Gillian Bendelow

Evaluating the influence of implicit models of mental disorder on processes of shared decision making within community-based multi-disciplinary teams

This paper reports findings from a qualitative study concerning the influence of implicit models of mental disorder on shared decision making within community-based mental health teams. One-hundred participants representing five distinct multi-agency groups: psychiatrists, community psychiatric nurses, approved social workers, patients and informal carers operating within Leicestershire, England were interviewed using a standard case vignette describing a person whose behaviour suggests he may have schizophrenia. The results showed that each of the studys multi-agency groups implicitly supports a complex range of model dimensions regarding the nature of schizophrenia, the appropriateness of specific forms of treatment and care, and their respective rights and obligations towards each other. The influence of these implicit model patterns on processes of shared decision making are discussed through evaluating their contribution to our understanding of the power relationships existing between various practitioner groups (including informal carers), and between practitioners and patients during clinical encounters.

Pain, suffering and risk

Abstract A primary role of medicine is often perceived as treating or alleviating pain, but what actually constitutes pain can be defined in many ways. A major impediment to a more adequate conceptualization of pain is thought to be the manner in which it has been ‘medicalized,’ over the course of the twentieth century resulting in the inevitable Cartesian split between body and mind. Consequently, the dominant conceptualization of pain has focused almost exclusively upon the neurophysiological aspects, both in diagnosis and treatment, with the subsequent inference that it can be rationally and objectively measured. Social science, in particular the sociological literature on chronic illness, offers a framework for understanding the experience of pain by focusing on ‘lived experience,’ including narratives of suffering. Medically, pain is often explained in terms of risk by attempting to measure so-called objective symptoms, whereas accounts of suffering may encompass more easily the notion of total pain (Saunders 1976), which includes psychological, spiritual, interpersonal and even financial aspects of chronic pain, as well as its physical aspects. This paper proposes that illness narratives and phenomenological accounts have become intrinsic to the understanding and treatment of pain and, using examples from empirical research, considers how pain narratives challenge biomedical approaches to chronic pain, which are inevitably framed in the discourse of risk.

Children's Health In Primary Schools

Combining anecdotal accounts, inter-professional experiences, critical debate and practical pointers to being a good observer, this book explores issues surrounding observation in social science-orientated research.

Screening for breast cancer : medicalization, visualization and the embodied experience

Women’s perspectives on breast screening (mammography and breast awareness) were explored in interviews with midlife women sampled for diversity of background and health experience. Attending mammography screening was considered a social obligation despite women’s fears and experiences of discomfort. Women gave considerable legitimacy to mammography visualizations of the breast, and the expert interpretation of these. In comparison, women lacked confidence in breast awareness practices, directly comparing their sensory capabilities with those of the mammogram, although mammography screening did not substitute breast awareness in a straightforward way. The authors argue that reliance on visualizing technology may create a fragmented sense of the body, separating the at risk breast from embodied experience.

'Recalcitrant Bodies'? Children, Cancer and the Transgression of Corporeal Boundaries

Located within the context of recent debates about the body as both a material and socially constructed entity, this article takes up these corporeal issues through a focus on children’s images and depictions of cancer. Key themes here include monstrous/demonic bodies, dys-figured/absent bodies, the combustible body, pathological bodies and mortal bodies. Under-pinning these representations, it is suggested, is a view of the primordial body as a ‘recalcitrant’, ‘transgressive’ entity; something with a ‘will of its own’ which, despite our best efforts, can go horribly wrong. A focus on issues of corporeal transgression, therefore, throws into critical relief the relationship between the material and the cultural, the physical and the social, the rational and the emotional. Explorations of malignant bodies, however culturally constituted, lie at the heart of this dialectic. The article concludes with a series of reflections on these issues, including the notion of children as active agents, the relationship between lay and scientific knowledge, and a view of the material body which is not only shaped by social relations, but enters into their very construction and transgression, as both a resource and constraint, a limit and opportunity.

It makes you bald: children’s knowledge and beliefs about health and cancer prevention

Reports results from a study concerning children’s knowledge of and attitudes towards cancer, and their understanding of health and health‐related behaviours, with the specific aim of informing future health promotion work. Using “draw and write” techniques, the findings indicate that these children possessed considerable health‐related knowledge. Exercise and healthy eating were seen as the most important factors in keeping healthy, whereas smoking and bad diet were cited most often as representing unhealthy behaviour. However, both categories also included more general items, embracing both environmental and “individualistic” factors. Similarly, children appeared to possess considerable knowledge about cancer, particularly about lung cancer, but there was also some understanding of other cancers such as breast and skin cancer and leukaemia. Concerning sources of information, most of the children’s knowledge about cancer appeared to derive from television and other media; in particular, soap operas appeared to exert a considerable influence on these young children. Considers the implications of these findings for traditional approaches to health education and the methodological issues involved in researching children’s health.

Children's emotional learning in primary schools

Using insights gleaned from the sociology of childhood to challenge prevailing conceptualizations of children as emotionally ‘incomplete’ or ‘immature’ in relation to adults, this study demonstrates the interactive nature of the social order within primary schools and the centrality of emotional learning to childrens everyday lives and relationships. Analysis of the qualitative data shows how children recognize the role of emotional learning in sustaining a balanced and ‘healthy’ lifestyle in relation to their self-identity, particularly through the importance of enlisting and sustaining friendships as protection across the public/private divide and the institutional order of school life. Furthermore, the data show that children understand their subordination to adults and the role of ‘emotion work’ in the negotiation of these hierarchical relationships.

Chronic pain patients and the biomedical model of pain.

The biomedical definition of pain is inadequate to encompass the experiences of patients living with chronic pain.

Ethical aspects of personality disorders

Purpose of review To review recent literature around the controversial diagnosis of personality disorder, and to assess the ethical aspects of its status as a medical disorder. Recent findings The diagnostic currency of personality disorder as a psychiatric/medical disorder has a longstanding history of ethical and social challenges through critiques of the medicalization of deviance. More recently controversies by reflexive physicians around the inclusion of the category in the forthcoming revisions of International Classification of Diseases and Diagnostic and Statistical Manual of Mental Disorders classifications reflect the problems of value-laden criteria, with the diagnostic category being severely challenged from within psychiatry as well as from without. Summary The clinical diagnostic criteria for extremely value-laden psychiatric conditions such as personality disorder need to be analyzed through the lens of values-based medicine, as well as through clinical evidence, as the propensity for political and sociolegal appropriation of the categories can render their clinical and diagnostic value meaningless.

Sociology and Concepts of Mental Illness

DIFFERING SOCIOLOGICAL PERSPECTIVES of mental health and illness can be linked to theoretical contributions from Durkheim, Weber, Freud, Foucault, and Marx (social causation, labeling theory, critical theory, social constructivism, and social realism, respectively) but sociology in general, and medical sociology in particular, has often been accused of neglecting the field of mental health and illness. Certainly, as a discipline, it is unable to provide an overarching explanatory framework; rather, as Pilgrim and Rogers describe, “‘sedimented layers of knowledge which overlap unevenly in time and across disciplinary boundaries and professional preoccupations” (1999, 11). Nevertheless, since Durkheim’s (1964/1895) path-breaking insights as to the role of social processes on the norms and values of any society, sociologists have been concerned with distinctions between the normal and the pathological, as in Parsons’ (1951) analysis of illness as deviance. Although the limitations of functionalism have since been well documented, the implication that mental disorder as socially and culturally relative was developed further by Scheff’s concept of labeling theory (1999/1967) and, of course, was highly influential in the work of the anti-psychiatrists such as Laing (1963) and Szasz (1970) in viewing mental illness as the breaking of social, political, and ethical norms. In collaboration with sociologists of science, there is a strong tradition of challenging DSM and other psychiatric classifications to examine the social and political shaping of categories of mental disorder, including how they disappear and reappear (Brown 1990; Manning 2001). Busfield (2001, 2002) has made the distinction between disorders of behavior and disorders of thought, and, although Foucault’s (1967) analysis of reason and madness can be placed firmly in the latter camp, the emphasis on the social and cultural relativity remains. As a paradigm, social constructivism has been highly influential in the ‘deconstruction’ of psychiatric diagnosis and treatment, particularly in the development of feminist and anti-racist critiques and within other vulnerable social groups. It has probably also generated the most controversy—the notion of mental illness as a ‘social construct’ is widely used in lay terminology and even by some mental health professionals, as Fulford and Colombo’s research reveals. Whereas there have been enormous benefits in identifying the socially and politically controlling aspects of psychiatry which at worst, are an abuse of human rights, more recently, the dangers of the extremes of cultural reductionism have been recognized, not just by doctors, sufferers, and their families, but by sociologists themselves. Before his own tragic suicide, Peter Sedg-