Navigating the cartographies of trust: how patients and carers establish the credibility of online treatment claims

Digital media offer citizens novel ways of ‘enacting’ health and illness, and treatment and care. However, while digital media may so ‘empower’ citizens, those searching for credible information will be confronted with various, often‐conflicting claims that may have ‘disempowering’ effects. This article uses Gieryn's concept of the ‘cultural cartography’ to explore the criteria that patients and carers employ in establishing the credibility of information on alleged treatments. Drawing on data from interviews with Australian patients and carers who have travelled or considered travelling abroad for unproven commercial stem cell treatments, the article examines how individuals assess rival sources of epistemic authority – science‐based and non‐science‐based – as they search for credible information. As we argue, in a context where conventional treatment options are perceived to be limited or non‐existent – which is likely to be the case with those suffering severe, life‐limiting conditions – and the credibility of sources uncertain, matters of opinion and belief are prone to being interpreted as matters of fact, with potentially far‐reaching implications for citizens’ health. Revealing the mechanisms by which individuals ascribe credibility to health information, we conclude, has become crucial as digital media assume a growing role in health and healthcare and governments encourage citizens to become ‘digitally literate’.     

Shifting paradigms? Reflections on regenerative medicine,embryonic stem cells and pharmaceuticals

Will human embryonic stem (hES) cells lead to a revolutionary new regenerative medicine? We begin to answer this question by drawing on interviews with scientists and clinicians from leading labs and clinics in the UK and the USA, exploring their views on the bench‐bedside interface in the fields of hES cells, neuroscience and diabetes. We employ Bourdieu's concepts of field, habitus and capital in order to understand stem cell science and cell transplantation. We also build on research on the sociology of expectations, and explore expectations of pharmaceutical approaches in hES research through our concept of ‘expectational capital’. In the process we discuss emerging expectations within stem cell research, most especially the ‘disease in a dish’ approach, where hES cells will be used as tools for unravelling the mechanisms of disease to enable the development of new drugs. We argue that experts’ persuasive promises advance their interests in the uncertain stem cell field, and explore how this performative strategy might stabilise the emerging ‘disease in a dish’ model of translational research.     

Why the cognitive science of religion cannot rescue ‘spiritual care’

Peter Kevern believes that the cognitive science of religion (CSR) provides a justification for the idea of spiritual care in the health services. In this paper, I suggest that he is mistaken on two counts. First, CSR does not entail the conclusions Kevern wants to draw. His treatment of it consists largely of nonsequiturs. I show this by presenting an account of CSR, and then explaining why Kevern's reasons for thinking it rescues ‘spirituality’ discourse do not work. Second, the debate about spirituality‐in‐health is about classification: what shall count as a ‘spiritual need’ and what shall count as ‘spiritual care’. It is about the politics of meaning, an exercise in persuasive definition. The function of ‘spirituality’ talk in health care is to change the denotation of ‘spiritual’, and attach its indelibly religious connotations to as many health‐related concepts and practices as possible. CSR, however plausible it may be as a theory of the origins and pervasiveness of religious belief, is irrelevant to this debate.     

Public challenge and endorsement of sex category ambiguity in online debate: ‘The sooner people stop thinking that gender is a matter of choice the better’

Despite academic feminist debate over several decades, the binary nature of sex as a (perhaps the) primary social classification is often taken for granted, as is the assumption that individuals can be unproblematically assigned a biological sex at birth. This article presents analysis of online debate on the BBC news website in November 2013, comprising 864 readers' responses to an article entitled ‘Germany allows ‘indeterminate’ gender at birth’. It explores how discourse reflecting Western essentialist beliefs about people having one sex or ‘the other’ is maintained in debates conducted in this online public space. Comments were coded thematically and are presented under five sub‐headings: overall evaluation of the German law; discussing and disputing statistics and ‘facts’; binary categorisations; religion and politics; and ‘conversations’ and threads. Although for many the mapping of binary sex onto gender was unquestionable, this view was strongly disputed by commentators who questioned the meanings of ‘natural’ and ‘normal’, raised the possibility of removing societal binary male‐female distinctions or saw maleness–femaleness as a continuum. While recognising that online commentators are anonymous and can control their self‐presentation, this animated discussion suggests that social classifications as male or female, even if questioned, remain fundamental in public debate in the early 21^st century.     

Forecasting science futures: legitimising hope and calming fears in the embryo stem cell debate

Controversies about biotechnologies often centre not so much on present scientific facts as on speculations about risks and benefits in the future. It is this key futuristic element in these arguments that is the focus of this article. We examine how competing visions of utopia or dystopia are defended through the use of diverse vocabularies, metaphors, associations and appeals to authority. Our case study explores how these rhetorical processes play out in the debate about embryo stem cell research in UK national press and TV news media. The findings show how predictions from those in favour of embryo stem cell research are supported by both hype and by anti-hype, by inconsistent appeals to the technologies' innovative status and by the selective deconstruction of concepts such as 'potential' and 'hope'. The debate also mobilises binary oppositions around reason versus emotion, science versus religion and fact versus fiction. This article highlights how traditional assertions of expertise are now combined with ideas about compassion and respect for democracy and diversity. It also highlights the fact that although news reporters are often responding to topical events the real focus is often on years, even decades ahead. Close attention to how images of the future are constructed, and the evolution of new strategies for legitimation are, we suggest, important areas of on-going research, particularly in discussions of scientific and medical developments and policy.     

Enacting alcohol realities: gendering practices in Australian studies on ‘alcohol-related presentations’ to emergency departments

‘Alcohol-fuelled violence’ and its prevention has been the subject of recent intense policy debate in Australia, with the content of this debate informed by a surprisingly narrow range of research resources. In particular, given the well-established relationship between masculinities and violence, the meagre attention paid to the role of gender in alcohol research and policy recommendations stands out as a critical issue. In this article, which draws on recent work in feminist science studies and science and technology studies, we focus on the treatment of gender, alcohol and violence in Australian research on ‘alcohol-related presentations’ to emergency departments (EDs), analysing this type of research because of its prominence in policy debates. We focus on four types of ‘gendering practice’ through which research genders ‘alcohol-related presentations’ to EDs: omitting gender from consideration, overlooking clearly gendered data when making gender-neutral policy recommendations, rendering gender invisible via methodological considerations, and addressing gender in terms of risk and vulnerability. We argue that ED research practices and their policy recommendations reproduce normative understandings of alcohol's effects and of the operations of gender in social arrangements, thereby contributing to the ‘evidence base’ supporting unfair policy responses.     

The exclusion of the other: challenges to the ethics of closeness

Abstract There is an ongoing discussion concerning personal vs. impersonal considerations in professional care. In this article, three different positions within the ethics of closeness will be discussed. These are: (a) reserving the ethics of closeness for close experienced others, ‘including the experienced Other’, which is Nortvedt's position; (b) trying to bring the distant, non‐experienced others closer, ‘including the Third’; and (c) finally, an examination of whether a perspective of closeness may lead to the exclusion of various groups in need of help, ‘including the Other at the expense of the Third’. These positions are discussed with a view to clarifying some of the challenges that the ethics of closeness faces when it maintains that greater ethical obligation is associated with personal than with impersonal relations, without discussing the terms on which the obligation is based. Key questions that arise for a nurse or other health professional are: If our primary moral responsibility is for those that are close to us, the experienced others, who is to be responsible for those that are outside the established health services, the non‐experienced others? Is it evident that favouring the experienced others is based on legitimate needs? Can a discussion on the legitimate basis of nursing be avoided in questions relating to closeness and priorities? This discussion touches the heart of our discipline. Is a one‐sided perspective of closeness, rejecting moral responsibility for those with whom we have no relationship, a defensible ethical position?     

Biopedagogy digitalized: ‘educational’ relations among participants on an online weight loss surgery forum

Foucault uses the term ‘biopower’ to describe the totalizing effects of regulation of life through the manipulation of political messages, such as those in the obesity debate. This paper attempts to uncover ways in which these flows are made manifest among members of a public online weight loss surgery (WLS) discussion forum. Drawing from Foucauldian scholarship, we spent two-and-a-half years conducting a critical discourse analysis of over 2000 conversational threads on one US-based public discussion forum devoted to providing a support community to those who were considering WLS. Our intent is to analyze how ‘truths’ about the surgery are constructed among and between the community participants at different stages of the surgery to identify how they engage with ideologies associated with contemporary obesity and healthism.     

Nursing in a postemotional society

Abstract Globalization is often seen as the final stage in the transition towards a market economy. It is argued that a side‐effect of globalization is cultural homogeneity and loss of life world, or ‘McDonaldization’. McDonaldization represents the rationalization of society in the quest for extreme efficiency. More recently, Me?trovi? has argued that the rationalization of emotions has also occurred and that Western societies are entering a postemotional phase. In postemotional societies there has been a separation of emotion from action. The result is synthetic, manufactured emotions manipulated and standardized for mass consumption. In this paper I explore what it means to nurse in a ‘postemotional society’ and what impact this dulling of the emotions has had on a profession that locates ‘care’ as its central defining concept. My aim is to generate critical discussion of the shape and direction of contemporary society and the role of nursing within it.     

How can Rorty help nursing science in the development of a philosophical ‘foundation’?

What can nurse scientists learn from Rorty in the development of a philosophical foundation? Indeed, Rorty in his 1989 text entitled Contingency, Irony, and Solidarity tantalizes the reader with debates of reason ‘against’ philosophizing. Forget truth seeking; move on to what matters. Rorty would rather the ‘high brow’ thinking go to those that do the work in order to make the effort useful. Nursing as an applied science, has something real that is worth looking at, and that nurse researchers need to think about. And as a profession built upon relationships, we should be thinking of the exchanges we have with those around us, of the contrasts in vocabularies used and of the contingencies involved, letting this launch us into our imaginings and areas of enquiry. The business of nurse researchers is to study what nurses do – how we care; Rorty would have us care. But, not to dismiss the reflective thinker as Rorty advocates for the self‐doubting ironist to continue to seek the final vocabulary, the ideal of what ‘this’ means, accepting this as the best to be offered at the time. As a science struggling to find foundation, we need only to look at what we do and value – as antifoundational as Rorty portrays himself, Rorty ‘ironically’ may have revealed a foundation for nursing science that is consistent with its path.     

Wanting to work: managing the sick role in high‐stake sickness insurance meetings

This article respecifies and develops Parsons's sick role theory, focusing on the postulate that the sick person must ‘want’ to get well. Using conversation analysis and discursive psychology to study how the psychological term ‘want’ is used in high‐stake, multi‐professional meetings with sickness benefit claimants in Sweden, the article shows how establishing that one ‘wants’ to get well requires extensive interactional work. In the examined meetings, the sick person's ‘want’ formulations make explicit the relationship between ‘wants’ and illness or inabilities, thus allowing for motivational character to be established without committing to its implications, and without appearing strategic or biased. By contrast, professional parties in the meetings invoke the sick person's ‘wants’ either to hold them accountable, or for establishing a desired course of recovery, confirming the centrality of such ‘wants’ in this setting as well as the risks associated with expressing them. The article suggests that analysing psychological matters as they are oriented to by participants renders sick role theory relevant for a wide range of settings and respecifies criticism of the model.     

Policy and practice: fundamental contradictions in the conceptualization of community care for elderly people?

For more than two decades, community care has been proclaimed the answer to the 'social problem’ of the ageing of the population. Since the publication of the Community Care White Paper (Department of Health 1989), a plethora of discussion and guidance documents have followed. In this paper, critical examination is made of some of the assumptions that appear to underpin policy and debate about community care. It is argued that recent policy and community care reforms may be affected adversely by inherent conceptual contradictions and conflicting understandings and expectations about community care. It is suggested that the reassuring connotations of the phrase ‘community care’ may not be reflected in its reality and that the debate needs to be extended to acknowledge and address some of the underlying dynamics, contradictions and interactions that may have a bearing on the success of the reforms.     

Mental Health,Social Inclusion and the Green Agenda

Abstract

The current debate about social inclusion in the field of mental health reveals a tension between the political and economic objectives of social policy. The former utilises the language of citizen empowerment and rights, whilst the latter is concerned with reducing welfare dependency through labour market activation. A central question here is whether a suitable programme of therapeutic work, training and support will produce better outcomes than those predicted by either a clinical diagnostic assessment or indeed open employment in the labour market.

This article evaluates a research project with mental health users designed to develop pathways towards inclusion. The principal means for achieving this was a programme of ‘green’ land-based activities, training and social support. The researchers employed a mixed method approach, utilising a quasi-experimental design with a hypothetical control and standardised testing. This was followed by interviews with users, staff and focus group discussion.

The evaluation produced some unexpected findings; for example, it was found that no strong correlation existed between diagnosis and performance. Many users performed better than had been predicted by their diagnostic assessment. However, the reasons for this remained unclear until the qualitative interviews enabled users to give accounts of the problems they faced, explain what inclusion meant for them, and outline how the project had brought gains in confidence, motivation and self belief.

The data gathered during the research derived from different episte-mological positions. This can be seen as representing two ways of ‘slicing the reality cake' rather than producing one complete view of mental health users reality. One construction related to how ‘the system’ diagnosed, processed, and ‘objectively’ managed them. The other was about how users' responded to their situation, utilised the opportunities available, and made ‘subjective’ sense of their experience.     

Freedom to roam: a Deleuzian overture for the concept of care in nursing

From a position informed by the philosophical legacy of Gilles Deleuze and Felix Guattari, this paper examines the idea of ‘care’ in nursing theory and philosophy. Deleuze and Guattari make a distinction between, on the one hand, ‘concepts’, which are the proper domain of philosophy and, on the other, ‘functives’ which are the domain of science and all other empirical matters. At first blush, this distinction and use of the word concept appears rather odd, but Deleuze and Guattari hold it to be important for reasons that go beyond the acknowledged and obvious differences between philosophy and science. In Deleuzian terms, a ‘functive’ is any proposition that makes a verifiable truth‐claim about actual states of affairs, whereas a ‘concept’ is a philosophical tool that, although it is used in statements that make claims and that seek to affect our thinking on states of affairs, is not a representation of them in any verifiable (functive) sense. In this respect, philosophical concepts, and the statements in which they are used, are neither true nor false. I argue that the way in which the word ‘care’ is used in much nursing theory and philosophy conflates concept (neither true nor false) with functive (either true or false) with less than productive results. I seek to persuade that if we can gain more clarity between the use of care as a would‐be functive and its use as a philosophical concept, this would strengthen the purpose of the use of the idea of care in nursing theory. This is to say that I take the view that the role of ‘care’ as a philosophical concept is to be used in statements that ‘think the event’ called nursing; that seek to be ‘worthy of the event’, but without being an actual part of the event. Finally, I show how the concept of care in nursing philosophy has been, and can continue to be, reworked to achieve the permanent task of surveying the ever‐shifting planes of the event and how it is described.     

Medical education in the later 19th century: the science take-over

Summary. Established in 1858, the General Medical Council was responsible, inter alia, for improving the standard of medical education in Britain. It was agreed on all hands that there were serious deficiencies: there was far too much book-learning and not enough practical knowledge; students graduated who were wholly ignorant of important areas of medicine; there were 19 licensing bodies and the criteria for admission to practise differed widely. Debate continued from 1860 to 1890. A major question was, What sort of education should the student have received before he entered medical school? There were four common answers: (1) he should have received the preliminary education of ‘a well-educated gentleman’; (2) he should know a good deal about everything; (3) he should have a better knowledge of science — but how to define science?; (4) he should have done well at school, never mind what he had studied. A second major question was, How should science and practical instruction be combined in the medical curriculum? Many defended the old and not quite dead apprenticeship system; a practical ‘sandwich course’ was even suggested. The debate ended with the Report of the GMC's Education Committee in 1890, which increased the length of the medical course from 4 years to 5 and brought chemistry, physics and biology into the early years. The amount of clinical work, however, although it was supposed to increase, remained very small.     

The place of therapy: between lab and field in the psychoanalytic office

This article builds on recent scholarship in medicine, science and technology illuminating the role of place and materiality in medical work. Drawing on ethnographic observations and qualitative interviews with US psychiatrists, psychologists and clinical social workers, I examine how the therapy office shapes psychoanalytic psychotherapists’ efforts to understand their patients’ unconscious conflicts. The concepts of ‘laboratory’ and ‘field’ frame my discussion of the material set up of the clinical room and the relational practices it fosters. I show that psychoanalytic practitioners try to approximate ‘laboratory conditions’ that insulate patients’ problems from their everyday contexts and ensure a sense of stability. I also demonstrate that these clinicians’ work depends on revealing personal preferences in the therapy room and fostering therapeutic relationships that resemble those in patients’ everyday lives, making the office akin to the ‘field’. The office thus becomes epistemically productive through therapists’ management of the paradoxical relationship between laboratory and field.