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Biomedical subjects

H F Stein

Publications and source records attributed to H F Stein.

At least 19 recordsLinked to original sources
PubMed1993

Recent developments in alcoholism:substance and symbol.

Alcohol is discussed as a core symbol of American culture. The language associated with alcohol, other "substances," and their widely shared folklore are shown to underlie the official "disease" model of alcoholism and treatment. The cultural psychology that gives the disease model its plausibility and experimental validity is discussed. Similar to "possession" theories in other societies, in American alcoholism the "not-me" is seen as overtaking the normal, social "me," inducing states of drunkenness if not chronic disease. This depersonalizing creates a paradox: requiring control from one held to be out of control by virtue of the disease process. It is argued that the disease model inadvertently helps perpetuate the very problems its proponents aim to treat. The author argues that conventional theories of alcohol, alcoholism, and alcoholics provide a standardizing, homogenizing, stereotypic story of far more complex accounts of alcohol use. Alternatives to the current metaphor are suggested.

Alcohol Drinking↗
PubMed1992

The many-voiced cultural story line of a case of diabetes mellitus.

An ethnographic approach is used to conduct and describe my research into a case of chronic illness and to assist the family physician's interventions. What at first appeared to be a frustrating, difficult-to-control case of diabetes mellitus was later revealed to be an intricate drama involving multiple voices and issues: marital, life stage, family, religious, occupational, regional, economic, and physician family-of-origin. Questions such as who has the disease?, what is the disease?, what keeps the disease going?, who is the patient?, and who is the clinician? are explored in the context of this case. The case was "solved" when the loss and sadness of aging was discovered and accepted during a cathartic session involving the diabetic patient, her husband, their family physician, and myself, a consultant.

Aging↗
PubMed1990

In what systems do alcohol/chemical addictions make sense? Clinical ideologies and practices as cultural metaphors.

Based on 17 years of clinical teaching, supervision and participant observation in United States settings, this paper inquires into the cultural plausibility of the disease-model of chemical addictions in the U.S. The model is linked to (a) the targeting of pariah groups for scorn and punishment, (b) the resurgence of social darwinism and its distinction between 'fit' and 'discountable' people, and (c) increased nationalism, militarism, and the spectre of nuclear war. In an era of neopuritanism, addicts serve as reservoirs of 'badness' for mainstream society that wages war against them in the idiom of treatment. An ethnographic model for bridging 'critical' and 'clinical' concerns is proposed.

Alcoholism↗
PubMed1986

'Sick people' and 'trolls': a contribution to the understanding of the dynamics of physician explanatory models.

This paper describes and interprets a case in which the mutual influences of countertransference and physician explanatory model (EM) are identified, as are their roles in negotiating the clinical relationship and in clinical decision-making (assessment, diagnosis, treatment, expectations of outcome). The author argues that physicians' EMs do not derive exclusively from the official and professionally ideal biomedical model, but are shaped by situational, historical, and subjective influences. Patient-typing (e.g., the widespread distinction between "sick people" and "trolls"), together with its associated emotions (e.g., empathy and disdain, respectively), pervades medical education and practice, and often supersedes the biomedical model. Physicians' subjective responses to patients can affect biomedical diagnosis. Failed empathy can lead to missed diagnosis. Finally, the case study illustrates the validity and vitality of the ethnographic approach in clinical teaching and supervision, both in eliciting physicians' own complex EMs, and in facilitating the process of reinterpretation as well.

Attitude of Health Personnel↗