کردستان

Abstract

This paper presents a narrative analysis of complementary/alternative medicine (CAM) use by parents for children with Down syndrome (DS), based on interviews conducted with thirty families. Critics often presume that CAM use for children with developmental disabilities reflects parental desperation in the face of limited biomedical options. Integrating insights from anthropological studies of CAM with narrative analyses in disability studies, we constructively complicate this interpretation in two ways. First, we suggest that the appeal of CAM may lie in its discursive consonance with the broader narrative strategies through which parents construct alternatives to conventional definitions of DS as a condition with a fixed, universal, and essentially pathological course. Second, we submit that the process of seeking and evaluating information about CAM is consonant with how parents construct their identities as ‘good’ parents through describing their roles as committed advocates and service coordinators for their children. In these ways, CAM can be conceptualized as a new discursive resource that parents engage in their culturally and historically specific efforts to articulate the essential human rights of their children, and to assert the moral soundness of their own parenthood. These findings provide a new conceptualization of parents’ motives for choosing CAM, thereby posing new questions for further research about CAM use for developmental disabilities.

Author Keywords: Complementary/alternative medicine; Down syndrome; Narrative analysis; Disability studies; Consumerism; USA

Abstract

Public health practitioners in Australian indigenous health work in a complex political environment. Public health training is limited in providing them with conceptual tools needed to unpack the postcolonial nexus of ‘fourth-world’ health. A workshop was designed by the authors to facilitate critical reflection on how the concepts of race and culture are used in constructions of indigenous ill-health. It was attended by researchers, students, clinicians and bureaucrats working in public health in northern Australia.

A thematic analysis of the workshop minutes provided insight into public health practitioners’ narratives of Indigenous ill-health. The major themes that emerged included tension between structure and agency and between sameness and difference, and ambivalence surrounding the ‘helper’ identity of public health practitioners. We suggest that these narratives can be understood as attempts to maintain the moral integrity of both Indigenous people and practitioners. This task is necessitated by the specter of cultural relativism intrinsic to contemporary liberal discourses of multiculturalism that attempt to reconcile the universal rights of the citizen with the special rights of minority groups.

We argue that the concepts of self-determination and neocolonialism mark the spaces where universal and particular discourses overlap and clash. Practitioners who seek to escape neocolonialism must inhabit only the discursive space of public health congruent with self-determination, leaving them in a bind common to many postcolonial situations. They must relieve the ill-health of indigenous people without acting upon them; change them without declaring that change is required.

Keywords: Indigenous; Public health; Multiculturalism; Postcolonial; Politics; Australia

Abstrac

This paper examines how palliative care nurses do criticism of other professionals in talk within settings for care of the dying (two hospices and one general hospital). Strategies for the production of moral identities include the use of direct criticism, indirect criticism and quoted speech, hence ‘inverted comma criticism’. Criticism is done through the construction and reconstruction of ‘atrocity stories’. Atrocity stories are used as a medium by nurses to express their opinions and feelings about doctors who might have behaved insensitively. At the same time, it allows doctors to redeem themselves. The analysis of talk reveals that the voices of absent patients are reactivated and co-opted into the nurses’ talk. The stories serve to produce an image of nurses as caring, morally responsible patient advocates and loyal characters to their medical colleagues. Through the analysis of talk, the communication skills and strategies for the maintenance of interactional order are made visible and displayed. Skills for the production of the palliative care team work are also made visible. Emotional labour is analysed as a project for the production of particular kinds of niceness which in turn require particular types of emotional labour. This paper argues that educators should aim to identify and make conscious use of nurses’ own available interactional skills, and focus on valuable cultural (rules of decorum) and material resources (the disease process) which are readily available and accessible for nurses, as a starting point in communication training. The theory of an account of co-production of niceness which benefits each other, hence, symbiotic niceness, reveals that being nice to each other can be rewarding and therapeutic in that it helps to smooth, distance and ameliorate problems occurring in the reality of palliative care nurses’ and their patients’ life-worlds.

Keywords: Palliative care nurses; Care of the dying; Emotional labour; Criticism; Atro

Abstract

This paper explores the lived experiences and the identity processes attached to attendance at free clinics. It draws on a qualitative study of 94 patients and 37 professionals who were interviewed at four free clinics in France. Since these facilities are for the poor and for people without health coverage, attendance reflects a medical experience as well as an experience of assistance, both of which have an impact on healthcare utilisation. Nevertheless, the meaning attached to the recourse to free clinics and the patients’ lived experiences change over time and depend on interactions with clinic staff. This study proposes a typology of care recourse modes (occasional, regular and inconsistent attendance) crossed with different types of lived experiences. Occasional attendance and distant patient–professionals relationships, often due to the humiliation that some people feel when they have to ask for social assistance, characterise the first time people have recourse to care. Patients commit to regular follow-ups only when they have come to terms with their position in the medical and assistance system, doing so by rationalising and adjusting their identity Our aim in discussing our findings is to gain greater insight into the utilisation of healthcare by different population groups and in different contexts.

Keywords: Healthcare utilisation; Free clinics; Moral career; Doctor–patient relationship; Poverty; France

city stories; Communication skills; UK

Abstract

This paper presents a cognitive social–psychological theoretical framework on emotions, derived from Richard Lazarus, to understand how teachers’ identity can be affected in a context of reforms. The emphasis of this approach is on the cognitive–affective processes of individual teachers, enabling us to gain a detailed understanding of what teachers have at stake or what their personal, moral, and social concerns are. To illustrate the usefulness of this approach, a case of a reform-enthusiast Dutch secondary school teacher of Dutch language and literature is presented. The analysis of his emotions of enthusiasm for the reforms, and his emotions of anxiety, anger, guilt, and shame related to the way the reforms unfold in his school and influence his work, show the many ways his identity and concerns are affected, resulting in a loss of reform enthusiasm. The paper ends with a reflection on the possible risks of current educational policies to the commitment and quality of the current and next generation of teachers.

Keywords: Teacher emotion; Professional identity; Educational reform; Teacher resistance