Olaug S. Lian

Medical constructions of long-term exhaustion, past and present

Culture and history affect the ways in which medical knowledge is shaped, sustained and changed. The less knowledge we have, the larger the space for the cultural imprint becomes. Based on these assumptions, we ask: how have medical constructions of long-term exhaustion changed over time, and how are changing constructions related to societal change? To discuss these questions we conducted a comparative study of medical texts from two historical periods: 1860-1930 and 1970-2013. Our data are limited to two diagnoses: neurasthenia and encephalomyelitis. After comparing the two periods by identifying diverging and converging aspects, we interpreted observed continuities and interruptions in relation to historical developments. We found that in the medical literature, long-term exhaustion became transformed from a somatic ailment bred by modern civilisation to a self-inflicted psychiatric ailment. At the same time, it changed from being a male-connoted high-status condition to a female-connoted low-status condition. We interpret these changes as contingent upon culturally available modes of interpretations. Medical knowledge thereby becomes infused with cultural norms and values which give them a distinct cultural bias. The historical controversies surrounding this medically contested condition neatly display the socially contingent factors that govern the social construction of medical knowledge.

“United We Stand” Framing Myalgic Encephalomyelitis in a Virtual Symbolic Community

In this article, we report on a study that seeks to explore how the contested chronic condition myalgic encephalomyelitis (ME), one of the current medical diagnoses for medically unexplained long-term exhaustion, is negotiated within the context of Norwegian internet sites. From an analysis of discussions on 14 internet forums sustained by and for people living with ME, we seek to understand how their online activity sustains a virtual symbolic community (VSC). After exploring the content on these sites, we identified four discursive domains, or fields of conversation, that are demarcated by a discursive frame, or norms, values, and goals that define and reinforce the boundaries of the community. Interpreting discursive domains and their discursive frame provides insight not only to the culture of the ME VSC but also to its role in an international social health movement, including its potential for becoming politically influential.

Overweight and obesity in young adult women: A matter of health or appearance? The Tromsø study: Fit futures

With the increasing number of overweight and obese people, there is a growing public health concern and focus on body size and lifestyle issues, especially in the media. Young adult women comprise a vulnerable group regarding issues of weight balance and appearance. The aim of the study was to examine the experiences of young women on how this focus influences their attitudes concerning weight changes, appearance, and health. We conducted 12 interviews with young women from two different weight groups about the attention on overweight issues. The results from the in-depth interviews were scrutinized through content analyses. The main findings indicate that young women experience a considerable focus on overweight issues with a trend towards appearance rather than health. Overweight and obesity are sensitive topics, and participants expressed strong views on the cultural definitions of normal body size and appearance. The squeeze between cultural norms and young womens perceptions of their own body and health was described as a possible negative factor influencing well-being as well as motivation for lifestyle changes. A more relaxed focus on overweight issues and especially on appearance is necessary when addressing weight-balance issues and lifestyle changes in young adult women.

Factors facilitating patient satisfaction among women with medically unexplained long-term fatigue: A relational perspective:

Bodily conditions that are difficult to identify, explain and treat with the aid of medical knowledge and technology appear to be particularly challenging to medical encounters. Patients are often dissatisfied with the help they receive, and they often experience that their medical needs are not met. To explore factors facilitating patient satisfaction among patients with a medically unexplained condition, we ask: what is the importance of individual versus relational factors in facilitating patient satisfaction in clinical encounters between general practitioners (GPs) and women with medically unexplained long-term fatigue? We approach this question through a statistical analysis of survey data collected from a net sample of 431 women recruited through a patient organisation for people suffering from myalgic encephalomyelitis in 2013. Participants were asked about their experiences with general practitioners in the Norwegian national health system in two different phases: shortly after illness onset, and current regular general practitioner last 12 months. The questions evolved around themes concerning shared understanding and decision making, being taken seriously, being paid due respect and being treated as an equal partner. Through descriptive statistics and multivariable logistic regression analyses, we explored how their experiences were related to individual and relational factors, respectively. Free-text comments from the questionnaires were used while interpreting the results. The analysis illuminates that relational aspects in medical encounters between GPs and ME patients, especially continuity, congruence in doctor–patient views and being seen by a specialist, are important catalysts of patient satisfaction. The probability of being satisfied with the initial investigation was more than six times higher in women who were referred to specialists, compared to those who were not. We conclude that continuity of care and experiences of being in a partnership that operates on a common ground – a shared understanding of the patient’s illness – foster patient satisfaction among women with medically unexplained long-term fatigue.

Life according to ME: Caught in the ebb-tide

In this article, we explore the role of ‘place’ in shaping people’s illness experiences through a data-led inductive case-study based on experiential data from people living with myalgic encephalomyelitis (ME) in Norway. Our main aim is to understand how they experience, interpret and attach meaning to various places in which they reside, and how they construct the course of a life influenced by chronic illness. The study is based on stories containing photographs and written texts, received from 10 women and men. In their stories, they describe those places where they experience their illness in the least and most taxing ways. Through a narrative and photographic analysis of their stories, we explore how they perceive the relationship between place and illness as experienced, managed and endured. Our analysis is based on a place-sensitive sociology, in which we approach place both as physicality and a symbolic construction. The participants describe how a wide range of places are intimately linked to their illness experiences, and they interpret these links by referring to both physical and symbolic factors. They describe their lives in terms of a need for equilibrium between activity and rest. Risk is a strong underlying theme: whatever they do, they risk losing something. Most of all, the participants describe how they are looking for places to escape to and from. Places to escape to are those places where privacy and peace can be found, which primarily revolve around being at home. Places to escape from are those places that make their energy ‘slowly ebb away’.

”It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters.

ABSTRACT Purpose: Clinical encounters related to medically unexplained physical symptoms (MUPS) are associated with high levels of conflict between patients and doctors. Collaborative difficulties are fused by the medical uncertainty that dominates these consultations. The main aim of this study is to explore the interactional dynamics of clinical encounters riddled by medical uncertainty, as experienced by people living with long-term medically unexplained fatigue in Norway. Method: A qualitative thematic analysis of written texts from 256 study participants. Results: We found that patients experience being met with disbelief, inappropriate psychological explanations, marginalisation of experiences, disrespectful treatment, lack of physical examination and damaging health advice. The main source of their discontent is not the lack of biomedical knowledge, but doctors who fail to communicate acknowledgement of patients’ experiences, knowledge and autonomy. War metaphors are emblematic of how participants describe their medical encounters. The overarching storyline depicts experiences of being caught in a power struggle with doctors and health systems, fused by a lack of common conceptual ground. Conclusion: When physical symptoms cannot be detected, explained and managed by biomedical knowledge and technology, good doctor-patient partnerships are crucial. Without clearly acknowledging patients’ perspectives and capabilities in clinical practice, such partnerships cannot be achieved.

Cross-sectional study of the differences between measured, perceived and desired body size and their relations with self-perceived health in young adults: The Tromsø Study – Fit Futures 2:

Aims: The aim of this study was to explore the relationships between measured body size (body mass index (BMI)), perceived body size, weight change wishes and self-perceived health in young adults. Methods: The participants were recruited from a school-based population study in Norway, the Tromsø Study: Fit Futures 2, carried out in 2012–2013. A total of 629 young women and men (aged 18–23 years) reported on the main variables. The data were collected through weight and height measurements and questionnaires. The analyses were performed with descriptive statistics, the χ2 test and Student’s t-test. Results: A total of 20% of the women and 28% of the men were overweight or obese. There were considerable discrepancies between the measured BMI and perceived body size in both sexes. A substantial number of participants wanted to change their weight. Among the 174 women who reported that they were trying to lose weight, as many as 57 (32.8%) had a low normal weight (BMI 18.5–21.9 kg/m2). Correspondingly, among the 66 men who reported that they wanted to gain weight, as many as 19 (28.8%) had a high normal weight (BMI 22–24.9 kg/m2). We found no relation between body size perceptions, weight change wishes and self-perceived health. Conclusions: Discrepancies between measured and perceived body size and weight change wishes are common findings in young adults. The lack of relation with self-perceived health found in our study is surprising and not easy to interpret. To gain more knowledge about these matters, further research, including both qualitative and quantitative studies, is needed.

Global challenges, global solutions? A cross-national comparison of primary health care in Britain, Norway and the Czech Republic

Abstract Are current health policy changes leading to a greater degree of convergence in the health systems of European nations, or to a pattern of divergence? How can the degree of convergence/divergence be explained, and what can it tell us about local versus global impulses of change? The most common answer to these questions is that because the process of globalisation is driving different countries toward similar reform programs, their health systems converge at some common point. An alternative hypothesis is that each country has unique cultural, economic, political and historical traditions which are likely to override global changes, thus creating patterns of divergence. In this article, theories of globalisation and convergence are the theoretical foundation for a cross-national comparison of the development of primary health care in Europe. By comparing the development in three different countries between 1990 and 2005, converging and diverging paths are identified and explained.

Norms for priority setting among health professionals: a view from Norway

Which patients should be treated, and who should be treated first? In this paper, the attitudes of health professionals towards setting priorities are examined through an analysis of interview and questionnaire data answered by senior physicians and senior nurses in Norwegian hospitals. The data indicate that patients’ needs remain the most important motive behind such decisions, especially among the eldest respondents. Expected medical effects of the intervention are also important, but not the ratio of effects to costs. Some, especially the youngest respondents, say that they give priority to patients’ on sick leave. Differences between age groups may be a sign of a changing normative orientation. The two professions usually agree, except that nurses are more concerned about financial aspects than physicians are. Differences between departments and hospitals suggest that their normative orientation is influenced by the clinical problems with which they are dealing.

“I Do Not Really Belong Out There Anymore” Sense of Being and Belonging Among People With Medically Unexplained Long-Term Fatigue

In this article, we explore relations between health, being, belonging and place through an interpretive thematic analysis of autobiographic text and photographs about the everyday lives of 10 women and men living with medically unexplained long-term fatigue in Norway. While interpreting their place-related illness experiences, we ask: How do they experience their being in the world, where do they experience a sense of belonging/not belonging, and why do places become places of belonging/not belonging? The participants describe experiences of (a) being socially detached and alienated, (b) being imprisoned, (c) being spectators who observe the world, and (d) senses of belonging. They describe senses of being and belonging/not belonging as closely attached to physical and symbolic aspects of places in which they reside, and they wistfully reflect on the question of “why.” The study illustrates the influence of experienced place—material as well as immaterial—on health and illness.