JournalTOCs

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]

“Not a lifestyle disease”: the importance of boundary work for the
construction of a collective illness identity among people with type 1
diabetes
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  Abstract: In this study, we analyse how collective illness identities are created and sustained among people with type 1 diabetes using sociological perspectives on identity formation and symbolic boundaries. Drawing on 24 in-depth interviews, we show how collective illness identities are established and maintained through both inclusionary and exclusionary mechanisms. Informants discussed their collective illness identity by invoking common experiences and interests while also establishing experiential, biomedical and moral boundaries that distinguished them from other social groups. In particular, we highlight how the informants distanced themselves from type 2 diabetes on the basis of the latter’s status as a ‘lifestyle disease’. Our findings demonstrate the importance of boundary work for collective illness identity formation and the management of stigma, and the ambivalent relationship between illness identities and biomedical knowledge.
  PubDate: 2023-06-01
Mindfulness meditation as “good medicine”: a new epistemological
pluralism in health care
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  Abstract: Scholars have documented tensions that develop as a result of the integration of complementary and alternative medical practices (CAM) into conventional medicine, but few studies have analyzed the process of integration. I use the Mindfulness-Based Stress Reduction program (MBSR), an increasingly popular CAM intervention, as a case study to investigate this process. Drawing on interviews and salient texts, I argue that MBSR leaders (MBSR teachers, doctors, and researchers) have fostered a cultural environment that allows the paradigms of alternative and conventional medicine to coexist: a new epistemological pluralism. Rather than exclusively defining MBSR as either CAM or conventional medicine, MBSR leaders strategically moved back and forth across contradictory epistemological paradigms, enabling them to maintain the integrity of mindfulness and its approach to “healing” while simultaneously conforming to the structural constraints of conventional medical institutions. This study contributes to theoretical research on institutions by suggesting that although this process may look like institutional isomorphism with CAM therapies conforming to the standards of conventional medical institutions, institutional actors’ comfort with contradictions and hybridized views supports institutional heterogeneity and possibly even divergence.
  PubDate: 2023-06-01
What shapes local health system actors’ thinking and action on social
inequalities in health' A meta-ethnography
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  Abstract: Local health systems are increasingly tasked to play a more central role in driving action to reduce social inequalities in health. Past experience, however, has demonstrated the challenge of reorienting health system actions towards prevention and the wider determinants of health. In this review, I use meta-ethnographic methods to synthesise findings from eleven qualitative research studies that have examined how ambitions to tackle social inequalities in health take shape within local health systems. The resulting line-of-argument illustrates how such inequalities continue to be problematised in narrow and reductionist ways to fit both with pre-existing conceptions of health, and the institutional practices which shape thinking and action. Instances of health system actors adopting a more social view of inequalities, and taking a more active role in influencing the social and structural determinants of health, were attributed to the beliefs and values of system leaders, and their ability to push-back against dominant discourses and institutional norms. This synthesised account provides an additional layer of understanding about the specific challenges experienced by health workforces when tasked to address this complex and enduring problem, and provides essential insights for understanding the success and shortcomings of future cross-sectoral efforts to tackle social inequalities in health.
  PubDate: 2023-06-01
Revisiting rural healthcare access through Held’s ethics of care
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  Abstract: Access to healthcare and health seeking behaviours of rural people often hinge on the existing relationships between healthcare providers and (prospective) healthcare users. However, rich micro-level health professional-healthcare user relationships and the unique relational context of rural settings are largely missing from dominant rural healthcare access conceptual frameworks. We argue rural healthcare access conceptualisations require revisiting from a relational perspective to ensure future healthcare access policy accounts for the relational nature of healthcare in rural contexts. Ethics of care is a moral theory informed by feminism which rejects liberal individualist notions and emphasises interdependence. We used Held’s ethics of care characteristics to examine Russell and colleagues’ healthcare access framework and dimensions for rural and remote populations. This process revealed Held’s ethics of care characteristics are only somewhat evident across Russell et al.’s dimensions: most evident in the acceptability and accommodation dimensions, and most absent in the availability and affordability dimensions. Future rural healthcare access frameworks need to pay further attention to the relational aspects of rural healthcare, particularly around the availability and affordability of healthcare, to bolster future efforts to improve healthcare access for rural people.
  PubDate: 2023-06-01
An unproblematized truth: Foucault, biopolitics, and the making of a
sociological canon
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  Abstract: Foucault’s argument that a major break occurred in the nature of power in the European Eighteenth century—an unprecedented socialization of medicine and concern for the health of bodies and populations, the birth of biopolitics—has become since the 1990s a dominant narrative among sociologists but is rarely if ever scrutinized in its premises. This article problematizes Foucault’s periodization about the politics of health and the way its story has been solidified into an uncritical account. Building on novel historiographic work, it challenges the modernist bias of histories of biopolitics and public health and considers an earlier and more plural history of collective practices of health of which the story told by Foucault is just one important episode. Finally, it discusses the implications of this revised model for wider sociological debates on the link between modernity, health and the body.
  PubDate: 2023-06-01
Negotiating body and power in forensic mental health care
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  Abstract: Since the beginning of the 2000s, the reduction of coercive methods has been a tendency in psychiatric care in Finland. Combined with the transforming ideas of healing, the reduction has changed practices in the institutions of forensic mental health care, by encouraging efforts to increase self-determination and individual responsibility. This article addresses the coexistence of the previous and current bodily regimes, and the resulting complex and contested spatial and bodily arrangements. We combine the discussions on biopower and bodily regimes in our analysis of the practices and negotiations related to the alternative methods to coercion (special observation and restricting garments), mundane practices (eating and exercising), and negotiations related to touch and sexuality. As our study shows, bodily regimes and care practices are constantly under negotiation, during which there may be inconsistences in what is or is not allowed. Moreover, what seems to be a positive tendency towards increased self-determination has led to new forms of pressure, resulting from the increased possibility to protest by using one’s own body (e.g. by ignoring hygiene), or from the diminishing self-determination of the nurses (e.g. during special observation).
  PubDate: 2023-03-30
‘You’d think they’d know’: social epistemology and informal carers
of mental health service users
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  Abstract: This paper considers the experience of informal carers for people with mental health problems from the point of view of social epistemology, where human knowledge is seen as a social achievement and people’s social position informs the kinds of knowledge they accumulate and deploy. Based on interviews with 31 carers for people with mental health problems, three areas of localised, specified epistemological activity were identified. First, the management of knowledge involved in shaping the situation to gain professionals’ recognition. Relatedly, the second theme concerned the participants’ construction of what it was that the professionals knew but which was felt to be withheld from carers. Finally, there were aspects of being a carer, such as dealing with the emotional friction in the caring relationship which either ‘nobody tells you about’ or which ‘you can’t tell anyone’. Examining these experiences through the lens of social epistemology highlights the interactive and personal work that carer participants did to create, shape and manage both knowledge itself and their relationships with health professionals and the cared-for person.
  PubDate: 2023-03-01
Examining the U.S. premed path as an example of discriminatory design
& exploring the role(s) of capital
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  Abstract: The college-level pathway to medical school (i.e., the “premed path”) includes all coursework, extra-curriculars, shadowing, volunteering, high-stakes examination (e.g., MCAT®), and application-related processes. Although medical school admission committees routinely insist their interest in diverse and “well-rounded” applicants, the premed path (PMP), through formal and informal mechanisms, is constructed to favor those from high in socioeconomic status (SES) privileged backgrounds, and those majoring in typical premed majors such as in the Biological Sciences. In these respects, the PMP is an example of Discriminatory Design—an entity constructed and sustained in a manner that (un)intentionally discriminates against certain groups of individuals. We begin this paper by providing a brief description of the PMP (within the U.S. specifically) and conceptual and theoretical overview of the discriminatory design framework. We then explore how the PMP is an example of discriminatory design through the distinct but related role(s) of financial, social, cultural, and (what we term) (extra)curricular capital. Using data gleaned from interviews with premedical students, content analyses of the curricular structure of particular majors and publicly available data on the various “costs” associated with the PMP, we detail how the PMP is reflective of discriminatory design, spotlighting specific barriers and hurdles for certain groups of students. Given the persistent lack of representation of students from minoritized groups as well as those from diverse academic backgrounds within medical schools, our goal is to spotlight key features and processes within the PMP that actively favor the pursuit of certain majors and students from more privileged backgrounds. In turn, we conclude by offering medical schools and undergraduate institutions specific recommendations for remediating these barriers and hurdles.
  PubDate: 2023-03-01
Structural determination and social practice: towards a new understanding
of ‘structure’ in health inequality research
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  Abstract: The relationship between social position and health is a central issue in medical sociology. While researchers typically agree that health inequalities are ultimately determined by structural factors, the concept of ‘structure’ is often unspecified and vaguely understood. This paper contributes to our understanding of structure by clarifying and critiquing two main understandings of structure within health inequality research, respectively, ‘structure’ as synonymous with socioeconomic inequality and ‘structure’ as an arrangement of pre-given components. Inspired by the concept of structuration, I then outline a more practice-oriented conception hinging on a threefold distinction between structural determinants, structuring practices and structural outcomes. A model is then presented in which ‘structure’ is understood as the evolving conditions and outcome of practices in which actors produce, distribute and consume resources according to social schemas. The conclusion discusses the concept’s implications for researchers aiming to examine and reduce social inequalities in health.
  PubDate: 2023-03-01
Understanding social inequalities in cardiac treatment through the lens of
cultural health capital: a study of Danish socially disadvantaged ischemic
heart patients’ lived experiences of healthcare interactions
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  Abstract: Socially disadvantaged ischemic heart patients are more likely to report poor patient satisfaction and problematic patient-provider communication than patients without social disadvantages. These inequalities are often understood with the use of concepts emphasising the individual’s cognitive abilities, such as health literacy. This study aims to explore Danish socially disadvantaged ischemic heart patients’ lived experiences of healthcare interactions through the lens of cultural health capital, and thereby further our understanding of more underlying structural, social and interpersonal factors shaping social inequalities in cardiac treatment. The study was carried out as a nationwide critical hermeneutic study in Denmark between October 2018 and August 2019. Data consist of qualitative interviews with 30 participants and supplementary observations. The findings showed that the healthcare interactions were characterised by unequal power balances. The healthcare professionals dominated the norms of the clinical encounter and thereby what kind of cultural health capital that held the highest exchange value. Furthermore, the participants felt inferior compared to patients with a higher social status who managed to display valued parts of the cultural health capital, and thereby receive more attentive treatment. The findings indicate that treatment of this group of patients should acknowledge the patients’ habitus and life circumstances.
  PubDate: 2023-03-01
Patients’ knowledge and their trust in surgical doctors. A
questionnaire-based study and a theoretical discussion from Norway
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  Abstract: This paper seeks to examine whether knowledge about treatment, mental well-being and socio-demographic variables can predict patients’ trust in surgeons. A cross-sectional study was conducted in Norway. A total of 147 participants completed a questionnaire with items on knowledge, mental well-being, socio-demographic background, and trust in doctors in elective surgery. Our findings indicate that knowledge about treatment was a significant predictor of trust, and that the lowest levels of knowledge were associated with lower levels of trust. Most participants reported moderate/high well-being, however, patients with the lowest well-being scores had significantly lower trust in surgical doctors. We discuss these findings in the context of other relevant research and provide a theoretical discussion on the issue using Luhmann’s theory of trust. We argue that both knowledge and trust have forward-looking aspects, meaning that knowledge is to some extent acquired to cope with the future and trust is also related to expectations of the future. This theoretical approach can provide a framework for understanding our empiric findings. As knowledge was a significant predictor of trust, and is related to future expectations, information given to patients should focus on issues that may affect their personal future health.
  PubDate: 2023-03-01
Earbuds, smartphones, and music. Spiritual care and existential changes in
COVID-19 times
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  Abstract: Rooted in a Durkheimian functionalist reading of religion, in this article, we present and discuss the results of a scoping study of on-line sources on the delivery of spiritual care during the COVID-19 pandemic in England. Spiritual care highlights the bond between healthcare and religion/spirituality, particularly within the growing paradigm of holistic and humane care. Spiritual care is also an area where the importance of the physical presence of receivers and providers is exceptionally important, as a classic anthropological understanding of the religious ritual would maintain. Three themes were found, which speak to changes brought about by the pandemic. These revolve around disembodiment, solitude, and technology in spiritual care, of religious and non-religious nature. A fourth theme encapsulates the ambivalence in the experience of spiritual care delivery, whereby distant and virtual care could only partially compensate for the impossibility of physical presence. On the one hand, we draw from anthropology of the ritual and phenomenology to make the case for the inalienability of intercorporeality in being there for the other. On the other hand, relying on digital religious studies and post-human theories, we argue for an opening up to new ways of conceptualising the body, being there, and being human.
  PubDate: 2023-02-06
  DOI: 10.1057/s41285-022-00192-6
‘The almighty pill and the blessed healthcare provider’:
medicalisation of mental distress from an Eliasian perspective
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  Abstract: The analysis of factors and actors that lead to the increasing medicalisation of common mental health issues is generally focused on the healthcare system (the medical profession, in particular) or other related fields (the pharmaceutical industry, the media, or governments, among others). In this article, I in turn examine how and which processes in a society as a whole might drive to unpleasant emotions of everyday life being managed through medical and, particularly, pharmaceutical solutions, rather than employing other resources. Using reflexive thematic analysis and drawing upon Elias’s process sociology, I present the analysis of 21 in-depth interviews with healthcare providers and users of services who are or have been treated for depression or anxiety disorders in Spain. It is concluded that the trends of scientisation and individualisation, coupled with demands for emotional self-control, enable the growing medicalisation of emotions. Professional help seeking represents rationalisation, whereas suffering unpleasant (yet non-disordered) emotions is viewed as irrational.
  PubDate: 2022-12-01
  DOI: 10.1057/s41285-021-00165-1
How to make sense of cultural difference in mental health care: analyzing
biographies of diasporic Muslim women with mental health problems
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  Abstract: The existing international research evidence shows that second- and third-generation migrant women often have a family history of labor migration and experience mental health problems due to the multi-dimensional problems and precarious life situations in which they are enmeshed. Our qualitative study builds on the suggestion of diverse authors to investigate cultural aspects and dynamics that affect the help-seeking process. Since different research approaches and foci have been used to cast light on this issue, we argue that research risks to rely on an essentialist and pejorative notion of culture. In this study, we adopt an affirmative and productive notion of cultural difference that allows us to uncover the biographies of diasporic Muslim women with mental health problems to capture their strategies of meaning making and agency as rooted in their specific historical, social, political, and cultural contexts.
  PubDate: 2022-12-01
  DOI: 10.1057/s41285-021-00168-y
An ecological and systems thinking approach for support to siblings with
and without disabilities
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  Abstract: This paper uses theory to progress practical understandings of what it means to support siblings with and without disabilities. Research about siblings where one has a disability has been advancing in recent years from an individual-level perspective to one that takes better account of the social determinants of health. However, the advances have not yet been fully applied to extend models of sibling support within health and social care. The paper, therefore, highlights how further use of ecological and systems thinking theory can help to offer new approaches to sibling support. Using a case study, the paper applies the systems thinking concepts of ‘feedback loops’ and ‘levers’ to show how the ecological system of influences on siblings with and without disabilities might be influenced to change through sibling support practice. This provides a basis for broadening sibling support to not only focus on individual outcomes, but also on where broader societal influences can be changed to benefit siblings. It also enables sibling support to go beyond individual-level support to also include outcomes for the shared sibling relationship, as it is experienced by the sibling both with and without the disability. Implications for practitioners in health and social care are discussed.
  PubDate: 2022-12-01
  DOI: 10.1057/s41285-020-00158-6
Medicalization of sciatica and its treatment
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  Abstract: Sciatica is a common back problem with a generally positive natural course. This interview study was performed to gain increased insight into ambivalent and reluctant medicalization on the interactional level regarding the perceptions of Dutch patients and physicians about sciatica and its treatment options as a case study. While the concept of medicalization was introduced decades ago, nuanced perspectives on medicalization on the interactional level—ambivalent and reluctant medicalization—were added recently. Interviews were conducted with 10 patients and 22 clinicians and analyzed using these perspectives. The findings show that patients and clinicians share the problem definition of sciatica, which is stated to be the essence of medicalization. They differ from each other regarding the preferred course of action after diagnosis. Ambivalent and reluctant medicalization both highlight that medicalization in practice is often an uncertain and contested process, with medical intervention as a compromise result. In this case, the problem was not in the diagnosis but in reaching a treatment compromise, considering how much discomfort due to sciatica a patient could handle.
  PubDate: 2022-12-01
  DOI: 10.1057/s41285-021-00161-5
Strength- and recovery-based approaches in forensic mental health in late
modernity: Increasingly incorporating a human rights angle'
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  Abstract: Forensic mental health care is situated across both criminal justice and healthcare systems and is subject to political, cultural, legal and economic shifts in these contexts. The implementation of strength- and recovery-based models of care should be understood in light of these social and structural processes. Drawing on novel empirical fieldwork and the extant literature, we argue that full realisation of strength- and recovery-based principles is at odds with aspects of late modern social control. Not wholly compatible, we highlight how concepts of empowerment, autonomy, identity and connectedness can unhelpfully rub-up against the concepts of punitiveness, otherness and risk management. Conceptually this is problematic, but in frontline forensic psychiatry settings, this has real lived-experience detrimental effects for patients – as our data demonstrate. To address this, a human rights approach might be fruitful. Grounding arguments for strength- and recovery-based principles in the heuristic framework of human rights can offer a set of common values to stimulate reform in forensic mental healthcare. The right to respect for private and family life, home and correspondence under Article 8 of the European Convention on Human Rights and Fundamental Freedoms offers a particularly promising, robust and well-defined framework for these future changes – as we outline.
  PubDate: 2022-12-01
  DOI: 10.1057/s41285-021-00169-x
How US newspapers view the UK’s NHS: a study in international
lesson-drawing
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  Abstract: Healthcare on both sides of the Atlantic is a highly charged political and economic subject. This work considers US media coverage of the UK’s National Health Service (NHS), an under-researched area. We assess the framing of the NHS in editorials, opinion and feature articles during the time of the Obama administration to show how media can perform the role of lesson-drawing, a theory adopted from public policy research. The study also applies the notion of journalistic habitus in this context. Using these ideas, we address a hypothesis which holds that US coverage is framed around the flaws of the UK’s NHS. The paper considers how intermedia editorial and news values operate, with commentators drawing a range of negative lessons in both the Democrat- and Republican-supporting press. We find that the NHS was often posited as a flawed international variant of the single-payer model, where newspapers employed an ahistoric explanation of failure and decline.
  PubDate: 2022-12-01
  DOI: 10.1057/s41285-021-00162-4
Professionalization of Chinese medicine practice in Canada: from medical
pluralism to neo-orientalism
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  Abstract: Chinese medicine came to Canada during the twentieth century in the hands of ethnic Chinese immigrants. This paper investigates the key features of professionalized Chinese medicine practice in the city of Vancouver, which lies in the Canadian province of British Columbia. The methodology adopted for this research involved face-to-face interviews with practitioners and the scrutinizing of webpages of various institutes and clinics offering Chinese medical services. In order to comply with regulatory requirements, the practice of Chinese medicine has been professionalized according to western biomedicine, ignoring the historical development and cultural connotations of this ancient system of health and wellness. Many practitioners in Vancouver do not speak Chinese, share Chinese culture, and have never been to China. The education and service delivery under Chinese medicine specialties have focused exclusively on curative care and have disregarded the preventive and moral regimen. A consumer class has developed across the city and the holistic content of Chinese medicine has become a selling point. This paper concludes that the commodified version of Chinese medicine that has so far been developed in Vancouver as part of its professionalization echoes neo-orientalism. The West has intervened in the formalization process of Chinese medicine practice, justifying authority through the process of non-disputed inclusion. This is, however, an ahistorical proponent fulfilling new age desires and contaminating eastern healing in the west for profit maximization.
  PubDate: 2022-11-09
  DOI: 10.1057/s41285-022-00191-7
Contextualizing race and sex-related health disparities: doing difference
and sexual risk behaviors
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  Abstract: Sexually transmitted infections (STI) are a group of illnesses that disproportionately impact emerging adults, ages 18–25, African Americans, and men. The current study serves to contextualize race and sex-based trends by testing for the impact of gender traits, or sex roles. Data come from the Longitudinal Study of Adolescent and Adult Health (ADD Health) and includes White and African American respondents ages 18–25. Results of regression analyses showed (1) male sex and African American race increases the likelihood of condom use, (2) employment decreases the likelihood of condom use, and (3) African American race and masculine gender traits predict greater numbers of sexual partners. This study suggests social psychological aspects of race and gender promote sexual risk taking in emerging adulthood and should be considered in future studies and related interventions.
  PubDate: 2022-11-09
  DOI: 10.1057/s41285-022-00189-1