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Illness, Therapy and the Modern Urban American Family
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... Rather, a brief overview is provided as a background to the evolution in theories of doctor-patient interaction. Parsons is perhaps most well known for his discussion of the 'sick role' (Parsons 1974;Parsons 1975;Parsons 1978;Parsons and Fox 2010) that is associated with three socio-structural features (Shilling 2002). First, an individual's illness is not regarded as his or her fault yet the sick individual has a moral responsibility to overcome the illness as soon as possible. ...
... Rather, a brief overview is provided as a background to the evolution in theories of doctor-patient interaction. Parsons is perhaps most well known for his discussion of the 'sick role' (Parsons 1974;Parsons 1975;Parsons 1978;Parsons and Fox 2010) that is associated with three socio-structural features (Shilling 2002). First, an individual's illness is not regarded as his or her fault yet the sick individual has a moral responsibility to overcome the illness as soon as possible. ...
... Second, the sick individual is temporarily obligated to abstain from ordinary social responsibilities and expectations. Third, the sick individual is required to seek help from a health professional while cooperating with the professional in the process of recovery (Parsons 1974;Parsons 1975;Parsons 1978;Parsons and Fox 2010). ...
... The theory outlined here suggests that this obligation to undergo the trials of treatment helps to maintain the stability of the institution in the face of would-be deceivers. Indeed, Parsons and Fox (1952) note how negative aspects of interaction with the health care system "are the penalties which give impetus to the patient's desire to re-achieve wellness". ...
Ineffective, aversive and harmful medical treatments are common cross-culturally, historically and today. Using evolutionary game theory, we develop the following model to explain their persistence. Humans are often incapacitated by illness and injury, and are unusually dependent on care from others during convalescence. However, such caregiving is vulnerable to exploitation via illness deception, whereby people feign or exaggerate illness in order to gain access to care. Our model demonstrates that aversive treatments can counter-intuitively increase the range of conditions where caregiving is evolutionarily viable, because only individuals who stand to gain substantially from care will accept the treatment. Thus, contemporary and historical “ineffective” treatments may be solutions to the problem of allocating care to people whose true need is difficult to discern.
... ...an individual's reaction to his disability is dependent not only upon his predisability self-concept and social position, but upon the reaction toward his disability on the part of his significant others and the nature of the changes brought about in their usual mode of interaction. Parsons and Fox (1958) in a frequently referrred to article, "Illness, Therapy and the Modern Urban American Family," ...
... These investments may enable the patient to grow and break free of the constraints of suffering and dependency. But if these investments become codified -within discourses of professionalism, or as is sometimes the case in caring settings, within a repetition of a parent-child dependency (Parsons and Fox 1952, Forrester 1990, Fox 1993, then what was an empowering relationship becomes disempowerment, what might have enabled such growth becomes more to do with power and control. ...
... The second category of theories, including family systems theory (Minuchin, 1974), behavioral approaches (Block, Kremer, & Gaylor, Il)HO). and role theory (Parsons & Fox, 1958), focuses on the family as II Nocial environment that generates and maintains the behaviors of its Individual members. According to family systems theory, there are several features of flll11ilies that play an important part in their functioning. ...
focuses on the effects of chronic illness on the marital relationship, and ways in which well partners affect their spouses' adjustment to the illness / describe theoretical perspectives on the family and on relationships, which can provide a framework for understanding and interpreting the research in this area and can suggest avenues for further exploration (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Medical treatment offers hope of overcoming unwanted childlessness, refiecting an increasing tendency to turn to medicine for solutions to social problems. Unlike other conditions for which diagnosis may provide legitimacy for the illness (Parsons and Fox 1952), the medical diagnosis of infertility does not serve such a function because individuals seldom reveal to others their efforts to conceive or to seek medical care for infertility. Most persons who seek infertility treatment do so without the knowledge of others in an effort to fit the cultural norm before their failure to meet it has been identified (Becker 1990, Miall 1986). ...
The social and cultural basis of medicalisation is explored through an examination of infertility, a social condition that has recently been recast as a disease. Infertility illustrates a basic dilemma of medicalisation: the health care system reflects the same value system at work throughout society. Placing social problems within a biomedical framework does not provide a satisfactory solution for conditions that deviate from cultural norms because those norms are replicated in biomedical ideologies about the nature and treatment of disease. We examine three phases of this dilemma through an analysis of data collected in in-depth interviews with 43 American couples who were undergoing infertility treatment: 1) the disparity between initial expectations about ease and speed of treatment and its actual complexity, 2) the confrontation with medical definitions of abnormality, and 3) the cumulative effects of treatment, in which emotional exhaustion from infertility treatment vies with the continuing need to ‘fix’ the infertility and produce a pregnancy. We conclude that individuals' efforts to eradicate feelings of abnormality for their childlessness by lending medical legitimacy to their failure to conceive are undermined by entering a medical system in which concepts of disease and abnormality are implicit.
... At one and the same time, however, the sick person is enjoined to accept the definition of his status as undesirable and the obligation to get well as expeditiously as possible. (Parsons and Fox, 1952, p. 32) Foucault (1967) described how people are 'conscripted' into pathological identities and suggested that this was a feature of the dominant Western scientific and medical discourse. This invariably involves the use (and abuse) of power to impose such meanings on people, and in turn to apply sanctions, such as exclusion or even enforced treatments. ...
This paper describes a qualitative research study which compared accounts from interviews with families where difficulties had evolved into serious problems with those where an escalation into pathology has been avoided. These accounts confirm that family life is commonly seen to be problematic and stressful, particularly during transitional stages. Specifically, it appears that it is not simply the severity of the initial stresses and problems that distinguishes families, but the meanings that these evoke and the corresponding patterns of responses, especially the ‘attempted solutions’ that are set in motion. These responses, fuelled by external interventions, can launch families along pathological pathways. It is suggested that the meanings ascribed to difficulties and the ensuing responses are predominantly shaped and constrained by three factors: the dominant societally shared discourses of mental health and distress; the emotional resources and attachments of family members; and systemic interpersonal processes. Some therapeutic implications, especially the importance of assisting families to resist pathologizing processes are indicated.
The subdiscipline of the sociology of health has had a very strong presence in New Zealand sociology since the inception of sociology as a distinct academic subject. New Zealand health sociologists have made an extraordinarily rich contribution to a variety of domains ranging from policy and advocacy to theoretical developments in the discipline. Medical or health sociological concerns have a long history in the New Zealand academy. From the 1920s students studying preventive medicine at the University of Otago wrote on such topics as the gendered division of labour in factories and the lives of those living in poor housing. Jim Robb was the founder of the first sociology department in New Zealand at Victoria University of Wellington, and he conducted extensive research on medical social work services in the 1960s and established links with epidemiologists at Wellington Hospital. This chapter will look at the work undertaken by New Zealand sociologists, and those in allied disciplines, including sociolinguistics and Māori health researchers, to consider the ways in which they have facilitated different ways of thinking about and acting on healthcare delivery.
The young adult has a central place in family practice. Young adulthood is the period in life when old nuclear families break up and new ones are formed, when the individual shifts his or her primary social allegiance from one family to another. This fact alone would make the young adult a crucial point of reference for the family physician. In addition, however, the change in family identification often brings with it a change of doctors. Whereas family medicine envisions an ideal of continuity of care over several generations of a family, our society has become so mobile that in many families each new generation of adults must find a new primary physician in a new locale. Thus, young adulthood becomes the key point of entry for patients into a family practice.
The patient-physician relationship is considered in its historical perspectives and the roots of the relationship are briefly sketched. Several suggested models are examined. The good of the patient, basic to any consideration of the patient-physician relationship, is examined. Some of the problems such as confidentiality, conflict of interest, consent, and experimentation are briefly considered in the light of the previous discussion.
A family can be a group of 20 or more persons; it can include only 2. It can be an elaborate reticulum of “invisible loyalties” that extend across decades, generations, and centuries to give a person a sense of family identity and feelings of pride; it may last but a few days. Or it may begin but never be completed in the sense of having two parents living with the child(ren). A family usually is a small group of people living face-to-face and tête-à-tête, forming intense affiliations and conflicts, loving and hating in highly charged situations.
Comprehensive pediatric care provided by an interdisciplinary team is often recommended to help families cope with the considerable stresses involved in dialysis and renal transplantation.1 The various functions of comprehensive care include emotional support of families through the course of treatment, attention to the child’s psychosocial adjustment, and facilitation of patient-physician communications. The structure and emphasis of comprehensive care program vary considerably from setting to setting. This report describes the role of one comprehensive care team in aiding family coping and helping families with treatment decisions, with particular reference to renal transplantation.
Dieser Band stellt im engsten Sinne eine Fortsetzung des vorangehenden Bandes 6 dar, indem er das Thema des menschlichen Lebenslaufs von der Jugend in die Familie und ins Alter verfolgt. Auch in diesem Falle treten die gesamtgesellschaftlichen Vorstellungen von Ehe, Familie, Alter hervor, so daß ständig neben der Einzelanalyse die übergreifenden Strukturen sichtbar und spürbar werden. Wiederum erfahren altüberlieferte Begriffe eine empfindliche Modifikation, allen voran der naive Begriff von der Universalität der Nuklearfamilie, wobei unter Kernfamilie nur die zusammenebende Gruppe von Mann, Frau und minderjährigen Kindern verstanden wird. Gewiß gibt es überall eine „kleinste“ Einheit der Familie, aber gleichzeitig entscheidet sich aus gesamtgesellschaftlichen Vorstellungen, wie „klein“ diese Kernfamilie jeweils ist. Sie kann beträchtlich über den genannten Personenkreis hinausgehen und trotzdem als „kleinste Einheit“ begriffen werden. Trifft das vor allem zu in der anthropologisch-vergleichenden Forschung, so ist das auch in ganz ausnehmendem Maße der Fall in der lebensläuflichen Behandlung des Familienzyklus, der jener Aspekt des Problems ist, in dem die beiden Beiträge dieses Bandes verklammert sind.
Since time immemorial an intimate relationship has existed between nature, the family, smells, tastes, afflictions, disease and health. An obsession with health, thinness and aesthetics must not act to the detriment of the balanced diet that the human organism requires. Eating too much or not wanting to eat are two extreme attitudes, each of which favours the appearance of disease. With these issues in mind, this paper intends to develop three aspects that we consider of primary importance. The first relates to the influence exerted by the formation of smells, tastes and pleasure on a hedonistic society, along with the associated risks. The second relates to concerns with the influence of the family in dietary terms, and its effects on the health of the family members, considering the social, economic, cultural, gender and family transformations in progress. Finally, in view of the new agri-food technologies and the inflexibility of work and school timetables, the last seeks to study the ways in which the family manages to negotiate the use of these new forms without adverse effects on the health of its members.
The treatment of end-stage renal disease (ESRD) raises many of the ethical issues and dilemmas associated with therapy of chronic, irreversible diseases and of catastrophic illness, and with the use of life-sustaining technologies. The thorniest problems which trouble nephrologists in dealing with ESRD include the multiple issues surrounding initiating treatment and terminating treatment. Concerned nephrologists, citizens, politicians and bureaucrats worry about the high cost of the long-term therapy, the cost-benefit and the allocation of scarce resources since provision of care for one expensive governmentally funded medical program often means cuts in another program (1). Hard choices in therapy may be influenced by forces outside the medical professions including politicians, lawyers, ethicists, clergy and lay persons.
The article surveys the key issues in medical anthropology that have been discussed in the 1990s-2000s in major periodicals such as "Medical Anthropology Quarterly: International Journal for the Analysis of Health", "Anthropology &Medicine", "Studies in Medical Anthropology", and others. The history of institutionalization of the Society for Medical Anthropology as well as its major activities and methodological foundations are reviewed. Presently medical anthropology plays an important part in interdisciplinary research on the origin and dissemination of certain illness/health models and in the study of ethical consequences of shifts in the notions of body and personality. Medical anthropologists are to assume a leading role in the shaping of an integral system of health care as well as in working out the concept of medicine of the future.
This enthralling and provocative book provides a new grounding for the understanding of sexual rights. It argues that all varieties of sexuality under capitalism are materially constructed out of the complex interrelationship between the market and the state. The examples of different sexual rights and lack of rights that it examines include the experience of male homosexuals, bisexuals, transvestites, transsexualists and children. Meticulous, focused and challenging, it will be required reading for anyone interested in modern human sexualities.
Conflict is ubiquitous and inevitable, but people generally dislike it and try to prevent or avoid it as much as possible. So why do clashes of right and wrong occur? And why are some more serious than others? This book presents a new theory of conflict that provides answers to these and many other questions. The heart of the theory is a completely new concept of social time. The book claims that the root cause of conflict is the movement of social time, including relational, vertical, and cultural time-changes in intimacy, inequality, and diversity. The theory of moral time reveals the causes of conflict in all human relationships, from marital and other close relationships to those between strangers, ethnic groups, and entire societies. Moreover, the theory explains the origins and clash of right and wrong not only in modern societies but across the world and across history, from conflict concerning sexual behavior such as rape, adultery, and homosexuality, to bad manners and dislike in everyday life, theft and other crime, racism, anti-Semitism, anti-Americanism, witchcraft accusations, warfare, heresy, obscenity, creativity, and insanity. The book concludes by explaining the evolution of conflict and morality across human history, from the tribal to the modern age. It also provides surprising insights into the postmodern emergence of the right to happiness and the expanding rights of humans and non-humans across the world. The book offers an incisive, powerful, and radically new understanding of human conflict-a fundamental and inescapable feature of social life.
Sociologists have studied the experience of illness for at least the past four decades (Conrad 1987). The earliest studies focused on how patients managed the sick role (Parsons 1951) or how they maneuvered through the stages of an illness career (Suchman 1965). Beginning with the work of Anselm Strauss and his colleagues (Glaser and Strauss 1965; Strauss and Glaser 1975), sociological researchers started investigating the experience of illness by examining the illness experience from the patient's viewpoint. This has led to several lines of work that focused on how people live with and in spite of their illness, the subjective experience of illness, and strategies sufferers develop to manage their illnesses and lives (e.g., Charmaz 1999; Bury 1982; Bell 2000). Researchers have typically used qualitative research methods, especially interviews, to examine the experience of illness (Conrad 1987; Charmaz 1999) and have studied stigmatized illnesses like epilepsy (Schneider and Conrad 1983) and HIV/AIDS (Weitz 1991; Klitzman and Bayer 2003), contested illnesses like fibromyalgia (Barker 2005), psychiatric disorders like major depression (Karp 1997), and medical conditions such as infertility (Greil 1991) and genetic disorders (Cox and McKellin 1999). Numerous studies have focused on how sufferers manage their identity (Charmaz 1991), stigma (Weitz 1991), biographical disruption (Bury 1982), or narrative reconstruction (Williams 1984).
Illness is a ubiquitous experience in all societies. Until the past two decades, illness remained largely a private experience. With the development of the Internet, especially what has been termed Web 2.0, with interactive websites, illness has become increasingly a public experience. Vehicles like bulletin boards, chat rooms, listservs, electronic support groups, and more recently social media facilitate thousands of online communities where individuals with illness share information, interaction, experience, and advocacy. With the advent of social media, communication has increased and brought new challenges for online interaction. It is likely that the transformation of illness from a largely private to an increasingly public experience is a revolutionary change that is here to stay, with numerous social consequences.
The Social Thought of Talcott Parsons offers an insightful new reading of the work of Talcott Parsons, keeping in view at once the important influences of Max Weber on his sociology and the central place occupied by methodology - which enables us to better understand the relationship between American and European social theory. Revealing American democracy and its nemesis, National Socialism in Germany as the basis of his theory of society, this book explores the debates in which Parsons was engaged throughout his life, with the Frankfurt School, C. Wright Mills and the young radicals among the "disobedient" student generation, as well as economism and utilitarianism in social theory; the opponents that Parsons confronted in the interests of humanism. in addition to revisiting Parsons' extensive oeuvre, Uta Gerhardt takes up themes in current research and theory - including social inequality, civic culture, and globalization - offering a fascinating demonstration of what the conceptual approaches of Parsons can accomplish today. Revealing methodology and the American ethos to be the cornerstones of Parsons' social thought, this book will appeal not only to those with interests in classical sociology - and who wish to fully understand what this 'classic' has to offer - but also to those who wish to make sociology answer to the problems of the society of the present.
The effects of a cystic-fibrotic child upon the personalities of family members, intra-familial role functioning, and family-community relationships are described and discussed in relationship to the findings of other studies of chronic and terminal childhood illness and related areas of investigation.
How is inner city space represented and by whom? Drawing from an extensive framing analysis of print media portrayals of Vancouver’s Downtown Eastside between 1996 and 2008, we offer a detailed assessment of the predominately negative portrayal of the neighbourhood, and the centrality of three frames: medicalization, criminalization, and socialization. Certain social actors are given a privileged position in the media in the representation of the inner city. Outsiders are privileged over insiders, with the neighbourhood constituted as a problematic space and its residents as passive victims. The effect is to further the stigmatization of an already marginalized neighbourhood, and to accentuate the disempowerment of its residents.
This paper examines the question of why patients decline treatment for cancer. Though small in number, patients with cancer who refuse treatment pose a problem for physicians and other health professionals managing their care. From the medical perspective such a decision appears irrational, and research has been conducted to try to identify features of patients and their situation that predispose this outcome. Research has also examined communication strategies used by doctors to influence patient decision making. The identification of these features supports an individualist perspective on this issue, even in the literature that seeks to comprehend the patient's point of view. Making use of a narrative perspective involving illustrative cases drawn from published research, this paper proposes that such decisions need to be understood in terms of patients' relationship to medicine, something that is changing with respect to medicine's weakened authority and the growth of a consumerist ethos. Second, the emergence in society of competing ideologies provides the possibility for alternative value sets in which the meaning of life can be assessed. This means that what seems an individual act of defiance is actually one of the highest social degree. To see treatment refusal in this way has implications for the mismatch between professional and patient preferences.
Today, citizenship both as target and life quality benchmark of societies and governments’ legitimacy has increased in importance. Citizenship’s acquired and extension aspects require scrupulous attention of urban systems (including urban management, urban governments, urban states, urban organizations, urban officials and municipalities) to benefit from urban citizenization policies in order to develop a form of relationship between officials with both citizens and the city, that yield the best way of living in the city and dealing with the city’s complex issues. Actualization of citizenship to the fullest requires enjoyment of the rights and fulfillment of responsibilities by all citizens, regardless of their gender, race, age, religion, health, social status, economic status and cultural status. Moreover, citizen-centered planning and executing, which significantly rely on quantitative and qualitative data, is of urban management responsibilities that can be of great assistance as well. For the sake of future planning, following the overview of theoretical subjects about disability and citizenship based on urban management frameworks, the present article attempts to provide data about disability status in Tehran. Like the part of the society who due to hereditary diseases, natural illnesses, accidents, sociocultural circumstances and environmental conditions lose some of their abilities, the disabled suffer from a higher rate of death than others. In under development countries, the disabled are deprived of the services (such as health, education, skill training and job search services) that are accessible to others. Disabled adults’ income is dwarfed by non-disabled adults’ income. Having a disabled kid cripples the married life and negatively affects other members of the family. Of social and economic features accompanying disability are poverty and deprivation. According to findings, fifteen percent of Iran’s disabled population live in Tehran, ninety percent of whom live in urban areas. Districts 12, 19 and 10 in order, rank the highest in disability. Analyzed by districts' regions; Region 3 of district 4, region 9 of district 2 and region 1 of district 1 host the lowest number of the disabled per one-thousand population. Whereas, Region 4 of district 19, region 9 of district 1, region 6 of district 20, region 4 of district 12 and region 1 of district 15 accommodate the biggest number of the disabled.
Background: Spouses play a major role in adaptation following the onset of their partner's aphasia. Sometimes, overprotection can occur in the relationship and this may be a disadvantage in adapting to aphasia. Overprotection from spouses can manifest itself in conversation when the spouse “speaks for” the person with aphasia and this could affect his or her participation in conversation. Aim: The aim of the present research was to study the phenomenon of overprotection, “speaking for” behaviours in conversation as well as the person with aphasia's participation in conversation. Methods & Procedures: A total of 18 couples, each including one person with aphasia, participated in this study. The perceptions of overprotection by persons with aphasia and their spouses were measured with the Overprotection Scale for Adults (Thompson & Sobolew‐Shubin, 199322.
Thompson , S. C. and
Sobolew‐Shubin , A. 1993. Overprotective relationships: A nonsupportive side of social networks.. Basic and Applied Social Psychology, 14: 363–383. [Taylor & Francis Online], [Web of Science ®], [CSA]View all references) and the Questionnaire on Resources and Stress for Families with Chronically Ill or Handicapped Members (Holroyd, 19876.
Holroyd , J. 1987. Questionnaire on resources and stress for families with chronically ill or handicapped members, Brandon, VT: Clinical Psychology Publishing Co. View all references). The participants were also videotaped in an interview situation where they answered questions on a systematic turn‐by‐turn basis. “Speaking for” behaviours, defined as the conversational turns in which the non‐aphasic spouse expressed an opinion or added information when the person with aphasia was clearly talking with the interviewer, were measured. Participation was measured by tabulating the number of contributive turns produced by the person with aphasia and the spouse in the nine turns following the “speaking for” behaviour. Participation of the aphasic person was considered “minor” if the number of those turns was fewer than those produced by the spouse. Outcomes & Results: Results showed that overprotection reported by spouses was positively associated with “speaking for” behaviours produced by spouses. “Speaking for” behaviours were positively related to minor participation in conversation. Aphasia severity and motor disability were also associated to minor participation of persons with aphasia in conversation. Conclusions: More research on overprotection and its effects on conversation is needed to further our understanding about the links between communication and psychosocial aspects of aphasia. In rehabilitation, attention should be given to overprotection and “speaking for” behaviours on the part of the spouse. In fact, the person with aphasia and the rehabilitation team's efforts to improve language and communication could be labour in vain if overprotection and “speaking for” behaviours on the part of the spouse develop and persist.
In theory, counseling may be stimulated by many disciplines, but over the years it has adopted the posture of a monogamous mistress to psychology. Sociology, now recognized only as a passive source of information, might also become active; it can fertilize counseling with new concepts, propositions, techniques and perspectives. Not only can the talents of sociologists be brought to the service of counseling in counseling sociology (developing and evaluating theory and practice more adequate to the social world), they can also lead to development of a sociology of counseling (study of the relation between counseling and society). A few of many potentials are suggested; potentials to be realized only if members of each field are awakened to the intrigue of the related area of understanding. (43 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Advance planning by the elederly for long-term care decisions promises to enhance personal responsibility and autonomy while improving their quality of life. Such planning becomes an extension of the concepts of client empowerment and self-care and is based on the ethical principles of individual autonomy and freedom of choice. These have clear implications for the content and process of advance planning, including the activities of “effective deliberation” and “moral reflection.” A sense of self-respect and the provision of care-provider support and social resources become key ingredients in this process, leading to the development of the concept of “cooperative empowerment.” Broader risk assessment methodologies are proposed to encourage the planning process, which can be given direction by the development of a personal planning guide and workshops. Attention must be drawn particularly to the importance of human values at the core of personal decisions and life plans.
Involving family members in the patient's treatment is central for coping with chronic diseases. The family's functioning and their involvement in the treatment process have a significant influence on compliance as well as on the patient's coping and quality of life. This article illustrates this broad topic through selected aspects. First, the importance of the family for the patient's coping and quality of life is highlighted in certain examples. Criteria for the family's involvement and important topics for the doctor's encounter with family members are introduced. Second, the necessities, problems, and consequences of doctor-family communication are illustrated for the examples of stroke and dementia. Overall, there is only limited time to include the family in in-patient as well as out-patient care. As a result, physician-family communication is not integrated sufficiently in general care, even for chronic diseases.
This chapter is available at http://dx.doi.org/10.1002/9781444314786.ch2
ABSTRACT
This chapter explains why culture is significant in health-related behavior, begiining with an overview of the classic definitions of culture and main research trends. Next, the article discusses the link between culture and health bahavior and, finally, focuses on the link between culture and health systems.
Physical pain, psychological distress and the deleterious effects of medical procedures all cause the chronically ill to suffer as they experience their illnesses. However, a narrow medicalized view of suffering, solely defined as physical discomfort, ignores or minimizes the broader significance of the suffering experienced by debilitated chronically ill adults. A fundamental form of that suffering is the loss of self in chronically ill persons who observe their former self-images crumbling away without the simultaneous development of equally valued new ones. As a result of their illnesses, these individuals suffer from (1) leading restricted lives, (2) experiencing social isolation, (3) being discredited and (4) burdening others. Each of these four sources of suffering is analysed in relation to its effects on the consciousness of the ill person. The data are drawn from a qualitative study of 57 chronically ill persons with varied diagnoses.
This article examines and clarifies controversies about the concept of illness in the field of family therapy. We contend that illness, as traditionally understood in all cultures, is a relational, transactional concept that is highly congruent with core principles of present-day family theories. Family therapists need not buy into a biotechnical, reductionistic reframing of illness as disease. Rather, it is more appropriate to conceptualize and work with illness as a narrative placed in a biopsychosocial context. Such a narrative includes how shared responsibility for coping and for finding solutions can take place, without becoming involved in disputes about causal models.
When illness is socially defined, the task of therapy is to enable the patient to move from a sick role to one of maximal social functioning. In a day hospital setting, methods are explored to involve a patient with his family both directly and indirectly. Thus the patient is supported both in the treatment milieu and when he is at home. Not only the patient, but the family, is vulnerable at this time and each must be helped to make parallel and complementary shifts in interpersonal behavior. To view the family solely as a resource for the support of the ill member and his treatment is to fail to accept the need of the family as a whole for reorganization and strengthening.
How do families choose a health plan when offered the option of insurance or a Health Maintenance Organization (HMO)? Choices are influenced by health consumerism, decision variables, family health needs, family composition, family socioeconomic status, and knowledge about HMOs. Subjects in the research reported here chose insurance or one of four HMOs; control subjects had no HMOs available. The model is estimated with LOGIT regression, yielding a pseudoR
2 of.22 for the adjusted model. Participation in the decision process, number of chronic illnesses, and knowledge about HMOs all are significantly and positively associated with choosing an HMO; also, young adults are more likely than older adults to choose HMOs. The consumerism variable fails to attain significance. LOGIT analysis of the adjusted model indicates that the model predicted 72% of plan choices correctly. Suggested research for other family forms, for the poor, and for the elderly's health plan choices are discussed.
The purpose of the study reported here is to determine the relationship between family systems functioning, family health role, and family utilization of health services. The research is based in the Circumplex Model of Marital and Family Systems (Olson, Sprenkle, & Russel, 1979). Family functioning variables include family level of cohesion, family adaptability, and family type, as measured by FACES II. Family health role (i.e., leadership role and acceptance of sick role) and utilization of health services are measured by scales of the investigator-developed Family Health Questionnaire. The sample consists of 140 parents of 70 families, composed of two parents with children under 25 years of age living at home. Analysis reveals significant relationships between the family level of adaptability and acceptance of the sick role, in conjunction with significant gender and gender interaction effects. There are no significant differences between family cohesion levels or family typologies with the health variables.
For several years, there has been a growing awareness of the impact of the large psychiatric institution upon the patient's illness. 1 The wide interest in the "therapeutic community" and the role of milieu on psychiatric t~eatment attest to this?. 3 And it is clearly evident that "custodialism" not only offers no solution to the prime economic and medical problem of caring for the chronic.ally disabled, but, in fact, may actually be contributing to that chronicity. In the words of Klapmanr "... if we seek to. make ho~spitalization truly therapeutic we shall not overlook to what extent ho,spitalization itself, as it is now so often constituted, conspires with the p~bie~t [italics a4ded] to produce a state which robs him of all incentive... Some of the characteristics to be found in ho,spitalized chronic schizophrenics are to a considerable extent artifacts fostered by the hospitalization itself." This suggestion that hospital and patient actually work together (conspire.) toward a common reprehensible goal is similarly implied by Martin, 5 who believes "the institution has a strong po.wer to mold patients into the type best suited for its purpose; and those who are predisposed stand in the most acute danger."
Gender homophily in physician preference (desire for a physician of the same sex) and more general homophily preferences (race, religion, and gender) were investigated among a population of college undergraduate and health professional students for a variety of health problems. Findings indicated that gender homophily preference was stronger for men than for women. However, the preferences may not reflect antifemale physician prejudice, particularly self-prejudice of women clients. Male preferred their doctors to be men significantly more than did females, regardless of the health problem. More serious health problems requiring greater physician skill (cancer, heart disease) did not produce significantly greater preference for males than problems requiring a lesser amount of skill. It appeared that health problems requiring a greater degree of physical intimacy (e.g., complete physical exam, gynecological or prostate problem) or psychological intimacy (e.g., emotional problem) produced greater homophily preference. Whether or not the student had had experience in clinical settings as a preprofessional or professional student did not have an impact on homophily preferences. Implications for the future delivery of health care, especially increased numbers of women in medicine, are discussed.
The introduction of a diagnosis such as cancer to an adolescent confounds an already stressful existence, as chronically ill adolescents face the same developmental tasks and challenges as healthy adolescents. Understanding and enhancing the unique coping strategies employed by teenagers is an important method to improve adjustment to cancer. Through two series of group therapy sessions for adolescents with cancer and their parents we discovered four primary challenges that adolescent cancer survivors face as well as various strategies that they use to cope with these challenges.
This article is available at http://dx.doi.org/10.1007/s10308-011-0286-y
ABSTRACT
This article explores critically the assumption that the burden of disease remains heavier for women than for men. The impact of gender on health is better understood when the burden of disease is analysed in terms of its two dimensions, the domestic and the public. This dual approach reveals that, concerning the public burden of disease, morbidity and mortality trends are becoming similar for men and women while, with the domestic burden of disease, gender shows that differences seem to persist in men and women’s roles within the family, particularly involving illness prevention and management at home. This argument is explored in this paper through two types of evidence: to investigate the domestic burden of disease, reference is made
to findings from studies on gender roles in the family; and the public burden of disease is explored using the World Health Organization’s latest figures on mortality and morbidity. The domestic and public dimensions of the burden of disease are discussed in the context of ten Asian countries at different stages of socio-economic development (Japan, Singapore, South Korea, Malaysia, Thailand, China, Indonesia, Philippines, Vietnam and Cambodia).
The purpose of this paper has been to provide a framework for conceptualizing the health care needs of economically disadvantaged urban residents. The need to approach health problems in a comprehensive manner was stressed. It is felt that a broad framework such as the one outlined is needed in the area of medical activity currently referred to as social psychiatry. The kinds of data systems that are needed in order to effectively plan for health care needs were reviewed. The ideas presented constitute an orientation and a rationale that can be followed when attempting to develop ways of dealing with the health care needs of the economically disadvantaged population sector. In this orientation, behavioral science constructs and methods are brought to bear on medical phenomena, the latter viewed generically. Ways of combining differing types of needs in order to arrive at an index that reflects the relative need of the community was discussed.
Using a general systems model this paper examines the role of political ideology, particularly the “Thoughts” of Mao Tse Tung, in fulfilling the functional prerequisites of the Chinese health system. Materials from the Peking Review are utilized in analyzing the contribution of ideology as guide to treatment priorities, basis for diagnosis and therapy, explanation of health care failures, rationale for health delivery systems, channel for patient gratitude, justification for health, sensitivity training for health workers, basis for health ethnocentrism, and as motivational devices for health workers and patients. The case of China is offered as an example of social control over a key professional area through system input of ideological information, and of the barriers to such input in the American situation.
This Special Issue of Social Science & Medicine investigates the potential for positive inter-disciplinary interaction, a 'generative dance', between organization studies (OS), and two of the journal's traditional disciplinary foundations: health policy and medical sociology. This is both necessary and timely because of the extent to which organizations have become a neglected topic within medical sociology and health policy analysis. We argue there is need for further and more sustained theoretical and conceptual synergy between OS, medical sociology and health policy, which provides, on the one-hand a cutting-edge and thought-provoking basis for the analysis of contemporary health reforms, and on the other hand, enables the development and elaboration of theory. We emphasize that sociologists and policy analysts in healthcare have been leading contributors to our understanding of organizations in modern society, that OS enhances our understanding of medical settings, and that organizations remain one of the most influential actors of our time. As a starting point to discussion, we outline the genealogy of OS and its application to healthcare settings. We then consider how medical sociology and health policy converge or diverge with the concerns of OS in the study of healthcare settings. Following this, we focus upon the material environment, specifically the position of business schools, which frames the generative dance between OS, medical sociology and health policy. This sets the context for introducing the thirteen articles that constitute the Special Issue of Social Science & Medicine.
This paper reviews differential diagnosis of the difficult oncology patient, focusing on how the patient, the physician, the patient-physician relationship, and the cancer setting may all contribute to clinicians' experiences of difficulty. Because many difficult patients have personality disorders, we then review assessment and treatment of the personality disorders that tend to be most problematic in the cancer setting, suggesting a team-based approach for management.
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