Thesis advisor: Stephen Pfohl / Assisted reproductive technologies have transformed the way medicine responds to infertility, as well as the ways those who go through difficulty conceiving understand their bodies and their experiences. In many capacities, however, the biomedical model is insufficient: recognition is contingent upon attempts to conceive, diagnosis is often imprecise or unexplained, and treatments strive for solutions without cures - and are frequently incapable of providing even the former. Interviews with 26 participants with current or recent histories of infertility revealed the ways they negotiate the biomedical model: 1) going beyond medical treatment in making lifestyle changes; 2) pursuing alternative treatments; 3) questioning doctors and playing active roles in determining courses of treatment; 4) using religion, spirituality, or magical thinking to develop other, non-bodily ways of controlling infertility; 5) extracting meaning from the experiences, infusing the objective idea of "disease" with subjective purpose; 6) building personal, alternate models that encompass a wide range of ways of thinking about infertility; and 7) directly challenging the scientific authority of the biomedical model, resisting the terms of treatment, or questioning the ability of medicine to offer them solutions. No participants showed pure compliance - as all included at least one of the negotiations - and none showed full resistance - as all had sought at least some medical treatments. Understanding these negotiations leads to a better concept of patient identity and the "illness" experience; it can inform policy in regards to prevention, education, and insurance mandates; and it better reveals who society permits to pursue parenthood in what ways. / Thesis (MA) — Boston College, 2009. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Sociology.

Orientador: Everardo Duarte Nunes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T03:55:38Z (GMT). No. of bitstreams: 1 Oliveira_AnaLuizadeOliveirae_D.pdf: 2702547 bytes, checksum: 0bf25c81d495f78cd8137e819973c1e9 (MD5) Previous issue date: 2015 / Resumo: A fisioterapia foi legitimada como profissão no Brasil em 1969, tornando-se uma das 14 profissões regulamentadas no campo da saúde. Moldada pelo modelo biomédico de atenção e pelo discurso do profissionalismo como forma normativa e ideológica de organização do trabalho, a profissão vem traçando seu caminho em busca de uma autonomia profissional que garanta uma identidade profissional ancorada na expertise cientificamente orientada. Neste contexto político, econômico e social, a autorregulação profissional promoveu uma organização interna em duas esferas, a Institucional e a Interacional. A primeira, construída por meio de análise documental das resoluções do COFFITO; a segunda, por meio de estudo transversal com fisioterapeutas no estado de São Paulo, Brasil (n = 2.684). Os achados sugerem que a Fisioterapia Institucional defende uma posição protegida no mercado de trabalho com base nas credenciais qualificadas, treinamento e habilidades especializadas, além do compromisso dos fisioterapeutas em realizar um bom trabalho utilizando elementos instrumentais do discurso do profissionalismo. Esta postura constrói uma representação social tecnicista na profissão. A Fisioterapia Interacional, embora acrescente uma perspectiva moral e mercantilista à representação social tecnicista, segue reafirmando a centralidade da ciência especializada como uma forma de sucesso profissional. O discurso do profissionalismo e do modelo biomédico modela a ação profissional da Fisioterapia ao combinar modos de agir tecnicistas, morais e mercantilistas, o que pode ser visto como impedimento da efetiva autonomia profissional. A construção de uma abordagem dialógica para o surgimento de um novo discurso do profissionalismo na Fisioterapia brasileira pode ser uma possibilidade de ruptura com o modelo biomédico, o que levaria a profissão a compreender o seu papel no campo da saúde a partir de uma perspectiva crítica e reflexiva, como parte da autonomia e da identidade profissional do fisioterapeuta / Abstract: Physiotherapy was legitimised as a profession in Brazil in 1969, becoming one of the 14 currently recognized professions in the healthcare field. Shaped by the biomedical model of care and the discourse of professionalism as the normative and ideological way of work organization, the profession has been building its path looking for professional autonomy to ensure a professional identity based on scientific expertise. In this political, economic and social context, professional self-regulation promoted an internal organization into two spheres, Institutional and Interactional. The first one was built using documentary analysis of Physiotherapy National Council legislation. The second one, was built using a cross-sectional survey with physiotherapists in the state of São Paulo, Brazil (n = 2,684). The findings suggest that the Institutional Physiotherapy advocates a labour protected position based on qualified credentials, specialized training and skill and the physiotherapists¿ commitment to doing good work using instrumental elements of the discourse of professionalism. This approach builds a technical social representation in the profession. The Interactional Physiotherapy, although it adds a moral and mercantilist perspective on the profession¿s social representation, keeps following the specialized science centrality as a form of professional success. The discourse of professionalism and the biomedical model could be shaping the Physiotherapy professional action by the combination of technical, moral and mercantilist as an impediment of a real professional autonomy. Building a dialogical approach to the emergence of a new discourse of professionalism in the Brazilian Physiotherapy may be a possibility of rupture with the biomedical model, which would lead the profession to understand its role in the healthcare and build a critical and reflective perspective as part of a physiotherapist autonomy and professional identity / Doutorado / Ciências Sociais em Saúde / Doutora em Saúde Coletiva

This study explores the multiple ways in which Acquired Immune Deficiency Syndrome (AIDS) functioned through concrete biomedical institutions, namely, the Centres for Disease Control (CDC), the National Institutes of Health (NIH), and the World Health Organization (WHO). AIDS is viewed as a product of the full range of institutional practices in which it became embedded and in which it was set within the boundaries of Louis Pasteur's germ theory of disease (see the Preface section). This biomedical model of disease was materialized through journalistic practices and sold as news. Within these operative terms can be understood another analytical strategy that also designates the main domain of my study of this contemporary social form: I argue in this thesis that knowledge about AIDS was by no means dependent solely on the objective, scientifically determined, "received narrative" of biomedicine; what is today known as AIDS is also a product of a wide range of social practices produced and reproduced over time and space. AIDS is also an outcome of the resolutions, judgements and decisions that working journalists made over time in terms of what they generated or covered as news; the disease is also product of a large assortment of representational mirrors that I call `authentic voices', to take as good examples, the "narrative of moral protest", the narrative of a "homosexual disease", the narrative of a "heterosexual disease," and the narrative of a "modern-day Black Death" (plague). The story of AIDS in the media can also be seen to be defined by the proliferation of these authentic voices. From this reading, the distinctive trait of AIDS in the media lies in the fact that it is a constructed object, a disease framed through a specific structure of meanings. When we look at these structure of meanings we find that their moral and cultural assumptions and stereotypical connotations embody certain aspects of the organism of the society within which they were created and nourished over a much longer history. / Sociology / D.Litt. et Phil. (Sociology)

This study explores the multiple ways in which Acquired Immune Deficiency Syndrome (AIDS) functioned through concrete biomedical institutions, namely, the Centres for Disease Control (CDC), the National Institutes of Health (NIH), and the World Health Organization (WHO). AIDS is viewed as a product of the full range of institutional practices in which it became embedded and in which it was set within the boundaries of Louis Pasteur's germ theory of disease (see the Preface section). This biomedical model of disease was materialized through journalistic practices and sold as news. Within these operative terms can be understood another analytical strategy that also designates the main domain of my study of this contemporary social form: I argue in this thesis that knowledge about AIDS was by no means dependent solely on the objective, scientifically determined, "received narrative" of biomedicine; what is today known as AIDS is also a product of a wide range of social practices produced and reproduced over time and space. AIDS is also an outcome of the resolutions, judgements and decisions that working journalists made over time in terms of what they generated or covered as news; the disease is also product of a large assortment of representational mirrors that I call `authentic voices', to take as good examples, the "narrative of moral protest", the narrative of a "homosexual disease", the narrative of a "heterosexual disease," and the narrative of a "modern-day Black Death" (plague). The story of AIDS in the media can also be seen to be defined by the proliferation of these authentic voices. From this reading, the distinctive trait of AIDS in the media lies in the fact that it is a constructed object, a disease framed through a specific structure of meanings. When we look at these structure of meanings we find that their moral and cultural assumptions and stereotypical connotations embody certain aspects of the organism of the society within which they were created and nourished over a much longer history. / Sociology / D.Litt. et Phil. (Sociology)

Made available in DSpace on 2016-08-03T16:34:26Z (GMT). No. of bitstreams: 1 LUANA YEHIA DE LA BARRA.pdf: 647369 bytes, checksum: 5ed787f9c3f80662f9156a0374495f95 (MD5) Previous issue date: 2006-02-08 / The biopsychosocial approach is very important for physical therapists to enabling them to act with human beings, in a global way, not only focusing their attention only on the pathology, but also on the ill person as a whole. The comprehension of the profession and the concepts of health illness, and patient, are also needed for the physical therapists to consider their intervention on a more extended basis than only on the rehabilitation one. The purpose of this study is to investigate the comprehension of the last year´s Physical therapy students from a private University in São Paulo about health illness, patient, Physical therapy and the relationship between physical therapist and their patients, associating the understanding to the existent health models. In order to achieve these objectives it uses authors of the Health Psychology who defend the biopsychosocial approach, and also authors of Physical therapy and Medicine who write about the models for graduation curriculae of health professionals. Ten semi-structured interviews were led with students, asking about the subjects of the study. The results were analyzed qualitatively, using the construction of analysis categories to answer the objectives of the research. In conclusion, the students noticed some phsychological and social aspects of patients, but not in a clear way and in most of the students, this knowledge was adquired outside the University. Eventhough, the topics on humanities are included in their course, but at the time of the graduation, students don´t reach the objectives of a human comprehension of patient, and oscillate between the biomedical and biopsychosocial model / A visão biopsicossocial de homem é de fundamental importância para que os fisioterapeutas sejam capazes de atuar com seus pacientes, de forma global, sem focar a atenção apenas à doença, mas sim à pessoa doente. A compreensão acerca da profissão e dos conceitos de saúde-doença e paciente, também se faz necessária para que esses profissionais possam considerar sua intervenção num âmbito mais amplo do que a reabilitação. O objetivo deste trabalho é investigar a compreensão que os alunos do último ano de Fisioterapia de uma Universidade privada de São Paulo têm sobre saúde-doença, paciente, Fisioterapia e relacionamento fisioterapeuta-paciente e como associam estas compreensões aos modelos de saúde existentes. Para isso toma por base autores da Psicologia da Saúde que defendem uma visão biopsicossocial de homem, assim como autores da Fisioterapia e Medicina que escrevem sobre os modelos adotados nos currículos de formação dos profissionais da saúde. Foram realizadas 10 entrevistas semi-dirigidas com os alunos, apresentando questões a respeito dos temas em questão. Os resultados foram analisados de forma qualitativa através da construção de categorias de análise visando responder aos objetivos da pesquisa. Conclui-se que os alunos percebem alguns aspectos psicológicos e sociais do paciente, mas não de forma clara e, na maioria dos casos, este conhecimento se dá através de conhecimentos que não foram adquiridos na Universidade. Esta, apesar de fornecer os conteúdos para a formação mais humana do fisioterapeuta, não alcança os objetivos ao final do curso, já que os alunos oscilam entre os modelos biomédico e biopsicossocial

This thesis explores the position of Person-Centred Approach (PCA) in the practice of Czech clinical psychologists and psychiatrists who went through the PCA psychotherapy training and they use this approach in their current clinical practice. The main principles of PCA theory (1), principles of biomedical model in which clinical practice is rooted (2) and the new forms of person-centred psychopathology and psychodiagnosis (3) are the theoretical background of the following research. Based on the qualitative analysis of five recorded interviews (three clinical psychologists, two psychiatrists) the experience of the respondents is organised as comprehensive concepts concerning various areas and topics of the clinical practice (diagnosis, psychotherapy, dealing with PCA, dealing with biomedical model, therapeutic relationship, relation to the profession). Several common mechanisms are identified in the concept's dynamics. Through these mechanisms Person-Centred Approach is applied in areas and activities mentioned. The concepts based on experience and the PCA application mechanisms enrich the theories and ongoing research of PCA practice in the Western mental health care. Key words: Person-Centred Approach, Client-Centred Therapy, psychiatry, clinical psychology, psychotherapy, psychodiagnosis,...

Text in Afrikaans / Coronary artery disease (CAD) is a life-threatening disease. When heart patients in the treatment of their disease, due to certain subjugating discourses practised by the biomedical model or biomedicine, are treated in a way that contributes to their anxiety and they feel themselves marginalised by society, then CAD becomes even more threatening. The narrative-pastoral approach of this study aims to treat heart patients in a way that has a calming effect on them that could assist them to deal with their heart disease more efficiently. This study shows how a heart patient's illness stories can be centralised by means of narrative therapy and how a pastoral and ethical attitude of love and respect can produce a climate that's conducive to better health and well-being. I indicate how my methodology of participatory action research succeeds in making the heart patients active participants to the research project. Their active participation indicates that meaning is not created on their behalf in therapy; rather, they are responsible for the process of richer construction of meaning. I describe how the participants socially co-constructed alternative and richer descriptions of their illness. Futhermore, I point out how their richer descriptions of illness contribute to perceptible and measurable results that are of value to the heart patients. / Koronere hartvatsiekte (KHS) is 'n lewensbedreigende siekte. Wanneer hartpasiente in die behandeling van hul siekte vanwee sekere onderdrukkende diskoerse van siekte vanuit die biomediese model of biomedisyne s6 hanteer word dat dit spanning op hul plaas en deur die samelewing gemarginaliseer word, word KHS des te meer gevaarlik. In hierdie studie gaan dit oor 'n narratief-pastorale benadering wat hartpasiente op 'n kalmerende manier hanteer sodat hulle kan kom tot 'n meer doeltreffende hantering van hul hartsiekte. Hierdie studie toon aan hoe hartpasiente se siekteverhale deur middel van narratiewe terapie gesentreer word en hoe 'n etiese en pastorale gesindheid van liefde en respek 'n klimaat skep wat bevorderlik is vir beter gesondheid en welwese. Ek dui aan hoe my metodologie van deelnemende aksienavorsing daarin geslaag het om die hartpasiente aktiewe deelnemers te maak aan die navorsingsprojek. Hul aktiewe deelname impliseer dat betekenis nie in terapie vir hulle geskep word nie, maar dat hulle self skeppend betrokke is in die proses van ryker betekeniskonstruering. Ek beskryf hoe die deelnemers altematiewe en ryker beskrywings van hul siekte sosiaal ko-konstrueer. Ek dui verder aan hoe hul ryker beskrywings van siekte bydra tot sigbare en meetbare resultate wat vir hartpasiente van waarde is. / Practical Theology / D. Th. (Praktiese Teologie)

Text in Afrikaans / Coronary artery disease (CAD) is a life-threatening disease. When heart patients in the treatment of their disease, due to certain subjugating discourses practised by the biomedical model or biomedicine, are treated in a way that contributes to their anxiety and they feel themselves marginalised by society, then CAD becomes even more threatening. The narrative-pastoral approach of this study aims to treat heart patients in a way that has a calming effect on them that could assist them to deal with their heart disease more efficiently. This study shows how a heart patient's illness stories can be centralised by means of narrative therapy and how a pastoral and ethical attitude of love and respect can produce a climate that's conducive to better health and well-being. I indicate how my methodology of participatory action research succeeds in making the heart patients active participants to the research project. Their active participation indicates that meaning is not created on their behalf in therapy; rather, they are responsible for the process of richer construction of meaning. I describe how the participants socially co-constructed alternative and richer descriptions of their illness. Futhermore, I point out how their richer descriptions of illness contribute to perceptible and measurable results that are of value to the heart patients. / Koronere hartvatsiekte (KHS) is 'n lewensbedreigende siekte. Wanneer hartpasiente in die behandeling van hul siekte vanwee sekere onderdrukkende diskoerse van siekte vanuit die biomediese model of biomedisyne s6 hanteer word dat dit spanning op hul plaas en deur die samelewing gemarginaliseer word, word KHS des te meer gevaarlik. In hierdie studie gaan dit oor 'n narratief-pastorale benadering wat hartpasiente op 'n kalmerende manier hanteer sodat hulle kan kom tot 'n meer doeltreffende hantering van hul hartsiekte. Hierdie studie toon aan hoe hartpasiente se siekteverhale deur middel van narratiewe terapie gesentreer word en hoe 'n etiese en pastorale gesindheid van liefde en respek 'n klimaat skep wat bevorderlik is vir beter gesondheid en welwese. Ek dui aan hoe my metodologie van deelnemende aksienavorsing daarin geslaag het om die hartpasiente aktiewe deelnemers te maak aan die navorsingsprojek. Hul aktiewe deelname impliseer dat betekenis nie in terapie vir hulle geskep word nie, maar dat hulle self skeppend betrokke is in die proses van ryker betekeniskonstruering. Ek beskryf hoe die deelnemers altematiewe en ryker beskrywings van hul siekte sosiaal ko-konstrueer. Ek dui verder aan hoe hul ryker beskrywings van siekte bydra tot sigbare en meetbare resultate wat vir hartpasiente van waarde is. / Philosophy, Practical and Systematic Theology / D. Th. (Praktiese Teologie)