Nanna Mik-Meyer

The negotiation of the sick role: general practitioners’ classification of patients with medically unexplained symptoms

In encounters between general practitioners (GPs) and patients with medically unexplained symptoms (MUS), the negotiation of the sick role is a social process. In this process, GPs not only use traditional biomedical diagnostic tools but also rely on their own opinions and evaluations of a patient’s particular circumstances in deciding whether that patient is legitimately sick. The doctor is thus a gatekeeper of legitimacy. This article presents results from a qualitative interview study conducted in Denmark with GPs concerning their approach to patients with MUS. We employ a symbolic interaction approach that pays special attention to the external validation of the sick role, making GPs’ accounts of such patients particularly relevant. One of the article’s main findings is that GPs’ criteria for judging the legitimacy of claims by those patients that present with MUS are influenced by the extent to which GPs are able to constitute these patients as people with social problems and problematic personality traits.

Othering, ableism and disability: A discursive analysis of co-workers’ construction of colleagues with visible impairments

The aim of this article is to explore how able-bodied co-workers engage in the ‘othering’ of colleagues with impairments. Taking a discursive analytical approach, the article examines interviews with 19 managers and 43 colleagues who all worked closely with an employee with cerebral palsy in 13 different work organizations. The primary finding of the article is that co-workers spontaneously refer to other ‘different’ people (e.g. transvestites, homosexuals, immigrants) when talking about a colleague with visible impairments. This finding suggests that disability is simultaneously a discursive category (i.e. the discourse of ableism prevents co-workers from talking about the impairments of a colleague) and a material phenomenon (i.e. employees with impairments are a distinct category of employees in the eyes of the co-workers). Othering of employees with disabilities thus demonstrates contradictory discourses of ableism (which automatically produce difference) and tolerance and inclusiveness (which automatically render it problematic to talk about difference).

On being credibly ill: Class and gender in illness stories among welfare officers and clients with medically unexplained symptoms

Abstract This paper explores the intersection of gender and class concerning welfare clients with medically unexplained symptoms. The study is conducted in Denmark using qualitative interviews with welfare officers and clients. The paper’s focus is on how issues of gender and class intersect in the negotiation of illness among welfare officers and clients. The particular client group in question consists of individuals that are defined by their lack of a bio-medical diagnosis. Their ‘lack’ of identity accentuates how gender and class become central in the categorisation practices, constructing the ill person as either bio-medically sick or as a person who may be suffering but only from diffuse psychological problems. The paper shows that it is predominantly poorly educated women without a bio-medical diagnosis that welfare officers describe as suffering from psychological problems despite the fact that the women themselves focus on physical ailments in their illness stories. Men and better-educated women are described by the welfare officers as tired and exhausted or truly stressed after a long working life.

Disability and ‘care’: managers, employees and colleagues with impairments negotiating the social order of disability

This study explores how the ‘care’ of able-bodied employees and managers (observers) affects their relationships with colleagues with cerebral palsy. Disability researchers have established that ‘help’ and ‘care’ may cause feelings of dependency with the recipient. However, few workplace studies have investigated the potential negative consequences of ‘caring for’ colleagues with disabilities. Through open-ended interviews conducted in 2013 in 13 Danish work organizations with 13 employees with cerebral palsy and 62 observers, the study examines how the relational aspect of ‘care’ may result in relationships between colleagues of ‘parent–child’ or ‘helper–helpless’. The study thus clarifies the inherent contradictions embedded in the dynamics of organizational behaviour in relation to employees with disabilities, namely that workplaces may hire a person with physical limitations (perhaps to deflect accusations of social discrimination) and still end up stigmatizing these workers because of the stereotypical assumptions related to employees with disabilities.

Health promotion viewed in a critical perspective

The aim of this paper is to reflect critically on the current health promotion initiatives targeting overweight individuals in Western countries. The paper’s methodological approach is to draw on analytical findings from my and other sociologists’ empirical work on how the problems of overweight people are being defined in various settings in Denmark, England, Australia and the US. I try to illustrate how health promotion targeting overweight individuals can not only be seen as a project aimed at securing longer lives and fewer illnesses for people carrying excess fat but also a moral project that, in a more general sense, aims to tell people how they ought to live their lives. I link this moral aspect of health promotion to a) the medicalization tendency in current Western society (e.g. a growing pharmaceutical industry and its economic interest in transforming the human condition of being overweight into a treatable disorder) and b) the strong focus on individual risk today. One of the main arguments in the paper is that health in relation to overweight is primarily defined from a biomedical perspective that praises certain physical measurements of the body, as well as dominant societal values such as  self-responsibility and self-control, and that a combination of biomedicine and these dominating values can lead to health promotion becoming a problematic moral endeavour.

Disability, sameness, and equality: able-bodied managers and employees discussing diversity in a Scandinavian context

This article contributes to research examining the work situations of employees with disabilities. This is performed by demonstrating how able-bodied norms affect the work lives of employees with cerebral palsy in Danish work organizations. Thus, this article investigates how able-bodied managers and employees talk about their co-workers with cerebral palsy and examines the narratives of diversity among able-bodied managers and employees when they discuss the work situation of their colleagues with cerebral palsy. The empirical point of departure is 6 weeks of participant observations in 2 work organizations along with interviews conducted in 13 work organizations with 19 managers and 43 colleagues who work with an employee with cerebral palsy on a daily basis. The article finds two dominating narratives regarding diversity that have to do with being either ‘different but the same’ or ‘just different’. These two narratives relate to the highly praised value of equality in Scandinavia.

Health in a Risk Perspective: The Case of Overweight

This chapter argues that the current large focus on health issues in Western societies (including Denmark) is strongly related to an also currently prevailing risk agenda. The chapter builds on research that shows how health and risk are matters that individually cannot be understood fully without paying attention to the other. In other words, the rising dominance of health issues in society can be seen as imbedded within the present risk discourse (Petersen and Lupton, 2000).

Doing Danishness: identity as a three-dimensional process

Richard Jenkins is well known internationally for his work on identity processes, and his new book, Being Danish: paradoxes of identity in everyday life will no doubt enhance this reputation. In this monograph we learn about identity processes among Danes in a medium-sized town in Denmark (Jutland). The setting is Skive, but it quickly becomes apparent that the paradoxical identity processes at work here, which are the main focus of Jenkins’ analysis, could well be any mediumsized town in any northern European country. Or could it? One of the strengths in this monograph – as with successful anthropological monographs in general – is its ability to produce a double analysis that captures both the general and specific elements of what it takes, in this case, to be Danish. Jenkins discusses the general aspect of identity work in chapter one (the interaction between internal self-identification or group identification and the external categorisation impressed upon the self by others), while in the rest of the book he discusses the specificity of identification processes among Danes. These perspectives combine in the idea of identity as a ‘three-dimensional’ process: ‘being Danish’ is about ‘about doing stuff, as well as thinking it’ (p. 292). This process relates to the Danes’ particular history, culture and organizational arrangements. Potentially, the book has many readers: the scholar who wants to get a handle on how to study identification processes in this ‘three-dimensional’ way; the scholar who wishes to understand the many paradoxes of identities in (welfare) states; the foreigner who has just moved to Denmark and wishes to acquire assistance in adapting to a new environment; or any Dane or Scandinavian for that matter – people who want to understand everyday life, as seen from an outsider’s perspective. I belong to most categories just mentioned, and from these various positions (except the position of the foreigner) I have to say that I have learned a lot from reading this book. Jenkins’ clear style of writing makes his analysis of how historical, cultural and identification processes relate both enjoyable to read and easy to follow. And the same goes for his analysis of how the paradoxes of welfare states such as Denmark relate to neoliberalistic trends (my term). Belonging also to the category of ‘any Dane’, I must admit that I was often greatly amused by Jenkins’ insights and observations. All nations should have an anthropologist visit them – the outsider perspective gives a perfect opportunity to get a closer look at all the taken-for-grantedaspects of one’s daily life. Do we really wave flags as much as Jenkins notes? Why Journal of Political Power Vol. 4, No. 2, August 2011, 327–329

Defining health and illness in a gender and class perspective: Identity negotiations among welfare officers and clients with medical unexplained symptoms

This paper explores the intersection of gender, class and sickness identities concerning clients with medically unexplained symptoms. The focus is on how issues of gender and class intersect in the negotiation of sickness among welfare officers and clients. The particular client group in question is individuals that are defined by their lack of a bio medical diagnosis. Their “lack”-identity accentuates how gender and class and other structural features become central in the categorization practices transforming the ill person to either really physically sick (in a bio-medical way) or into a person who may be suffering, but only from diffuse psychological problems. The paper shows that it is lower educated women who lack a bio-medical diagnosis that is believed to be not really sick (but are believed instead to suffer from psychological problems). Men and higher educated women, are believed to be tired and exhausted, or truly stressed after a long working life.