Linda Liska Belgrave

Mental health and the elderly: factors in stability and change over time.

Data from the Cleveland GAO Study reveal that, over one year, more elderly persons improved or remained stable than declined in self-assessed mental health and psychiatric symptoms. This pattern is contrary to findings that mental impairment increases with age. Factor analysis of a commonly used psychiatric symptom checklist identified two subscales, one a measure of psychological symptoms and the other of somatic symptoms; both of these are analyzed in this report. Secondary analysis of the 1,332 persons for whom data from both Ti (1975) and T2 (1976) are available evaluates this unexpected stability and improvement. Good physical health at T2 and less illness during the year emerged as the most powerful explanands for gains in all mental health measures, with higher educational levels also contributing to such gains. Improvement in self-assessed mental health was more likely for blacks than for whites, and males were more likely than females to show improvement in somatic symptomatology. Implications offindings for measurement of mental health and for the quality of life among the elderly are discussed.

The relevance of chronic illness in the everyday lives of elderly women

Much past research on the experience of chronic illness and disability is based on the theoretical assumption of illness as a stigmatizing deviance. Among the elderly, however, for whom chronic illness is almost anticipated, there is likely to be less potential for stigma, so that other aspects of physical problems may be more important to an understanding of the illness experience. In-depth interviews were conducted with 29 elderly women suffering from diabetes, arthritis, hypertension, and/or some other chronic health problem. The following research questions were addressed: (a) What is the experience of chronic illness in the everyday lives of noninstitutionalized elderly women? (b) In what ways is stigmatization part of this experience? (c) How is the chronic illness experience related to self-concept? (d) How is this relationship affected by the experience of specific ailments? Inductive data analysis revealed that although the concept of stigma was of limited value in describing the illness experience, more mundane effects of physical problems on daily tasks and lifestyles as a whole were common. For some, specific symptoms led to significant changes, whereas for others illness-related limitations on time and energy were key factors in these effects. Importantly, alterations of self-concept were not experienced universally. For some, illness was not incorporated into self-concept, despite severe physical limitations. Both illness-specific and global aspects of the illness experience emerged during the research.

Discrimination against older women in health care.

Growing awareness of apparent gaps in health care received by women and men raises concern over possible discrimination. This literature review examines this issue for elderly women, whose health care is obtained in a system that also may be permeated with age discrimination. Physicians tend to spend more time with women and older patients, suggesting that discrimination may not be an issue in the physician-patient relationship or may work in favor of older women. However, this may simply reflect elderly womens poorer health. Gender and age disparities in medical treatments received provide a more compelling argument that the health care system is a source of discrimination against older women, who are less likely than others to receive available treatments for cardiac, renal, and other conditions. The history of medical treatment of menopause suggests that stereotypes of older women have been advantageous for segments of the health care system. Finally, in addition to discrimination that has its source within the health care system itself, societal-wide inequities, particularly economic, are extremely detrimental to older womens health care. As we respond to the health care crisis, we must be alert to the potential to rectify those structures and tendencies that can lead to discrimination against women and the aged. Health care reform presents a unique opportunity to ensure health care equity.

“She Works Hard for the Money”: Drag Queens and the Management of Their Contradictory Status of Celebrity and Marginality

This article reports an ethnographic study of drag queens who perform in Miami Beach. Drag queens are marginalized, both economically and socially. However, drag enables some gay men to emphasize and manipulate aspects of femininity for the means of earning attention and income and garnering situational power. Grounding their empirical findings in symbolic interaction, identity, and performance theories, the authors argue that drag queens employ nuanced strategies to negotiate their contradictory status of admired yet alienated performers. The authors use observational and in-depth interview data to explore how participants experience, cope with, and challenge their social marginality. The authors then detail the rewards of drag, focusing on the allure of the transformation, situational power, and income. A subjective understanding of drag reveals that although marginalization is a serious issue, the rewards of drag can be empowering. The authors argue that identity work emerges as a link between marginalization and rewards.

The reconstruction of everyday life: Experiencing Hurricane Andrew

This is an ethnographic account based on interviews collected from people who rebuilt their lives after the devastation caused by Hurricane Andrew in August 1992 in Dade County, Florida. Three themes describe the recovery period: a time out from everyday life, life in “the zone,” and living between two worlds. Time out from everyday life is the initial postdisaster phase and describes the problems encountered in both the physical and the relational aspects of the intimate world—the household. Life in the zone is not a phase but rather a way of dealing with a community that lacked not only the comforts but also some of the necessities of everyday life; life in the zone was a life of shortages, scarcity, and frustration. The phase of living between two worlds describes the problems associated with constantly moving between the orderly and organized world of work and the disorganized world of home and neighborhood. Finally, for some, the inability to reconstruct former lives or continue with anticipated projects led to altered lives.

Change in student physicians' views on authority relationships with patients.

Evidence that the public is currently challenging the authority of physicians in both attitudes and behavior raises the question of whether medical schools are socializing students through medical education to deal with the new consumerist patients. A study of the class of 1982 in two Midwestern medical schools, one focusing on community practice and the other more committed to specialization, reveals that during their training students tend to become more egalitarian in their attitudes toward relationships with patients. This shift occurs between school entry and the end of the two preclinical years, at graduation, and again after thefirst year of internship/residency. The type of medical school partly explains the attitude changes; certain structural and attitudinal variables also have an effect.

Modern Symbolic Interaction Theory and Health

As sociologists we know that people are connected both to and through society. Individuals share much in the way of values and understandings of the world and their actions generally appear to be coordinated—yet human actors are more than well-socialized cogs in a machine. The symbolic interactionist perspective helps us understand relationships between the individual and the larger society as dynamic. This theoretical perspective views concepts of self, social situations, and society as accomplished through people’s actions and interactions. Through its concepts and guiding assumptions, symbolic interactionism fosters theoretically-driven research with implications for medical sociology, which we address here.

Successful/Productive Aging, Responsibility, and Reflection

Successful aging is a central piece of the “new gerontology,” an effort by scholars and others to view aging in a fresh, positive light (Holstein and Minkler 2003; Moody 2005). This new approach must be viewed within its historical and contradictory cultural context (Moody 2002). In the twentieth century, improvements to the public health and social welfare infrastructures, coupled with advances in biomedicine, engendered shifts in the goals of modern medicine. With the increase in life expectancy, chronic health conditions supplanted acute health conditions as the primary threats to health and well-being. To accommodate this shift, healthcare efforts in the twenty-first century were increasingly targeted toward managing quality of life through long-term disease management. The increased prevalence of chronic conditions and the aging of the population are seen as creating tremendous pressure on the healthcare system and society. Indeed, many argue that our social welfare and healthcare infrastructures are not equipped to efficiently handle the burdens of chronic diseases and an aging population (Kovner and Knickman 2011). Recent research suggests that elders consume a relatively large share of healthcare, although they comprise only 13 % of the population in the United States (Stanton 2006). This is in part because they are victim to multiple chronic conditions that are expensive to treat and also because of the medicalization of normal aging processes (Illich 2000; Stanton 2006). Accordingly, curbing healthcare costs of elders is a key focus in the battle for efficient healthcare service delivery.

George Herbert Mead: Meanings and Selves in Illness

George Herbert Mead is widely recognised as the father of symbolic interactionism, a theoretical perspective that gave new direction to research in diverse fields of study. His dynamic theory of action based on meaning, agency and process challenged conceptions of social structures as fixed and stable and has been fruitfully used to examine facets of chronic illness, our main substantive focus here.

Studying Illness and Dying through Constructivist Grounded Theory

The sociological study of death and dying and the grounded theory method made a simultaneous debut. Barney G. Glaser and Anselm L. Strauss’s (1965) book, Awareness of Dying, brought death and dying into sociological purview, and put the experience of death and dying on the agenda of grounded theorists. Any review of death and dying through using grounded theory methodology must therefore begin with this study of the social organisation of dying in US hospitals. Glaser and Strauss demonstrated that sociologists could bring new analytic insights to the study of death and dying, thus contributing to both their discipline and professional practice. Subsequently in 1967, the authors published their initial statement of their methods for studying dying, The Discovery of Grounded Theory: Strategies for Qualitative Research. This book profoundly influenced the social scientific study of illness, dying, and death, and rapidly spread qualitative methods far beyond the confines of sociology. Glaser and Strauss’s argument in the Discovery book not only answered numerous criticisms of qualitative research but also set forth a new agenda for qualitative inquiry.