Recapturing Control: Robotics and the Shift from Medicalized to Biomedicalized Surgery

ABSTRACT

Biomedicalization theory has proven itself a generative theoretical lens for examining the commodification of health and the associated constitution of new medical practices. A shift from the control over bodies to the technoscientific transformation of bodies is a major difference between the medicalization and biomedicalization eras. The case of robotic surgery provides an example of how the bodies of health care providers are being transformed while offering an opportunity to expand our understanding of the differences between these two eras. While new medical technologies can transform bodies and identities, they sometimes do so with an eye toward achieving the professional goals of the medicalization era. Ethnographic data regarding the da Vinci® Surgical System are used to elaborate these concepts. These were gathered through content analysis of marketing materials, interviews with surgical professionals, and participant-observation at a recruitment event for prospective da Vinci® surgeons. While patient-facing marketing materials alternately conflate and separate robotic surgery from the traditional, minimally invasive surgery (MIS) it is meant to replace, the participation of surgeons is obtained through the technology’s transformation of their bodily capabilities. The benefits for surgeons include increased control over laparoscopy and a reification of their place at the top of the surgical hierarchy.     

Transformations in the medicalization of sex: HIV prevention between discipline and biopolitics

This article examines transformations in HIV prevention strategies from the 1980s to the present. Drawing on the concepts of medicalization (Conrad, 2007 ), discipline and biopolitics (Foucault, 1976/ 1988 ), and biomedicalization (Clarke, Fishman, Fosket, Mamo, & Shim, 2003 ), it explores the shift from behavioral to biomedical and surgical prevention techniques-a shift symbolic of a more general trend toward the biomedicalization of sexuality. It argues that, although biomedical and surgical approaches (chemoprevention and male circumcision) have certain benefits, their efficacy is limited and uncertain. They do not guarantee individual protection. The aim is no longer the modification of sexual behavior through disciplinary strategies aimed at the development of subjective and sexual awareness, but the modification of health behavior as a positive response to biomedical recommendations. Through the use of preventative or curative drugs, the same type of sexual awareness is seen as no longer required.     

Couple’s Relationship With Diabetes: Means and Meanings for Management Success

Diabetes is a serious chronic illness that involves individuals, couples, and families in complex reciprocal interactions with the illness and other life dimensions. A major issue in diabetes management is how well the patient is able to follow the established medical regimen of selfcare. Situated within personal, physical, and social contexts, the meaning that a couple creates and the emotions they feel in their adaptation to living with diabetes and its demanding regimen can be viewed as the couple’s relationship with diabetes.     

Identity processes in the global era: the case of young immigrants living in Italy

The paper explores processes of identity construction in young people of foreign origin living in Italy. The aim was to understand how youth construct their selves in the global era, characterized by an increase in the possibility of choosing but also in the perception of uncertainty; how they perceive this uncertainty, whether as a chance to construct multifaceted and continually changing identities or as a source of insecurity and loss for their identity. Drawing on 46 in-depth interviews, the research reveals that young people of foreign origin are continually shaping their identities mixing different cultural repertories related to their – or their parents’ – homeland, to the host country, global cultures and youth cultures. Several patterns of identity emerge and they are linked to different perception of uncertainty. A typology of these patterns was developed: young people construct flexible identities or hyphenated identities, or move from a fixed identity to an undefined identity. These types of identity are respectively associated with the perception of uncertainty as a resource, as a constraint, finally with a strategy of reducing or eliminating uncertainty.     

Lay theories and criticisms of mental health news: elaborating the concept of biocommunicability

Abstract

This article examines how mental health service users/consumers, advocates, professionals and researchers interpret and theorise the impacts of mental health news. It focuses on the following themes: Creating fears about mental illness by focusing on criminal and violent acts; Reinforcing power imbalances by privileging biomedical issues and sources; and Sanitising mental health issues through the selective use of personal narratives. The study draws upon the concept of biocommunicability, which casts light on the performative power of health news in reinforcing ideas and expectations about the appropriate role for different actors to adopt in relation to health knowledge. Previous research on health news has identified biomedical authority, patient-consumer and public sphere as three predominant models of biocommunicability and this article examines how these are bound up with criticisms of mental health news. The findings are related to the ‘mediatisation of psychiatric culture’ as one of extremes and perspectives from Mad Studies.     

Exploring college students’ sexual and reproductive health literacy

Abstract

Objective: To assess college students’ sexual and reproductive health (SRH) literacy experiences, specific to contraception use and STI prevention. Participants: In Spring 2015, participants (n?=?43) from a large institution participated in six focus groups (two male and four females groups). Methods: Focus groups were guided by the health literacy domains (access; understand; appraise; apply); data were analyzed in MaxQDA using the constant comparative method. Results: The Internet was the most commonly accessed source for SRH information. Participants discussed facilitators (eg, use of visuals) and barriers (eg, medical jargon) to understanding information; and personal lifestyle, advice from family/friends, symptoms, and sexual partners as appraisal factors. Participants applied information by communicating with friends/providers and seeking healthcare. However, findings were not linear nor mutually exclusive, representing the interaction of health literacy skills. Conclusion: Findings suggest that a patient-centered intervention capitalizing on technology and trusted individuals (providers/peer educators) may facilitate college students’ SRH literacy.     

Residual Categories in Medical Simulation: The Role of Affect in the Performance of Disease

Extending Susan Leigh Star’s conceptualization of residual categories, the author highlights the role of affect in the construction of standardized symptoms in medical simulation and in the performance of scientific evidence. The author analyzes two cases, public performances of hysteria in the 19th century and standardized patients in contemporary simulation laboratories, revealing potentialities in the construction of medically accurate and pedagogically achievable standards. Conceptualizing patient performers as a standardization technology representing medical knowledge of patient experience allows the author to reveal how the performers’ affective perspective becomes appropriated into the biomedical discourse to legitimate its categories and educate healthcare professionals.     

Mental Illness as a Barrier to Marriage Among Unmarried Mothers

This study explores how mental illness shapes transitions to marriage among unwed mothers using augmented data from the Fragile Families and Child Wellbeing study (N= 2,351). We estimate proportional hazard models to assess the effects of mental illness on the likelihood of marriage over a 5‐year period following a nonmarital birth. Diagnosed mental illness was obtained from the survey respondents’ prenatal medical records. We find that mothers with mental illness are about two thirds as likely as mothers without mental illness to marry, even after controlling for demographic characteristics, and that human capital, relationship quality, partner selection, and substance abuse appear to explain only a small proportion of the effect of mental illness on marriage.     

The new ‘hidden abode’: reflections on value and labour in the new economy

In a pivotal section of Capital, volume 1, Marx (1976 : 279) notes that, in order to understand the capitalist production of value, we must descend into the ‘hidden abode of production’: the site of the labour process conducted within an employment relationship. In this paper we argue that by remaining wedded to an analysis of labour that is confined to the employment relationship, Labour Process Theory (LPT) has missed a fundamental shift in the location of value production in contemporary capitalism. We examine this shift through the work of Autonomist Marxists like Hardt and Negri, Lazaratto and Arvidsson, who offer theoretical leverage to prize open a new ‘hidden abode’ outside employment, for example in the ‘production of organization’ and in consumption. Although they can open up this new ‘hidden abode’, without LPT's fine‐grained analysis of control/resistance, indeterminacy and structured antagonism, these theorists risk succumbing to empirically naive claims about the ‘new economy’. Through developing an expanded conception of a ‘new hidden abode’ of production, the paper demarcates an analytical space in which both LPT and Autonomist Marxism can expand and develop their understanding of labour and value production in today's economy.     

Identity Development in an International Transracial Adoptive Family: A 5-Year Case Study

Our case study focused on the adoptive identity development of two female Chinese adoptees over the course of five years (from when they were 7 and 9 until they were 12 and 14 years old, respectively). The study investigated the adoptive parent’s and family identities through six interviews with the adoptive mother, adoptees’ behavioral adjustment reported by the mother, two unstructured observations, and exploration of adoptees’ narratives. The study was guided by a narrative-based framework situated with the cultural socialization approach. Results highlight four central themes: 1) becoming Chinese-Americans; 2) meaning related to adoption is both spoken and unspoken; 3) a we-ness identity, and 4) social-cultural contexts of identity work. Findings demonstrate the incorporation of adoption and the adoptees’ race and culture into the adoptive parent’s and family identities. Findings further illuminate that one’s identity is developed within personal, familial, and social-cultural contexts.     

Achieving the indeterminate: Accomplishing degrees of certainty in life and death situations

This paper explores technology's pivotal position at the intersection of control and uncertainty. It examines two areas: Intensive Care and a Labour Ward. Building on the work of Davis (1960), it argues that certainty and uncertainty are socially constructable and reconstructable. This is actively achieved by the deployment of strategies involving particular paradigms (the biomedical model) and artefacts (medical technology). Power lies in control over knowledge and the structures and practices which sustain it, including those embedded in advanced technology. The contribution of medical technology to the achievement of certainty in Intensive Care and end-game Obstetrics (the Labour Ward) is considered. Achieved certainty in medical situations is seen as: the structured masking of uncertainty by the application of medical iconography, artefacts and techniques to create the illusion of certainty. The accomplishment of uncertainty in Obstetrics (as a precursor to technological intervention) is also explored. The accomplishment of uncertainty in medical situations is seen as associated with the structured projection of uncertainty, involving using medical discourse rooted in the medical paradigm to exaggerate the generality of risk and the probability of pathology. It is argued that the highly structured and routinised settings of ICU and the labour Ward, not only aid control by the medical profession but diminish perceptions of uncertainty.     

Searching for the Self: Adult International Adoptees’ Narratives of Their Search for and Reunion With Their Birth Families

In this case study, five international adoptees from Finland were interviewed about their search and reunion experiences to find out what meanings they ascribed to their identities and family relations. The thematic analysis yielded three themes: search and reunion in significant periods of life, meaning of reunion for identity, and belonging and relatedness within family. The first theme was characterized by the changing interest in birth family from the inability in childhood to fully understand the meaning of adoption and the growing interest in adolescence to adulthood where participants’ own parenthood intensified their interest. The second theme was characterized by the sense of coherence and sense of continuity that the adoptees, despite the conflicting emotions of reunion, felt they had achieved through reunion. In the third theme, reunion with their birth family appeared significant, even though belonging to a family was interpreted more as an outcome of attachment and nurture than biology. Particular for all themes was the meaning of communicating about adoption-related issues for the adoptee–adoptive parent relationship. Future research is needed to concentrate in more detail on the broad themes and to investigate how the meanings of the birth family for adoptive identity change over life courses.     

Caring Adults: A Brief Report Assessing Adults’ Needs in Feeling More Comfortable Having Sexual Health Conversations with Youth in South Texas

Abstract

Objectives: As part of a larger Substance Abuse and Mental Health Services Administration-funded project in South Texas, this study sought to understand adults’ needs with regard to engaging in sexual health conversations with youth and young adults.

Methods: A total of 223 participants were surveyed to assess comfort engaging in sexual health conversations. Data were analyzed using thematic coding. Stigma surrounding sexual health conversations underlined all themes.

Results: Differences by gender and sexual orientation in the data were noted. Stigma around sexual health topics reduced participants’ comfort.

Conclusions: To this end, interventions must go beyond psychosocial and educational programs and address societal factors that contribute to the stigma.     

A model of social work classification in health care

Abstract

The introduction of casemix funding for Australian acute health care services has challenged Social Work to demonstrate clear reporting mechanisms, demonstrate effective practice and to justify interventions provided. The term ‘casemix’ is used to describe the mix and type of patients treated by a hospital or other health care services. There is wide acknowledgement that the procedure-based system of Diagnosis Related Groupings (DRGs) is grounded in a medical/illness perspective and is unsatisfactory in describing and predicting the activity of Social Work and other allied health professions in health care service delivery. The National Allied Health Casemix Committee was established in 1991 as the peak body to represent allied health professions in matters related to casemix classification. This Committee has pioneered a nationally consistent, patient-centred information system for allied health. This paper describes the classification systems and codes developed for Social Work, which includes a minimum data set, a classification hierarchy, the set of activity (input) codes and ‘indicator for intervention’ codes. The advantages and limitations of the system are also discussed.     

Investing to Protect Our Children: Using Economics to Derive an Evidence‐based Strategy

Child abuse and neglect are global problems that affect over 25 per cent of children and have serious health, social and economic consequences. Government and other agencies are heavily committed to the provision of services to address the consequences of abuse and neglect. In a climate of scarce resources, there is increasing interest in developing cost‐effective strategies to prevent child maltreatment. Economic evaluation in the context of formal ‘priority setting’ can contribute to the development of an efficient child protection strategy and at the same time develop the arguments to support an increased investment in the prevention of child maltreatment. Key challenges arise from incompleteness of the evidence base of effective interventions and the considerable complexity of the cross‐portfolio effects. The latter has resulted in the widespread failure to capture the full range of impacts, most notably intergenerational effects, quality of life and mortality. This means the benefits of investing in effective preventive strategies to address child maltreatment will be underestimated and too few resources allocated to this important task. Adoption of the proposed priority‐setting framework and translation into action are likely to reduce child maltreatment and associated harms for children at risk now and in the future. Copyright © 2011 John Wiley & Sons, Ltd.

Citing Literature

Number of times cited: 7

• Inga Wagenknecht, Uta Meier-Gräwe and Ute Ziegenhain , Kosten und Nutzen Früher Hilfen - aktuelle Erkenntnisse und zukünftiger Forschungsbedarf/ Economic efficiency of early intervention – current findings and future need for research , Kindesmisshandlung und -vernachlässigung , 18 , 1 , (10) , (2015) . Crossref
• Nicole RS Boyer, Kathleen A Boyd, Fiona Turner-Halliday, Nicholas Watson and Helen Minnis , Examining the feasibility of an economic analysis of dyadic developmental psychotherapy for children with maltreatment associated psychiatric problems in the United Kingdom , BMC Psychiatry , 14 , 1 , (2014) . Crossref
• Madeleine Stevens, Lucy Harris, Megan Ellis, Crispin Day and Jennifer Beecham , Investigating changes in use of services by high‐need families following the Helping Families Programme, an innovative parenting intervention for children with severe and persistent conduct problems , Child and Adolescent Mental Health , 19 , 3 , (185-191) , (2013) . Wiley Online Library
• Madeleine Stevens , The cost-effectiveness of UK parenting programmes for preventing children's behaviour problems - a review of the evidence , Child & Family Social Work , 19 , 1 , (109) , (2014) . Crossref
• Sarah Skeen and Mark Tomlinson , A public health approach to preventing child abuse in low- and middle-income countries: A call for action , International Journal of Psychology , 48 , 2 , (108) , (2013) . Crossref
• Peter Sidebotham , Safeguarding in an Age of Austerity , Child Abuse Review , 21 , 5 , (313-317) , (2012) . Wiley Online Library
• , Public Health Approaches to Safeguarding Children , Child Abuse Review , 20 , 4 , (231-237) , (2011) . Wiley Online Library

Volume 20 , Issue 4 July/August 2011

Pages 274-289     

Disability activisms: social model stalwarts and biological citizens

The Disabled People’s Movement (DPM) in the UK rejects the view that disability is an illness. For the DPM it is the social processes of discrimination and oppression that create the material circumstances out of which solidarity and politicisation arise. The DPM has also been shy about impairment, arguing that it is generally irrelevant to the issue of disability and that a clear distinction between impairment and disability is necessary if disability is to be understood as a basis for identity politics. The biological citizens that support embodied health movements use impairment, genetic status, biomedical diagnosis and classification as calling cards that signal their claims to identity. Whilst the DPM has challenged medical hegemony and scientific ideas, many ‘biosocial’ groups embrace the specialised medical and scientific knowledge associated with their ‘condition’, particularly where it might be used to enhance their claims to citizenship. This paper argues that disability activism in the UK is bifurcating. It addresses the difference in perspective and action between the ‘social model stalwarts’ of the DPM and biological citizens that organise politically around particular diagnostic labels.     

Resituating Funds of Identity Within Contemporary Interpretations of Perezhivanie

There is still a tendency for researchers and teachers using a Funds of Identity approach for social justice purposes to exclude negative emotions and experiences from the classroom. This article addresses this issue by situating Funds of Identity within contemporary interpretations of perezhivanie to theorize what we call existential funds of identity, which we present as an enrichment of the Funds of Identity approach. The findings from a case study of Valerie, a 16-year-old Chinese high school student, suggest that both positive and negative emotions and experiences can be accommodated in the classroom through the use of new technology, which can also help to bridge the gap between home and school.     

Special Considerations in the Treatment of College Students With Bipolar Disorder

Abstract

Bipolar disorder is a relatively common mental disorder that often has its onset during the college years. This means that students simultaneously face both the challenge of late adolescent development and the challenge of adapting to a major mental illness. As a further complication, the college environment is not well suited to the kinds of lifestyle changes that add stability to the lives of people with bipolar disorder. Treatment involves establishing an alliance, education about lifestyle changes, aiding adaptation to the illness, careful medication to minimize side effects, and loosening the affective constriction that can result from fear of relapse. Both the health care provider and student can use the culture of learning and self-discovery in the college setting to the treatment's benefit. As well, the provider can use the time-limited nature of college to lessen ambivalence about making long-term changes.     

FROM THE WESTERN TO THE MURDER MYSTERY: THE SOCIOLOGICAL IMAGINATION OF C. WRIGHT MILLS

More than half a century after its emergence as a formal field of study, medical sociology remains an important substantive area within our discipline, wide ranging in its appeal and the plethora of topics it engages. Tangible indicators, including the increase in the number of medical sociology journals and the number of medical sociology courses offered in colleges and universities across the country (Bloom 2000), point to the continued interest in this field. The vitality of medical sociology stems in part from the fact that today's health sector is an extraordinarily broad and vibrant arena of society (Weiss and Lonnquist 2000). Major topics of current interest have included the medicalization of society, sociocultural responses to health and illness, patterns of physician-patient interactions, health services utilization, alternative healers and alternative health practices, and comparative health care systems. The array of topics of analysis in our field continues to expand; recently emerging areas of interest include the social effects of health care technology, medical ethics, managed care, and health care reform. Indeed, it is an exciting time to be a medical sociologist. In the Call for Papers distributed for this special issue, we announced that we hoped to explore health- and illness-related topics that should continue to be influential into the new millennium. Further, we specifically encouraged submission of various formats and lengths not typically included in Sociological Spectrum or similar publications. Thus, this collection is unique in its conceptual essays, and methodological and theoretical notes. As suggested by the special issue's title, we hold a broadened view of medical sociology, a view also encouraged by scholars such as Conrad (2001), Weiss and Lonnquist (2000), and Charmaz and Paterniti (1999), that encompasses a sociology of health, healing and illness, as well as of medicine. Although not all inclusive, the organizational schema of the special issue reflects the broad range of topics that scholars who responded to our Call for Papers, our special issues reviewers, and we, as co-editors, considered particularly relevant to medical sociologists at this point in time.