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PubMed2001

Technology and effect: HIV/AIDS testing in Brazil.

Contemporary techno-scientific and medical developments are restructuring social interactions and the very processes by which individual subjectivity is formed. This essay elaborates on the experiential and ethical impact of such transformations from the perspective of people who, in ordinary and unexpected ways, act science and technology out. We carried out ethnographic research in an HIV/AIDS Testing and Counseling Center (CTA) in northeastern Brazil, combining participant observation with epidemiological analyses and clinical survey. We found a high demand for free testing by low-risk clients, largely working and middle class, experiencing anxiety and complaining of AIDS-like symptoms. Most of the clients were sero-negative and many returned for a second and third testing. We understand this to be a new techno-cultural phenomenon and call it imaginary AIDS. Throughout this essay, we describe CTA's routine practices, place these practices in historical, political, economic and cross-cultural perspective, and analyze the subjective data we collected from the clients of our pilot study. We explore how clinical epidemiological expertise and HIV testing technology are integrated into new forms of bio-politics aimed at specific marketable and disease-free populations, and on the affective absorption of bio-technical truth and the engendering of a technoneurosis in this testing center.

AIDS Serodiagnosis↗
PubMed1998

Using anecdotal information in evidence-based health care: heresy or necessity?

Anecdotes are powerful tools that humans use to make decisions. Despite their power and influence, they are sometimes misused, and sometimes undervalued. Ignoring or under-estimating the role of anecdotal information in health care decisions is likely to hinder communication among decision makers, and to retard their uptake of research evidence. Anecdotal information should not be considered as a replacement for, but as a complement to formal research evidence. If evidence-based health care is to meet its potential, the important role of anecdotes must be acknowledged, studied and utilized.

Anecdotes as Topic↗
PubMed2001

Innovation in HIV prevention: organizational and intervention characteristics affecting program adoption.

A multiple case study design was used to explore the organizational characteristics of community-based organizations that provide HIV prevention programs and the criteria these organizations employ when judging the merits of externally-developed HIV prevention programs. In-depth interviews were conducted with organizational representatives of 38 randomly-selected HIV prevention providers throughout Illinois. Results indicated that there were three main types of adopting organizations: adopters of entire programs, adopters of program components and practices, and adopters of common ideas. These three types of organizations were distinguished by their level of organizational commitment to HIV prevention, organizational resources, and level of organizational maturity. Narrative data from the interviews are used to describe the dimensions that underlie the organizations' program adoption criteria. The criteria of merit used by these organizations to evaluate prevention programs provide partial empirical support for existing theories of technology transfer. Implications for designing and disseminating HIV prevention programs are discussed.

Adolescent↗
PubMed2001

Searching for a normal life: personal accounts of adults with schizophrenia, their parents and well-siblings.

Using a life course perspective, the research examines personal accounts of adults with schizophrenia, and their parents and well-siblings from six families. Accounts of multiple members of the same family, including the family member with schizophrenia, are used to describe how families understand and accommodate life changes that result from the illness. Families describe the loss of a "normal life" as one of the most devastating aspects of schizophrenia. We present the personal and social losses described by adults with schizophrenia and their well family members, and document families' search for ways that their ill family member can achieve or maintain valued social roles. The concerns of well family members for the future of the ill family member and ways families contemplate transfer of care issues are described. Implications of the study for community research and action are discussed.

Adaptation, Psychological↗
PubMed2001

A unique panic-disorder presentation among Khmer refugees: the sore-neck syndrome.

This article describes a previously unreported cultural syndrome among Khmer refugees. This common presentation of distress centers on the complaint of a sore neck, the sufferer fearing that wind-and-blood pressure may burst the vessels in this area. During an acute episode, a Khmer endures many--if not all--of the following neck-and-head complaints: headache, blurry vision, a buzzing in the ear, and dizziness. While in the throes of the sore-neck attack, the patient frequently experiences palpitations as well as other symptoms of autonomic arousal, such as diaphoresis, shortness of breath, and trembling. A sufferer of sore-neck episodes often meets panic disorder criteria. In a clinic survey, thirty-five out of eighty-five patients (41%) were found to currently suffer the "sore-neck syndrome" (i.e., to have endured at least one episode in the last month), with almost all of these thirty-five patients (80%) fearing death during the acute event. The sore-neck syndrome represents a common and important way in which distress becomes embodied. The clinician must learn this body language; otherwise, the patient's communication of psychic, interpersonal, and physical pain goes unheard--and grave somatic suffering and disability unattended to--discounted as puzzling somatic complaints and unreasonable obsessionalism about blood pressure.

Adult↗
PubMed2001

Pathways through the border of biomedicine and traditional chinese medicine: a meeting of medical systems in a Japanese psychiatry department.

This article examines a meeting of biomedicine and Traditional Chinese Medicine (TCM) in the context of a psychiatry department in a Japanese national medical school. The meeting is explored through stories of four individuals, the professor of the department and three Chinese physicians studying as exchange students. Global structures of medical authority are revealed in the way each participant follows a different trajectory through this space, positioning themselves by virtue of the medical epistemologies they embody. The particular geography of this meeting between systems allowed for a productive synthesis of diagnostic techniques, quite different from the more common therapeutic syntheses. This synthesis is particularly important for contemporary psychiatry because of its ability to attend to dimensional as opposed to categorical aspects of mental health.

Adult↗
PubMed2001

NHS trust chief executives as heroes?

This paper presents a reading of the transcripts of interviews with NHS Trust Chief Executives. Using a poststructuralist understanding of the interviews, it privileges a reading that (ironically) represents these Chief Executives as heroes. Following the classic hero story line, they leave the civilized order of home and journey into a threatening wilderness where they encounter dangerous and magical things but overcome them all because of their masculine characteristics such as rationality, strength and resourcefulness. One way in which these stories can be understood to have significance is that they (misleadingly but powerfully) portray management as obvious and necessary by evocatively drawing on a myth of ancient origin. The piece concludes with some reflections on the ontological implications of the analysis and reflexive comments on the production of truth as a problem.

Anecdotes as Topic↗
PubMed2001

'Transgressing venues': 'health' studies, cultural studies and the media.

This paper looks at how the strategies of media and cultural studies can be applied to the health studies field. This relationship, however, has been met with resistance due to a number of status debates. We argue the importance of fostering links between these 'disciplines' namely because the definition of what constitutes 'health' has been broadened and is inscribed in most forms of popular media. Using the example of the 'health and lifestyle' debate, we argue that the media informs cultural understandings about requirements for living and is therefore a crucial area of analysis for health studies (and cultural/media studies) students. We are also concerned with analysing how the media contributes to the construction and regulation of 'healthy' subjects making links with public health discourses and current debates in the field of media and health.

Anecdotes as Topic↗
PubMed2002

The spirit of community psychology. 2001 Seymour B. Sarason Award Address.

Community psychology as a field may have lost some of its original spirit; a spirit dominant at the founding of the field. Spirit is a difficult concept to discuss since it is a concept beyond usual discourse in psychology as a denotative, measurable and verifiable concept. Taking the lead from William James, Spirit, however elusive, is most essential to a sense of self. I offer three suggestions to enhance and to make our individual and collective spirit more vital: (1) Continuing education in the history of community psychology; (2) Creating time to share stories about our work; (3) Creating safe settings to enlarge our spirit. These ideas are offered as pragmatic suggestions to enable us to create more coherence between our personal and professional selves.

Anecdotes as Topic↗
PubMed2002

The tension between overt talk and covert emotions in illness narratives: transition from clinician to researcher.

In this article I discuss my interview experiences as joint constructions with Finnish parents whose children had been diagnosed with cancer. In doing so both the interviewer and interviewees became engaged as anxious "defended subjects" in an intersubjectivity of acknowledging but unable to talk of "how it really is" to have a child diagnosed with cancer. This appeared as tensions between overt talk and covert emotions. In the overt talk the parents underlined the manageable aspects of the illness. The speechless and painful part of the illness experience appeared as covert emotions that the interviewer was able to recognise and contain. Only when both the overt talk and the covert emotions were taken into account did it open up a more comprehensive way to understand the depth of the illness suffering. This is illustrated with one interview as an example.

Adult↗
PubMed2002

Agonias: the social and sacred suffering of Azorean immigrants.

Agonias, meaning "the agonies," is a culture-specific somatic phenomenon experienced by Azorean immigrants. Although the community's health providers conceptualize agonias as an "anxiety disorder," interviews with community members revealed a more complex phenomenon. For them, agonias is a somatomoral experience--where the somatic, the social, the religious and the moral are inextricably linked. Because agonias connects things that, from the traditional medical perspective, should not be connected, such as mind, body, spirit, and community, it defies our psychiatric categorisation and goes beyond disciplinary boundaries. Agonias is a dynamic multivocal symbol that is not just an inanimate signifier but also a therapeutic act. On an individual level, it connects the sufferer with others and with God, transforming the interpersonal and divine space. On the societal level, it connects a community, losing its way of life, to the past and to its identity, preserving its social and religious traditions.

Anecdotes as Topic↗
PubMed2002

Medical decision-making: an argument for narrative and metaphor.

This study examines the processes of decision-making used by intensive care (critical care) specialists. Ninety-nine specialists completed a questionnaire involving three clinical cases, using a novel methodology investigating the role of uncertainty and temporal-related factors, and exploring a range of ethical issues. Validation and triangulation of the results was done via a comparison study with a medically lay, but highly informed group of 37 law students. For both study groups, constructing reasons for a decision was largely an interpretative and imaginative exercise that went beyond the data (as presented), commonly resulting in different reasons supporting the same conclusions and similar reasons supporting opposite conclusions. The skills of ethical imagination and interpretation were related to an individual's prior lived experience, construed in the broadest sense. Application of these skills of ethical imagination and interpretation always occurred, to some degree, in a state of uncertainty and almost always involved temporal relationships. Using these results, a theory of ethical decision-making is proffered. Three levels or types of reasoning processes may be present. Type I decision-making involves the application of rules, usually in a deductive fashion. Type II decision-making is characterised by a process where a plurality of reasons are balanced, weighed and sifted with each other. Type III decision-making is intimately linked with respondents lived experiences and 'crafts' the content of type I and II reasoning processes, via the application of ethical imagination and interpretation. Relationships between these three types of reasoning processes, and with narrative ethics, are also discussed.

Anecdotes as Topic↗
PubMed2002

Adolescent girls' use of the Internet for health information: issues beyond access.

Whilst the "digital divide" in access to Internet technology has rightly concerned commentators on health inequalities, there are issues beyond physical access that must be tackled if adolescents and adults are to optimize the benefits of this developing medium. Emerging themes from an exploratory qualitative study of adolescents' use of the Internet for information about health and medicines describe four major challenges. Access issues persist if there are insufficient school computers that are unable to cope with increasing Web site sophistication. Software on school-based machines preventing exposure to material that is deemed to be unsuitable may also prohibit access to educational sites about sexual health and drug misuse. Strategies to manage the volume of available information are needed. The interplay of active and passive information seeking challenges whether the Internet can be truly useful during acute illness episodes. This exploration with future health service users highlights important questions for further study.

Adolescent↗
PubMed2002

Between "science" and "superstition": moral perceptions of induced abortion among young adults in Vietnam.

Despite the increasing use of reproductive technologies the world over, anthropological studies have paid remarkably limited attention to the ethical dilemmas involved in people's choices of such technologies. Against this background, the author analyzes moral perceptions of induced abortion among unmarried young adults in urban North Vietnam. While the ethical aspects of abortion are shrouded in silence in public life in Vietnam, the young people participating in the study expressed strong moral scepticism towards the practice of abortion, even while undergoing it themselves. Through the analysis of young people's experiences and perceptions, the paper demonstrates how moral ideas are tied to particular social situations and structured by larger socio-political circumstances. It is argued that moral notions which are dominant in a society's public sphere may not be representative of the moral sentiments that are lived in practice and felt in private.

Abortion, Induced↗
PubMed2002

Commercial sex work or ukuphanda? Sex-for-money exchange in Soweto and Hammanskraal area, South Africa.

This article introduces the concept of ukuphanda, a Zulu verb that is used to describe the sex-for-money exchanges that take place outside of commercial sex work in Soweto and Hammanskraal area, South Africa. In line with the ethnographic literature from others areas of sub-Saharan Africa, it is argued that women who exchange sex for money in taverns do not self-identify as commercial sex workers and experience less stigma from the community. Unlike commercial sex work (as characterized by the commercial sex work in Hillbrow, Johannesburg), which is understood to be associated with short skirts and other revealing attire, sex-for-money exchange in the taverns is viewed as more private, ambiguous and informal. Women who work as informal sex workers, or "-phandela imali" ('try to get money'), are understood to be using sex-for-money exchange to survive financially.

Adult↗
PubMed2003

Sexual harassment stories: testing a story-mediated model of juror decision-making in civil litigation.

The story model of juror decision-making proposes that jurors use personal experience and information presented at trial to create stories that guide their verdicts. This model has received strong empirical support in studies using criminal cases. The research presented here extends the story model to civil litigation and tests a story-mediated model against an unmediated model of jury decision-making. In Phase 1, content analysis of mock juror responses to 4 realistic sexual harassment cases revealed prototypic plaintiff and defense stories. In Phase 2, these prototypic stories were included as mediators in a model predicting verdicts in 4 additional sexual harassment cases. Mock juror attitudes, experiences, and demographics were assessed, then attorneys presented abbreviated versions of 4 actual sexual harassment cases. Path analyses provided support for the story-mediated model, which added significantly to the amount of variance accounted for in the outcome measures of verdict, commitment to verdict, and confidence times verdict. Implications for sexual harassment and other types of civil cases are discussed.

Adult↗
PubMed2000

Oliver Sacks--a neurologist explores the lifeworld.

The neurologist Oliver Sacks has become very famous for his writings. His popularity has scattered all mass medias. In his books, he eloquently tells stories about patients suffering from extraordinary neurological diseases. Since the conceptual framework of Sacks' narratives has been widely unconsidered, this article pursues a more general and systematic approach to his work. Sacks terms his idiographic and phenomenological access to the world of science Romantical Science. With its features, he develops a concept of a Neurology of Identity, that is basically concerned with the patient's personality and subjectivity. Sacks' personal approach to medicine implies another understanding of diseases: For him, diseases cannot be reduced to pathological facts, they constitute other worlds. He characteristically uses philosophical, psychological and mythical terms for interpretation and narration. But conversely to its sympathetic appearance, Sacks' approach entails some deficits: His presentation is not always realistic, his interpretations are often one-sided. The theoretical reflections on his method and attitude remain poor. Nevertheless, he puts medicine back into lifeworld, to open it for many discourse universes beyond science in practice and theoretical reflection.

Adaptation, Psychological↗