| 1. |
- Knechtel, Maricel L, 1968-
(författare)
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Categorization Work in the Swedish Welfare State : Doctors and social insurance officers on persons with mental ill-health
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation contributes to the debate on street-level bureaucracy, which highlights how the decisions made by workers in public bureaucracies effectively become public policy. This debate has paid relatively little attention to the study of how professionals carry out their work by means of institutional categorization, a knowledge gap that this study helps to close. Moreover, this study contributes to the understanding of how persons with mental ill-health are matched with institutional categories.The aim of this dissertation is to shed light on the institutional categorization process involving persons with mental ill-health in two interrelated areas of welfare settings: primary healthcare and sickness insurance. To pursue this aim, 27 in-depth interviews with 30 participants (18 doctors and 12 social insurance officers) were performed. The interviews, which were based on vignettes – short hypothetical scenarios – made it possible to get insight into how doctors and social insurance officers would reason in a situation similar to that depicted in the vignette.This study emphasizes how discretion is exercised when individuals are matched with the institutional categories that doctors in primary health settings and social insurance officers have at their disposal. Ideally, this process is a rational process through which clients’ objective traits are assessed against the criteria that define the various institutional categories. However, the process is not straightforward; thus, different kinds of social mechanisms are linked to the processes of institutional categorization, such as signaling, screening, the logic of appropriateness, moral work, and discrimination. On a more practical level, this study emphasizes the difficulties imbued in the process of institutional categorization. There are multiple reasons for these difficulties. Human complexity is one of them: the interviewed professionals often work with situations that require responses to human dimensions, which are oftentimes too complicated to reduce to standard formats. Another reason for these difficulties has to do with the ambiguity and/or complexity of institutional category schemes. Moreover, the process of institutional categorization takes place in a context of conflicting demands and professional logics, both within a single organization and across the organizations that work together with respect to the same patient/client.Future research concerned with institutional categorization should address how persons with mental ill-health are matched with the institutional categories in other areas of welfare, such as social services and employment services. A deeper knowledge about how the various organizations of the welfare state match individuals with institutional categories, could bring us closer to an understanding of the problems of multi-organizational collaboration.
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| 2. |
- Lassinantti, Kitty, 1968-
(författare)
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Diagnosens dilemman : Identitet, anpassning och motstånd hos kvinnor med ADHD
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis explores the increasing medicalization of society, the process whereby social phenomenon are transformed into medical problems. Alike the general tendency of neu- ropsychiatric diagnoses, the number of people with ADHD (Attention Deficit Hyperactiv- ity Disorder) has increased and expanded from a boys’ diagnosis to include both adult men and women. Studies on the latter category is however scarce. The objective of the thesis is to contribute with a micro sociological and critical perspective on the effects of the biomedicalization process, by focusing women's experience of getting and living with ADHD. The empirical material consists of narrative interviews with sixteen women, diagnosed with ADHD in adulthood. The participants, age 20 to 50, were enrolled via Swedish NGO:s in 2010 and 2013.The thesis resides on four analytical themes: biomedicalization, pharmaceuticalizaton, functionality and gender. It shows how diagnostics evokes processes that involve learning and using a biomedical terminology to describe and understand oneself. ADHD is, in general, depicted as diffuse, expansionary, masculine and deviant sociability and cognitiv- ity. Unlike depression and anxiety, described as temporary and unwanted illnesses, the ADHD-diagnosis embraces the whole personality. Hence, the women find it difficult to identifying and separating ADHD from the self. Furthermore, categorizations of oneself as a ‘woman with ADHD’ imply constructions of individual and collective identity that has ideological implications, i.e. the individual narratives are related to grand narratives. These contradictory grand narratives bring about ideological dilemmas that are handled rhetorically in the women's everyday life. The masculine connotation of ADHD, for ex- ample, render the women experiencing themselves as transgressing not only femininity but also ADHD-personhood. Additionally, as social actions are attributed to the ‘ADHD brain’, the brain is portrayed as a pathological deviant and dysfunctional object for phar- maceutical intervention. Nevertheless, this discourse is also contested by the women by pointing to 1) positive aspects of the ‘ADHD-brain’ in everyday life, or 2) gender inequal- ities and demands of the late-modern society. Concluding, the women in this study are not only victims of their bodies or societal norms, but also agents negotiating– adapting and opposing to – expectations of how to be an ideal citizen or woman.
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| 3. |
- Isaksson, Joakim, 1976-
(författare)
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Spänningen mellan normalitet och avvikelse : om skolans insatser för elever i behov av särskilt stöd
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In Sweden, an increasing number of pupils are defined as having some form of difficulties in school. In order to receive special support measures in school, these difficulties must have been subject to a pedagogical examination that state that the pupil is in need of special support measures. This work of identifying and defining difficulties implies that questions about normality and deviance inevitably come into play in school. There has been an increasing demand in school politics to identify these difficulties as early as possible, and this demand has placed further pressure on school personnel in this issue. Furthermore, the personnel’s perspective on the difficulties is also important, i.e., in terms of their origin, because this has importance for the design and content of the special support measures. The overall aim of this thesis is to analyse the tension between normality and deviance that is manifested in the school’s work procedures for pupils with special educational needs. Related to the overall aim, four overarching research questions are addressed. How have pupils with special educational needs and special education been articulated in national policy documents during recent decades? What perspective on school difficulties are being portrayed in schools’ individual educational plans for pupils with special educational needs? How do school personnel identify and differentiate pupils with special educational needs from “normal” pupils? How do pupils with special educational needs and their parents experience the special support measures that they receive in school and what seems to be the main concern of such support measures? The thesis consists of four studies that are based on different empirical materials such as policy documents, individual educational plans (IEPs) and qualitative interviews with school personnel, pupils and parents. The methods that are used for analysing the material are policy analysis, content analysis and grounded theory. The results show that the target group for special support measures has been ascribed with different meanings (over time) in policy documents, something that has affected the recommendations of the support measures and the choice of actors who are assigned to provide such support. Furthermore, the IEPs, as well as the interviews, reveal that an individual perspective on school difficulties seems to be deeply rooted in school. The identification process of special educational needs followed three models: a pedagogical model, a social model, and a medical/health model. However, the process of sorting out and defining these pupils invoked ambivalent feelings in the school personnel and the school class usually became the frame of reference for normal or deviant behaviour. Finally, the pupils’ and parent’ main concern of special support measures in school were described as a struggle for recognition and inclusion. The results are discussed with theoretical perspectives on school difficulties and special education. In the concluding discussion, it is argued that pupils with special educational needs have to balance between normality and deviance in school, but also between a pedagogical and a medical discourse by means of having a medical diagnosis in school.
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| 4. |
- Svanevie, Kajsa, 1976-
(författare)
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Evidensbaserat socialt arbete : Från idé till praktik
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- As an innovation Evidence-Based Practice (EBP) is designed as a tool for clinical problem solving. According to its theory of use EBP will bring a difference for policy makers, for professionals, for researchers and for service users. One question to be asked is whether EBP actually leads to the radical social change it is designed to accomplish. The aim of the study is to describe and analyse the outcome of the effort to establish EBP, with a focus on the case of social work in Sweden. The research questions are: What is EBP? Why are efforts made to establish EBP? What is the outcome of the EBP project? How can the outcome of the EBP project be explained?The case study was conducted on a critical realistic meta-theoretical ground with a focus on explanation of social change with an explicit actor-structure perspective. Methodologically, a narrative synthesis of studies was made. As a complement primary data were collected to fill empirical gaps. The state of things was described before and after the EBP-initiatives. Several helping theories – Kuhn’s theory of paradigm, program theory, neo-institutional theory and theory of diffusion – were used to analyse the empirically mapped outcome of the EBP project.The results show that the import of the original model of Evidence-Based Medicine (EBM) to social work is a part of a wider social movement in the helping and educational professions. The new model has influenced social work as a discipline, as a field of practice and as a field of policy. There are examples of full-scale implementations of EBP, although EBP has not reached a general status as daily practice. Some obstacles remain.The gradual adaption of EBP corresponds to criteria hold by Kuhn for a paradigm shift. Acceptance of the model has contributed to change the structure and function of social systems. At an organizational level, this change means on-going institutionalization. The innovation is influencing the way institutional actors conduct their work. Although the structural conditions have been optimal, the EBP-model has been debated with heat. The EBP-debate and policy-driven infrastructural efforts have brought a more in-depth examination of the model. So-called coercive, normative, and regulative isomorphisms were used to change organizations. The degree of institutionalization depended on the individuals and the organizations willingness and preparedness to change, to understand, and to put the model into practice. When actors used a less strict version of the original EBP model, the pace of cultural and institutional change slowed down.
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| 5. |
- Hultgren, Peter, 1970-
(författare)
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Det dubbla statushandikappet och sjukförsäkringens moraliska praktiker : en aktstudie om sjukpenningärenden som får negativa beslut på Försäkringskassan
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In recent years an increasing number of sickness allowance cases have been closed with a negative decision despite the fact that a certifying doctor has recommended sick leave. At Social Insurance Offices, a case file is established for each sickness allowance case. The case files for 538 rejected cases form the basis for this study.The assessment of the entitlement to sickness allowance is a key instrument of control in the health insurance system and the sharpened borderline between the obligation to work and the entitlement to sickness allowance can be interpreted as the result of a political aim to promote work through the health insurance system. This thesis explores these demarcation practices, highlighting the ways in which this policy of work promotion is translated into and made manifest in real world cases.Three aspects of these practices were highlighted in the study described in the thesis. The first aspect concerns the identification of those who are denied sickness allowance; their diagnoses and work situations. The second aspect relates to the interaction between the certifying doctor, the medical officer and the case officer and their respective roles in the process leading to negative decisions. The third aspect examines how the actors interpret and apply the concepts of sickness and ability to work in cases with negative decisions. In addition to these themes, in the final chapter of the thesis, I draw on theories of institutionalised organisations and moral practices to analyse the outcomes of the decision-making process.The thesis shows that a negative decision is most likely to be applied to insured persons who are either unemployed or who are manual workers without educational qualifications, and who have received diagnoses of mental illhealth or of diagnoses of pain and ache problems in the locomotive organs. It is argued that this is a moral category formed through the interaction of government policy dictates promoting work with actors, who in their official roles must apply an extremely vague criterion for entitlement to social insurance, namely disablement caused by illness. In this way, the dual handicap – undervalued labour (market) position plus undervalued gravity of illness – has become a borderline marker when the right to sickness allowance is being investigated and contested.
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| 6. |
- Medina, Eduardo, 1957-
(författare)
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Från ”tyst vår” till ”hållbar utveckling” : En kritisk diskursanalys av miljöfrågans utveckling 1962–1987
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation studies the development of the environmental issue from a discursive perspective. Through an analysis of views on nature and the environment in several NGOs and main political organs, the dissertation tries to explain how a certain view became hegemonic. The analysis pertains to the period between the publication of Silent Spring in 1962 and the introduction of the concept sustainable development by the UN in 1987. From a realistic starting point and with critical discourse analysis (CDA) as its method, the dissertation aims to identify causal powers and mechanisms that have generated and institutionalized the environmental discourse. An analytical model is developed and applied on three levels; a sociolinguistic, institutional, and macrosocial level; which also reflect the methodological progression of the study from description to explanation.The result shows that the discursive practice was hegemonized by a Western view promoting economic growth. This discourse gradually gained ground at the expense of an anti-systemic discourse which posited structural societal changes as the answer to environmental problems. Mechanisms such as the exclusion of some views and actors from common discursive practices were crucial for the process of homogenizing the discourse and developing consensus. Through incorporating that part of the environmental movement which did not fight the dominant economic and political system, the UN turned it into support for its own project, which is part of the process of hegemony. At the same time the environmental objectives of the hegemonic discourse were established in the institutional spheres.The institutionalization of the environmental issue changed the focus from social critique to a question of development and technology, something which helped displace the original critical and partially anti-systemic character of environmental discourse. Through turning the critical and negative account of the situation into a more harmonious and hopeful vision, for instance in terms of sustainable development, a foundation was laid for the later development of ecological modernization. When the hegemonic discourse invested the concept of sustainable development with emphases on progress and economic growth, it encapsulated the environmental issue within the framework of the prevailing social system.
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| 7. |
- Olsen, Terje, 1967-
(författare)
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Versjoner av arbeid : Dagaktivitet og arbeid etter avviklingen av institusjonsomsorgen
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation is a study of employment and daytime activities for people defined as having an intellectual disability. The study’s point of origin is the somewhat paradoxical situation these individuals are put into when it comes to work and daytime activities. They are on the one hand granted a disability benefit and made objects for a logic of caretaking; they are regarded as vocationally disabled and defined as outside the workforce. On the other hand, they are still included in a hegemonic work ethic with political objectives for ‘full employment’ and ‘a working-life for all’. A main objective in this study has been to discuss what different types of work and daytime activities mean to these individuals themselves; what role work and daytime activities have in their identity management and self-presentation in everyday life.The study consists of three parts. Part I outlines a historical contextualisation of the relationship between intellectual disability and participation in work and production. This part also provides a brief account for the labour market situation for these individuals today, and discusses the present situation related to the official aims of the administrative reform, which closed down the state-financed institutions for people with intellectual disabilities. Part II discusses the theoretical perspectives and methodological approach used within the study. The theoretical perspectives are developed using concepts from Dorothy Holland et.al, Pierre Bourdieu and Erving Goffman. The methodological approach is based on qualitative case studies with participatory observations and interviews within the different settings where people with intellectual disability work. Part III presents and analyses data derived from fieldwork. Central elements in the meaning of work in identity management are discussed and classified in six basic ‘key stories’ about work and daytime activity. Different forms of adapted and ordinary work are discussed in context of gender roles and social class aspects.
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| 8. |
- Salmonsson, Lisa, 1978-
(författare)
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The 'Other' Doctor : Boundary work within the Swedish medical profession
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is about medical doctors with immigrant backgrounds who work in Sweden. Based on 15 qualitative interviews with medical doctors with immigrant backgrounds, this thesis explores the medical doctors’ feeling of professional belonging and boundary work. This thesis focuses mainly on the doctors’ experiences of being part of the Swedish medical profession while, at the same time, being regarded as ‘different’ from their Swedish medical counterparts. It starts off with the idea that medical doctors with immigrant backgrounds may have, or could be regarded as having, contradictory social positions. By virtue of being part of the Swedish medical profession, they belong to one of the most privileged groups in Swedish society. However, due to their immigrant background these doctors do not necessarily occupy a privileged position either within their profession or in society in general. This thesis shows that doctors with immigrant backgrounds feel that they are not perceived as full-fledged doctors, which seem related to how they are somewhat ‘othered'. The results show that these doctors cope with being seen as different from doctor with non-immigrant backgrounds, by using the notion of ‘migranthood’ as a resource in negotiations in everyday work life but they also do what they can to overcome the boundaries of ‘Swedishness’. Belonging should therefore be seen as having a formal and an informal side, as getting a Swedish license does not automatically mean that you feel belonging to, in this case, the Swedish medical profession. This seems to put doctors with immigrant backgrounds in a somewhat outsider within position, which seems having to do with boundaries between who is included in the ‘us’ and in the ‘them’. Lastly, these findings indicate that sociologists need to expand the understanding of professional groups to also include boundary work within these groups. In order to do so, this thesis argues that sociological theory on professional groups could be combined with sociological theory about social positions as that is one way to understand the outsider-within position that these doctors (and presumably other skilled migrants) have to cope with.
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| 9. |
- Sépulchre, Marie, 1987-
(författare)
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This is not citizenship. Analysing the claims of disability activists in Sweden
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation aims to contribute to sociology, citizenship studies and disability studies by responding to T.H. Marshall’s ([1950]1992) invitation to examine the development of equal citizenship in a context of structural inequality, and Jenkins’ (1991) call to consider disability as a dimension of social stratification. Based on the analysis of blog posts and debate articles published in daily newspapers and written by Swedish disability activists (n=474), this dissertation argues that disability activism can be considered as a citizenship struggle claiming equal membership and rejecting the structural inequalities caused by disability. The analysis highlights a number of tensions and contradictions between and within the various components of citizenship as well as between and within the claims of the disability activists. These observations correspond to T.H. Marshall’s insight that citizenship is a developing institution full of contradictions, and to the observations of some citizenship scholars, arguing that citizenship claims-making features tensions and dilemmas. Moreover, the dissertation is in line with T.H. Marshall’s insight that the inclusion of previously excluded individuals – in this case, disabled people – as equal citizens brings forward important challenges, with respect to social (in)equality. In particular, challenges regarding recognition (who do we consider and value as full citizens?) and redistribution (how do we redistribute socio-material resources?). Based on the empirical analysis, this dissertation argues that the disability activists’ claims are defensive and proactive because the activists engage in both defending existing social rights and proposing new ways to construct citizenship for disabled people in Sweden. Finally, this dissertation points at different strategies used by the disability activists and at the dilemmas that some of these strategies imply. Among others, the Swedish disability activists highlight the importance of equal rights, while recognising the reality of costs; demand that disabled people be considered as ordinary citizens while asking for the accommodation of their specific needs; and view the state as the protector of equal citizenship while criticising it as a cause of the structural inequalities faced by disabled people. Thus, this dissertation opens new perspectives on citizenship and disability, and encourages future research to continue the analysis of citizenship in relation to structural inequalities.
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| 10. |
- Dag, Munir, 1968-
(författare)
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Unga människor med rörelsehinder : förankring, marginalisering och social exkludering
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the thesis was to describe the specific barriers young people with disabilities experience in their ambition to get a job. The aim was also to investigate how these young people’s social and economic situation has been affected by their disability. The results are based on two reports: one qualitative, consisting of interviews with 12 individuals with physical disabilities, and one quantitative in the form of a questionnaire answered by 706 persons. In the case of the questionnaire, the response rate was 48 per cent. Both reports are based on the same criteria, namely, that the respondents should have a physical disability, be 20–35 years of age and be participating in some form of employment policy program. The results from both studies show that individuals with physical disabilities encounter different types of barriers on the labour market, which can be categorised as being either at the individual level or at the social level. The barriers at the individual level are low education, long-term unemployment, grave physical disability and lack of work experience. The barriers identified at the social level are primarily poorly adapted workplaces, a too high working pace, employers’ negative attitudes, insufficient knowledge of the competence of disabled persons and an overly generous social welfare system. All these factors constitute a direct obstacle to employing persons with a physical disability. The results from the interview study show that the respondents have few social relations. The majority of the respondents have social intercourse solely with family members or parents. Most of the respondents in the questionnaire study state that they have frequent social relations with friends and acquaintances. Both the interview study and the questionnaire study reveal that the respondents’ financial position has worsened as a result if their physical disability. Conclusions that can be drawn from this thesis are that young people with physical disabilities encounter different barriers in their attempts to get a job and to maintain social relations. Based on the results, some of the respondents can be regarded as being socio-economically marginalised.
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