Love in Times of Cholera: Systemic Reflections on Supporting Families Through the Journey(s) of Illness

This paper is the result of our increasing interest in the experience of illness in families and the concomitant reflections on how best to therapeutically support these families through this process. This interest led us to reflect on the nuanced way in which language establishes a play with the experience of illness, a play that can amplify or reduce its effects. Such an interplay in turn led us to consider the valuable role that family therapists have in helping families and treating practitioners to create a safe space for conversation about illness. Further questions are also explored in relation to whether there is a role for family therapists in facilitating the interface between our clinical practice with clients and the wider treating medical community. And, if so, what shape would such an interface take? Considerations at this level would include the anticipation of psychological reactions to diagnosis of chronic and life‐threatening illnesses, in particular the importance of ‘normalisation’ of the psychological reactions to such chronic and/or life threatening diagnoses; the complex dynamics emerging from the interface between the effects of illness in the subjectivity of the ill person and the grief experienced by the other family members; different family members’ narratives of the illness; relevant community contexts; and, lastly, ways to help the family members and/or the ill person navigate the medical system including the use of second opinions, cyberspace information, and other systems in their ecology, such as the spiritual dimension. Some aspects of children's narratives of illness are also identified. The paper has been organised around the dialogue that the authors had around one of their clinical cases.     

Understanding Environmental Risk Perceptions: A Case of Contested Illness in South Florida

Communities facing environmental health threats can experience contention when residents have conflicting interpretations of risks; yet little is known about the social–psychological processes that contribute to divergent risk perceptions in these cases. Drawing on previous work on environmental contamination, contested illness, and literature on risk perceptions, we offer a framework for analyzing how residents assess potential environmental risks. Using the case of The Acreage, Florida, we examine a community where a cancer cluster has been established, but an environmental cause has not been determined. Specifically, we ask how residents individually assess risks concerning possible environmental contamination in cases of contested illness. Data come from 57 in‐depth interviews conducted with current and former residents of The Acreage. We argue that residents utilized particular cognitive heuristics to develop understandings and assessments of the situation. However, when these assessments contradicted those of other residents, community conflict emerged. We conclude by discussing how the framework utilized in our analysis can be applied in future research of contaminated communities.     

Environmental Hazards and Veterans'Framing of Gulf War Illness

Military personnel and other civilians were exposed to numerous environmental hazards during their service in the Persian Gulf Crisis. Nearly a decade later well over 100,000 veterans, spouses, and other civilians are claiming illnesses related to these exposures. The U.S. government denies a connection and refuses to sanction these claims of environmental illness. Analyzing data from in-depth interviews and various documents, the author examines the veterans'framing of Gulf War Illness and the government's response to this environmental illness frame.     

Factors Affecting Older Women's Adherence to Medication and Treatment

Over the past 25 years, there has been a growing interest in why many patients do not take prescribed medications or fail to follow medical advice. As many as 50% of all patients fail to adhere adequately to therapeutic advice or engage in inappropriate use of prescribed medications. Additionally, there has been a struggle over how best to describe this variance between what medical practitioners recommend and what patients actually do. This article examines factors thought to affect women's adherence to medication and treatment regimens. Literature on age, comorbid conditions, socioeconomic factors, environmental factors, and perceived susceptibility for an illness is reviewed as are individual psychological idiosyncratic dynamics that may influence health care behaviors.     

COMMUNITY FRAME ANALYSIS IN LOVE CANAL: UNDERSTANDING MESSAGES IN A CONTAMINATED COMMUNITY

This article addresses the development of frame analysis in understanding the environmental problems in a contaminated community. The problems at Love Canal, New York are examined through the use of local newspaper sources, government archives, and historical documents, such as activist and industry publications. Four distinct frame sources are examined at Love Canal: local newspaper coverage, community activists, government, and industry. These frames represent major differences in how the specific environmental and social problems at Love Canal were represented to the public. Specifically, contrasting opinions focus on four planks: the existence of a problem, victims of a problem, liability, and resettlement. Conclusions address the social construction of environmental problems and the dependence on direct experience when adopting frames. Understanding the messages that individuals receive in the time of environmental crisis is a critical step in understanding community response and reaction to the problem.     

Electronic support groups, patient-consumers, and medicalization: the case of contested illness

This article illustrates the role electronic support groups play in consumer-driven medicalization. The analysis is based on an observational study of a year in the life of an electronic support group for sufferers of the contested illness fibromyalgia syndrome. The analysis builds on and extends scholarship concerning the growing influence of lay expertise in the context of medical uncertainty by showing how the dominant beliefs and routine practices of this electronic community simultaneously (and paradoxically) challenge the expertise of physicians and encourage the expansion of medicine's jurisdiction. Drawing on their shared embodied expertise, participants confirm the medical character of their problem and its remedy, and they empower each other to search for physicians who will recognize and treat their condition accordingly. Physician compliance is introduced as a useful concept for understanding the relationship between lay expertise, patient-consumer demand, and contemporary (and future) instances of medicalization.     

Time,Knowledge, and Power in Psychotherapy: A Comparison of Psychodynamic and Cognitive Behavioral Practices

Time has long been recognized as a marker of professional control and a tool for the organization of work. Yet we know less about how temporality intersects with experts’ epistemic goals. This article illustrates how the patterning of time in psychotherapy shapes the construction of knowledge about mental illness and how this relationship is mediated by patients’ own interventions. I focus on psychodynamic and cognitive behavioral therapeutic practices and draw on data from ethnographic observations in an outpatient psychiatry clinic and in-depth interviews with psychotherapists. The article details the constitutive relationship between two dimensions of temporality: first, clock time, namely the length of treatment, the length and frequency of sessions, and the flow of the therapy hour, and second, the temporal epistemics of illness, its construction as a phenomenon with a past, present, and future. Clinicians in the two orientations attempt to construct particular temporal landscapes by integrating these two facets of their work. Yet they must always do so in response to patients’ own temporal interventions. By attending both to the organization of professional work and the temporality of illness, this article brings together two largely distinct literatures within medical sociology, namely scholarship on the profession of medicine and social scientific understandings of the temporal dimensions of illness. It shows that temporality is constitutive of how knowledge and power are negotiated in expert work.     

Individualization and Prevention

SUMMARY

In 1905, Massachusetts General Hospital initiated the first medical social work program in the United States. Based on the writings of its leaders, this paper presents the early history of medical social work in the United States. Inspired by developments in European health care that emphasized the community context of disease, medical social work pioneers saw a need to individualize the patient while also promoting public health measures in the community, improving the patient's environment to eliminate the causes of disease. In addition, since they served patients because of their diseases rather than their poverty, medical social workers were among the first to provide social work services to the non-poor. In spite of their emphasis on environmental change, many of early medical social work leaders had an anti-institutional bias; they were suspicious of large-scale solutions for what they saw as fundamentally individual problems. Consequently, methods for promoting individual adaptation developed more rapidly than methods for promoting environmental change. Ironically, the medicalization of social problems in contemporary times has resulted in a focus on individual pathology rather than social and lifestyle causation in health, even as the rising cost and complexity of the system challenges health care consumers in the United States. Reaffirming the environmental emphasis of medical social work pioneers provides a way for today's health care social workers to incorporate environmental modification into their practice and promote the health of all citizens.     

Job matching and return to work: Occupational rehabilitation as the link

Return to work after injury or illness is important for the worker and the employer. Medical providers manage and treat the worker with the illness or injury. Except in cases of focused specialists, the medical professional's role is to take care of a patient, rather than empower a worker. As much as there is promotion of the workers compensation health care system to be similar to sports medicine, there are significant dissimilarities. One major barrier is that the medical caregivers do not know the demands of jobs as they would know the details of sports. Thus, there is a gap in returning a worker to function as the medical professional cannot accurately match the worker to specific jobs. A new model of job function matching, based on research and skills of occupational rehabilitation professionals, is proposed to bridge the gap between the medical community, the employers and the workers.     

A PLACE TO CALL HOME: Identification With Dwelling, Community, and Region

The concept of place identity has been the subject of a number of empirical studies in a variety of disciplines, but there have been relatively few attempts to integrate this literature into a more general theory of identity and environment. Such endeavors have been limited by a lack of studies that simultaneously examine identification with places of different scale. This article addresses this critical omission by analyzing how residents of Cape Cod, Massachusetts, develop a sense of home with respect to dwelling, community, and region. Our results suggest that different social and environmental factors discriminate identification across place loci: specifically, that demographic qualities of residents and interpretive residential affiliations are critical to dwelling identity; that social participation in the local community is essential for community identity; and that patterns of intercommunity spatial activity promote a regional identity. Such understandings, we propose, are important to constructing an integrated theory of place identity, one sensitive to the complex ways the self is situated in the social-spatial environment.     

Urban gradients alter the diversity,specific composition and guild distribution in tropical butterfly communities

The increasing expansion of the urban environment has been considered one of the causes of biodiversity loss. Due to the decrease of the quantity and quality of habitats, this process causes the restriction of organisms to sometimes-specific microhabitats. The patterns of variation of the biodiversity along the environmental gradients, however, are still poorly understood. This study evaluated how urban gradients affect the diversity, specific composition and frequency of guild of the community of butterflies. Butterflies were collected in three transects continuously traversing the urban, rural and preserved habitats using baited traps and by active sampling. We found that the urban gradient acts as an environmental filter in the butterfly communities, reducing the richness and frequency of guilds of frugivorous butterflies, structuring the community through turnover, but without effects in the abundance. This study shows the importance of the urban gradients approach in the butterfly community and its applicability in the management of urban areas in order to include native vegetation along the gradients, aiming at increasing environmental heterogeneity, to preserve butterflies and maintain the ecosystem services and network interactions in altered landscapes.

     

‘Our Diagnoses,Our Selves’: The Rise of the Technoscientific Illness Identity

Biomedicine situates the definitions, practices, and controls of the medical system within the field of technoscience, which relies on new knowledge, high technology, and biomedical health and risk surveillance. Since the middle of the 20th century technoscientific efforts to understand human phenomena at the microbiological level have secured the place of the biomedical model of disease and the technology used to understand and manage human bodies, selves, and socialities. Specifically, high technology has provoked a paradigm shift from controlling disease and finding cures (medicalization) to transforming bodies and managing risk through technoscientific means (biomedicalization). Though there has been a major shift in the role of the medical consumer since the 1970s and a general recognition of patients’ rights to meaningful information about their health and illness conditions, biomedicine holds significant authority over peoples’ lives to the degree that biomedicalization now involves the production of individual and collective identities that are constructed through technoscientific means. The technoscientific identity has even become a type of illness identity that involves applying biomedical information and characteristics to a person’s sense of self in the face of illness.     

The cost of implementing a jail diversion program for people with mental illness in San Antonio,Texas

Jail diversion programs for people with mental illness are designed to redirect offenders with mental illness into community treatment. Although much has been published about program models and their successes, little detail is available to policy makers and community stakeholders on the resources required to start and implement a jail diversion program and which agencies bear how much of the burden. The current study used data on a model jail diversion program in San Antonio, Texas, to address this research gap. Data on staff costs, client contacts, planning, and implementation were collected for three types of diversion: pre-booking police, post-booking bond, and post-booking docket. An activity-based costing algorithm was developed to which parameter values were applied. The start-up cost for the program was $556,638.69. Pre-booking diversion cost $370 per person; 90% of costs were incurred by community mental health agencies for short-term monitoring and screening (>80% of activities). Post-booking bond and docket diversion cost $238 and $205 per person, respectively; the majority of costs were incurred by the courts for court decisions. Developing a multiple-intercept jail diversion program requires significant up-front investment. The share of costs varies greatly depending on the type of diversion.     

Enabling careers, autonomy, and prosperity: Using community organizing and building approaches to improve the educational outcomes of people with mental illness

Objectives: The objective of this regional initiative was to develop access to educational opportunities for people with mental illness with a view to ultimately advancing their career prospects. Participants: The initiative engaged a broad range of community stakeholders including people with mental illness, their families, educators, mental health service providers and, policy analysts. Methods: The initiative used community organizing and development strategies to develop solutions to problems related to access to education. Results: The initiative was successful in mobilizing community participation, identifying priorities, and translating these priorities into action plans. Working groups of community stakeholders engaged in initiatives related to improving access to resources to support education, developing training for teachers in secondary schools, creating peer support systems, and developing a pilot supported education program as a partnership between a college and mental health service. Conclusion: Organized community building provided a foundation for a broad range of initiatives meant to improve access to educational opportunities for people with mental illness. Evaluation efforts will need to focus on the extent to which these initiatives ultimately ledto positive changes in the careers of people with mental illness.     

Disability and Chronic Illness Identity: Interviews with Lesbians and Bisexual Women and Their Partners

Disability rights activists and cultural workers are articulating disability identity and culture. Through interviews with lesbians and bisexual women with disabilities or chronic illnesses and their partners, the present study examined disability/chronic illness identity on the level of individual, couple, and community. Participants shared differing perspectives about how disability/chronic illness identity relates to other aspects of identity, and about whether disability/chronic illness identity is fluid or constant. They described several challenges they have encountered in developing disability/chronic illness identity. Couples talked about developing boundaries and balance in their relationships, and about how disability or chronic illness has strengthened their relationships. A number of participants spoke about identity as intimately linked with community. Implications for community building are discussed.     

Environmental Health Advocacy and Industry Obstruction: The Case of Black Lung Disease

There has been a deadly resurgence of black lung disease, particularly in central Appalachia. The disease has a long and contentious history in the United States. During the 1960s, coal miners and their supporters successfully mobilized for recognition and treatment of the disease when it was largely eradicated. We draw from literature on environmental health movements and contested environmental illness to analyze black lung advocacy and continued obstruction from the coal industry. Our data come from a case study that includes in-depth interviews, participant observation, and document analysis. Results indicate that the black lung movement is now being spearheaded by professionals, such as medical and legal advocates, who partner with retired miners and their supporters. Unlike previous organizing efforts around black lung, active miners are largely absent from current advocacy efforts. Our findings also reveal four major obstruction tactics utilized by the industry, including: (1) industry denial, (2) falsifying records, (3) fear and intimidation, and (4) contestation of new regulations.     

Negotiating Sustainability: Climate Change Framing in the Communications,Energy and Paperworkers Union

Environmental problems are often reduced to a catch‐22 that portrays sustainability‐oriented policies as disastrous for resource sector workers. Despite efforts by many industry leaders to frame climate change in “jobs versus environment” terms, the Communications, Energy and Paperworkers Union of Canada (CEP) has supported ambitious greenhouse gas reduction policies. Using interviews with union members and staff, this study examines CEP's climate change framing. It finds that CEP extended the environmental justice master frame to define its response to climate change, neutralize anti‐Kyoto rhetoric, and work with the environmental movement. CEP's framing was accomplished through negotiation processes that continue to unfold as members work out the union's positions relative to their own values, experiences, and interpretations of what is possible. These findings suggest sustainability can be understood as an emergent, localized, and contested social order, and point to “self‐negotiation” in longer‐term social change struggles as a potential area of further study.     

From an Agrarian to an Environmental,Food, and Natural Resource Base for Agricultural Policy: Some Reflections on the Case of the EC

Abstract The agriculture of the European Community (EC) has experienced significant changes in the last decade. From a situation of deficiency in agricultural and food production, the twelve-nation community has shifted to a situation of food overproduction. This change has also been characterized by a rapid decrease in the agricultural labor force and a decrease of its importance in the employment structure which has manifested itself in fewer, more efficient farms. This alteration of structural conditions has led to the emergence of a new set of agricultural issues. This article discusses these changes by underscoring the decline of agrarian-based issues and the emergence of environmental, food, and natural resource-based issues. It is maintained that EC agricultural policies have been instrumental in both the resolution of agrarian-based issues and in the creation of new problems embodied in the environmental, food, and natural resource-based policies. The combination of the demise of agrarian-based policies and the emergence of environmental, food, and natural resource-based policies is also employed as a theoretical perspective from which the evolution of the agricultural sector in the EC can be interpreted.     

Schizophrenia Fellowship of Australia,Inc.

One of the most stigmatized health areas is mental health, so the feasibility of a self-help organization to assist those with the common mental illness, schizophrenia, was contemplated with some misgivings by the Victorian Mental Health Authority in 1977. However, as it was departmental policy to encourage community involvement in alleviating mental illness and its associated problems, a number of relatives of people with schizophrenia were contacted to assess their reaction to the proposition. The response was positive and eight relatives agreed to become a steering committee to organize a public meeting to put forward the idea of forming a self-help organization centred on schizophrenia.     

Accounting for the Performance of Environmentally Significant Behavior: The Symbolic Significance of Recycling

The scientific community has pronounced climate change unequivocal and its consequences disastrous. Yet Americans' behavioral response to the global social problem of environmental degradation has been largely confined to the individual act of recycling. This article examines why Americans are not doing more to address climate change and other environmental issues. Taking a cognitive sociological perspective, I describe how Americans think about environmental issues and pro‐environmental behavior. I draw on Swidler's concept of a “cultural tool kit,” to examine the cultural narratives Americans use to account for the small amount of pro‐environmental behavior they perform. The act of recycling functions as a synecdoche for pro‐environmental behavior in general, allowing individuals to over‐claim the significance of a modest amount of pro‐environmental behavior. I argue that Americans' failure to engage with environmental issues at a collective level is rooted in the individualized culture of American environmentalism.