On being credibly Ill: Class and gender in illness stories among welfare officers and clients with medically unexplained symptoms (original) (raw)
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The Interaction of Class and Gender in Illness Narratives
Sociology, 2008
Perspectives on gender and identity that emphasize variability of performance, local context and individual agency have displaced earlier paradigms.These are now perceived to have supported gender stereotypes and language ideologies by emphasizing gender difference and homogeneity within genders. In a secondary analysis of health and illness narratives we explore the interaction of class and gender in individuals' constructions of gendered identity. High social class men perform gender in particularly varied ways and we speculate that this variable repertoire, including the use of what was once termed `women's language', is linked to a capacity to maintain social distinction and authority. Men's performance of conventional masculinity is often threatened by both the experience of illness and being interviewed about personal experience. Lower social class women in particular demonstrate an intensification of a pre-existing informal family and support group culture, ma...
Journal of Power, 2010
In modern, neo-liberal societies like Denmark, social welfare and medical treatment are provided to individuals who ‘take ownership’ of their problems. Thus, sickness benefits are given to people who suffer from their ‘own illnesses,’ not to people with diffuse, chronic pains ‘of the whole person.’ This article presents findings from a qualitative research project into how power relates to identity negotiations among social workers and medical doctors who are dealing with patients who lack a bio-medical identity. The analysis shows that social workers and doctors have swapped roles in their negotiation with patients and that the new roles can be related to structural elements such as the law and discursively produced understandings of what it is to be a ‘patient.’ Keywords: neo-liberalism; discursive power; structural power; identity; diagnosis; illness
Social Theory & Health, 2015
The present article examines how doctors explain patients’ symptoms that are medically unexplained (MUS). Present analysis departs in a qualitative study that was conducted in Denmark in 2008–2009 and involved eight small group interviews and three individual interviews with 21 doctors. The following themes evolved from the interviews: (i) descriptions of patients with MUS, (ii) the role of the welfare system and (iii) the role of general practitioner (GP)s in their contacts with this particular patient group according to the doctors. The study demonstrates that MUS patients’ symptoms fail as symptoms in the context of medicine; however, the study shows that if doctors apply the politicised context of the current welfare state in Denmark, then they are able to translate the symptoms of MUS patients into social problems. Doctors can subsequently explain the symptoms described by MUS patients. The study finds that GPs assume a politicised role in their contact with MUS patients, which valorises moral reflections on the Danish welfare state and results in descriptions of individuals’ well-being that are in accordance with a political context regarding the rights and obligations of citizens.
In recent years an extensive social gradient in cancer outcome has attracted much attention, with late diagnosis proposed as one important reason for this. Whereas earlier research has investigated health care seeking among cancer patients, these social differences may be better understood by looking at health care seeking practices among people who are not diagnosed with cancer. Drawing on long-term ethnographic fieldwork among two different social classes in Denmark, our aim in this article is to explore the relevance of class to health care seeking practices and illness concerns. In the higher middle class, we predominantly encountered health care seeking resembling notions of health consumerism, practices sanctioned and encouraged by the health care system. However, among people in the lower working class, health care seeking was often shaped by the inseparability of physical, political, and social dimensions of discomfort, making these practices difficult for the health care system to accommodate.
Hillman 2014 Sociology of Health & Illness
This article examines the processes of negotiation that occur between patients and medical staff over accessing emergency medical resources. The field extracts are drawn from an ethnographic study of a UK emergency department (ED) in a large, inner city teaching hospital. The article focuses on the triage system for patient prioritisation as the first point of access to the ED. The processes of categorising patients for priority of treatment and care provide staff with the opportunities to maintain control over what defines the ED as a service, as types of work and as particular kinds of patients. Patients and relatives are implicated in this categorical work in the course of interactions with staff as they provide reasons and justifications for their attendance. Their success in legitimising their claim to treatment depends upon self-presentation and identity work that (re)produces individual responsibility as a dominant moral order. The extent to which people attending the ED can successfully perform as legitimate is shown to contribute to their placement into positive or negative staff-constituted patient categories, thus shaping their access to the resources of emergency medicine and their experience of care.
Class differences in the social consequences of illness?
Journal of Epidemiology & Community Health, 2002
Study objective: To investigate adverse social consequences of limiting longstanding illness and the modifying effect of socioeconomic position on these consequences. Design: Cohort study on the panel within the annual Swedish Survey of Living Conditions where participants were interviewed twice with eight years interval 1979-89 and 1986-97. Sociodemographic characteristics, self reported longstanding illness, employment situation and financial conditions were measured at baseline. Social consequences (economic inactivity, unemployment, financial difficulties) of limiting longstanding illness were measured at follow up eight years later. Setting: National sample for Sweden during a period that partly was characterised by high unemployment and reduction in insurance benefits. Participants: Participants were 13 855 men and women, economically active, not unemployed, without financial difficulties at the first interview and aged 25-64 years at the follow up. Main results: Persons with limiting longstanding illness had a higher risk of adverse social consequences than persons without illness. The effect was modified by socioeconomic position only for labour market exclusion while the effects on unemployment and financial difficulties were equal across socioeconomic groups. Conclusions: Labour market policies as well as income maintenance policies that deal with social and economical consequences of longstanding illness are important elements of programmes to tackle inequalities in health. Rehabilitation within health care has a similar important part to play in this.
Identity work and illness careers of patients with medically unexplained symptoms
Health, 2017
This article reports a case study of the illness career and identity work of patients who have had medically unexplained symptoms for many years with a particular emphasis on their interactions with a specialized and standardized health care system. Patients with medically unexplained symptoms often experience being met with mistrust and feel their identity threatened as a consequence of being illegitimately ill. There is a strong tendency in health care towards assessment thorough standardized so-called assessment packages. The study used a case study approach. Ethnographic fieldwork was carried out and several types of data were sampled through theoretical sampling, resulting in data from and about a sample of 13 patients, from which two patients were selected as cases.
year: 2003, 2003
Background: Mental health care in Sweden encounters a multicultural population. Meaning given to illness may differ between patient, family and caregiver and this affects the clinical encounter and outcome of treatment. The general aim of this thesis is to explore, understand, and describe how a group of Swedish and a group of Turkish-born women, assessed as somatizing by their caregivers, and in contact with local health care in Western Stockholm, gave meaning to their illness. Additional aims are to explore participants' restructuring of illness meaning, caregivers' experiences and meanings of encountering patients using a bodily idiom for emotional distress, in a multicultural milieu, and how caregivers imparted their professional agenda of illness meaning. Methods and results: The thesis consists of five explorative qualitative studies and one paper discussing methodology. Data were collected 1997-2001. Study I explores structures of illness meaning among 8 Swedishborn women. Data were collected via 25 interviews. Some data were collected to reflect the caregivers' professional opinions. Study II explores structures of illness meaning among 10 Turkish-born women. Data were collected via 29 interviews. Some data were collected to reflect the caregivers' professional opinions. Results of Studies I and II describe illness expressions, healing strategies, meanings, and initial differences in illness meaning between participants and caregivers, caregivers' introduction of a "psychological language" of distress, and participants' efforts to grasp their caregivers' meaning. Study III explores restructuring of illness meaning among the 10 Turkish-born women from Study II. Data were collected by a secondary analysis of data from Study II and 8 new interviews. Results describe restructuring to include loss of meanings, shifts in expressions and healing strategies, and a push towards restructuring illness into a psychological or psychiatric framework. Restructuring was in many ways a disruptive experience and participants tried to bridge gaps between perspectives. In this, they perceived poor support from their social context. Study IV explores restructuring of illness meaning among the 8 Swedish-born women from Study I. Data were collected by a secondary analysis of data from Study I and 7 new interviews. Results describe restructuring to include two trends, firstly an acceptance of a psychological language of distress and secondly paying attention to stress and demanding work conditions. Restructuring was not uncomplicated and participants tried to bridge gaps between perspectives. In this, the social context was important. Study V explores caregivers' experiences and meanings of encountering patients using a bodily idiom for emotional distress in a multicultural milieu and how caregivers imparted their professional agenda of illness meaning. Data were collected via 7 focus group interviews. Results describe caregivers' experiences and meanings and that, in imparting their professional agenda, caregivers lacked support from organisational structures and clinical models for adapting work to the multicultural population and for treating mental ill health in primary care. Paper VI highlights the experiences, and reviews the literature, of using focus groups as a qualitative method in transcultural psychiatric research. Discussion and conclusion: From the results of Studies III & IV, I suggest that Antonovsky's Sense of Coherence Concept may be relevant when considering the restructuring of illness meaning, and that constructing coherence between experience, expression, and past and new illness meanings, may be significant for patients' recovery. From the results of Studies I-V, from a patients perspective, I wish to formulate the following hypotheses for the clinical encounter of emotional distress and mental illness in multicultural milieus: 1) Constructing a sense of coherence between experience, expression, past and new meanings given to illness, may be significant for patients' recovery. 2) Regarding clinical transaction of meanings, for the disruptive experience of illness, restructuring patients' illness meaning needs to be carried out in such a way as to facilitate for the patient to construct a sense of coherence between her/his illness meaning and the caregivers' medical framework. 3) The individual illness reality of the patient needs to be given an integral and important role as a collaborative resource alongside the medical framework. Implications: For the clinical encounter, results stress the significance of becoming acquainted with patients' meanings associated with illness experiences. For caregivers, in multicultural milieus, results argue for the importance of support from organisational structures and shared formulated models for adapting their work to the diversity of the population and for treating mental ill health in primary health care. For research, results point to the significance of further studies on interaction between health care and individuals and different social/cultural groups as well as on how people make sense of, use, and cope with the clinical encounter for recovery. This is of special importance for patients in an immigration situation as immigration involves being uprooted, dislocated and relocated.
Class, Social Suffering and Health Consumerism
Medical Anthropology, 2015
In recent years an extensive social gradient in cancer outcome has attracted much attention, with late diagnosis proposed as one important reason for this. Whereas earlier research has investigated health care seeking among cancer patients, these social differences may be better understood by looking at health care seeking practices among people who are not diagnosed with cancer. Drawing on long-term ethnographic fieldwork among two different social classes in Denmark, our aim in this article is to explore the relevance of class to health care seeking practices and illness concerns. In the higher middle class, we predominantly encountered health care seeking resembling notions of health consumerism, practices sanctioned and encouraged by the health care system. However among people in the lower social class, health care seeking was often shaped by the inseparability of physical, political, and social dimensions of discomfort, making these practices difficult for the health care system to accommodate.
British Journal of Political Science
Politicians engage in, and the media amplifies, social constructions of welfare recipients as undeserving. Such messaging seeks to influence mass public opinion, but what are the effects on the target population receiving welfare benefits? We test if deservingness messaging affects welfare recipients' mental health. To do so, we exploit a quasi-experiment entailing a dramatic shift in deservingness messaging after a welfare recipient in Denmark became the subject of a national debate, utilizing detailed administrative data on the ensuing consumption of antidepressants by other welfare recipients. We find evidence that welfare recipients experienced worse mental health outcomes after being exposed to deservingness messaging, reflected in a 1.2-percentage-point increase in the use of antidepressants in the weeks following the airing of a critical interview. Deservingness messaging particularly affected more vulnerable groups who had a history of mental health problems.