Sociology of health and medicine

In questo libro il legame fra salute, medicina e società viene dapprima analiz-zato in prospettiva microsociologica, osservando, cioè, come salute e malattia si radichino nei corpi degli individui e nelle loro relazioni sociali. Si passa poi al livello delle organizzazioni sociali intermedie: dalla famiglia alle professioni sa-nitarie, all'ospedale, ai servizi territoriali e domiciliari e alle comunità locali. Da ultimo, vengono esaminati i processi sociali di più vasta portata, focalizzando l'attenzione sulle politiche sanitarie, sui sistemi sanitari e sulle disuguaglianze sociali di salute, e affrontando le problematiche venute più di recente ad emersione.

Why do some mental illnesses emerge in certain times and places and later disappear? Because it integrates a wide array of social processes and relies on a strong epistemological position, Hacking's theory of ecological niches constitutes the most comprehensive and ambitious attempt to answer this question. However, this theory lacks a convincing definition of its research object ("transient mental illnesses"), a conceptualization of how individuals would "fall ill" as well as a solid methodological framework to form case studies. This article addresses these issues in order to propose an extended theory of ecological niches.

This chapter introduces the sociology of health and medicine as a field of study, its origins and contemporary development across the globe. It argues for a role for social theory in the understanding of health and medicine, discussing how social theory performs a variety of purposes and functions, and showcases some of the outstanding achievements in social theory in this field. This leads to a discussion of social theorists and theoretical frameworks, and why some come to prominence and others do not, and why each in turn appears to come ‘into fashion’ and later fall from favour. The chapter concludes with an overview of the structure and contents of the book, explaining the importance of its historical format and broad selection of social theories and theorists.

1.1. Il triangolo della malattia: illness, sickness, disease secondo un approccio connessionista alla disabilità In questo capitolo intendo definire la disabilità come una poliedrica manifestazione fisica e/o psichica dell'essere umano che difficilmente si presta ad una definizione unitaria e univoca. Tanto complessa si presenta la sua definizione (mai statica, ma dinamica e soggetta alle evoluzioni scientifiche e sociali della comunità nel susseguirsi del tempo) quanto molteplici si presentano le domande circa la sua contestualizzazione nella società odierna, soprattutto in rapporto al tema della salute. Oggi quest'ultima è un problema sociale e il suo concetto si evolve al mutare degli scenari della società in cui si manifesta; rispetto ai tempi passati, a seguito della transizione demografica e della transizione epidemiologica cambiano le modalità con cui la salute viene intesa (Giarelli, Venneri 2012, p. 157). Se nelle società proto-industriali la salute si configura come una semplice assenza di malattia, la transizione demografica presenta un quadro di riferimento in cui diminuiscono drasticamente natalità e mortalità e in cui la popolazione che invecchia è in incremento continuo; parallelamente nella transizione epidemiologica le patologie prevalenti sono quelle cronico degenerative soprattutto negli anziani, diminuisce l'emergenza sulle malattie infettive (ivi, p. 158). Questo mutato scenario apre la strada alla nuova concezione normativa dell'OMS, la norma si riferisce alla costruzione di un nuovo quadro di valori verso cui orientare le azioni dei servizi sanitari: «La salute è uno stato di completo benessere fisico, mentale e sociale e non solo assenza di malattia» (OMS 1948). In linea con tali premesse è possibile riferirsi ad un modello analitico per cui la salute diventa un processo più che uno stato, definito dalle connessioni delle relazioni sociali che formano il sistema salute; il fenomeno della disabilità si manifesta in forme diverse a seconda del contesto culturale e storico in cui origina e delle relazioni tra gli attori istituzionali e non, che vi partecipano: in tal senso è multidimensionale (ivi, p. 161). La sociologia della disabilità, fondata su un approccio connessionista 1 si propone di sviluppare un modello multidimensionale della disabilità, quest'ultimo termine si è spesso trovato relegato ai margini della riflessione sociologica, accomunato ai concetti di malattia e devianza (ivi, p. 50). Le varie correnti sociologiche che si sono succedute nel tempo classificano e interpretano la disabilità secondo varie accezioni. Il filone struttural-funzionalista identifica la disabilità come devianza, il disabile è un deviante, colui che appunto devia dalla norma attesa in una comunità; per la corrente interazionista la disabilità coincide con lo stigma, per cui il disabile è essenzialmente un discriminato; nella corrente sociobiologica la disabilità appartiene alla sfera della cronicità e il disabile diviene dunque un paziente adattato; nella visione conflittualista la disabilità si identifica col sub-proletariato e il disabile è uno sfruttato, un emarginato; l'approccio connessionista, invece, pone la disabilità in termini di (dis) uguaglianza e il suo oggetto d'analisi è il cittadino (ivi, p. 23). In questo testo, se non altrimenti specificato, la parola disabilità è intesa secondo le sottocategorie definite dall'OMS, dunque disabilità fisica, cognitiva, intellettiva, sensoriale (OMS 2011). 1 Sociologicamente tale concetto è sviluppato da Ardigò (1997) e successivamente da Cipolla (2005), il quadrilatero di Ardigò è composto dall'interazione di quattro elementi: la natura esterna ovvero l'ambiente fisico; il sistema sociale cioè la rete di comunicazione tra individui; la persona come soggetto, ovvero l'Io (ego) e il Social self (Me); la natura interna dunque il corpo come entità biologica, a partire dal patrimonio genetico. I successivi sviluppi di tale impostazione rilevano l'emergere di due rappresentazioni della malattia, una legata al sapere medico e una come espressione soggettiva del malato nel suo mondo vitale. Gli stili di vita, passando per la stratificazione sociale incontrano la salute nella società di riferimento, la natura esterna viene definita ambiente e interagisce con il sistema sociale, inteso anche come organizzazione delle cure in sanità; il soggetto è l'attore nel processo di cura e terapia. La connessione è tra i livelli di analisi sociologica micro, macro e meso. Sulla scorta di queste considerazioni Giarelli elabora il modello correlazionale di sistema della salute (2003), una struttura composta da interconnessioni analitiche dette multidimensionali che, oltre ad essere utile per l'analisi comparativa di un sistema sanitario, fornisce prospettive che vanno oltre quest'ultimo (Di Santo 2013, pp. 31-32-33).

Conventional approaches to the sociology of health and medicine sometimes mention the early writings of Frederich Engels on the poor health of the 19th century British working class, but rarely acknowledge the extent to which he, with colleague Karl Marx, lay down an extensive critique of the medical theorising of the period. The first half of the chapter offers an overview of this powerful critique, and outlines a theoretical framework in which the pair revealed the connections between capitalism and poor health. The second half of the chapter indicates how this theoretical framework has been extended in the 20th century by various theorists, including Lesley Doyal and Imogen Pennell, to highlight the intense commodification of health services and the creation of a world-wide healthcare industry.

Open access:  https://www.berghahnbooks.com/title/LeibingPreventing
This book is about the drastic change in the conceptualization of dementia and the impact this change has or may have on individuals and, more generally, on the landscapes of aging in different societies.A recent report by the Lancet commission in 2017 which received significant media attention, suggests that one third of the cases of AD could be prevented, mostly through lifestyle interventions.  In other words, general public health recommendations easily merge with ideas of active and successful aging – for instance, avoiding physical inactivity, smoking, and unhealthy food – are now also applicable to dementia. In contrast to a former strict neuro-centric perspective on the disease, the body and by this, technologies and practices related to the whole body are becoming relevant again.

Монография посвящена экономическим агентам, которые подменяют или дополняют собой официальную систему здравоохранения в современной России, обслуживая альтернативные практики поддержания здоровья. Детализированное описание их деятельности дано на основе анализа открытых источников, а также наблюдений и интервью, полученных в ходе полевого исследования в Пермском крае в 2013 году. В том числе рассматриваются рынки сетевого маркетинга и выездной торговли товарами для здоровья; скрытые социальные функции аптек; услуги целителей и врачей альтернативной медицины; собирательство и производство целебных даров природы в личных хозяйствах; практики участия религиозных организаций в решении проблем со здоровьем; распространение информации для самолечения в массмедиа. Книга адресована широкому кругу читателей — специалистов в области управления здравоохранением, представителей социальных наук, а также всех интересующихся проблемами охраны здоровья и неформальной экономики в России.

The Centers for Disease Control and Prevention (CDC) has announced a set of provisional guidelines concerning male circumcision, in which they suggest that the benefits of the surgery outweigh the risks. In this brief comment, I highlight a few of the key scientific and ethical issues worth considering in interpreting the CDC recommendations.

Σε μεγάλο βαθμό η εργαλειακή αντιμετώπιση της φύσης σε συνάρτηση με μια πεπερασμένη αναπαράστασής της, εγγενή στην υφιστάμενη κοινωνική οργάνωση  της παραγωγής, όπως εξωτερικεύεται στη μαζική ενεργοποίηση φυσικών και ανθρώπινων πόρων, παράγει κινδύνους και διακινδυνεύσεις (πρωτογενείς) που μόνο περιορισμένα μπορούν να ελεγχθούν. Εντούτοις η προϊούσα ενσωμάτωση της επιστήμης και της τεχνολογίας στο σύστημα παραγωγής (βιομηχανοποίηση της γνώσης κ.λπ.), ευνοεί  την αυτονόμηση τους από τη πολιτική, νομιμοποιώντας  τεχνοκρατικές λύσεις των κοινωνικών προβλημάτων. Έτσι τα προβλήματα απομονωμένα από τις κοινωνικές και πολιτισμικές τους συνδηλώσεις αφήνονται στους ειδικούς. Με αυτή την έννοια  η  αντιμετώπιση του Covid-19 ως αποκλειστικά ιατρικού ζητήματος, συνιστά τεχνοκρατική διαχείριση, παρόλο που οι διακινδυνεύσεις (δευτερογενείς) που εδώ παράγονται χρήζουν τώρα διεπιστημονικής αντιμετώπισης, καθώς υπονομεύουν τους κοινωνικούς κόσμους εργασίας, ζωής και ελεύθερου χρόνου (βλ. lockdown, κοινωνική αποστασιοποίηση κ.λπ.). Παρόλο που η αντιμετώπιση της πανδημίας είναι περισσότερο επίδικο της κοινωνικής δράσης, αφού από εδώ εξαρτάται η κοινωνική οργάνωση των πόρων (επιδημιολογική ετοιμότητα, κοινωνικές υποδομές, συστήματα υγείας κ.λπ.), ωστόσο η τεχνοκρατική διαχείριση της πανδημίας φυσικοποιεί τις πολιτικές κατανομής τους, εμφανίζοντας την ιατρική (κλινική) διαχείριση της πανδημίας ως μονόδρομο.

Differing accounts are conventionally given of the origins of medical sociology and its parent discipline of sociology. These distinct ‘histories’ are justified on the basis that the sociological founders were disinterested in medicine, mortality and disease. This paper challenges these ‘constructions’ of the past, proposing the theorisation of health not as a ‘late development of sociology’ but an integral part of its formation. Drawing on a selection of key sociological texts, it is argued that evidence of the founders’ sustained interest in the infirmities of the individual, of mortality, and in medicine, have been expunged from the historical record through processes of ‘canonisation’ and ‘medicalisation’.

In 1992, Health Care of Australia, an international hospital corporation, was contracted by the NSW Government to construct and manage a new, hi-tech, privately owned, 161 bed 'public' hospital. (In other words, a private hospital which contracts with the Government to supply public hospital services). This was the Pt Macquarie Base Hospital, situated on the east coast of Australia almost half-way between Sydney and Brisbane. With this privatisation strategy, the NSW Government expected to save $46 million over 20 years. The proposed privatisation of Pt Macquarie's hospital services brought union and community consternation, but the privatisation continued nevertheless. This case study of the privatisation of the hospital uncovers the real costs of the venture and the way the costs of private services are subsequently distributed between users, owners and tax-payers. In the light of these findings, the paper offers an insight into why governments privatise health services.

If sanity and insanity exist, how shall we know them?
The question is neither capricious nor itself insane. However much we may be personally convinced that we can tell the normal from the abnormal, the evidence
is simply not compelling. It is commonplace, for example, to read about murder trials wherein eminent psychiatrists for the defense are contradicted by equally
eminent psychiatrists for the prosecution on the matter of the defendant's sanity. More generally, there are a great deal of conflicting data on the reliability,
utility, and meaning of such terms as "sanity," "insanity," "mental illness," and "schizophrenia" [1]. Finally, as early as 1934, {Ruth} Benedict suggested that
normality and abnormality are not universal. [2] What is viewed as normal in one culture may be seen as quite aberrant in another. Thus, notions of normality
and abnormality may not be quite as accurate as people believe they are.
To raise questions regarding normality and abnormality is in no way to question the fact that some behaviors are deviant or odd. Murder is deviant. So, too, are
hallucinations. Nor does raising such questions deny the existence of the personal anguish that is often associated with "mental illness." Anxiety and depression
exist. Psychological suffering exists. But normality and abnormality, sanity and insanity, and the diagnoses that flow from them may be less substantive than
many believe them to be.

This paper analyses the underlying principles and social consequences of the increasing detachment between human reproduction and sexuality via the process of technological intervention in the biological body, with a focus on current debates in Portugal. With biomedical techno-sciences, conception has become artificial (in vivo or in vitro fertilization) and independent of the coital activity. The risks and uncertainties concerning the development of Science and Technique in the biomedical field applied to reproduction present important challenges and bring forth critical questions to future generations and to humanity as a whole. For example, gametes donation (heterologous artificial insemination) implies fulfilling some ethical principles such as informed consent, anonymity and gratuitous involvement; other possible problems include the potential development of eugenic aspirations, dilemmas arising from the commercialization of gametes, embryos and fetus or surrogate motherhood, from reproductive cloning or embryonic stem-cell research techniques. In this framework, new entities appear on the scene like gametes donors, cryopreserved embryos or rented wombs that demand new laws and governmental regulation. Therefore, it is essential to study which values the techno-sciences are actually redefining, the range of social choices towards these values and the consequences these choices have – in terms of parenthood rights and family ties, for example. In this context, the paper will reflect upon these new values and will question whether they are compatible or not with democratic principles such as autonomy, human dignity or equal rights. Building upon my post-doctoral research, I will approach this problem theoretically, using tools from the Sociology of Science and of Medicine, and through data analysis (such as reports from ethical committees, legislation and media).

Introduction: Fruit and vegetable consumption is an important determinant of health and life expectancy. Past research shows that Slovenian adolescents do not consume sufficient amounts of fruit and vegetable. The aim of this study was to analyse the frequency and to examine socio-demographic and socio-economic differences in fruit and vegetable consumption using a nationally representative sample of youth in Slovenia aged 16–27 years.
Method: We analysed survey data from the FES-CEPYUS Slovenian Youth 2013 Study (N = 907; Mage = 21.9; 48.3 % women). Two indicators of dietary habits were analysed: the number of fruit servings and the number of vegetable servings consumed daily (1 = “do not eat fruit/vegetable”; 8 = “6 or more servings daily”).
Results: A relative majority of young people reported consuming only one serving of fruit daily (28.8 %) and one serving of vegetable daily (32.3 %). On average, respondents consumed 3.62 servings of combined fruit and vegetable daily and only 33 % consumed 5 or more servings daily. Chi-square tests indicated that fruit and vegetable intake was higher among women (compared to men) and among youth from high-status families (compared to low- and middle-status families), while other socio-demographic and socio-economic differences were not statistically significant.
Discussion: Two thirds of young people in Slovenia do not consume the recommended daily amounts of fruit and vegetable. The results of this study provide a basis for programmes and measures for raising fruit and vegetable consumption among young people, which should especially focus on young men and youth from low-status families, also by emphasizing the beneficial health effects of fruit and vegetable consumption.

Izhodišča: Uživanje sadja in zelenjave je pomemben dejavnik zdravja in pričakovane življenjske dobe. Pretekle raziskave kažejo, da slovenski adolescenti ne uživajo zadostnih količin sadja in zelenjave. Namen pričujoče raziskave je bil analizirati pogostost in razlike v uživanja sadja in zelenjave na reprezentativnem vzorcu mladih v Sloveniji, starih med 16 in 27 let.
Metode: Uporabljeni so bili podatki anketne raziskave slovenske mladine Youth 2013 (N = 907; N = 907; Mstarost = 21,9; 48,3 % žensk). Analizirali smo dva indikatorja prehranjevalnih navad, in sicer število enot zaužitega sadja in zaužite zelenjave dnevno (1 = »ne jem sadja/zelenjave«; 8 = »6 ali več enot dnevno«).
Rezultati: Največji delež mladih dnevno zaužije le eno enoto sadja (28,8 %) in eno enoto zelenjave (32,3 %). Mladi dnevno v povprečju zaužijejo 3,62 enot sadja in zelenjave, le 33 % pa jih zaužije pet ali več enot dnevno. Hi-kvadrat testi so pokazali, da sadje in zelenjavo v večji meri uživajo ženske ter mladostniki iz družin z višjim materialnim statusom. Ostali sociodemografski in socioekonomski dejavniki niso bili statistično značilni.
Razprava: Dve tretjini mladih v Sloveniji ne uživa priporočenih dnevnih količin sadja in zelenjave. Rezultati pričujoče študije lahko predstavljajo podlago za programe in ukrepe na področju zviševanja uživanja sadja in zelenjave med mladimi, ki bi morali biti usmerjeni še posebej na mlade moške in mlade iz socioekonomsko depriviligiranih družin, med drugim tudi s poudarjanjem pozitivnih zdravstvenih učinkov uživanja sadja in zelenjave.

This course provides an interdisciplinary sociological and anthropological exploration of medical systems, with a special emphasis on Canadian healthcare. By adopting critical social science approaches to explore healthcare services and health, illness and well-being at individual and societal levels, students will gain an in-depth understanding of the social determinants of health, and the role played by medical systems in remedying or even worsening population health disparities and inequalities.

The first half of the course explores the evolution and recent history of Canada’s medical systems, with attention paid to the development, policy and operations of Medicare. We will then discuss the contribution of religious healing and complementary and alternative medical systems for Canadians’ sense of wellbeing and their health and healing practices. The second half of the course will introduce and critically evaluate the beliefs that shape the social acceptability and provision of particular medical services, inform health decision-making, access and use, animate provider-patient interactions and treatment processes, and determine outcomes. In the area of medical systems research and theory, special attention will be paid to the social construction of health, illness and medical knowledge, biomedical hegemony and its effects for medical pluralism, and the hierarchies, politics and ethical challenges associated with medical service provision. Then, in order to emphasize the diverse ways that clinical medicine is subjectively understood and experienced, the course will draw on an innovative array of ethnographic studies of health, healing and healthcare systems, and those that prioritize patients’ and providers’ points of view in particular.

With regard to patients’ navigation and experience of these same systems, the course will assess how the social determinants of health - such as how they concern economic standing, gender, ethnicity, and race - impact health at individual and societal levels. Efforts will also be made to identify the health inequities, deprivations and disadvantages that are over-distributed among and experienced by First Nations, Inuit and Métis, ethnic minority and LGBTQ+ communities. As importantly, the course will investigate how health beliefs, experiences, practices and even medical ethics are shaped and conveyed by culturally specific illness representations, treatment accounts, and narratives.

Throughout the course, attention will be paid to the ways the aforementioned issues intersect with the COVID-19 pandemic.

In toxic torts, if the defendants’ negligence is confirmed, the court’s ruling is a punishment translated into monetary amounts, which the plaintiffs are compelled to accept. However, past exposure to toxic substances might continue to cause damage after the judgment, not only among the plaintiffs, but also among their descendants, making an exact measurement of the total damage inflicted almost impossible. A ruling or out-of-court settlement is therefore necessarily a compromise between the obligation to end the dispute and deliver some kind of justice for the victims and the radical uncertainty inherent to toxic torts. In the case of the electronics industry, due to the numerous chemicals to which workers are exposed, the uncertainty of health hazards is particularly high. This article proposes a framework for the valuation of exposure to toxicants, to address both the necessity and the limits of monetary compensation. It is based on a ten-year participating observation of the collective lawsuit launched by more than a thousand former employees of RCA plants in Taiwan, as well as thirty-five in-depth interviews of the plaintiffs following the High Court and Supreme Court decisions.

摘要: 在職業病與公害的侵權訴訟中, 如果法官判定被告有過失, 會命令被告給付原告一定數額的賠償金, 而原告必須接受。然而, 在判決確定後, 原告過去所暴露的有毒物質, 依然可能會繼續對其造成損害。損害所及不僅對原告本人, 可能還包括其後代。從而, 究竟損害的總量有多少, 幾乎無法精確衡量。此外, 經歷親人過世與胎兒流產, 罹患癌症等重大疾病, 乃至面對化學暴露在人體內所留下的不定時炸彈所帶來的心理壓力, 這種經歷都難以換算為金額。因此, 一份判決或和解, 無可避免地, 會是某種妥協: 一邊是為受害者提供某種正義來結束糾紛的責任, 另一邊是毒物侵權糾紛案內在的高度不確定性。而在電子工業的案件中, 由於工人接觸的化學物質眾多, 健康危害的不確定性又更高。本文試圖提供一個衡量毒物暴露的金錢價值的分析框架, 以探討金錢賠償的必要性及其侷限性。本文的經驗材料來自十年來作者對台灣RCA工廠一千多名前員工所發起之團體訴訟的參與觀察, 以及在高等法院和最高法院作出判決後, 對原告進行的三十五個深入採訪。

Con l'introduzione di dispositivi biomedici sempre più performanti e perso-nalizzati, come muta la relazione tra gli individui e la loro salute? Posto che nella società digitale la medicina si esercita oltre la clinica, muovendosi tra pratiche di auto-monitoraggio e utilizzo di app e wearable devices, quali con-nessioni si creano tra benessere, cura e malattia? E come cambiano il sapere e le narrazioni di salute impiegando una prospettiva di genere? Il libro cerca di rispondere a queste domande raccogliendo i contributi di giovani sociologhe italiane che avanzano, attraverso esperienze di ricerca tra loro diverse, nuove prospettive intersezionali a partire da fondamenti e innovazioni concettuali proposte dalla Sociologia della salute e dagli Science and Technology Studies. Le riflessioni, distribuite nei vari capitoli, si concentrano su tre aspetti. An-zitutto l'utilizzo di nuove tecnologie per la salute e per la ricerca biomedica, che alimenta un approccio sociomateriale, evidenziando il cambiamento che queste comportano in ottiche di una nuova concettualizzazione, visualizzazio-ne e impiego del corpo umano. Viene altresì discusso l'approccio digitale al benessere e alla malattia, in cui convergono un potenziamento nel ruolo del cittadino/paziente, nonché un supporto all'operato di medici e professionisti sanitari; il tutto marcato da nuove logiche di sorveglianza e controllo sui dati. Infine si propone la prospettiva di genere quale fil rouge in merito alle for-me di riproduzione, soggettivazione del vissuto di malattia e nella narrazione biografica. Veronica Moretti è assegnista di ricerca e docente a contratto (Laboratorio Metodologico di Ri-cerca Sociale) presso il Dipartimento di Scienze Politiche e Sociali dell'Università di Bologna, dove collabora al progetto europeo "Co-creation of Service Innovations in Europe" (Horizon 2020). Ha conseguito il dottorato in

The promotion of choice is a common theme in both policy discourses and commercial marketing claims about healthcare. However, within the multiple potential pathways of the healthcare 'maze', how do healthcare 'consumers' or patients understand and experience choice? What is meant by 'choice' in the policy context, and, importantly from a sociological perspective, how are such choices socially produced and structured? In this theoretical article, the authors consider the interplay of Bourdieu's three key, interlinked concepts – capital, habitus and field – in the structuring of healthcare choice. These are offered as an alternative to rational choice theory, where 'choice' is regarded uncritically as a fundamental 'good' and able to provide a solution to the problems of the healthcare system. The authors argue that sociological analyses of healthcare choice

Purpose: Past research indicates that blacks are less trusting of physicians than are whites; yet, researchers have not examined within group differences in physician trust by religious denomination – an effort that is complicated by the high correlated nature of race and religion. To better understand black-white differences in physician trust, this paper examines heterogeneity in trust levels among blacks associated with religious designations that distinguish Black Protestants from other ethnoreligious groups.
Methodology/Approach: Using data from the 2002 and 2006 General Social Surveys, this study adopts an intersectional (i.e., race X religion) typology of religious denomination to understand the black-white gap in physician trust. Weighted multivariate linear regression is employed.
Findings: Black-white differences in physician trust are identified only when religious affiliation is considered but not when religious affiliation is omitted. Blacks who are affiliated with Black Protestant churches are more trusting than other religious groups, including Evangelical Protestants, Mainline Protestants, and blacks who are affiliated with other faiths.
Originality/Value of Paper: This paper indicates that there is more heterogeneity in trust levels among blacks than between blacks and whites. Moreover, the findings suggest that religion can play an important role in bridging the trust gap between blacks and the medical sciences.

Beyond the imaginary of science: the chronic disease between hospitalization and daily life. Modernity has produced the image of the disease like an organic disorder on which the medicine operates, by its scientific method, to lead the body back to the norm. So, the modern medicine carries out a soteriological function: to emancipate man from the utmost Evil and save him from death. The scientific paradigm has interpreted the disease by the opposition good/evil, separating it from the life and controlling it by its instruments. The consequent medicalization of social space is a reply to the need to keep the order purging the society from every form of Evil. But what happens when the chronic disease gets out from under science and enters daily life? When difference imposes on the social order and the disease, rather than being forced into elsewhere, is part of the life obligating us to recognise an indissoluble bond between good and evil? The article will try to respond to these questions, from the analysis of the process of social construction of the modern categories of health and disease and the related imaginaries. Keywords Imaginary of disease | Chronicity | Scientific paradigm| Medicalization| Evil

El  presente  artículo  propone  un  marco conceptual    para    describir    la    interacción    como microsistemas  sociales  en  losque  se  enmarcan  las agresiones  al  personal  de  salud como  tipos  de interacciones  específicas.  Para  describir  las  agresiones, se  realizó  una  revisión  de  ochenta  y  una  notas  de prensa  y  se  efectuaron  treinta  y  nueve  entrevistas  con el    objetivo    de  comprender las  experiencias    de trabajadoras y trabajadores de lasalud. Se identificaron tres  tipos  de  agresiones;  exclusión  racional,  estigma  y estallido  hostil.  Los  hallazgos  mostraron  que  la evaluación  racional  para  el  distanciamiento  en  la interacción,  portar  unabata  blancao  un  uniforme como  elemento  simbólico  deriesgo  y  las  creencias  en torno a la enfermedad propiciaron formas de violencia específica hacia los trabajadores. También se explica la importancia del tiempo para el desvanecimiento de los enfrentamientos. Por    último, la investigación proporciona  un  marco  general  para  comprender  la pandemia como objeto de estudio sociológico.

Patients et professionnels de la santé souhaitent-ils devenir des partenaires dans la relation de soins ? Il est dans l'air du temps de le croire. Mais rien n'assure que ce soit le cas. L'analyse de données collectées auprès de l'Espace Patients & Proches, où les usagers du CHUV déposent leurs doléances liées à des difficultés rencontrées à l'hôpital, montre que les patients, leurs proches comme les professionnels de la santé souffrent d'un processus de dé-subjectivisation alimenté par la place grandissante des technologies et la standardisation des prises en charge. Ils éprouvent d'abord le besoin d'être reconnus comme des sujets avant de pouvoir envisager de devenir des partenaires. Ni les uns ni les autres ne formulent d'attentes quant à une relation égali-taire. Les tentatives allant dans ce sens sont parfois même vécues comme douloureuses.

Patients : becoming a person before being a partner
Do patients and health care professionals wish to become partners in the relationship of care ? While many tend to think like that, it is far from certain that this is really the case. Data collected by the Espace Patients&Proches, where users of the Lausanne University Hospital are allowed to complain about health care-related problems, show that patients, their relatives, and health care professionals suffer from a process of de-subjectivization owing to the increasing tech-nologization and standardization of care. Indeed, they want to be recognized as subjects before even thinking of becoming partners. Neither patients, their relatives, nor health care professionals call for a symmetrical relationship yet ; such attempts may moreover be e xperienced as painful.

台灣的近視盛行率奇高，1990年代以來號稱｢近視王國｣，激發許多學術調查與政府介入。那麼相應的治理部署究竟何時和如何成形、有什麼結構性轉變、家長又是如何回應這些措施與訊息呢？我分析期刊、調查報告、政府檔案資料，進行多元行動者的深度訪談（28位），以釐清這些研究問題。本文的研究發現與貢獻如下：（1）近視在1960年代的問題化，附屬於政府與教育界對｢升學主義｣的一系列論述與介入，近視治理源於教育問題。醫療專家與官員配合同時代的教育改革，聚焦於國中小學生、以過度升學競爭解釋學生大量近視，並靠改善教室空間和特定眼睛體操介入。眼科醫師對該議題的壟斷也隨1980年的近視政策而強化。（2）自1990年代起，近視治理在學生近視盛行率逐步攀高的治理危機下，更著重家庭親職的自我照護，我稱之為｢家庭化轉向｣。治理對象逐漸擴及「學齡前｣的幼童以及電視和電腦等視聽娛樂風險、相關論述越來越著重親職的責任、措施由特定眼睛體操轉變為日常活動時間的計算、日益擴大的眼科市場也出現了角膜塑型片等新手段。（3）近視照護的親職顯示：文化健康資本必須包含｢照護勞動時間｣這項要素，近視照護的兩難也彰顯不同親職實作之間的張力。一方面，預防、檢查、處理到度數控制等各環節，都有特定的健康不平等，家長的健康知能、財力與投入照護的勞動時間扮演了關鍵角色。另一方面，家長會以強化眼睛、差別性排除風險因子、選擇性接受部分風險等方式，來協商相互衝突的要求。最後，我也提出政策建議：視力保健應由國小延伸至國中，並分辨不同的家庭型態，且在流行病調查中結合教養風格與醫療商品等面向。

關鍵詞：近視、視力保健、治理、升學主義、文化健康資本、親職。



English Abstract
Known as the “kingdom of myopia” due to its high prevalence rate of myopia since the 1990s, such an epidemic in Taiwan leads to a great deal of investigations and interventions. This thesis analyses how and when the dispositif of myopia governance is developed, whether and how it changes historically, and how the Taiwanese parents respond to such an issue in their care practices. Through the examinations of journals, research papers, policy documents and 28 in-depth interviews, this paper has three major findings. (1) The problematization of myopia during 1960s follows the lead of critique and intervention by the ministry of education against “education fanaticism”, the myopia governance is thus originated from the educational concern. Influenced by contemporary educational reforms, the experts and the officers focus on middle and primary school students and explain their prevalence rate by the over-competition under education fanaticism. They also strive to improve the spatial environments of school and impose certain forms of eye gymnastics, and strengthen their monopoly of this issue with the help of the creation of the policy of myopia in 1980. (2) Since 1990s, however, under the crisis of the climb of the prevalence rates, the governance of myopia turn to focus on the self-care of family parents, I call it as “the domestic turn”, in which the objet of governance extends to the pre-school children and the risks of audio-video leisure (such as TV and computers), the relevant discourses tend to explore the responsibility of parents, the eys gymnastics are replaced by the calculation of out-door activities, and Ortho-K emerges in the growing market of ophthalmology. (3) This case shows that the cultural health capital should include the “care-labor time”, and the dilemma of myopia care embodies the tension between different parental practices and dispositions. On the one hand, from prevention, examination, treatment and control, all these practices show a form of health inequality caused by the differences of health-related competences, economic means and the time available for care ; on the other hand, parents interviewed tend to negotiate the pressure of education fanaticism and the health of the eye by strengthening the eyes of their children, discriminating and excluding some risk factors while selectively accepting some others. Based on these findings, this paper suggests that the policy interventions should extend to the secondary schools, distinguish different forms of family and take into consideration the style of childrearing and the use of medical commodity.

Keywords: myopia, the promotion of health of eyes, education fanaticism, governance, cultural health capital, parenthood.

This article reports on a citation-context analysis of journal articles from Australia, the United
Kingdom and the United States of America. Examining publications from the sociology of health
and medicine, the study draws a number of conclusions about the state of sociology, inter-country
relationships between knowledge workers, and national systems of sociological knowledge
production. It finds that core–periphery relations define significant features of sociological
work, impacting on citation patterns, inter-country collaboration and the selection of reference
materials. Core–periphery relations are also found to influence the sociological production of
knowledge across the Australian university sector.

Recopilación de los principales planteamientos teórico conceptuales que orientan la enseñanza de la medicina y disciplinas afines en sus aspectos prácticos con la comunidad y en su vinculación con los servicios asistenciales.  Sr revisan los elementos políticos y sociales que condicionan en México y el origen de la escuela politécnica del área médica.  Con este marco general se aborda una descripción convencional de los procedimientos que las escuelas del IPN de dicha área utilizan en la implementación de la enseñanza comunitaria. 
Se establecen variables de estudio o ejes de abordaje que se aplican a cada escuela, mismos que resultan de la hipótesis central de trabajo que considera la ine3xistencia de un sustento pedagógico docente asistencial en la enseñanza comunitaria actual de las disciplinas médicas del Instituto Politécnico Nacional. 
El método de comprobación utilizado es el de la correlación lógica entre variables y se exponen conclusiones por escuela y en forma global para el Instituto. 
La principal fuente de información son los programas de prácticas de comunidad de las escuelas, de los años 1988 a 1993.

Modern medicine and conscious cuisine have become complex disciplines reflecting upon their own status and upon human condition in late modernity, raising hermeneutic, philosophical and ethical questions. Just like a complex religious tradition requiring more and more theological knowledge not just some rudimentary reflection on some taken for granted religious “truths”, medical and nutritional knowledge becomes a systematic attempt to control death by both elaborated reflection and standardized practice.
Medicine and conscious diet become no less engaged in saving human souls than any traditional religion. As nutritionists, these preachers of immortality, love to say, the food we eat may be the most powerful form of medicine or the slowest poison. Both medicine and food kill or heal.
The terrifying expression “risk factor” is therefore sacred and feared; the fatal indicators make modern people nervous about everything they eat, drink and breathe. The smoking, the sedentary life, the excess of refined carbs, salt, and alcohol are enumerations that one cultivates with dread and reverence. Every modern individual hopes that, by keeping herself informed about the updated lists of risk factors, her body would be, at the long last, spared. Permanent adaptation, medical and nutritional knowledge, and daily reflection are required, but, sooner or later, one will no more be able to keep up.
Medicine gets more complicated, and so is our death. Your terrible illness is your terrible fault and your terrible sin. And your death is your punish for eating sluggishly. Your lifestyle mainly consists in finding ways to avoid getting caught. You’re ill, therefore you’re guilty.

In its heyday, around the mid-twentieth century, psychosomatic medicine was promoted as heralding a new science of body/mind relations that held the promise of transforming medicine as a whole. Sixty years on, the field appears to have achieved no more than a respectable position as a research specialism within the medical status quo. This paper articulates the problematic of psychosomatics through a number of propositions that reconnect its promise of novelty to the present and to contemporary concerns. In contrast to classic approaches to 'psychosomatic problems', which typically set out by denouncing the conceptual inadequacy of mind/ body dualism, the focus proposed is on the resilience of dualism as an empirical datum deserving closer analysis. The paper thus asks: what is the character of dualism considered under the aspect of what it achieves, and thus as an expression of value? Drawing on the thought of A N Whitehead, Michel Foucault and Viktor von Weizsäcker, the argument formulates a set of 'psychosomatic problems' informed by the concept of biopolitics and introduces their relevance in relation to the politics of participatory medicine. There are stories that need to be ceaselessly reactivated in order to be relayed with new givens and new unknowns. 1

ENGLISH. The phenomenon of defensive medicine should be seen as a symptom of a “care scene”, like the current one, crossed by a growing conflictuality. This conflictuality is favored by a “vicious circle” between the growing desire to integral health, on the one hand, and highly effective techno-scientific response to this desire, on the other hand, where the effectiveness does not satisfy the “need”, but instead encourages it to cultivate additional expectations – according to de inner logic of “desire”. This “circle” generates feelings of frustration that encourage users to legal recourses and professionals to defensive measures. Improve the technical and procedural aspects of care (appropriateness, effectiveness, legislation) is necessary as insufficient. It is necessary to commit resources in relational aspects and in sensemaking processes, which are the basis of the “care scene”. Overcoming the “providentialist” desire-response paradigm, focused on technical-procedural priorities, and developing collaborative imagination.
ITALIANO. Il fenomeno della medicina difensiva va letto come sintomo di una scena della cura, quale quella attuale, attraversata da una crescente conflittualità. Una conflittualità favorita dal “circolo vizioso” innescatosi tra desiderio di salute integrale, da un lato, e risposta tecno-scientifica altamente efficace a tale desiderio, dall’altro, dove l’efficacia non appaga il “bisogno”, ma al contrario lo incoraggia a coltivare aspettative supplementari, com’è proprio della logica del desiderio. Tale “circolo” genera sentimenti di delusione che spingono gli utenti ad azioni di rivalsa e i professionisti a misure di difesa. Migliorare gli aspetti tecnico-procedurali della cura (appropriatezza, efficacia, normativa) è necessario quanto insufficiente. Si rende necessario investire sugli aspetti relazionali e di senso in gioco nella scena della cura. Superando il paradigma “provvidenzialista” desiderio-risposta, a dominante tecnico-procedurale, e sviluppando immaginazione collaborativa.