1.
Knechtel, Maricel L, 1968-
(författare)
Categorization Work in the Swedish Welfare State : Doctors and social insurance officers on persons with mental ill-health
2019
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.
2.
Sépulchre, Marie, 1987-
(författare)
This is not citizenship. Analysing the claims of disability activists in Sweden
2019
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.
3.
Hultqvist, Sara, 1977-
(författare)
Att göra aktivitetsersättning : Om målförskjutning och icke-kontakt vid förtidspension för unga
2014
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.
4.
Lassinantti, Kitty, 1968-
(författare)
Diagnosens dilemman : Identitet, anpassning och motstånd hos kvinnor med ADHD
2014
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.
5.
Persson, Charlotte
(författare)
Implementing Community Based Re/habilitation in Uganda and Sweden : A Comparative Approach
2014
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.
6.
Salmonsson, Lisa, 1978-
(författare)
The 'Other' Doctor : Boundary work within the Swedish medical profession
2014
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.
7.
Medina, Eduardo, 1957-
(författare)
Från ”tyst vår” till ”hållbar utveckling” : En kritisk diskursanalys av miljöfrågans utveckling 1962–1987
2013
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.
8.
Hultgren, Peter, 1970-
(författare)
Det dubbla statushandikappet och sjukförsäkringens moraliska praktiker : en aktstudie om sjukpenningärenden som får negativa beslut på Försäkringskassan
2011
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.
9.
Svanevie, Kajsa, 1976-
(författare)
Evidensbaserat socialt arbete : Från idé till praktik
2011
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.
10.
Järkestig Berggren, Ulrika, 1969-
(författare)
Personligt ombud och förändringsprocesser på det socialpsykiatriska fältet
2010
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.