Judith T. Shuval

Diaspora Migration: Definitional Ambiguities and a Theoretical Paradigm

Diaspora migration is one of many types of migration likely to increase considerably during the early twenty-first century. This article addresses the many ambiguities that surround diaspora migration with a view to developing a meaningful theoretical scheme in which to better understand the processes involved. The term diaspora has acquired a broad semantic domain. It now encompasses a motley array of groups such as political refugees, alien residents, guest workers, immigrants, expellees, ethnic and racial minorities, and overseas communities. It is used increasingly by displaced persons who feel, maintain, invent or revive a connection with a prior home. Concepts of diaspora include a history of dispersal, myths/memories of the homeland, alienation in the host country, desire for eventual return – which can be ambivalent, eschatological or utopian – ongoing support of the homeland and, a collective identity defined by the above relationship. This article considers four central issues: How does diaspora theory link into other theoretical issues? How is diaspora migration different from other types of migration? Who are the relevant actors and what are their roles? What are the social and political functions of diaspora? On the basis of this analysis a theoretical paradigm of diasporas is presented to enable scholars to move beyond descriptive research by identifying different types of diasporas and the dynamics that differentiate among them. Use of the proposed typology – especially in comparative research of different diasporas – makes it possible to focus on structural differences and similarities that could be critical to the social processes involved.

Entering the well-guarded fortress: alternative practitioners in hospital settings

There is a growing evidence that alternative health care practitioners and physicians are working together in collaborative patterns. The paper examines these collaborative patterns in hospital settings in Israel. On the theoretical level, the specific issues relate to theories concerning relationships between dominant institutional structures which enjoy the benefits of epistemological legitimacy as well as extensive, supportive social structures and groups of non-conformists who seek to attain many of the same goals by utilizing different methods based on other epistemologies. In the most general sense, the issues involved concern processes of accommodation and social change. Data were collected by means of semi-structured, qualitative interviews in four general hospitals in Jerusalem during 2000. Nineteen persons were interviewed including 10 alternative practitioners working in a variety of fields and nine biomedical practitioners who worked with them (six physicians and three nurses). Interviews focused on background and training, reasons for entry into the hospital, length of practice, status in the hospital system, mode of remuneration, content of work, modes of interaction with others in the hospital and problems encountered. The findings suggest a dual process of simultaneous acceptance and marginalization of alternative practitioners. While small numbers of alternative practitioners were found to be practicing in a wide variety of hospital departments and in a broad spectrum of specialties, they were in no way accepted as regular staff members and their marginality was made clear by a variety of visible structural, symbolic and geographical cues. There is a division of labour expressed by focusing on the biomedical practitioners on the diagnosis and treatment of specific disease entities, while the alternative practitioners work in the illness context, concentrating of feelings and affective states involving the alleviation of pain, suffering and efforts to improve the quality of life.

Changing Boundaries: Modes of Coexistence of Alternative and Biomedicine

In this article, the authors address the boundaries of institutional structures, the dynamics of their configuration, and the nature of their permeability. The authors explored these issues in Israel, where the changing relationship of bio and alternative medicine elucidates recent processes of professional boundary redefinition. They used qualitative methods to analyze in-depth interviews in clinics and hospitals where alternative and biomedical practitioners work under the formal auspices of publicly sponsored biomedical organizations. The findings show an incursion by alternative practitioners into territories viewed until fairly recently as the exclusive domain of biomedicine. However, the “alternatives” are not defined as regular staff members, and their marginality is elucidated by a variety of visible structural, symbolic, and geographical cues. The authors used decoupling theory in interpreting the findings. Changed boundary contours signal underlying processes of social change that could have meaningful implications in defining membership criteria in the biomedical community.

The Reconstruction of Professional Identity Among Immigrant Physicians in Three Societies

The paper concerns the processes by which migrant physicians seek to re-establish themselves professionally in a new society. The empirical findings are drawn from a study of physicians who emigrated from the former Soviet Union in the early nineties to three different destinations: Canada, Israel, and the United States. The existential quality of the migration experience was explored by means of a set of life-history narratives related by immigrant physicians. Despite major structural differences among the three hosts, there are several important similarities in the processes observed in the three settings. The first concerns the high salience of the professional role for immigrant physicians and their determined efforts to regain their lossed status. These efforts are constrained by structural elements characterizing the three hosts. The second relates to the mediating effects of gender and age in the reconstruction of professional identity: female immigrant physicians are relatively disadvantaged as are older persons in the occupational sphere. Immigrant physicians who decide not to pursue medical licensure often redefine their occupational identity in areas that are close to the health field. Differences noted among the three groups are a function of structural differences among the three host societies.

Change and stability: use of complementary and alternative medicine in Israel: 1993, 2000 and 2007

BACKGROUND Complementary and alternative health care has gained increasing popularity in Western societies in recent years. The objective of the article is to explore cross-sectional variations and temporal changes in the patterns of complementary and alternative medicine (CAM) consultations in Israel in 1993, 2000 and 2007. METHODS Interviews were conducted with 2003 respondents in 1993, 2505 in 2000, and 752 in 2007, using identical questions. The samples represented the Israeli Jewish urban population aged 45-75 in the respective years. RESULTS The rate of use of CAM during the previous year increased from 6% in 1993, to 10% in 2000 and reached 12% in 2007. Women and highly educated persons have been significantly and consistently more likely to use CAM. Among the users, homeopathy, acupuncture and reflexology are the main types of CAM used. Lower back pain became the leading problem for which care was sought. A significant proportion of the users continue to use conventional medicine concurrently, and an increasing share was referred to CAM by their physician. Past good experience has become a major reason for CAM use. CONCLUSIONS Between 1993 and 2007, CAM use in the Israeli urban Jewish population aged 45-75 years increased significantly. As in other countries CAM grew from an infant industry and entered the mainstream of health care. The evidence reported here highlights the urgent need for the design of health and social policies aiming to achieve more effective integration between CAM and conventional medicine.

The occupational integration of former Soviet physicians in Israel.

This paper reports the findings of a five-year, three-stage study of the occupational status persistence of 333 physicians who immigrated to Israel from the former Soviet Union in 1990. The first data collection, by way of a structured questionnaire in Russian, was undertaken in 1991, during their participation in preparatory courses for the medical licensure examination. The second and third stages of data collection were undertaken by mail in 1993 and 1995. Data are presented regarding the influence of gender and age on employment status and on the relationship between employment status and psycho-social well-being, including work and general satisfaction, self-esteem, mood, health and overall adaptation, at both stages. The dynamics of occupational integration are investigated by looking at the effects of occupational stability vs occupational change between stage 2 and stage 3 on the psycho social outcome variables. After three years in Israel, men were more likely to be working as physicians than women, and women were more likely to be unemployed. However, after five years, women were equally likely to have found work in their profession, albeit in lower status positions. Younger respondents were more successful than older respondents in passing the licensure examination, finding work in their profession, and entering residency programs. The gap between them did not close between stage 2 and stage 3. At both stage 2 and stage 3, those working as physicians had significantly more positive well-being scores than those not working as physicians. All occupational groups had more positive scores at stage 3 than at stage 2, except for those who were working in non-medically related jobs. The greatest improvement in psycho-social well-being was among those who became physicians between stage 2 and stage 3, compared to those who were not physicians at either stage and those who were physicians at both stages.

Midwives Practice CAM: Feminism in the Delivery Room

This article focuses on midwives who practice complementary and alternative medicine (CAM) in Israel. After qualifying as nurses in mainstream biomedical institutions, these midwives have, at some point in their careers, opted to study a variety of CAM skills and practice them in hospital delivery rooms in Israel. The authors explore the relationship of selected elements of feminist ideology to the epistemology of CAM midwives. Seven context-specific themes are viewed as central to their epistemological stance: rejection of the medicalization of birth; a strong belief in the “naturalness” of childbirth; rejection of the overuse of technology; empowerment of women; nostalgia and reverence for the past; centrality of intuition, feeling, and emotion; and active advocacy. In-depth, semistructured interviews were carried out during 2004 to 2005 with 13 midwives. These narratives provided empirical material for a qualitative analysis. Evidence is shown to demonstrate the unique feminist quality of the core beliefs of the CAM midwives.

Illness: A mechanism for coping with failure☆

Abstract Illness represents one way of coping with failure and the physician plays a unique role as the sole authority granting legitimation for the sick role. For people of limited means or incomplete knowledge of and access to other medical alternatives, the neighborhood clinic, when it is free and accessible, may serve as the major locus for obtaining legitimation of illness. Such a situation places a special burden on the physician particularly in a social context in which feelings of failure could be widespread in the population. Helping people cope with failure is a stable function of medical institutions and is likely to persist in the face of possible changes in the structure of the professional role. It probably has a good deal of generality to many societies.

On knowing and believing: prenatal genetic screening and resistance to ‘risk-medicine’

This paper presents the concept of ‘risk-medicine’ through the analysis of the rejection of prenatal screening among ultra Orthodox Jews in Israel. The foundations of this phenomenon are examined, defining ‘risk’ as a major socio-cultural feature of late modern Western society. The authors describe eight possible components of resistance to biomedicine, some being specifically applicable to risk-medicine: cultural discrepancy, lack of information, religious prohibitions, risk-aversion, incompatible health and illness cosmologies, fear and mistrust, governmental control, and irreconcilable epistemological differences. The analysis identifies two fundamental dimensions associated with risk-medicine: its epistemological basis, and the governmental surveillance that it involves. While the former stems from diverging conceptions on the values of different forms of ‘gnosis’ (probabilities vs. certainty) the latter draws upon the relationship between the state and risk-medicine, portraying ultra Orthodox womens rejection of prenatal screening as a form of resistance to nationalist, secular forces. The paper advances new concepts (namely ‘risk-medicine’ and ‘gnosis’ as related to ‘pro-gnosis’ and ‘dia-gnosis’) that may constitute a ground for further research on forms of medical epistemologies and practices and their related forms of resistance, namely in the context of religious and ideological incompatibilities.

Are users of complementary and alternative medicine sicker than non-users?

Higher utilization of complementary and alternative medicine (CAM), both in cross-sections and over time, is commonly related to better socioeconomic status and to increased dissatisfaction with conventional medicine and its values. Little is known about health differences between users and non-users of CAM. The objective of the paper is to explore the difference in health measured by the SF-36 instrument between users and non-users of CAM, and to estimate the relative importance of the SF-36 health domains scales to the likelihood of consulting CAM providers. Interviews were used to collect information from a sample of 2000 persons in 1993 and 2500 persons in 2000, representing the Israeli Jewish urban population aged 45–75 in those years. Bivariate and logistic regression analyses were used to explore the above associations. The results show that while users of CAM enjoy higher socioeconomic status and younger age, they tend to report worse health than non-users on the eight SF-36 health domains scales in both years. However, controlling for personal characteristics, lower scores on the bodily pain, role-emotional and vitality scales are related to greater likelihood of CAM use in 2000. In 1993, no scale had a significant adjusted association with the use of CAM. The conclusions are that CAM users tend to report worse health. With CAM becoming a mainstream, though somewhat luxurious, medical practice, pain and affective-emotional distress are the main drivers of CAM use.