Health: current issue

Understanding sustained behavior change: the role of life crises and the process of reinvention

Ogden, J., Hills, L. — 2008-09-25

Much research has addressed behavior change but has tended to focus on short term changes. This study aimed to explore the mechanisms behind sustained changes in behavior and involved qualitative interviews with 34 `success stories' who had either lost weight through changes in diet and exercise (n = 24) or stopped smoking (n = 10) and had maintained this change for at least 3 years. The results showed that the majority described how their sustained behavior change had been triggered by a significant life crisis relating to their health, relationships or salient milestones. This initial change was then translated into sustained change if three sustaining conditions were met: the function of the unhealthy behavior was disrupted, the individual perceived that their choice over carrying out the unhealthy behavior had been reduced and they adhered to a behavioral model of their problem. Further, these conditions functioned by enabling a process of reinvention with participants showing a shift in identity toward a new healthier self. The results are discussed in terms of self-regulation and the establishment of a new post-crisis healthier equilibrium.

Resilience and depression: perspectives from primary care

Dowrick, C., Kokanovic, R., Hegarty, K., Griffiths, F., Gunn, J. — 2008-09-25

Resilience refers to the capacity for successful adaptation or change in the face of adversity. This concept has rarely been applied to the study of distress and depression. We propose two key elements of resilience — ordinary magic and personal medicine — which enable people to survive and flourish despite current experience of emotional distress. We investigate the extent to which these elements are considered important by a sample of 100 people, drawn from a longitudinal study of the management of depression in primary care in Victoria, Australia. We also assess how respondents rate personal resilience in comparison with help received from professional sources. Our data are obtained from semi-structured telephone interviews, and analysed inductively through refinement of our theoretical framework. We find substantial evidence of resilience both in terms of ordinary magic — drawing on existing social support and affectional bonds; and in terms of personal medicine — building on personal strengths and expanding positive emotions. There is a strong preference for personal over professional approaches to dealing with mental health problems. We conclude that personal resilience is important in the minds of our respondents, and that these elements should be actively considered in future research involving people with experience of mental health problems.

Negotiating the diagnostic uncertainty of contested illnesses: physician practices and paradigms

Swoboda, D. A. — 2008-09-25

In the absence of scientific consensus about contested illnesses such as Chronic Fatigue Syndrome (CFS), Multiple Chemical Sensitivities (MCS), and Gulf War Syndrome (GWS), physicians must make sense of competing accounts and develop practices for patient evaluation. A survey of 800 United States physicians examined physician propensity to diagnose CFS, MCS, and GWS, and the factors shaping clinical decision making. Results indicate that a substantial portion of physicians, including nonexperts, are diagnosing CFS, MCS, and GWS. Diagnosing physicians manage the uncertainty associated with these illnesses by using strategies that enhance bounded rationality and aid in thinking beyond current disease models. Strategies include consulting ancillary information sources, conducting analytically informed testing, and considering physiological explanations of causation. By relying on these practices and paradigms, physicians fit CFS, MCS, and GWS into an explanatory system that makes them credible and understandable to them, their patients, and the medical community. Findings suggest that physicians employ rational decision making for diagnosing contested illnesses, creating a blueprint of how illnesses lacking conclusive pathogenic and etiological explanations can be diagnosed. Findings also suggest that patients with contested illnesses might benefit from working with physicians who use these diagnostic strategies, since they help manage the complexity and ambiguity of the contested illness diagnostic process and aid in diagnosis. In addition, findings provide a window into how emerging illnesses get diagnosed in the absence of medical and scientific consensus, and suggest that diagnosing physicians advance the legitimacy of controversial illnesses by constructing the means for their diagnosis.

Discourse of `transformational leadership' in infection control

Koteyko, N., Carter, R. — 2008-09-25

The article explores the impact of the `transformational leadership' style in the role of modern matron with regards to infection control practices. Policy and guidance on the modern matron role suggest that it is distinctive in its combination of management and clinical components, and in its reliance on transformational leadership. Senior nurses are therefore expected to motivate staff by creating high expectations, modelling appropriate behaviour, and providing personal attention to followers by giving respect and responsibility. In this article, we draw on policy documents and interview data to explore the potential impact of this new management style on infection control practices. Combining the techniques of discourse analysis and corpus linguistics, we identify examples where matrons appear to disassociate themselves from the role of `an empowered manager' who has control over human and financial resources to resolve problems in infection control efficiently.

The artist as surgical ethnographer: participant observers outside the social sciences

Harris, A. — 2008-09-25

Artists and novelists have rarely been considered as ethnographers in the medical social sciences. This article pursues the idea that ethnographically informed artistic works can be viewed as critical cultural texts alongside sociological and anthropological studies of surgery. It is proposed that art provides fresh perspectives on topics of interest in health sociology and medical anthropology while simultaneously expanding our engagement with ethnographic representation. Discussion revolves around a video installation incorporating images of heart surgery by contemporary artist Bill Viola and a recent novel by Ian McEwan detailing the day-in-the-life of a neurosurgeon. Considering an emerging re-engagement, particularly in contemporary art that artists are having with medical themes, and a concurrent `ethnographic turn' in art practice, it seems timely to recognize the potentially critical contribution of non-social scientist ethnographers to our understanding of a rapidly changing medical culture.

Constructions of the self in interaction with the Beck Depression Inventory

Galasinski, D. — 2008-09-25

In this article, I am interested in discourses of people completing the Polish version of the Beck Depression Inventory (BDI). I focus upon the negotiation of the spaces for constructing the self opened by the BDI. My corpus consists of transcripts of 50 sessions in which self-reportedly healthy people were asked to `think aloud' while completing the BDI. I shall demonstrate that in interactions with the `depression scale', the informants mostly rejected the spaces offered by it. Three strategies of such rejection are discussed: reformulation, recontextualization and an explicit challenge to the categories offered by the BDI. I shall argue that the concerns of lived experience in a particular context, when not subdued by the relationship of power in the situation of medical examination, overrule the frame imposed by the a-contextual questionnaire of sadness. Insight into depression or its intensity offered by `context-free' psychological or psychiatric instrument, set outside lived experience, is extremely problematic.

Book review: The body in question: A socio-cultural approach. Alan Peterson. London: Routledge, 2007. 169pp. ISBN 0-415-32162-x (pbk)

Gale, N. K. — 2008-09-25

Book review: Pink ribbons, Inc. breast cancer and the politics of philanthropy. Samantha King. Minneapolis and London: University of Minnesota Press, 2006, 157 pp. ISBN 978-0-8166-4898-6 (paper). $US18.95

Frank, A. W. — 2008-09-25

Book review: Review notices: books on death and dying

Frank, A. W. — 2008-09-25