Search

Abstract: For almost half a century social scientists have explored the phenomenon of chronic illness. In this paper, I examine how the concept of chronicity participates in present‐day mental health care settings. Using ethnomethodology and material‐semiotic theory within science and technology studies, I investigate how the classification ‘chronically mentally ill’ interacts with the everyday socio‐material shaping of public mental health care in the context of professional institutions. Drawing on ethnographic fieldwork in a psychiatric day hospital and in a community day care centre in Berlin, Germany, I demonstrate how the classification of chronicity acts as a tool of description (of people or their conditions), regulation (of therapy, health care or administration), and connection to infrastructures of care (practised technologies or standards of various kinds). In these ways, I argue, the classification engages in actions of producing treatability, arranging resources, demarcating responsibilities, practicing accountability, and doing presence. Notably, community mental health care has developed into a designated territory of the concept: explicitly arranged for ‘the chronically mentally ill’ as a human kind, we can take everyday life in these institutions as instructive of how chronicity is defined in daily practice. [ABSTRACT FROM AUTHOR]

The concept of biographical disruption has been used to explain the experience of a cancer diagnosis. Studies on cancer experience increasingly suggest that people diagnosed in older age may not have such disruptive experiences. Prostate cancer is diagnosed more often in older men and is often considered a disease of old age; furthermore, the signs of illness in prostate cancer and the signs of ageing might become convoluted. With this in mind, this paper aims to explore how 42 men with prostate cancer who participated in an interview study respond to and make sense of bodily changes. The sample was selected using a maximum variation strategy in order to describe a range of possible experiences with prostate cancer. Analysis was conducted thematically. The men's narratives tell of the constant process of dealing with ageing‐related and/or cancer‐related changes to both their bodies and their social interactions, and their struggle to disentangle the related effects of ageing and/or cancer on their bodies. We describe how men "muddle through" problems of urinary leakage, potency and loss of libido. We then identify how men attributed changes as part of ageing and/or cancer to (better) manage the experiences of loss. [ABSTRACT FROM AUTHOR]

Irene Wennemo's paper "Infant mortality, public policy and inequality: a comparison of 18 industrialised countries 1950-85" takes an important step further in the understanding of the relationship between social policy and infant mortality in developed countries. The German figures for 1981 can therefore be seen as a potential refutation of the effect of income distribution on national mortality rates which turned into a confirmation. In countries where data are lacking, one might almost suggest that life expectancy should be used as a proxy for income distribution, or infant mortality for relative poverty. But that would come unstuck among pre1989 Eastern European countries. Their mortality rates were relatively high despite comparatively small differences in income. The link between income distribution and national mortality rates which Wennemo and the author have shown has important implications for the understanding of the relationship between health inequalities and national mortality rates. It implies that health inequalities are not simply variations in health round an independently established national average, but that the amount of health inequality in each society represents a net burden on overall national standards of health.

The paper seeks to identify and explain shifts in dominance relationships between the medical profession and allied health professions in Germany, taking the occupational fields of nursing and psychotherapy as examples. It suggests an actor-based perspective which focuses on the strategic interplay between collective actors in the fields in question, namely professional associations and unions, state actors, sickness funds, universities, polytechnics and associations of work organisations. It considers the context of governance of the German health care system and an awareness of a changed demand. The thesis is that the interplay between the actors has led to a small reduction of medical dominance. It is examined whether changes in governance structures of the health care system have led to a more favourable context for shifts in the dominance relationships. Moreover, the possible effects of the recent re-organisation of health provision are considered. Based on an empirical investigation using the method of document analysis, the paper shows that there has been a small reduction of medical dominance which is essentially the outcome of the interrelated strategic actions of various collective actors in the fields. A public perception of a new kind of health care demand has facilitated this development. [ABSTRACT FROM AUTHOR]

This paper reports findings from a comparative study of Israeli and German genetic counsellors' perceptions of the moral standing of the fetus. Data collected through in-depth interviews with counsellors in both countries (N=32) are presented, and their moral practices are analysed. The paper's findings suggest that while German counsellors perceive the fetus as an autonomous being and debate the particular biological stages through which this autonomy is acquired; Israeli counsellors do not consider the moral status of the fetus independently of its relations with its family hence, deploying a 'relational ethics'. It is suggested that these differences are influenced by historical, political, legal, and religious traditions in Germany and Israel regarding abortions and the fetus. It is concluded that the deployment of a 'biological ethics' by German counsellors reproduces the model of fetal developmental stages (in itself a construction), and hence goes hand in hand with perceptions of the fetus as a 'life', and thus as the bearer of autonomous rights which are understood to contradict those of its mother. On the other hand, the rejection of 'biological ethics' by Israeli counsellors enables a perception of fetuses that is first and foremost defined by their relationships with others. [ABSTRACT FROM AUTHOR]

Health literature shows that unemployment has a gendered effect on health. However, whether men or women are more affected and why remains unclear. We assume that unemployment harms women less than men because of two mechanisms: social roles theories and health selection. First, the availability and centrality in individuals' lives of roles other than employment may reduce the detrimental effect of unemployment for women. Second, the gendered impact of unemployment on health results from the different ways selection mechanisms operate across genders. Moreover, these two mechanisms may operate differently in different contexts – for example, across different gender regimes. We investigate this by pursuing a three‐step comparative approach. The analysis relies on EU‐SILC data covering Italy and Sweden for 2004 to 2015 and SOEP data for Germany (1995–2017) and applies correlated dynamic random‐effects probit models. While we find weak support for the role of health selection in shaping the relations between unemployment, health, and gender, our empirical results are in line with the hypothesis of a larger gendered effect in older (vs younger) cohorts, western (vs eastern) Germany and Italy (vs. Sweden). Future empirical research needs to directly address the role of gender regimes in moderating such complex relationships. [ABSTRACT FROM AUTHOR]

Professions are increasingly studied from an international perspective, and understanding context is key to cross-national comparison of professions. This paper builds on studies of health service work in different countries and introduces actor-centred governance as a framework for comparing professions. The framework conceptualises context as institutions and, as such, offers a more systematic analysis of context and the interplay between context and actors. The framework is applied to a comparative study of community nursing in Britain and Germany, which includes a local case study of the governance of internal boundaries. Actor-centred governance helps to map out different actors and the interplay among them, to identify different types of institutions, and to trace how institutions relate to actors and vice versa. As such, actor-centred governance allows for a more systematic analysis of similarities and differences, and facilitates comparisons across different countries. [ABSTRACT FROM AUTHOR]

Abstract: This article reports an ethnographic study of the handover routines in Germany's first dementia village, with a central focus on how care is balanced between domestic intimacy and institutional detachment. The term ‘professionalised intimacy’ is used for the vivid interplay between comfort and intimacy that renders the interaction between care workers and residents far more complex than previous theories have articulated. Because of the intimacy involved in community building, however, the promise of personalised care must clash with the bureaucratic structures of an official institution, potentially depriving the care workers of their public, respected identity in the process. The study further suggests that most care workers, in fact, support this division between domestic intimacy and institutional detachment. Even if they subscribe to a dementia village's philosophy of personalised care, their medical training and enculturation has endowed them with a habitus compatible with the modern health profession, with incentives on achieving quantifiable health goals. The dementia village is thus illustrated as a pioneering health care experiment that negotiates rivalling discourses of intimacy, professionalisation, and medicalisation. [ABSTRACT FROM AUTHOR]

Despite academic feminist debate over several decades, the binary nature of sex as a (perhaps the) primary social classification is often taken for granted, as is the assumption that individuals can be unproblematically assigned a biological sex at birth. This article presents analysis of online debate on the BBC news website in November 2013, comprising 864 readers' responses to an article entitled 'Germany allows 'indeterminate' gender at birth'. It explores how discourse reflecting Western essentialist beliefs about people having one sex or 'the other' is maintained in debates conducted in this online public space. Comments were coded thematically and are presented under five sub-headings: overall evaluation of the German law; discussing and disputing statistics and 'facts'; binary categorisations; religion and politics; and 'conversations' and threads. Although for many the mapping of binary sex onto gender was unquestionable, this view was strongly disputed by commentators who questioned the meanings of 'natural' and 'normal', raised the possibility of removing societal binary male-female distinctions or saw maleness-femaleness as a continuum. While recognising that online commentators are anonymous and can control their self-presentation, this animated discussion suggests that social classifications as male or female, even if questioned, remain fundamental in public debate in the early 21st century. [ABSTRACT FROM AUTHOR]