Joseph A. Kotarba

Chronic pain : its social dimensions

A study of the social meanings of the experience of chronic pain. Kotarba uses data from observation, interviews, field research, and conversations, to show how pain becomes the focal point of the sufferers world. He reviews the medical perspectives and shows how pain affects relationships with family and with doctors. He also charts the general pattern of seeking help outside traditional medicine, and the search to find some reason or significance for the misfortune.

Perceptions of death, belief systems and the process of coping with chronic pain

Chronic pain is an on-going experience of embodied discomfort, quite often associated with neuromuscular pathologies, which fails either to heal naturally or to respond to normal medical intervention. The process of coping with chronic pain most commonly involves both the search for medical or non-medical cure, and the search for meaning for intractable suffering. In this paper, I survey various religious, philosophical and mystical belief systems and their empirical use as resources for meaning. The great variability in the ways ideas of death, the key elements extracted from belief systems during the process of coping, are used reflects the variable success in normalizing chronic pain. Theoretically, this paper adds an important dimension to the concept of the chronic illness trajectory, namely, the issue of inevitability, and discusses clinical and non-clinical aspects of depression among people with chronic pain.

ETHNOGRAPHY AND AIDS Returning to the Streets

Ethnography has become an important research method in social scientific efforts to understand AIDS. The relationship between ethnography and AIDS has had numerous consequences on the conduct of ethnographic work: (a) the influx of large-scale government funding; (b) the bureaucratization of the ethnographic team; (c) the need for sophisticated, computerized data management systems; (d) the use of ethnography as a mechanism for empowerment; (e) the movement from viewing the research collaborator as “subject” to “client”; (f) the reduction in the stigma traditionally attached to research on homosexual phenomena; (g) increased cooperation between qualitative and quantitative researchers; and (h) the opportunity to conduct a wide range of innovative ethnographic studies. Although the relationship between ethnography and AIDS can inform current academic debates on the ethnographic enterprise, the ultimate value of our research lies in our ability to elegantly describe the everyday lives of people who are coping with or simply trying to make sense of AIDS.

Managing the problem pain patient: compliance or social control?

This paper explores the usefulness of a social control perspective for the analysis of the everyday medical management of problem pain patients. The popular, social-psychologically based, patient-compliance model is founded on certain assumptions which limit applicability to pain patient-practitioner interaction. A social control model is proposed to account for the moral and social construction of the problem pain patient. Data are presented from studies of pain management seminars and the patient screening process in a comprehensive pain treatment center to illustrate how this moral and social construction is accomplished.

Macro-Level Social Forces and Micro-Level Consequences: Poverty, Alternate Occupations, and Drug Dealing

This article is an empirical examination of the ways in which macro-level social forces have had micro-level consequences in the New Orleans drug market. The article illustrates a clear connection between poverty and entrance into the drug market, as mitigated by race, lack of societal opportunity, lack of social capital, distressed families, and closed neighborhoods. Specifically, the research illustrates the mechanisms by which macro-level social forces intersect to legitimize drug dealing as a viable alternative method of acquiring money and social capital. These intersecting macro-level social forces, such as poverty, race, family structure, and neighborhood characteristics, ultimately constrain the life chances of those living in the inner city irrespective of personal traits, individual motivations, or private achievements.

Conceptualizing Sports Medicine as Occupational Health Care: Illustrations from Professional Rodeo and Wrestling

The purpose of this article is to propose a sociological model of sports medicine that conceptualizes it as occupational health care. All occupational health care systems can be summarized according to three types: elite, managed, and primitive. These types reflect the quality of health care provided, the social class membership of workers, and workers’ value to employers. The author presents ethnographic data to illustrate the social dynamics of primitive occupational health care delivered to rodeo cowboys and local professional wrestlers. This care is primitive because these athletes have relatively low economic value as workers, and the rugged individualism of their sports’ subcultures supports a system of health care that is inexpensive, nonmedical in its philosophy, personalistic in the structure of its practitioner-patient relationship, and incidental in its delivery.

American Acupuncturists: The New Entrepreneurs of Hope

AUTHOR’S NOTE: The author wishes to thank John Johnson and David Altheide for insight and inspiration. JOSEPH A. KOTARBA received his M.A. in sociology from Arizona State University, Tempe, in May 1975. He will continue his graduate studies at the University of California, San Diego, with an emphasis on the sociology of everyday life and of health and illness. This article, a revision of his master’s

21st-century leadership in nursing education: the need for trifocals.

In this qualitative study, deans of top-ranked graduate nursing schools were interviewed to examine how they are approaching leadership issues into the next century. Discussion focused on managing change, handling problems, communication/leadership styles, models of governance, research productivity, and expectations of faculty. The picture that emerged suggested that deans must be able to see objects and events from different perspectives, analogous to wearing trifocal eyeglasses. Deans described current roles, which were labeled as Director, Sensor, and Negotiator. However, future roles will require a different set of skills and competencies. Deans described these roles as Consensus Builder, Risk Taker, and Interactive Empowerer. Deans will need to react based on multiple points of vision and accommodate rapidly to maintain excellence in all areas of the mission.

Health locus of control among HIV-positive indigent women

The authors explored the multidimensional construct of health locus of control among 14 indigent HIV-positive women who attended one of two southwestern city health clinics. An exploratory survey design was used to compare the mean responses of the subjects on the Multidimensional Health Locus of Control (MHLC) Scales with established normative data. The women believed they had control over their health, yet felt powerful others and chance determine their health outcomes. These findings are drawn from high scores on both the Internal and External MHLC Scales. Findings imply that these women may not view themselves as having any control in the dichotomous world of acute and chronic illness. Authors recommend that nurses should encourage their patients to participate in the management of their health care.

Chronic Pain Center

The chronic pain phenomenon is becoming one of the most widely discussed topics in health care today. Chronic pain itself is an extended experience of embodied discomfort-quite often associated with neuromuscular pathologies-that fails either to heal naturally or to respond to normal medical intervention. Growing awareness of the prevalence of this disease, as well as its social and economic repercussions, has led many observers to conceive of it in epidemic terms (Brena, 1978: 4-5). Approximately 75 million Americans suffer from some kind of chronic