Gender differences in perceptions of pain : towards a phenomenological approach

This research explores the relationship between perceptions of pain and illness and the social characteristics of the individual, with a focus on the role of gender. It emphasizes the meaning and understanding of the phenomenon of pain, which as an area of research has been neglected by medical sociology. A survey of sociological, medical, psychological, anthropological and literary perspectives on pain reveals a consensus that pain is a 'subjective' phenomenon, and that there are therefore limitations in applying 'objective' measurements. Recent developments in the sociology of health and illness, particularly in the area of emotions, offer potential theoretical and methodological frameworks and these are explored. To try to broaden the definition of pain beyond the traditional biomedical approach a multi-method form of enquiry was adopted. A self-completion questionnaire examining health beliefs, and experiences of illness and pain during the life-cycle, was administered to a random sample of 107 men and women attending a GP practice in North West London. Significant gender differences were found with respect to the role of the emotions and social expectations of coping ability. These themes formed the basis of the second stage of fieldwork, in which a sub-sample of 21 men and women participated in a semi-structured in-depth interview, including the use of visual imagery. This explored definitions and experiences of pain. Responses were taperecorded and transcribed. Analysis of both the transcripts and the material relating to the use of visual imagery revealed complex and abstract conceptualisations of pain, related to the social context of the individual. Expenences of pain were found to incorporate feelings and vulnerabilities, and existential and religious beliefs as well nociceptive or sensory components. The attribution to women of superior capacities in coping with pain were phenomenologically linked to female biological and reproductive functioning, but also seen to be underpinned by gendered socialization and role-expectations

Diagnosing vulnerability and “dangerousness”: police use of Section 136 in England and Wales

Purpose – Police in England and Wales are empowered, under Section 136 of the Mental Health Act 1983 (s136), to detain individuals thought to be a danger to themselves or to others. Use of this authority is widespread, but varies across districts and attracts controversy because of inconsistent application and the fact that it requires police to make judgements about mental health. The purpose of this paper is to examine police attitudes to and criteria for using s136. Design/methodology/approach – The authors conducted focus groups with 30 officers in urban and rural areas of three different regions across England and Wales. Group interviews were audio-recorded, transcribed, and analysed using open and axial coding. Findings – Use of s136 authority has major implications for police work; liaison with mental health services is seen as desirable but often ineffective due to resource constraints and the latter's lack of availability. The decision to invoke s136 depends on social context and other particulars of individual cases. Research limitations/implications – Although the findings have limitations with respect to generalisability across the whole of the UK, there are patterns of responses which have major implications for policy recommendations. Practical implications – Police decisions to apply s136 reflect an implicit values-based classification of and response to emotionally disturbed behaviour, in light of available institutional and social supports. Social implications – Tasked primarily with protecting the public and keeping the peace, police “diagnoses” of risk often contrast with that of mental health professionals. Originality/value – A highly original piece of research which has attracted further funding from BA/Leverhulme. </jats:sec

S136 in Sussex: Final Report

Background: The research addresses the controversially high rates of Section 136 (s136) detentions across Sussex in collaboration with Sussex Police and the mental health trust (Sussex Partnership Trust), in order to understand the consistent patterning of a ratio of 2:1 detentions to police custody, rather than the 5 specialist NHS S136 suites. Methods: Multi method study i) secondary analysis of existing s136 statistics collected by Sussex police and Sussex Partnership Trust ii) in depth interviews and deliberative workshop with 37 members of the public who had been detained under s136 iii) interviews, focus groups, and observations with 79 police officers 160 NHS and allied staff and voluntary workers. Main outcome measures: social patterning and reasons for use of s136; differences in type of Place of Safety used and experience of users; impact of good practice and joint working strategies Results: S136 is mainly used by police in Sussex as the only means of supporting suicidal and highly vulnerable people who are reported to be in extreme distress in public places when there is no other service available as the majority of incidents happen ‘out of hours’. Innovative inter agency policy and practice working, in particular the national ‘Street Triage’ pilot which was rolled out across Sussex during the life of the study, has produced successful interventions to reduce the use of s136, but complex factors such as repeated detentions of vulnerable and socially marginalised reveal some of the underlying complexity. Conclusions: This study challenges some of the simplistic assumptions around the high rates of S136 detention, which can be reduced through effective joint agency interventions, but may always be needed as a life-saving ‘default mechanism’ in complex situations. Alongside the need for adequate resources to support sustain and increase effective alternatives to the use of s136, the study recommends that the voices of those with ‘lived experience’ must be included in developing effective interventions. Keywords: Mental health emergencies; emergency services; help seeking, joint working, suicide and suicide prevention, user experience, Street Triag

Designing 'Healthy' Prisons for Women: Incorporating Trauma-Informed Care and Practice (TICP) into Prison Planning and Design

There has been growing acknowledgment among scholars, prison staff and policy-makers that gender-informed thinking should feed into penal policy but must be implemented holistically if gains are to be made in reducing trauma, saving lives, ensuring emotional wellbeing and promoting desistance from crime. This means that not only healthcare services and psychology programmes must be sensitive to individuals' trauma histories, but that the architecture and design of prisons should also be sympathetic, facilitating and encouraging trauma-informed and trauma-sensitive practices within. This article problematises the Trauma-Informed Care & Practice (TICP) initiatives recently rolled out across the female prison estate, arguing that attempts to introduce trauma- sensitive services in establishments that are replete with hostile architecture, overt security paraphernalia, and dilapidated fixtures and fittings is futile. Using examples from healthcare and custodial settings, the article puts forward suggestions for prison commissioners, planners and architects which we believe will have novel implications for prison planning and penal practice in the UK and beyond

Screening for breast cancer : medicalization, visualization and the embodied experience

Women’s perspectives on breast screening (mammography and breast awareness) were explored in interviews with midlife women sampled for diversity of background and health experience. Attending mammography screening was considered a social obligation despite women’s fears and experiences of discomfort. Women gave considerable legitimacy to mammography visualizations of the breast, and the expert interpretation of these. In comparison, women lacked confidence in breast awareness practices, directly comparing their sensory capabilities with those of the mammogram, although mammography screening did not substitute breast awareness in a straightforward way. The authors argue that reliance on visualizing technology may create a fragmented sense of the body, separating the at risk breast from embodied experience

Explanatory pluralism in the medical sciences: theory and practice

Explanatory pluralism is the view that the best form and level of explanation depends on the kind of question one seeks to answer by the explanation, and that in order to answer all questions in the best way possible, we need more than one form and level of explanation. In the first part of this article, we argue that explanatory pluralism holds for the medical sciences, at least in theory. However, in the second part of the article we show that medical research and practice is actually not fully and truly explanatory pluralist yet. Although the literature demonstrates a slowly growing interest in non-reductive explanations in medicine, the dominant approach in medicine is still methodologically reductionist. This implies that non-reductive explanations often do not get the attention they deserve. We argue that the field of medicine could benefit greatly by reconsidering its reductive tendencies and becoming fully and truly explanatory pluralist. Nonetheless, trying to achieve the right balance in the search for and application of reductive and non-reductive explanations will in any case be a difficult exercise

Health beliefs of children and young people: using child centred methods

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Pain, suffering and risk

A primary role of medicine is often perceived as treating or alleviating pain, but what actually constitutes pain can be defined in many ways. A major impediment to a more adequate conceptualization of pain is thought to be the manner in which it has been 'medicalized,' over the course of the twentieth century resulting in the inevitable Cartesian split between body and mind. Consequently, the dominant conceptualization of pain has focused almost exclusively upon the neurophysiological aspects, both in diagnosis and treatment, with the subsequent inference that it can be rationally and objectively measured. Social science, in particular the sociological literature on chronic illness, offers a framework for understanding the experience of pain by focusing on 'lived experience,' including narratives of suffering. Medically, pain is often explained in terms of risk by attempting to measure so-called objective symptoms, whereas accounts of suffering may encompass more easily the notion of total pain (Saunders 1976), which includes psychological, spiritual, interpersonal and even financial aspects of chronic pain, as well as its physical aspects. This paper proposes that illness narratives and phenomenological accounts have become intrinsic to the understanding and treatment of pain and, using examples from empirical research, considers how pain narratives challenge biomedical approaches to chronic pain, which are inevitably framed in the discourse of risk