| 1. |
- Kjellström, Sofia
(författare)
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Ansvar, hälsa och människa : en studie av idéer om individens ansvar för sin hälsa
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- That people should take responsibility for their health is a prominent contemporary idea. But what does such responsibility actually entail, and what demands are being put on people? The objective of the dissertation is to describe and critically examine various ideas on personal responsibility for health. In the first step, I identify and describe a wide variation of uses of responsibility and in the second step, I problematize them. The analyzed material consists of Swedish government reports and various types of health advice literature, including medical books and alternative medicine literature. I employ a framework of philosophical, social scientific, and developmental psychology theories on responsibility to critically examine the material.The study shows that taking responsibility involves both body and mind. Common ideas are that it requires maintaining a healthy lifestyle and managing one's self-care. But it is also considered important to take responsibility for beliefs and emotions and to adopt an accepting attitude. Another idea is that spiritual insights expand the scope of responsibility. Some important abilities required to take responsibility are conscious healthy choices, self-knowledge, and critical thinking. The view of responsibility is also influenced by individual factors, cultural beliefs about health and disease, and social structures. In the literature, health responsibility is regarded both as a social duty and as a never-ending task performed by an active individual.Finally, I use Robert Kegan's theory of adult development to show that taking responsibility imposes psychological demands on people's awareness. The demands are often higher than many people can manage. Some of the stress and poor health that people experience may be the product of an inability to manage all of life's demands. The developmental perspective also asserts that people can develop the requisite capacity. One conceivable conclusion of the study is that if we want people to take more responsibility, we should not only invest resources in health information, but also in measures that generate self-knowledge, reflection, and personal development.
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| 2. |
- Lerner, Henrik, 1975-
(författare)
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The Concepts of Health, Well-being and Welfare as Applied to Animals : A Philosophical Analysis of the Concepts with the Regard to the Differences Between Animals
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is an analysis of the use and definition of the concepts health, well-being and welfare within the field called “the science of animal health and welfare”. The materials used are a literature survey of the field, qualitative interviews with Swedish veterinary surgeons and a study of the concepts in legislation concerning animals in England, Germany and Sweden. The main emphasis has been on theoretical definitions explicitly stated in the different texts or in the interviews. Two ways of distinguishing between animals are used: according to species and according to the role that animals have for humans. As a result it becomes salient whether the definitions have limits with regard to species or role.In the thesis a great number of definitions of the three concepts are interpreted, compared and criticised. As a result a limited number of definitions have been categorised and collected into clusters which fulfil minimal requirements of consistency and practicability.The analysis supports the use of all three concepts – health, well-being and welfare – since they are all needed for making crucial distinctions in the science of animal health and welfare.
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| 3. |
- Lindhe Söderlund, Lena, 1954-
(författare)
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Challenges of learning and practicing motivational interviewing
- 2009
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The past three decades have seen a growth in health promotion research and practice, stimulated by the epidemiologic transition of the leading causes of death from infectious to chronic diseases. An estimated 50% of mortality from the 10 leading causes of death is due to behaviour, which suggests individuals can make important contributions to their own health by adopting some health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a brief counselling approach for behavioural modification that builds on a patient empowerment perspective by supporting self-esteem and self-efficacy. MI has become increasingly popular in a variety of health care settings as well as non-health care settings.Aims: The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on the learning and practice of MI. The aim of study I was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services. The aim of study II was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies.Methods: Participants in study I were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Participants in study II were 15 community pharmacy pharmacists in Östergötland Sweden. Data for both studies were obtained through focus group interviews with the participants, using interview guides containing open-ended questions related to the aims of the studies. Study II also included five individual interviews. Interview data were interpreted from a phenomenological perspective.Results: In study I, important barriers were nurses’ lack of recognition that overweight and obesity among children constitutes a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything, and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem, and working with obese children rather than those who were overweight. In study II, pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. The opportunity to decide on appropriate clients and/or healthrelated behaviours for counselling was also an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. They also experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations.Conclusions: Learning and practicing MI effectively is difficult for many practitioners as it requires a new way of thinking and acting. Practitioners’ use of MI is not effective unless there is recognition that there is an important health-related problem to be solved. Practitioners feel more confident using MI with clients who have health-compromising behaviours and/or risks in which the practitioners feel they have expertise. Possessing considerable MI counselling skills does not compensate for insufficient knowledge about a targeted health-related behaviour and/or risk. Feedback from clients plays an important role for the quality and quantity of practitioners’ MI use.
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| 4. |
- Molin, Martin
(författare)
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Att vara i särklass : om delaktighet och utanförskap i gymnasiesärskolan
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the Swedish debate concerning disability issues it has been shown, as in many other countries, that the concept ‘participation’ has been used in a very vague and obscure way. For example, at an ideological level the concept often refers to ‘accessibility’. Others claim that it should be understood as ‘social integration’ or ‘inclusion’. In the International Classification of Functioning, Disability and Health (WHO) participation means ‘involvement’ in a life situation. In the literature there are several ways to approach the concept of participation. Broadly, it is used to describe a characteristic within the individual or the result of an interplay. The general aim of this thesis is to illuminate different forms of participation within the municipal upper secondary special programme for pupils with intellectual disabilities (ID).The study contains two main parts. On the one hand a semantic analysis is made for the purpose of illuminating different conceptual forms of participation. On the other hand a field study is performed. This empirical study can be described as a hermeneutically influenced field study designed to interpret participative patterns in everyday school situations.Data have been collected during a period of one school year. Several methods have been used in order to capture different kinds of patterns in the pupils’ participation in a chosen upper secondary individual program for pupils with ID. These methods involve participant observation in everyday school situations (which was recorded in field notes), interviews with pupils, staff and administrators.Rather often it is implied that a higher extent of involvement leads to a higher (or better) form of participation. My study showed something else. Several examples demonstrated how groups of pupils within the special programme setting gave up their involvement in specific activities since they wanted to show their belonging to a different community outside the school. The analysis showed that involvement, as one form of participation, is highly related to other forms of participation (for example formal and informal belonging). In one sense these pupils had a conception of how to behave in order to be accepted outside the special programme setting. Therefore it is possible to talk about the pupils in terms of different worlds of belonging. For a specific group of pupils the formal belonging to the special programme was a threat towards their self-image, which seemed to derive from another alternative world — with other ideals than are usually associated with special programmes for pupils with ID.
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| 5. |
- Neubeck, Anna-Karin, 1971-
(författare)
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The Prodromal Phase of What? : A Metapsychiatric Analysis of the Prodromal Phase of Schizophrenia
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Prodromes of schizophrenia or prodromes of psychosis are a relatively new and expanding field of interest in psychiatric research. They are seen by some researchers as the initial symptom of having schizophrenia and have become a crucial topic in early psychosis research and intervention.In this thesis current psychiatric research publications were analysed and eleven prospectively psychotic patients were interviewed. The research publications analysed were applyed on the information given by the patients, and the analysis showed that it was easy to find prodromes or prodrome-like phenomena in all the collected interviews. In addition a second analysis was performed on the material, a phenomenological psychological analysis, showing a more subject-oriented dimension of the interviews. This led to a further aim, analysing what explanations could be given of these phenomena.There are probably many possibilities of getting the diagnosis of schizophrenia, but the examples in this study show that long-term abuse, often sexual actually can trigger psychiatric conditions corresponding to the definition of “prodromes of schizophrenia” according to some psychiatric publications as well as “schizophrenia” according to DSMand ICD. This means that trauma and/or neglect proved to be a likely partial causal condition of the prodrome- like phenomena or schizophrenia to occur.However, trauma has not been shown to be a necessary condition for the occurrence of prodrome-like phenomena or schizophrenia.In the discussion of the results some consequences deriving from using different interpretations and explanations of the phenomena are analysed, for example using the prodromes of psychosis for the assessments of a coming psychosis, especially schizophrenia. I emphasize, because of the results of the phenomenological case analyses, the value of several dimensions of understanding prodrome-like phenomena as well as schizophrenia and schizophrenia-like conditions, especially as early as the initial phase.
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| 6. |
- Tinghög, Petter, 1973-
(författare)
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Migration, Stress and Mental Ill Health : Post-migration Factors and Experiences in the Swedish Context
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This predominantly empirical dissertation deals with how socio-economic living conditions and immigrant-specific factors can be linked to immigrants’ mental ill health. It is also explored how cultural representations can affect stress and whether mental ill health is expressed differently among immigrants from Iraq and Iran than among individuals of Nordic origin. Moreover, a conceptual analysis is conducted, where a phenomenological conceptualisation of stress is outlined with a special focus on how this stress approach can be related to culture and migration.The empirical material consists of eleven in-depth interviews with Iraqi and Iranian immigrant women and two population-based surveys.The main findings of this thesis suggest as follows: 1) Mental ill health is more common among foreign-born than among native-born Swedes and can to a great extent be attributed to their poorer socio-economic living conditions. 2) Immigrants’ mental health is independently associated with different types of factors, such as traumatic episodes, socio-cultural adaptation level and socioeconomic living conditions. 3) The self-reporting mental health instruments, HSCL-25 and WHO (ten) Wellbeing Index, produce scores that are comparable between Scandinavians and immigrants of Middle Eastern descent. 4) Nonuniversal representations that can be found in Iraq and Iran can amplify, or even be necessary ingredients in certain types of stressful experiences among immigrant women from these countries. 5) The distinctions between universal and non-universal stress, and between immigrant/minority and non-immigrant/nonminority stress appear to be crucial for an adequate comprehension of immigrants’ stressful experiences.
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| 7. |
- Belfrage, Henrik, 1955-
(författare)
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Psykiskt störda brottslingar : En studie av begreppet "jämställd med sinnessjukdom" - dess historiska bakgrund och praktiska tillämpning
- 1989
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The main objective of this thesis is to study the concept of "equivalent to insanity", its historical background and practical application.Based on a legal historical presentation I show that the term "equivalent to insanity" has one content under the 1864 Penal Statutes, and an entirely different one under the 1962 Criminal Code.The empirical findings are, that those persons in my material who were assessed to be "equivalent to insane" (298 persons), display similar characteristics as corresponding clientele in previous studies. They are, apart from being mentally disordered, also severely socially handicapped.After having examined the concept "equivalent to insanity" and described the persons which were deemed "equivalent", I then concentrate on the question of the reliability of these assessments. The findings are that there is good accordance between different assessments of the same criminal case.To answer the question whether this special category of offenders is treatable, I have used a control group consisting of offenders who where assessed not to be "equivalent to insane" (256 persons). My criterion for "treatability" is recidivism into crime in a three-year period. The results are, that psychiatric treatment has apositive crime preventive effect on some categories of offenders (especially offenders sentenced for assault), but none of significance on others (especially property offenders). It is therefore erroneous to pose the question: Does psychiatric treatment have more crime preventive effect than a prison sentence? The question is far too general. One must take into consideration the crime category dominating the study groups. But it is probable that even further ambiguities are concealed in the question. It is therefore cruicial that further research be aimed at seeking crime preventive factors of psychiatric treatment of mentally disordered offenders.
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| 8. |
- Bullington, Jennifer, 1957-
(författare)
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The Mysterious Life of the Body : A New look at Psychosomatics
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study is to critically examine traditional psychosomatic theories, paying special attention to certain philosophical issues such as the mind-body problem and efficacious mechanisms of interaction between meaning, understood as psychosocial factors, and that which is traditionally called "body" (the material, objectified body). Afterwards, an alternative psychosomatic theory is worked out, drawing inspiration from the phenomenology of Maurice Merleau-Ponty. The first part of the dissertation examines the following schools of thought (orientations) concerning psychosomatic theory: 1) psychodynamic theory, 2) psychosomatic medicine, 3) stress theory as well as neuroimmunology and neuroendocrinology, and 4) the work of the psychobiologist Herbert Weiner. The phenomenological alternative worked out in part II of the dissertation breaks up dualistic and materialistic-reductionistic thinking by starting with the "lived body" rather than the objective body studied by natural science. The question then becomes, how is the mind-body unity lived, and what categories of understanding open up when the person-world field becomes the focus for psychosomatic theory.
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| 9. |
- Dwyer, Lise-Lotte, 1965-
(författare)
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Dignity in the end of life care : what does it mean to older people and staff in nursing homes?
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The discussion of a palliative care and a dignified death has almost exclusively been applied to people dying of cancer. As people are getting older and are living longer, nursing homes have become an important place for end-of-life care and death. Dignity is a concept often used in health care documents but their meaning is rarely clarified. The main aim of this thesis was to gain a deeper understanding of what dignity meant to older people in end of life care as well as to nursing home staff. The thesis comprises four studies. The first and second study involved older people living in nursing home settings studied from a hermeneutic perspective. In the first study twelve older people in two nursing homes were interviewed two to four times over a period of 18–24 months during 2002–2003. Altogether, 39 interviews were analyzed by a hermeneutic method. Dignity was closely linked to self-image and identity. The themes of unrecognizable body, dependence and fragility constituted threats to dignity. The third theme, inner strength and sense of coherence, seemed to assist the older people in maintaining dignity of identity. In the second study the aim was to acquire a deeper understanding of how three older women from study I, created meaning in everyday life at the nursing home. A secondary analysis was carried out and showed meaning in everyday life was created by an inner dialogue, communication and relationships with others. The third study was to explore nursing home staff members’ experience of what dignity in end-of –life care means to older people and to themselves. Totally 21 interviews with staff were carried out and analyzed through a qualitative content analysis. The meaning of older people’s dignity was conceptualized as feeling trust, which implied being shown respect. Staff members’ dignity was conceptualized as maintaining self-respect. Dignity was threatened in situations where staff experienced themselves and the older people as being ignored and thereby marginalized. The fourth study was carried out through focus groups discussions with 20 staff members about seven older peoples dying death and care. The analyses showed that conversations and discussions about death were rare. Death was surrounded by silence. It was disclosed that the older dying person’s thoughts and attitudes of death were not explicitly known. A dignified death meant alleviation of bodily suffering and pain and meaningfulness. The staff’s ethical reasoning mainly concerned their experience of a gap between their personal ideals of what a dignified end of life should include and what they were able to provide in reality, which could result in conscious stress. Staff members need training and support. End of life care demands competence and teamwork. A challenge for future care of older people would be to develop a nursing home environment in which human dignity is promoted.
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| 10. |
- Furenhed, Ragnar, 1945-
(författare)
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En gåtfull verklighet : att förstå hur gravt utvecklingsstörda upplever sin värld
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation is a qualitative study which is based upon interviews with parents and caretakers of profoundly mentally disabled people. Firstly, the dissertation analyzes the subjects' evaluation of the quality of life of the mentally disabled person. The analysis focuses upon how the intellectual disability affects thinking, emotional life and relationships. The question of the mentally disabled person's well-being is in focus here. Secondly, it is shown how people in close relationships to the mentally disabled person obtain knowledge about the person's inner life through communication with him or her and through interpreting his or her behavior and body expressions. Thirdly, the dissertation investigates how some influential theories on quality of life can contribute to an understanding of profoundly mentally disabled peoples' well-being. The dissertation concludes with a reflection upon the disabled persons' dignity.
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| 11. |
- Jakobsson, Einar, 1946-
(författare)
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Psykoterapins uppgift : Hälsa, bot och självförbättring i modernt psykoanalytiskt tänkande
- 1994
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The main purpose of this study is to critically examine, by means of theoretical analysis, the limits of psychotherapeutic intervention and the view of mental health embraced by the psychotherapy which is based on a psychodynamic thinking and procedure. This is done by asking how different theorists, e g Freud, Heinz Kohut and Otto Kernberg, are dealing with the questions of the indications of a need of psychotherapy, the desired extension of a therapeutic change and how the goals of treatment should be formulated.The conclusion is that modern psychoanalysis offers some promise of treatment for a wide range of phenomena extending the traditional concept of negative health. Mental health, from the psychodynamic viewpoint, contains ideals which are primarily taken from four value perspectives: knowledge, autonomy, adaptation and well-being with certain ideals of life style and quality of life in connection with imperatives about the good, satisfying and meaningful life. A fourth category, autonomy, has had a very strong position in the psychoanalytic tradition. As an ideal it too should be assigned to the educational domain.Modern psychodynamic psychotherapies, especially the ones with an increasing element of support, have now come very close to a universal means with positive, restorative goals for the patient's whole self, including the conscious parts of his person. The psychoanalytic self psychology and object relations theory, considered as belief systems or philosophies of life, provide the practising psychotherapist both with thereasons of intervention and the belief system needed as a remedy.
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| 12. |
- Liss, Per-Erik, 1941-
(författare)
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Health care need : Meaning and measurement
- 1990
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Determining how the health services are to be, and allocating health care, are basic issues in health policy. Need is a frequent criterion for an ethical or rational allocation of health service resources. The primary aim of this study is to analyse and explicate the concept of health care need.Methods for measuring health care need are examined. Current views on the concept of health care need are analysed. The results generate questions about the logical structure of the concept of need. The analysis of this concept shows that need is instrumental. The thing needed is necessary for a certain goal. The significance of this goal is pointed out. It determines the object of need. The significant goal in the case of health care need is health. The study espouses a holistic theory of health where health is defined in terms of ability to realize vital goals. It is pointed out that 'health' is a value-laden concept and that it bears with it this value-load to the concept of health care need.The concepts of health care, prevention and promotion are analysed. They are distinguished according to the actions involved. Health care means improving a state of ill health. Prevention means avoiding a state of ill health. Promotion means enhancing or supporting a healthy state.Assigning priority to certain needs is necessary in a situation where the health service resources are scarce. The theoretical platform for the setting of priorities in accordance with need is examined. Seven dimensions for a ranking of health care needs are identified. Finally some implications for an assessment of health care need are discussed, and a model for such an assessment is sketched.
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| 13. |
- Nikku, Nina, 1959-
(författare)
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Informative Paternalism. Case studies in the ethics of promoting and predicting health
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation deals with the ethical conflict between promoting health and respecting the individual's right to self-determination. An action which is performed with the intention of benefiting the recipient but without his informed consent is defined as paternalistic. It is shown that also non-coercive actions like the giving of information can be ethically problematic acid characterised as paternalistic. An instrument for analysing paternalistic actions is introduced. For an illustration and test of this instrument two case studies are presented. The first concerns opportunistic health information where the health promoter uses the opportunity for givirig health information when he in his profession meets the recipient for another reason. The second case illustrates a relatively new area in health care, predictive medicine. The progress in genetics gives extended possibilities of tracing genetic dispositions for future disease in a healthy person long before the disease will develop. In spite of the advantage this may involve, in the form of the possibility of taking preventive measures, it is not always a piece of knowledge that is wanted. The analyses exemplify judgements based on different normative viewpoints but also show that there are certain conditions which are common to the various forms of justification of paternalistic actions.
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| 14. |
- Nilsen, Per, 1960-
(författare)
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Opening the Black Box of Community-Based Injury Prevention Programmes : Towards Improved Understanding of Factors that Influence Programme Effectiveness
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Despite wide application of community-based programmes to prevent injuries and promote health over the last 25 years, there is a paucity of evaluations from which to obtain evidence regarding the effectiveness and critical factors contributing to achieving effectiveness of these programmes. Research on community-based injury prevention programmes thus far has been driven by the question “does it work?” However, merely establishing whether a programme works or not provides insufficient information to generate new knowledge about these programmes. Many programme evaluations have been characterised as “black box” evaluations, with inadequate information about the intervening and contextual factors that mediate the relationship between the programme and its effects. Opening the black box is essential to developing the best evidence in relation to community-based programmes.Keeping the question “does it work?” in mind as a departure point, the seven studies of this thesis address different aspects of the questions “why does it work?” and “how does it work?” The aim is to aid in the understanding of factors that influence the operation and effectiveness of community-based injury prevention programmes.The findings from the studies support a number of conclusions with regard to the three research questions posed. There is limited evidence for the effectiveness of communitybased injury prevention programmes. Some of the problems of providing convincing evidence are due to the methodological difficulties of evaluating these programs.Contextual conditions and the amount of financial resources available to a programme are key factors associated with the effectiveness of community-based injury prevention programmes. There is inconclusive evidence regarding the importance of some of the socalled success factors described in the scientific literature for achieving effectiveness. While many programmes have access to locally collected injury data, they devote limited time to the analysis of this ssembled data. When selecting interventions, many programmes rely upon tuitive and subjective methods, e.g. discussions in networks, feedback from the general public, and experiences gained in their own work. This style of decision making is “experience-based” rather than evidence-based.The theoretical underpinning of the community-based approach has certain shortcomings, which could explain some of the difficulties in demonstrating effectiveness seen with many of these programmes. Programmes overwhelmingly define geographical units as communities. However, these entities can be highly heterogeneous and characterised by a weak sense of community, which can yield insufficient community member participation and intersectoral collaboration, as well as inadequate reach for many programmes. At the same time, none of the most plausible assumptions of the community-based approach appears to be fully or widely applied in programme practice. The implication is that many community-based programmes do not function at an optimum level.
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| 15. |
- Perselli, Jan, 1954-
(författare)
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Fostersyn i svensk rätt
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The first goal of this dissertation is to investigate the status of the fetus in Swedish law. The second goal is to contribute to the debate concerning attitudes toward mankind, attitudes toward the fetus, and the value of human life as these are expressed in our everyday concepts of law. The tbird goal is to contribute to greater uniformity in the future in the laws which touch upon human beings in the early phases of life (the fertilized egg, the blastula and the fetus). The study is based on an analysis of printed official government documents and records, instructions, motions, bills, minutes of the Riksdag, replies to official queries from experts and affected parties, and laws and government studies made prior to the drafting of legislation, such as SOU and Ds. The areas of the law which are analyzed include (i) the Abortion Act, (ii) the Transplant Act, (iii) the Act concerning Measures for Purposes of Research or Treatment Involving Fertilized Human Ova (LBÄ), (iv) the Act on the Treatment of Alcoholics and Drug Abusers (LVM) in certain cases, (v) the Inheritance Code, (vi) the National Registration Act, and (vii) the Burial Legislation. There are divergent views of the fetus in the various laws and statutes. This is partly due to the dissimilar purposes of the different laws, and partly due to the fact that the fetus is seldom or never the actual subject of these laws. The laws have also come into being at different points in time. The result is that the fetus is not regarded in the same way legally and morally in the divergent laws and statutes. In the conclusion the acceptability of these discrepancies is discussed. Special attention is paid to the debate concerning the underlying values. the divergence among them, and the extent to which such differences are acceptable. Finally, a discussion follows about what might be done, which leads into an appeal for an unbiased study of the need for uniform legal protection for the fetus in Swedish law.
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| 16. |
- Sundström, Per, 1955-
(författare)
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Icons of disease : A philosophical inquiry into the semantics, phenomenology and ontology of the clinical conceptions of disease
- 1987
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present study endeavers to answer the question: What are diseases in the clinical encounter between physician and patient? The answer supplied - actually, exposed and explicated throughout the study - is conceived in philosophical terms, engaging semantics, phenomenology, ethics and ontology.The methodological orientation of the study is humanistic and hermeneutical - besides the 'method' of philosophical discourse. Basic issues concerning the interpretation and understanding of texts, as well as of the knowing and acting subject in relation to the world, are tackled. Selected passages from a standard textbook of medicine are subjected to interpretive reading in order that the conceptions of disease of the clinical encounter emerge. A hermeneutic framework for the clinical encounter is formulated, accounting for clinical judgment as the physician's interpretive 'reading' of his patients.To put it shortly, the upshot of the study, and the answer to the questionhere initially posed, may be formulated thus: Diseases in the most basic or originary sense of the clinical encounter are action-oriented, pluridimensional conceptions, wedded to clinical judgment and action. These conceptions are the Icons of Disease.The implications for medical ethics of the theory of icons of diseasepropounded are also considered. The action-orientations and normativityinherent in the icons prove to be dependent on a presupposed ethicalmotive force, viz., a feeling for the integrity of the human organism. However, the icons provide only prima fade valid, general directions for clinical action; right action all-things-considered rests with the ethical discrimination of individual physicians attending to the real thing of the clinical encounter.
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| 17. |
- Svenaeus, Fredrik, 1966-
(författare)
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The hermeneutics of medicine and the phenomenology of health : steps towards a philosophy of medical practice
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study is an attempt to develop an ontology and epistemology of medicine with the aid of the philosophical theories of phenomenology and hermeneutics. Medicine, in this work, is considered to be a particular form of practice with a certain intersubjective structure, rather than an assembly of scientific theories and technologies applied in the clinic. To be more precise, medicine is suggested to be an interpretive, helping meeting between two persons - doctor or other health-care professional and patient - the goal of which is health for the ill, help-seeking party. Phenomenology and hermeneutics, mainly in the forms developed by Martin Heidegger and Hans-Georg Gadamer, are then used to more fully understand what is meant by an interpretive, helping meeting and by its goal - health. Health is characterized with the aid of the phenomenology of Heidegger, developed in his main work Sein und Zeit, as homelike being-in-the-world. Its opposite, illness, is explicated as an attunement (Befindlichkeit) of unhomelikeness, lived through every aspect of the being-in-the-world of Dasein, from body to language, and thus penetrating the entire understanding of the ill person. Medical practice, having the goal of establishing homelikeness in the patient's being-in-the-world, is then laid out, with the help of a reading of Gadamer's Wahrbeit und Methode, as a dialogic, interpretive coming together of the two different lifeworld horizons of doctor and patient. The two parties of the meeting must through this process of gradual fusion of horizons ultimately reach a to some extent shared understanding, which results in a therapeutic decision. The hermeneutics of medicine is thus, to speak with Gadamer, an applicative hermeneutics - a kind of understanding and interpretation put to work in a certain setting with a specific goal. This attentive, dialogic, goal-directed hermeneutics of medicine is shown, not to exclude, but to envelop the explanations, predictions and therapies of modern medical science. The philosophical analysis in this study is carried out through the illustrative use of clinical examples. Through choosing common types of illnesses and medical encounters, strategically placed in different paradigmatic corners of the clinical territory - streptococcal infection, chronic fatigue syndrome, prostate cancer, diabetes and stroke - the author has attempted to encompass as much as possible of the vast and diverse area of clinical practice.
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| 18. |
- Svensson, Tommy, 1950-
(författare)
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On the notion of mental illness : Problematizing the medical-model conception of certain abnormal behaviour and mental afflictions
- 1990
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study inquires into some polemics concerning the notion of mentalillness or disease. Some central arguments in the debate on psychiatry, of the 1960's and early 70's, are focused on.The analysis is performed in two steps. Important theoretical dimensionsof the early debate are analyzed in the context of a discussion of thepolemics surrounding Thomas Szasz's criticism of psychiatry. Then anattempt is made to take the analysis further by taking into account recentdevelopments in the philosophy of medicine. The theoretical line of criticism of the mental-illness notion is tested against two elaborate andarticulate medical models, with regard to their application to abnormal behaviour and mental afflictions.The conclusion is that the medical-model conception of so-called mental-illness phenomena appears problematic from theoretical points of view.In a final chapter some ideological dimensions of the debate on the notion of mental illness are touched upon.
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| 19. |
- Tengland, Per-Anders
(författare)
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Mental health : a philosophical analysis
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present dissertation is an attempt to analyze, philosophically, the notion of "positive mental health". In doing so the author presents a number of suggestions found in the literature. The discussion of these suggestions leads to a number of general conclusions. The most important one is that it is necessary to start from a general theory of health in order to be able to decide which specific mental features are necessary for having mental health. After having examined several theories of general health the author decides to work with the holistic theory put forward by Lennart Nordenfelt. Health is here seen as the person's general ability to reach vital goals. Given this theory it is no longer possible to formulate a general theory of optimal or good mental health. The author instead decides to discuss "acceptable mental health". This is the level of health where the person has the ability to reach "basic vital goals". The author now proceeds to a discussion of a material theory of mental health. The question to be answered is "which specific mental abilities are necessary, and to what degree, for being able to reach basic vital goals in our kind of society"? A number of abilities are analyzed. The author concludes that positive mental health is exhausted by two extensive abilities which together cover what we mean by acceptable mental health. These are the ability to exercise practical rationality and the ability to co-operate. It is then shown how some of the other abilities discussed are related to these two complex abilities. Finally, the author shows how a conceptual analysis of this kind can be of practical value in the health care field by discussing some instruments for measuring mental health and psychotherapy outcome.
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| 20. |
- Wagman, Petra
(författare)
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Conceptualizing life balance from an empirical and occupational therapy perspective
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Although it is an important concept in occupational therapy, there is a need for further knowledge about life balance. This thesis explores the concept oflife balance - how people think about it and how it is used in occupational therapy. Aim: The overall aim of the present thesis was to conceptualize life balance from an empirical and occupational therapy perspective in order to contribute to knowledge regarding the use of the concept in occupational therapy. The specific aims were to: explore the perceptions of life balance among working people who had not recently been on long-term sick leave explore what is considered important for life balance and whether or not this differs between people use perceptions of life balance data from men and women in a healthy population to validate the Model of Lifestyle Balance clarify the content in the concept of occupational balance as used within published articles related to occupational therapy Methods: In Study I, 19 participants were interviewed about their perceptions of lifebalance. In Study II, 32 participants sorted statements about life balance according to their importance. In Study III, data from Study I were reanalysed in relation to Matuska and Christiansen’s Model of Lifestyle Balance. In Study IV a concept analysis of occupational balance in occupational therapy was conducted, encompassing 43 articles. Results: Life balance was shown to be a subjective, dynamic, health-related and multidimensional concept. Similarities and differences between what the participants consider to be important for their life balance were revealed. Occupational balance was, in the concept analysis, shown to be a subjectively defined perception of having the right amount and variation of occupations. Conclusions: The results of the thesis indicate that life balance and occupational balance are two separate concepts. While life balance includes occupational balance, it goes beyond it and also includes other aspects. Future research is requried to investigate the generality of the findings.
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| 21. |
- Wärnberg-Gerdin, Elisabeth, 1958-
(författare)
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Nordisk samhällsodontologi : Forskningsområden och forskarparadigm
- 1994
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The subject of this dissertation is Nordic community dentistry, with the focus on its areas of research and its researcher paradigms. The main objective is to characterise and demarcate Nordic community dentistry research with the aid of empirical material.The dissertation includes four sub-studies. The first of these is based on literature studies; the second is based on a combination of qualitative and quantitative content analyses of research articles concerning Nordic community dentistry during the period 1973 to 1991; the third comprises qualitative content analyses of a selection of articles from the same period; and the fourth is based on a questionnaire sent to Nordic community dentistry researchers.As a theoretical basis and analytical tool in the inquiry into the content of Nordic community dentistry research and its researcher paradigms, Hakan Tömebohm's concept of paradigm is used.It is shown in the dissertation that Nordic community dentistry research is pursued within seven principal fields with subgroups and categories. It is further shown that this research is multi-paradigmatic and individual. It is, however, in the light of the results of the four sub-studies, possible to constmct a community dentistry main paradigm emerging from the four researcher attributes: the researcher's scientific outlook, interest, competence and world-picture.Those characteristics which are most clearly and frequently evident within the research community belong to the researcher's scientific outlook and less frequently to his or her world-picture. A total of 13 areas are characterised within the main paradigm.
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| 22. |
- Zeiler, Kristin, 1973-
(författare)
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Chosen Children? : An empirical study and a philosophical analysis of moral aspects of pre-implantation genetic diagnosis and germ-line gene therapy
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- With pre-implantation genetic diagnosis (PGD), genetic testing and selective transfer of embryos is possible. In the future, germ-line gene therapy (GLGT) applied to embryos before implantation, in order to introduce missing genes or replace mutant ones, may be possible. The objective of this dissertation is to analyse moral aspects of these technologies, as described by eighteen British, Italian and Swedish gynaecologists and geneticists. The objective is systematised into three parts: research interviews and qualitative analysis, philosophical analysis, and elaboration of a framework that supports the combination of analytic methods.PGD was described as positive since it enabled some couples at risk for a genetic disease to have a child without the disease. PGD was described as in different senses ‘better’ than methods for prenatal diagnosis and selective termination of pregnancy. It was also described as positive since it provided couples at risk with one more option, even if it did not result in the birth of a healthy child. However, interviewees were concerned about the difficulty of defining and evaluating genetic disease. They were also concerned about patients’ choices, and about exaggerated use or misuse. Whereas PGD gave rise to ambivalence in terms of how to understand, describe and evaluate it, GLGT was often described as unrealistic or undesirable.The results of the qualitative analysis are used in a philosophical analysis of the concepts of choice, autonomous choice, ambivalence, trust and ambivalence in trust relations. A set of distinct characteristics of each concept are elaborated. The results of the philosophical analysis are used in the discussion of the results of the qualitative analysis.The study shows that the technologies imply both ‘new’ ways to perform ‘old’ medical practices and ‘new’ practices. Old moral questions are reformulated. New moral questions are added. Against the background of this, the concept of genetic identity is discussed.Key words: empirical ethics, pre-implantation genetic diagnosis, germ-line gene therapy, qualitative research, philosophical analysis, medical progress, genetic disease, choice, autonomous choice, ambivalence, trust, genetic identity.
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