts of the digitalization of health on older adults from their own point of view. I will also argue that postphenomenlogy can throw light on digital technologies in their actual use. This may help researchers go beyond merely exploring conditions of use and adoption implemented through notions such as usability, trust, privacy, dignity, and the like, and gain knowledge of how users’ relationship with their surroundings reconfigures after exposure to digital assistive technologies.
PubDate: 2024-01-26
DOI: 10.1057/s41285-023-00202-1
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- Populism, moral foundations, and vaccine hesitancy during COVID-19
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Abstract: Abstract Vaccine hesitancy is a significant global health concern, with over 90% of countries reporting such hesitancy. In the United States, vaccine hesitancy has risen significantly, with over 79 million cases and 950,000 deaths in 2022. This highlights the political importance of vaccine hesitancy in the coming years. Moral foundations are associated with political alignments on the left-right axis, but they do not extend to beliefs about political contexts. Populism, a belief in the power of the people to take back power from the elite, is particularly important in the COVID-19 pandemic. This study explores possible associations of vaccine hesitancy with both moral foundations and populism using survey research. Results from multiple regression analysis show that while moral foundations are not entirely accounted for, populism can impact vaccine hesitancy outside of its overlap with moral foundations. The study reveals a significant association between vaccine hesitancy and populism and four moral foundations. It suggests that vaccine hesitancy is linked to populist sentiment and moral orientations and suggests that further research could explore the relationship between these factors. The study also suggests that the challenge of vaccine hesitancy is not solely about vaccines, but rather exacerbated skepticism and lack of trust in institutions and elite knowledge. The findings could help policymakers and practitioners understand the motivational factors influencing vaccine hesitancy, focusing on moral reasoning and sociopolitical narratives rather than swaying people with scientific elite knowledge. Emphasizing messages about vaccination as a form of loyalty to family, friends, and country could be more effective.
PubDate: 2024-01-12
DOI: 10.1057/s41285-023-00201-2
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- Conceptualising care: critical perspectives on informal care and
inequality-
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Abstract: Abstract Informal care occupies a paradoxical place in contemporary societies. It is at once reified as an inherent social good, and minimised, devalued, and pushed to the margins. The current ‘care crisis’ is bringing these tensions into sharp relief, fuelling renewed interest in care and its absences across a wide range of disciplines. In this article, we present an overview of five key literatures for comprehending informal care, with a focus on issues of inequality and injustice. These bodies of scholarship—which, respectively, emphasise the political-economic, affective, policy, geographic, and ecological dimensions of informal care—together furnish a critical conceptualisation of informal care that both recognises care’s social value, and underlines its embeddedness in systems and structures of oppression. Informal care, we show, evades easy definition, requiring a sophisticated array of critical concepts to capture its everyday complexities, avoid reductionism, and ultimately enable individual and collective flourishing.
PubDate: 2023-12-15
DOI: 10.1057/s41285-023-00200-3
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- RETRACTED ARTICLE: The omnipresence of risk and associated harms in secure
and forensic mental health services in England and Wales-
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PubDate: 2023-12-01
DOI: 10.1057/s41285-021-00167-z
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- Neurasthenia and autonomic imbalance as minor diagnoses: comparison,
concept and implications-
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Abstract: Abstract A new term, autonomic imbalance (自律神經失調 or AI), which refers to a wide variety of physical and mental symptoms that are medically unexplained, has recently emerged in Taiwan. Many people compared this condition to neurasthenia, a now obsolete diagnosis. Whether neurasthenia and AI are medically the same or merely similar is a debate that is better left to clinicians; however, this article endeavours to explore the significance of the comparability in terms of socio-cultural theory of health. With Deleuze and Guattari’s notion of minor literature as reference, the objectives of this paper are as follows: to address how and why neurasthenia and AI should be treated as ‘minor diagnoses’ and consequently expose the limitations of current clinical medicine; to provide and discuss reasons why AI can be seen as a reincarnated form of neurasthenia; and to further elaborate how this approach may elevate inquiries on the varieties of medically unexplained symptoms to highlight the bodies that suffer without a legitimate name.
PubDate: 2023-12-01
DOI: 10.1057/s41285-022-00184-6
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- (F)ailing mothers and the quest for redemption: a sociological study of
postnatal depression recovery blogs-
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Abstract: Abstract This article offers a sociological study of postnatal depression recovery blogs. Such media render ‘failing’ and ‘ailing’ publicly accountable in response to the performative demands of motherhood and the health role. Drawing from nine Anglophone blogs and classic and contemporary scholarship (e.g. on cycles of redemption, the medicalisation of cyberspace), it explores three main themes: (1) guilt, (2) purification and (3) redemption. Analysing these themes provides virtual ethnographic insights on the public drama of medicalised maternal distress. Critically, the limitations of medicalised rhetoric are also considered in a postfeminist context of stigma, deviance, shame and mother blame. Finally, the limitations of this study plus possibilities for future research, policy and social change are highlighted.
PubDate: 2023-11-24
DOI: 10.1057/s41285-023-00199-7
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- Habits and the socioeconomic patterning of health-related behaviour: a
pragmatist perspective-
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Abstract: Abstract Unhealthy behaviours are more prevalent in lower than in higher socioeconomic groups. Sociological attempts to explain the socioeconomic patterning of health-related behaviour typically draw on practice theories, as well as on the concept of lifestyles. When accounting for “sticky” habits and social structures, studies often ignore individuals’ capacity for reflection. The opposite is also true: research on individual-level factors has difficulty with the social determinants of behaviour. We argue that the pragmatist concept of habit is not only a precursor to practice theories but also offers a dynamic and action-oriented understanding of the mechanisms that “recruit” individuals to health-related practices. In pragmatism, habits are not merely repetitive behaviours, but creative solutions to problems confronted in everyday life and reflect individuals’ relationships to the material and social world around them. Ideally, the pragmatist conception of habits lays the theoretical ground for efficient prevention of and effective support for behaviour change.
PubDate: 2023-11-02
DOI: 10.1057/s41285-023-00198-8
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- Inequity in palliative care: class and active ageing when dying
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Abstract: Abstract The purpose of this article is to explore social inequity in palliative care in Denmark, a country that is seen as a stronghold of universal health care. Using data stemming from 2 years of research, we have selected two cases for analysis. They consist of palliative conversations with two quite different patients. Drawing on sociocultural class theory, we find that the conversations involve social exclusion processes due to discourses of active ageing. We find that one privileged patient performs in line with an entrepreneurial self and is supported by the nurse. The other, disadvantaged patient performs in a passive way, and the conversation mainly alleviates the disrespect he has experienced in healthcare encounters. We conclude that palliative care reinforces classifying practices and distinctions between “good” and “bad” patients, when active ageing becomes a dominant factor. We suggest improving the quality and sensitivity of medical training and call for increased reflexivity among professionals on the unequal situation of patients in order to reduce inequity in access to health care when close to death.
PubDate: 2023-09-28
DOI: 10.1057/s41285-023-00196-w
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- Postcolonial riskscapes: risk, trust, and the community-based response to
Ebola virus disease in Liberia-
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Abstract: Abstract The initial outbreak response to the 2014–2016 Ebola Virus Disease (EVD) in West Africa was met with resistance in Liberia. In part, this was because responders failed to account for how the country's colonial history and sociocultural circumstances influenced attitudes and perceptions of the population. We argue that understanding the relationship between the broader structural influences and the subjective aspects–the lived experience of people in the region–is crucial to developing more effective outbreak measures. In this light, we adopt and refine the concept of “riskscape” to highlight how the resistance to response teams shifted as the EVD outbreak unfolded. To illustrate our argument, we consider how the particular historical, cultural, and political forces constituted a postcolonial riskscape, influencing evolving perceptions of risk and trust in the context of the outbreak response in the West Point informal settlement located influcing Liberia's capital, Monrovia. As part of that discussion, we demonstrate how the adoption of a bottom-up community-based strategy by response officials, stimulated changes in the riskscape that helped pave the way for the adoption of an improved response strategy that resulted in a relatively swift decrease in EVD prevalence.
PubDate: 2023-09-05
DOI: 10.1057/s41285-023-00195-x
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- Is there power in Mad knowledge'
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Abstract: Abstract This paper addresses some conceptual and organizational questions which bear on the issue of whether those designated mad can produce knowledge from, about, and beyond their experience. Ideas encapsulated in concepts such as lack of reason and epistemic justice are deployed as well as the individuation that characterizes both the clinical encounter and services generally. It is argued that these prevent such knowledge making in itself and dissipate the structures which would enable it. The paper looks at ways in which the silencing of the mad has been broken and at responses which suppress or recuperate such developments. It argues, nonetheless, that counter-narratives are being established that resist these responses. Several empirical studies provide evidence to support the argument.
PubDate: 2023-07-31
DOI: 10.1057/s41285-023-00194-y
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