Sociology of health & illness最新文献

This article analyses mental health support through the lens of care. Drawing upon a study of various practices of teletherapy and remote counselling during the COVID-19 pandemic, it empirically analyses mental healthcare by tapping into the experiences of Finnish therapy and counselling professionals. In telecare, digital technology with its particularities brings forth particular forms of (networked) care: networked connectivity and the relations formed with and through digital technologies operate as 'worlding practices' that bring different modes of mental healthcare into being. Taking as its point of departure the assumption that networked connectivity has transformed and is transforming mental healthcare, this article seeks ways of incorporating networked connectivity into understandings of the enactment of care. By bringing together insights from science and technology studies, feminist materialism and research on networked connectivity, it is interested in asking and analysing how care comes to matter in networked societies. In particular, insights from studies of care networks and network connectivity are brought together to provide novel insights into these configurations and entanglements of care. Through detailed empirical analysis of interviews, the article further develops a concept of networked care.

Low-value care (LVC) is increasingly the focus of debates on how to reduce the use of healthcare resources while maintaining quality care. General practitioners (GPs) are often considered central to this aim. Although GPs facilitate early disease detection, disease prevention and coordinated medical care, they must do so while aiming to protect both patients and the healthcare system from the harmful effects of medical overactivity. Public healthcare systems with gatekeeping practices, such as Denmark, lack many of the identified economic and structural incentives for LVC. Why then does LVC persist? Drawing on ethnographic observations and interviews with practising GPs, we explore how Danish GPs handle the difficult task of drawing a line between what requires medical attention and what should be left untreated or monitored. Our findings suggest that LVC literature may overlook the value of some interventions when used by GPs to improve patient trajectories over a longer term, maintain the relationship between patient and practitioner or balance the use of time and resources across the healthcare system. We clarify this point by unpacking the relational and context-dependent work of GPs, which is central to their capacity to serve as trusted gatekeepers.

Narratives of resilience are proliferating in health policy and research where they are used to address problems threatening individuals and communities. Resilience approaches are often considered alternatives to other models of intervention because they signal a shift away from deficit assumptions to more empowering ways of promoting health. To date, however, there has been a lack of scrutiny of the nature, assumptions and effects of resilience discourse within the health field. This paper critically analyses the logics that underpin the use of such discourse, and the implications of their allure. Findings show that resilience discourse is largely understood and operationalised in neoliberal, individualistic and reductionist terms. Such logics create normative standards for what counts as 'proper resilience' and, by doing so, engender experiences of guilt and shame when individuals are not 'resilient enough'. Seen differently, through the logics of social relationality, for example, resilience can engender new forms of subjectivity and practice for individuals and communities as 'expert' and 'knowing'. Relational resilience is especially evident in First Nations scholarship, where it is conceptualised in terms of collective values, practices and identities rather than the attributes of individuals, offering opportunities to advance thinking about resilience and its use in health contexts.

We aim to explore the association between racial discrimination across the life course on common mental disorders (CMD) during the COVID-19 pandemic, testing direct and indirect pathways. Cross-sectional data were obtained from the Evidence for Equality National Survey (Feb-Nov 2021, N = 8897 ethnic minority people aged 18-60). The survey measured experiences of racial discrimination across multiple domains and time periods. Path analyses were used to explore the associations between racial discrimination and CMD and the indirect associations via SARS-CoV-2 infection, financial concerns, loneliness and belonging. We find a clear dose-response relationship between experiences of racial discrimination over time and CMD. Compared to no reporting of experiences, chronic experiences of racial discrimination were associated with 2.91 times the odds of CMD (95%CI: 2.33-3.65; recent experiences only OR = 2.11, 1.67-2.67; past experiences only OR = 1.50, 1.16-1.92). Recent and chronic experiences of racial discrimination (but not past experiences) were also indirectly associated with CMD, via SARS-CoV-2 infection, greater financial concerns, greater feelings of loneliness and a reduced sense of belonging. These findings were consistent across all domains of racial discrimination, indicating that racial discrimination in any setting can negatively impact mental health. Anti-racist interventions which target the interconnected dimensions of racism are needed.

Psychiatric and psychological research has confirmed that less than 1% of the research on eating disorders is focused on males. However, for the first time, the occurrence of eating disorders is reportedly growing faster among the male population. Nevertheless, men still are more likely to stay undiagnosed. This paper bridges this gap and offers an analysis of male eating disorders (MEDs) and particularly drawing from a feminist technoscience perspective, it examines how male eating disorders are made up in clinical practices and encounters. Specifically, in this paper, I investigate the different ways by which male eating disorders emerge as a situated matter of concern and object of clinical care. In other words, I explore the 'making present' of the male and maleness in the clinical practices treating eating disorders in the Australian healthcare system. Based on the data from 25 semi-structured, qualitative interviews with clinicians, the paper draws out how care in relation to eating disorders is organised and, specifically, how the enactment of a female/male binary mobilised in clinicians' accounts of clinical practices may act to constrain care. Finally, I demonstrate how care practices could attend to male eating disorders differently in a more sensitive and intersectional way.

Drawing on perspectives of care work as a collaborative and negotiated practice, this paper aims to explore how older service users actively contribute to care work and situations of care in the reablement policy context of homecare. The study analyses how service users in Danish and Norwegian municipal homecare settings place their bodies at disposal and how care workers' responses to service users' embodied contributions shape care practice and situations of care. Four ways of placing service users' bodies at disposal were identified: proactively, dependently, reluctantly and instructively. Care workers' capacity to attentively respond to service users' physical and emotional needs and their flexibility and adaptiveness in dealing with service users placing their bodies at disposal in various ways, seem to be key for care work as a collaborative practice that promotes dignity in care. The study applies affective ethnography as a methodological and analytical approach.

This article examines how vulnerability emerged, evolved and was contested during Austria's COVID-19 response, by attending to the entangled realities of people with dis/abilities. Using a posthumanist, agential realist lens and a diffractive methodology, the research explores how vulnerability is not a fixed state but a dynamic process shaped by material and discursive practices. It introduces the concept of 'vulnerability effects' to articulate that vulnerabilities are simultaneously a product of and a catalyst for material and discursive practices within systems of dis/ability and crisis response. Drawing on Carol Thomas's distinction between disablism and impairment effects, the analysis moves beyond binary framings to capture how vulnerabilities are simultaneously produced by systemic inequalities and contested through creative acts of resistance. Through the narratives of participants navigating institutional restrictions, inaccessible environments and intersecting crises, the article illustrates how debilitating conditions and activist affordances intra-act, shaping the possibilities for agency and resilience. The findings reveal the fluid, context-dependent and performative nature of vulnerability, challenging static paradigms in crisis response. By reframing vulnerability as relational and emergent, the article calls for inclusive and response-able approaches to policy and social structures that address systemic neglect and promote equitable opportunities.

Across health research, drawing on accounts from people with lived experience is often promoted as a shift away from epistemic injustice wherein the knowledge of the marginalised is ignored/silenced. Paradoxically for people with mental distress who are given a diagnostic label, aspects of their accounts may actually be foregrounded to categorise them with mental illness/disorder. In doing this, their sense of reality (e.g., ontological experiences) can be judged to be significantly different from other people in addition to their epistemic knowledge and understanding. This points to issues of ontological differences between lived experiencers of various forms of mental distress that need deeper consideration in mental health research and practice, alongside the ongoing work on epistemic considerations. Experiencing serious mental distress can include a loss of trust in one's sensory/perceptual signals which complicates how one makes sense of experience and knowledge. The complexities around these processes is at odds with the more straightforward ideas about testimonial accuracy and speaker credibility that underpin epistemic knowledge goals. This review outlines often-overlooked issues related to ontological differences between people in the context of mental health and offers suggestions for the future.

This article considers how name change comes about by examining fieldwide debates among actors such as professionals and activists. Analysing a range of primary qualitative materials produced by leading US organisations over a 75-year period, it focuses on a case from the disability advocacy field in several shifts from older terms to more recent 'intellectual disability' (ID) language in the United States. As opposed to framing these changes solely as matters of identity politics or destigmatisation, I argue that these naming politics can be better historically contextualised as struggles fundamentally tied to organised lay/professional expertise and field position. Although many professionals resisted proposed changes as counterproductive, insurgent activists repeatedly marshalled their own claims to expertise surrounding the disability experience and eventually successfully pushed for the replacement of previously legitimate diagnostic terminology. This recognition of expertise, however, does not translate to equal footing among stakeholders but varies by timing and issue context. To highlight this, I differentiate between traditional and emergent 'expert identity' and extent of 'expert control'. I suggest such a perspective might be applied to a range of fields where similar disputes over language have come to occupy significant attention.

There is a dearth of literature focusing on how allyship in health may be enacted in relation to people with learning disabilities (LD). This is concerning, because people with LD are vulnerable to health inequalities and forms of medical dehumanisation including do-not-resuscitate orders, diagnostic overshadowing and overprescription of psychotropic drugs. Deploying critical disability studies as a lens through which to understand disability, this paper reviews models of disability allyship developed in healthcare, research and theatre. In doing so it advocates transformative allyship as a model that can both animate action in support of people with learning disabilities and accommodate the involvement of others, including clinicians, carers and relatives, without compromising the all-important commitment to supporting disability cultures. The paper presents and analyses ethnographic data gained through observations of eleven healthcare appointments between seven clinicians and five patients with LD, undertaken as part of the ESRC-funded study Humanising Healthcare. It documents the potential of transformative allyship in healthcare to transform harmful disablist practices through emphasising respect, attention and collaborative action while also noting that broader structural conditions and diagnostic technologies limit the extent to which clinicians can enact transformative allyship.