IN SICKNESS AND IN HEALTH: THE IMPACT OF ILLNESS ON COUPLES' RELATIONSHIPS

When illness or disability strikes a couple's relationship, a number of significant structural and emotional skews are likely. A normative, preventive framework that addresses the special strains on couples can counteract dysfunctional relationship patterns and enhance opportunities for increased intimacy. This paper addresses key issues regarding intimacy and communication and then identifies key skews and treatment priorities to help couples rebalance their relationship. These include skews regarding (a) whose problem it is, (b) boundary issues, (c) patient-caregiver roles, (d) togetherness/separateness, (e) psychosocial recovery, (f) cognitive impairment, (g) gender, (h) sexuality, (i) belief systems, and (j) life cycle. Particular dilemmas for gay and lesbian relationships are noted. Dealing with these skews can promote a couple's resilience in the face of loss     

Counseling severely dysfunctional families of mentally and physically disabled persons

Some families of mentally and physically disabled persons behave in an extremely self-destructive or resistant manner. These severely dysfunctional families pose a formidable obstacle to their disabled relatives' habilitation. Because such families are particularly frustrating to work with, little professional assistance has been provided to them. This article examines probable causes of severely dysfunctional family behavior, details several maladaptive family patterns and suggests practical treatment strategies for helping these families.     

Extension and the disposal of the world: Double‐crossing systems,culture, self and language

Long indexed by sociological ideas of structure, the notion of extension is yet disparate and poorly disseminated – as evidenced by popular motifs such as ‘the world is at our disposal’ eschewing notions of emplacement and embeddedness and instead championing choice and individualised agency. On the assumption that this lacunae relates in part to paradigm debates over incommensurability, the proposal in this inaugural lecture is to explore double‐crossing as a methodological device by which to draw insights on extension from major ‘gatherings’ of Euro‐American thought, while respecting the orderings, institutional arrangements, situations and networks each approach imposes. In retracing the ‘disposal’ of the world through four theoretical perspectives germane to sociology – namely systems, culture, self and language – the objective is to illustrate the methodology of double crossing. Drawing on both my work on social and cultural theory and my field studies in market leaders, I first show how moving back and forth between the older and newer ground within each perspective helps to elicit what gets unsighted from either view. Secondly, inasmuch as the usual way of ‘making a clearing’ is argued as caught ‘in reaction’ from extant theory (ending up say talking of parts instead of wholes or consumption in place of production), I advance the methodology of double‐crossing by excavating the recessive arrangements and ordering implicit in each perspective and so illuminate the different ways extension is affected by how world is imagined and experienced.     

Managing Societal and Institutional Risk in Child Protection

Public sector services have been reshaped by two interacting factors: the growing dominance of risk management and the growing demands for transparency and accountability. For the caring professions, these have provoked radical reform. Using the child protection service as a case study, this article explores the impact of the changes on a service that deals with conflicting risks and has a poorly articulated knowledge base. Drawing on Rothstein et al. 's distinction between societal and institutional risks, it is argued that difficulties in managing societal risks are creating serious institutional risks. The latter are then being prioritized in the way the system operates. The preoccupation with such risks has been translated into concerted efforts to formalize the work of front line practitioners to make it transparent and auditable. Although done, in part, with the good intention of spreading good practice standards, this formalization has gone beyond the evidenced knowledge base to the extent that it is creating a new picture of "good practice" that omits significant dimensions of work and is distinct from measures of children's safety or welfare. Moreover, the process of formalization acts as an impediment to knowledge development in disciplines where such learning is urgently needed.     

Zero and Literature: Introduction

Jean‐Luc Nancy's The Inoperative Community is now one of the most celebrated interventions in rethinking community beyond the traditional substantialist discourses of unity and essence. It challengingly counters contemporary articulations of both communitarianism and liberalism in order to rescue the concept of community from forms of immanentism (Nancy's term for totalitarianism) and absolute individualism. Writing and literature feature quite prominently in Nancy's thesis. They are the “voice of interruption” that destabilises the mythical articulations of community and deconstructs its immanentist figurations. They are the spaces of sharing, exposure and being‐with, which according to Nancy, bring about the experience of community. This paper is, as such, an attempt to engage with Nancy's captivating approach to the concept of community and show how writing and literature provide, to some extent, the condition of possibility for interrupting the metaphysics of subjectivity and opening up an alternative space of community.     

Diabetes mellitus in older men

Most persons with diabetes mellitus are over the age of 60 years. Males develop diabetes more commonly than females. Older diabetics tend to have both impaired insulin release as well as insulin resistance. In older persons diabetes mellitus is associated with decreased functional status and cognitive dysfunction. In general, older persons with diabetes are inclined to be underdiagnosed and undertreated. Managing diabetes in older persons requires special considerations because of their differences in pathophysiology of diabetes and strong association with functional, cognitive impairments and comorbidities. The use of strict therapeutic diets is not recommended in older persons. Treatment of hypertension and hyperglycemia can improve outcomes in older persons. The interdisciplinary team approach is important for care of older diabetic persons.     

Book review

The ‘Research Governance Framework for Health and Social Care’ has recently been implemented in England and provides a set of standards to be used nationally in the conduct of health and social care research. Explicit and universal standards are to be welcomed in so far as they increase transparency in the contract between researchers and the agencies that participate in research, reiterate the importance of the ethical conduct of studies and the protection of participants. However, there have been some unanticipated consequences of the implementation of the framework which may serve to undermine the quality of research, the comparability of data and the timeliness of findings to inform policy and practice. This article examines these issues with reference to a recently established study involving vulnerable children and families. The potential implications for other studies are also explored and recommendations are made about how these issues may be overcome.     

Compelling Evidence: Research Methods,HIV/AIDS,and Politics in Papua,Indonesia

Increasing calls for an evidence-based public health (EBPH) rely on forms of quantitative evidence to decide HIV/AIDS interventions. A major criticism of this method is it downplays the significance of experiential, cultural or political facets of HIV/AIDS. We apply the concept of ‘rendering technical’ to explore the relationship between methods used in HIV/AIDS research in Papua, Indonesia and current socioeconomic conditions. We analysed research methods used in sixty-two HIV/AIDS studies, assessed presentations at an international AIDS conference, and conducted ethnographic research in Papua. Nation-wide EBPH initiatives are implemented in Papua, yet there remains a critical mass of qualitative ethnographic studies carried out by indigenous scholars emphasising experiences of persons and culture, often within a colonial or post-colonial framework. We argue these studies partially counter approaches which render technical complex realities. In political conditions where indigenous minorities suffer inequities, qualitative ethnographic research may yield critical kinds of evidence, potentially contributing to more nuanced decision-making around HIV.     

The Remains of the Say: Zero,Double‐crossing and the Landscaping of Language

This essay argues for a “landscaping” understanding of language, contrasting this with the more contemporary tradition of deconstruction, through Saussure, on difference. The paper opens with an evocation of the method of “double crossing” in Heidegger's () deconstruction of Western ontology, before drawing extensively on Heidegger's later discussion of the “bridge” to illustrate his landscaping argument over language. By crossing and criss‐crossing this reading of Heidegger with a critique of the same essay by Hillis Miller, a strong similarity in deconstructive technique is elicited despite an apparent clash in their views about language.