A critical theory of medical discourse: ideology, social control, and the processing of social context in medical encounters

The personal troubles that patients bring to doctors often have roots in social issues beyond medicine. While medical encounters involve "micro-level" interactions between individuals, these interpersonal processes occur in a social context shaped by "macro-level" structures in society. Examining prior theories pertinent to medical discourse leads to the propositions: (a) that medical encounters tend to convey ideologic messages supportive of the current social order; (b) that these encounters have repercussions for social control; and (c) that medical language generally excludes a critical appraisal of the social context. The technical structure of the medical encounter, as traditionally seen by health professionals, masks a deeper structure that may have little to do with the conscious thoughts of professionals about what they are saying and doing. Similar patterns may appear in encounters between clients and members of other "helping" professions. Expressed marginally or conveyed by absence of criticism about contextual issues, ideology and social control in medical discourse remain largely unintentional mechanisms for achieving consent.     

The Cycles of Social Work Practice

The social work profession has vascillated between addressing two different priorities during its history: personal troubles and public issues. The focus on personal troubles emphasizes the private interests, rehabilitation, and self-actualization needs of individuals. Public issues refers to collective needs, social action, and social reform. These riorities shaped the emergence of three distinct methods of social work practice-casework, groupwork, and community organization. This paper links these cyclical shifts in priorities to the socio-economic and political forces in American society, and suggests ways that the profession might sustain a practice framework that IS not so easily influenced by political cycles.     

Computer Ethics

Summary

As human service waiters implement computerized information technologies, they operate in areas in which problems of power, de-personalization, and the invasion of privacy are central. In attempting to understand and resolve these issues, studies of computer ethics deal with moral values, economic policy, and other social change impacts associated with computerization. Unfortunately, the diffuse focus of ethical discourse in computing is contusing. This paper, in clarifying the relation of “computer ethics” to issues of personal freedom, social control, and social inequality, seeks to provide human service workers and other professional computer specialists with a framework for identifying the social effects and moral dimensions of computerization.     

Wall Street Scandals: The Myth of Individual Greed1

There is rarely an introductory text in sociology that does not begin with C. Wright Mills’s (1967) distinction between personal troubles and structural or public issues. To lack sociological imagination is to confuse between these two levels of analysis in trying to explain public issues in terms of personal troubles, or history in terms of the individual’s biography. “Troubles occur within the character of the individual and within the range of his immediate relations with others; Issues have to do with matters that transcend these local environments of the individual and the range of his inner life” ( Mills, 1967:8 ). Issues are generated in response to the dynamics of the social system and unfold within the larger structural and historical contexts where the character of the individual takes shape. Yet, the most popular explanation of the contemporary financial crisis with its disastrous social and economic consequences is personal greed. It is the greedy investment bankers, corrupt politicians, and unscrupulous lobbyists who are to take the brunt of the current economic meltdown in the United States. A few bad apples on Wall Street have created havoc on Main Street. Here, one may argue that greed that—if not kept in check—which seems to afflict almost everyone, transcending social class and status boundaries, may be a public issue—a structural problem—rather than a problem within the character of the individual. Not to be greedy within the contemporary social and economic system may be considered pathological, an instance of personal trouble.     

Socialising disease: medical categories and inclusion of the aged1

When older peoples’ troubles are categorised as social rather than medical, hospital care can be denied them. Drawing on an ethnography of older people admitted as emergencies to an acute medical unit, the article demonstrates how medical categories can provide shelter for older people. By holding their clinical identity on medical rather than social grounds, physicians who specialise in gerontology in the acute medical domain can help prevent the over‐socialising of an older person's health troubles. As well as helping the older person to draw certain resources to themselves, such as treatment and care, this inclusion in positive medical categories can provide shelter for the older person, to keep at bay their effacement as 'social problems’. These findings suggest that contemporary sociological critique of biomedicine may underestimate how medical categorising, as the obligatory passage through which to access important resources and life chances, can constitute a process of social inclusion.     

On social work and what gender has got to do with it

Living in gendered societies makes it necessary to take into account the specific ways in which social problems and social issues affect the lives of women and men, girls and boys. Not only are social problems and social issues very often gender biased; this is also true for the professions dealing with these problems and issues, and for the training programmes for professions like social work. Sociological analysis of society and philosophical understanding of a good life are permeated by gender-specific perceptions -- often without those involved being aware of them. Furthermore, social policies reinforce gender-specific biases because they are based on gender-specific (i.e. male) standards. Gender as an analytical category has been brought into scientific and public discourse by feminist theoreticians and activists making women -- and thus also men -- visible with regard to structure and subject issues. The development of gender theory and research highlights the significance of gender arrangements to understand social phenomena and to support gender-equality ways of thinking and policies. At the same time, men and women are not only confronted with gendered structures, but via socialization processes and personal development they also reproduce these gender differences in their daily lives by 'doing gender'.     

阿Q精神对“屌丝”青年的社会引力

"屌丝文化"反映出社会变革转型期的时代特征和精神气质,透视、表征了社会心理结构的变迁。"屌丝"称谓放大为自我审视的精神符码,其传播具有庶民叙事的特征,网络亚文化由下而上的"话语革命"方式表达了"话语权"的获取与崛起。"屌丝文化"是自嘲中的解构与身份认同中的建构,它意味着青年草根阶层或弱势群体更多地获得了诠释自己生活的角度与权利。屌丝文化所反映的集体焦虑,折射了社会内在的深层次问题,其代表的自嘲韵味是解构文化中的快感和胜利,这和阿Q精神有着内在传承性,网上的"愤青"往往是现实生活中的"屌丝"。"虐骂"和"求虐"心理是屌丝文化集体喷射的快感。     

Pediatrics: The emerging psychosocial challenges of the AIDS epidemic

HIV has a pervasive and profound effect on the psychological, social and neuropsychological functioning of infected infants, children and their families. This article discusses direct and indirect psychological manifestations of HIV in children. Direct effects are the outcome of the virus acting on the central nervous system and can result in compromised cognitive, language, motor, socio-emotional and motivational functioning. Indirect effects involve psychological responses to the stress of living with a life threatening illness, the social ostracism, disruption in life goals and undergoing frequent invasive and protracted medical procedures. A major focus of this article is to outline and describe a model comprehensive psychosocial support system developed within the Pediatric Branch of the National Cancer Institute. This includes early intervention issues and strategies for working with families during the introductory phase of the treatment program that also provides the framework for a care management approach, salient mental health problems that frequently occur in this group, and appropriate interventions for individuals and families. Attention is also given to dealing with anticipatory loss and bereavement, implementing traditional innovative intervention techniques, and for providing advocacy services concerning possible legal, financial, housing, and educational issues.     

Breaking Down or Breaking Through

Abstract

Case studies of ten Hong Kong women diagnosed with depression demonstrate that depression is not necessarily, but can be, one strategy for dealing with the problems of everyday life. Neither is it always an outspoken critique of the family as an institution and the gender inequality in the Hong Kong society. However, depression should never be understood simply as personal or social pathology, but as an attempt to negotiate with social reality. These women used their bodies for experiencing, interpreting, and communicating about emotions and social issues. Depression is one of the strategies these women used to resist social forces and transform them into conditions that made possible the creation of space for personal changes.     

Discourses of service user involvement in meeting places in Norwegian community mental health care: a discourse analysis of staff accounts

In previous research, meeting places have been favourably addressed by service users, but they have also been contested as exclusionary. In this participatory explorative study, we sought to perform a contextual analysis of meeting places in Norway based on a discourse analysis of three focus group discussions with 15 staff members. We asked the following question: how do meeting-place employees discuss their concrete and abstract encounters with service users and their experiences? We focused on service user involvement, which was largely analysed as neoliberal consultation and responsibilisation. Service users were positioned as resisting responsibility trickling down and defending staffed meeting places. Social democratic discourse was identified in the gaps of neoliberal discourse, which is noteworthy given that Norway is a social democracy. This relates to global concerns about displacements of democracy. We suggest that meeting places appear to hold the potential for staff and service users to collaborate more democratically.     

Symbolic Interaction and Applied Social Research: A Focus on Translational Science

In symbolic interaction, a traditional yet unfortunate and unnecessary distinction has been made between basic and applied research. The argument has been made that basic research is intended to generate new knowledge, whereas applied research is intended to apply knowledge to the solution of practical (social and organizational) problems. I will argue that the distinction between basic and applied research in symbolic interaction is outdated and dysfunctional. The masters of symbolic interactionist thought have left us a proud legacy of shaping their scholarly thinking and inquiry in response to and in light of practical issues of the day (e.g., Park and Blumer). Current interactionist work continues this tradition in topical areas such as social justice studies. Applied research, especially in term of evaluation and needs assessment studies, can be designed to serve both basic and applied goals. Symbolic interaction provides three great resources to do this. The first is its orientation to dynamic sensitizing concepts that direct research and ask questions instead of supplying a priori and often impractical answers. The second is its orientation to qualitative methods, and appreciation for the logic of grounded theory. The third is interactionism's overall holistic approach to interfacing with the everyday life world. The primary illustrative case here is the qualitative component of the evaluation of an National Institutes of Health‐funded, translational medical research program. The qualitative component has provided interactionist‐inspired insights into translational research, such as examining cultural change in medical research in terms of changes in the form and content of formal and informal discourse among scientists; delineating the impact of significant symbols such as “my lab” on the social organization of science; and appreciating the essence of the self‐concept “scientist” on the increasingly bureaucratic and administrative identities of medical researchers. This component has also contributed to the basic social scientific literature on complex organizations and the self.     

Identity,impairment and disablement: exploring the social processes impacting identity change in adults living with acquired neurological impairments

The social model of disability acknowledges the impact of impairments but argues that disablement is socially constructed. Taking a theoretical perspective, underpinned by the social model of disability and elements of social identity theory, we investigated the relationship between impairment, disablement and identity change in adults living with an acquired neurological impairment. Through the thematic analysis, three themes emerged: changing self described the personal factors for identity change in people acquiring impairment; changing communities explored the contextual factors creating both socially constructed disablement and identity change; and influencing identity change considered strategies adopted by individuals to both counter socially constructed disablement and promote exploration of identity. A systemic change towards acknowledgement and valuing a disabled identity may counter socially constructed disablement and support enablement and social inclusivity.     

The Importance of “Empty Gestures” in Recovery: Being Human Together

What do clients/patients want or value from their encounters with healthcare providers? Based on ethnographic research conducted with individuals suffering from drug addiction and mental health issues, this article argues that clients/patients treasure “everyday” or “human” interaction with medical staff. Everydayness is accomplished through three generic social processes: **co‐silence, inclusion in back‐stage activity, and physical dramatizations of authenticity. These processes and other ordinary interactional strategies for “being human together” should be seen as vital tools for recovery.     

"WE DON'T PAY FOR BUS TICKETS, BUT WE CAN HELP YOU FIND WORK":

Guided by the concept of social problems work and the micropolitics of trouble perspective, we examine the discursive strategies used by social workers to conduct intake interviews with homeless clients. Trouble was a pervasive feature of these encounters: clients often requested services that diverged from the service preferences expressed by social workers. Social workers used elicitation strategies to solicit information about clients' biographies and their service needs and seminarrative raps to construct service plans with clients. Conceptualized as rhetorical devices, these strategies appear to have managed trouble in ways that articulated closely with material and nonmaterial aspects of the organizational context. We illustrate how these strategies articulated with an agency preference for consensus-style service planning and a focus on clients' recent biographies and immediate problems. Further, we show how these strategies managed the provision of scarce resources in ways that focused on remedies that could be tied to long-term client stability. We conclude by offering the outlines of a general model of the micropolitics of trouble in human service encounters.     

Paradigm of ‘better life’: ‘development’ among the Khumi in the Chittagong Hill Tracts

Development is conventionally understood in various ways including economic growth, increase of gross domestic product (GDP), rise of per-capita income, improvement of social facilities, political stabilities, and women's empowerment and many other issues, but it finally means bringing positive changes in the life of people. However, development is always contextual because the notion and nature of development often varies from society to society depending on the context of local–societal dynamics. Therefore what is regarded globally accepted model of development can be challenged by the local discourse of development, since local-level perception could contest the universal model. This article addresses such a case of development which is conceptualised from the social and cultural point of view amid everyday experiences of ordinary people's lives. The article contextualises its argument with specific reference to the Khumi people living in the Chittagong Hill Tracts of Bangladesh.     

Relational Troubles and Semiofficial Suspicion: Educators and the Medicalization of “Unruly” Children

Using an interview‐based analysis of the accounts of interactions between educators, parents, and clinicians, this study explores educators' roles in interpreting childhood troubles as the medical phenomenon of attention deficit‐hyperactivity disorder (ADHD). The analysis of interviews shows how children's “personal” troubles become understood as “relational” ones, prompting increasingly sophisticated social responses. I argue that the institution of education, operating in a clinical capacity but lacking the legitimate authority to assign ADHD diagnoses, plays a hybridized, semiofficial role in the medicalization process. This assertion informs a critique of the “informal/official” dichotomy found in the sociology of deviance lexicon, and furthers previous positions in the sociology of mental health that have implicated school representatives in the social construction of behavior disorders.     

Reshaping Clinical Practice for the New Millennium

In the new millennium, oppression will continue to affect social workers’ clients. This article discusses training clinical practitioners to address oppression. Drawing on poststructural, postmodern, feminist, and social constructivist theories, the article argues that to challenge oppression, clinical practice must address the dialectical relationship between private troubles and public issues while transforming professional relationships that disempower clients. The article describes a second-year MSW clinical practice sequence taught from feminist, poststructuralist, postmodern, and social constructionist perspectives, where students learn to assess the impacts of oppression, discover clients’ strengths, and respond in personal, social, and political contexts.     

Inside the ‘efficacy gap’: Migration policy and the dynamics of encounter

In recent years, migration has become an important policy priority within and beyond the European Union. While the discourse that surrounds the contemporary migration policy agenda is one of the technocratic migration management, this overarching narrative conceals an underlying goal of prevention. Preventive efforts are increasingly geared towards stopping migratory movements before they have even begun. The effectiveness of such an approach remains contested and unclear. This article builds on the theoretical work of Czaika and de Haas (Population and Development Review, 2013, 39, 487) to explore the limits of prevention strategies designed to change minds, alter plans and redirect behaviours. It does so by drawing on insights from our own research into migration decision-making, alongside wider literature on individual sense-making, and connecting these to ongoing debates around policy effectiveness. In doing so, we show how the nature of localised encounters between ‘target’ populations and implemented policies can create potential sources of policy failure.     

Engaging through Learning—Learning through Engaging: An Alternative Approach to Professional Learning about Human Diversity

This paper presents an alternative framework for construing learning about human diversity as an ongoing, socially constructed, contextual process based in relational learning. The approach enables shifts in understanding for teachers, students, practitioners, client groups and organizations. Conceived to strengthen professional social workers' capacity for on the job learning, this approach provides another entry point for social work faculty to conceptualize the learning process as relational, contextual and process based. It seeks to capitalize on the learning process itself as a mechanism through which learners simultaneously engage one another around issues of culture, identity, and difference and learn through the engagement. The approach is guided by four conceptual touchstones, 14 years of social work practice in a global context, and eight iterations of teaching a masters level diversity course. Eight constructs animate this process approach. They include: exposure, engagement, emotion, empathy, narrative, personal disposition, the learning environment, and a sense of ‘self‐in‐relation’. In addition to illuminating the social structures and social processes that construct diversity, the approach can also engender the sense of relational solidarity among learners necessary for prolonged commitment to social change.