| 1. |
- 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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| 2. |
- 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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| 3. |
- 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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| 4. |
- Klamas, Maria
(författare)
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Av egen kraft tillsammans med andra : Personer med psykiska funktionshinder, socialt stöd och återhämtning.
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this study was to describe and analyse the significance of social support to adults with psychiatric disabilities, based on the individual's experiences. This includes research questions concerning what type of social support was perceived to be beneficial or restrictive, which relational aspects were considered having a beneficial or restrictive effect on the support- and recovery process, as well as what strategies and capacities the individual developed on their own in order to cope with their obstacles and disadvantages.The empirical material was based on qualitative inteviews with ten individuals that defined themselves as having psychiatric disabilities. They were each interviewed on three occasions. The repetetive form of the interviews lead to three separate interview guides being created over the course of the data collection process. The goal of the first interview was to get a general idea of the subject's daily life, activities, arenas, relationships and support. The second interview focused on meaningful relationships. The third and final interview had one general and one individual part. The general part focused on the subject's psychiatric disabilities, their opportunities as well as existing and desired support measures. The subject matters in the individual part were related to the previous interviews with each of the participants and aimed to develop or expand on previous discussion.The material was analysed using theories about social support and recovery and was presented with roots in four different networking entities: close and extended family, friends, coworkers and fellow students, as well as formal support instances. The result showed that it is the support with mobilising qualities that is beneficial to the recovery process. It increases the individual's degree of control over their illness, obstacles and challenges. In addition, it appeals to the individual as a central actor and as a person with difficulties as well as resources. The fact that the social support from the various support agencies have varying focus and direction benefits recovery since it increases the individual's opportunity to maintain as well as develop their social bonds and roles within the community. A relational prerequisite for social support is an equal relationship, which benefits the recovery process as it encompasses acknowledgement and acceptance of both the individual on a personal level and of their situation. The type of social support that hinders recovery is the kind that lacks a connection between the individual's perceived problems, their need for support and their over time fluctuating ability to handle their psychiatric disability. This is due to the fact that it robs the individual of control over the situation, increases the need for support and strengthens their perception of themselves as sick. Recovery comes to a halt when the individual isn't included in the support and recovery process, which is clarified in relational aspects such as lacking attentiveness, subpar acceptance as well as rejection. The individual's will and capacity to actively take on the responsibility to steer their recovery in a positive direction was made visible through four groups of strategies that were crystallised through the course of the research; creation of understanding and legitimisation, cultivation, including strategies and the creation of boundaries.
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| 5. |
- 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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| 6. |
- Persson, Charlotte
(författare)
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Implementing Community Based Re/habilitation in Uganda and Sweden : A Comparative Approach
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In our global world, ideas in general and social work models in particular are spread and implemented in a variety of socioeconomic, political and cultural contexts, generating different outcomes. Many ideas and services launched in different countries by international organisations or governments in order to bring social justice to marginalised and oppressed groups, such as people with disabilities, have been criticised for not reaching or involving those such services aim to serve. Low impact of social programs on the welfare of people and communities has put the effectiveness of such programs into question and can leave people with disabilities dissatisfied with the social services available in their environment.The main purpose of this dissertation is to examine how an international idea for social work practice, as community based rehabilitation (CBR), is implemented in different structures and institutional contexts. To examine how an idea is implemented in different contexts, following research questions have guided the work: “How was the idea of CBR introduced to and implemented in Uganda and Sweden?”, “What contextual factors influenced the implementation of CBR in these countries?”, “What limitations and possibilities affected CBRs chances of continuity and institutionalisation in the two countries?” and finally“Can international ideas and models for social work be successfully used in different structural and institutional contexts?”.The study is based on a qualitative design with a comparative approach using qualitative content analysis for analysing data collected through official documents and interviews with parents to children with disabilities and professionals working in the children’s surrounding. The results show how difficult it is to monitor development through projects in both non-Western and Western countries. International ideas of social work, such as CBR, can make a difference in both Uganda and Sweden for the improvement of the living condition of those in need of services; at least, as long as there are funding for the projects and cooperation between authorities, NGOs and the parents of children with disabilities.The results show also that there are many differences in the process of the implementation of CBR in Uganda and Sweden. The colonial past of Uganda and its weak welfare state make CBR an important project for the improvement of the life conditions of children with disabilities. Meanwhile, the Swedish strong welfare state and legal protection of children with disabilities make CBR much more marginal in Sweden than in Uganda. However, CBRs successes to promote social justice for children with disabilities and their families makes it necessary to integrate the project to the existing organisation of the welfare state in the two countries. Changing existing welfare services requires engagement in political decision-makings, cooperation, and a critical examination of structural and institutional arrangements, in order to include successful projects in the daily functions and duties of the welfare state of every country. This will prevent an international idea for social work to not only be a temporary trend to follow, but also an established working method for helping people in need of proper services.
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| 7. |
- 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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| 8. |
- Ståhl, Christian, 1980-
(författare)
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In Cooperation We Trust : Interorganizational Cooperation in Return-to-Work and Labour Market Reintegration
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overarching aim of this thesis is to study Coordination Associations (CAs) as a structure for interor-ganizational cooperation in rehabilitation, return-to-work and labour market reintegration. This has been done through empirical studies of two CAs in eastern Sweden.Central questions for the thesis are:How have representatives on different hierarchical levels in the participating organizations experi-enced cooperation within the structure of CAs?What influence do different organizational and/or professional preferences have on interorganiza-tional cooperation?The four studies in this thesis have had different approaches to studying interorganizational cooperation.Study I was concerned with a specific work form, namely interdisciplinary rehabilitation teams, where the analysis concerned how the different professionals in these teams perceived the common work, and how they interpreted the concept of work ability, which is a central concept for determining eligibility for sickness benefits.Study II focused on managers and board members of the CAs in order to determine their motives for and commitment to interorganizational cooperation. The analysis was concerned with the organizational identification and the self-interest of each actor, where the issue of trust between representatives from dif-ferent organizations was specifically targeted in the analysis.Study II focused on managers and board members of the CAs in order to determine their motives for and commitment to interorganizational cooperation. The analysis was concerned with the organizational identification and the self-interest of each actor, where the issue of trust between representatives from dif-ferent organizations was specifically targeted in the analysis.Study III aimed to elucidate the perspectives of officials in different organizations connected to the CAs regarding both the development of cooperation in the CAs, and how the recent changes in sickness insurance regulations will influence future cooperation.Study IV focused on different perspectives regarding the concept of work ability among representa-tives from all participating organizations, since changes in sickness insurance regulations have changed the assessment process and therefore also the demands for interorganizational cooperation.The general methodological approach to the studies in this thesis has been explorative; qualitative methods have been used, involving interviews, focus groups and problem-based group discussions. Inter-views and focus groups have had an open-ended structure, and the material has been analysed through qualitative content analysis.The aim of the Coordination Associations studied in this thesis has been to bridge the gaps between the participating organizations by promoting consensus through common work forms. However, the re-sults from the studies show that such ambitions are troublesome in highly specialized public organizations. Cooperation in the CAs has to a large extent been organized as collaborative work forms rather than as coordination of existing practices. The collaboration has been based on an idea of consensus, where all organizations were expected to participate on equal terms and find common work forms. Although it has been shown that officials from different organizations can work together, the managerial level’s priorities are more determined by their organizational goals and values, which makes them unwilling to finance collaborative work on a longer term.Another theme of the thesis is the lack of cooperation between the public rehabilitation system and the employers. The public actors lack knowledge of working conditions, and since the work principle guides the rehabilitation process, it is necessary to incorporate employers into the cooperation to facilitate sustainable return-to-work and labour market reintegration.A central conclusion of the thesis is that consensus is not a reasonable starting point when designing cooperation structures between public organizations. A sustainable cooperation structure needs to incorpo-rate and coordinate the different actors’ priorities into a long-term cooperation strategy, rather than base the cooperation on vulnerable collaboration projects.
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| 9. |
- Hultqvist, Sara, 1977-
(författare)
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Att göra aktivitetsersättning : Om målförskjutning och icke-kontakt vid förtidspension för unga
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis investigates ‘the doing’ of the Swedish social insurance program Activity Compensation (AC). AC is an example of disability policies in Western welfare states. These policies have two goals: to ensure financial security and to promote social participation. In 2003 AC replaced Early Retirement Pension for persons aged 19 to 29 years and who, for medical reasons, have reduced work capacity.Three features characterize AC. Young adults are differentiated in a separate system. For them, benefits are time-limited. Benefits include an established right to participate in activities.Doing AC is studied bottom-up. Interviews with two actor groups have provided the empirical base: 1) persons accorded AC and medically certified to have an anxiety and/or a depression diagnosis and 2) the respective administrator(s) at the Swedish Social Insurance Agency. National legislative preparatory texts and legal documents complete the data.The conclusions of this study are three-fold addressing goal displacement and non-contact. Firstly, a discursive change in respect to the denotation of social participation within the politics of principle has appeared throughout OECD countries over the last decennium. This goal displacement obscures the goal of economic security emphasizing the profitability of work. AC explicitly manifests this change in establishing a right to activity participation for beneficiaries. This displacement is without full impact in the politics of practice when actors’ experience of doing AC is examined. Financial security remains the foremost goal in the local politics of practice mirroring the initial function of safeguard for those with reduced work capacity due to certified illness.Relating to this lexical displacement, the study concludes that social participation is revealed as a goal to be realized in a specific form, salaried employment, within a distinct arena, the labor market. Values such as life-quality are neglected as regulatory efforts to get persons on the track to work have been underscored.Finally, the prescribed contact between the insured young adults and their administrator(s) is not consistently present. This contact is a necessary condition for the intended planning of activities to take place. When non-contact prevails, the established regulatory right to participate in activities can not materialize.
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| 10. |
- Järkestig Berggren, Ulrika, 1969-
(författare)
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Personligt ombud och förändringsprocesser på det socialpsykiatriska fältet
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In a new reform in 2001, Swedish authorities emphasized the need for support for persons with psychiatric disabilities living in the community. This reform included the establishment of a new occupation: the Swedish case manager, personligt ombud (PO). In examining this new occupation, the overall aim of this thesis is to analyze how the Swedish case manager, PO, as an evolving occupation, affects and is affected by the organisational and professional field in which it enters. More specifically, the aim is to describe and analyse, using organisational and professional theories, the changing processes that the PO con-tributes to in the welfare system and the practice of social policy, the field of social psychiatry focusing on the discretion for professionals and in the under-standing of the professional role to help as described by clients.Three studies have been carried out. The first study, for the licentiate´s degree, focused on the PO occupational role and functions for the welfare system as well as for mental health service users. In the second study, the results from the first study were analyzed together with the results of another reform, namely, the Swedish care manager reform, in order to investigate their joint implications for social policy and its practice. The third study focused on what meaning the PO has for the clients and particularly what features of the service the clients find to be helpful.In summary, the results indicate that the PO contributes to the development of a negotiated rights model, by taking on the assignment of advocacy as a client representative, and then defining the social worker as a representative for the organisation with the assignment of needs assessment. In the field of social psychiatry, the PO fills a vacancy by supporting the legitimacy of the professionals as well as their organisations. Furthermore, the PO has a function of providing organised transparency through restricting the discretion of other professionals. The discretion of the PO itself has weak boundaries allowing for great liberty of action. Finally, the PO service has led to a new understanding of the professional role, as built on reciprocity with the client, using knowledge evolving from the interaction between the professional PO and the client. These findings suggest that the PO could be understood as a new occupation evolving from weak professional traits to, as suggested, a new model for professionalism, called user-mandated professionalism. This emphasizes the reciprocative foundation of knowledge between the service user and the professional.
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