Il lavoro si propone di rendere conto del ruolo dell’associazionismo di auto-mutuo aiuto (self-help) nel contesto del modello di welfare regionale lombardo, il “quasi mercato”. Questa forma associata vive una nuova stagione di sviluppo e dimostra di essere una delle risposte possibili ai recenti mutamenti dei sistemi di welfare, soprattutto in un contesto socio-demografico caratterizzato dall’invecchiamento della popolazione, dalla riduzione dei componenti delle famiglie e dal prevalere di malattie croniche e di disabilità. L’associazionismo di auto-mutuo aiuto si dimostra una delle risorse emergenti della società civile, capace di trasformare soggetti passivi e marginalizzati in cittadini attivi e responsabili; è più difficile capire quale sia il suo ruolo all’interno della governance locale, in termini di partecipazione. La ricerca presenta un quadro complesso, in cui il self-help riesce a promuovere innovazioni capaci di divenire risorse per il territorio locale, ma anche una certa incapacità di essere valorizzate presso le istituzioni locali, in ragione della fragilità istituzionale di cui soffre ancora questo tipo di associazionismo. / Purpose of the present study is to explain the role played by self-help associations within the Lombardia regional welfare model, the so-called ‘quasi-market’. Such associative forms are undergoing a whole new deal of development and prove to be one of the possible answers to the recent changes typical of the welfare systems, especially in a socio-demographic context characterized by ageing processes, decrease in the number of family members, prevailing of chronic diseases and disabilities. Self-help associations prove to be one of the resources emerging from civil society, able to transform passive subjects into active and responsible citizens. However, it is still difficult to understand what role they play in the local governance, in terms of participation. Major finding of the research is a complex picture, where self-help associations are able, on the one hand, to encourage innovations able in their turn to become resources for the local communities; on the other hand, they still show a certain inability to be fully appreciated by the local institutions because of the institutional fragility that still characterize these specific associations.

<p>This dissertation, broadly, examines how power dynamics manifest during clinical interactions related to vague and gendered medical symptoms, such as pelvic pain. To examine this issue, I approach my research questions through multiple methods including a critical discourse analysis of the medical discourse on pelvic pain, a survey experiment administered to healthcare workers in the US, and a narrative analysis of pelvic pain patient experiences. While the focus of this research is on pelvic pain, the analyses presented here reach far beyond ideas of power dynamics and pelvic pain. Rather, the findings from this research speak to theoretical discussions medical sociologists have been having for decades. Specifically, findings provide new insight on: 1) the limits of evidence-based medicine as a biomedical paradigm, 2) how fundamental causes of health inequality intersect with each other as well as other factors, such as gender, important in predicting health outcomes and 3) how discussions of metamechanisms in fundamental cause theory can inform our understanding of the accumulation of cultural health capital. In providing such insight, this dissertation uses the case of pelvic pain to integrate multiple perspectives and theories in medical sociology to drive the field forward in a way that acknowledges the many ways power is simultaneously constituted in the clinical interaction. From the role of gender, race, and class in power relations, to the ways medical knowledge, discourse, and authority dictate the clinical interaction, this research covers a wide range of sociological theories and concepts. In doing so, this dissertation sheds new light on current understandings of power in the clinical interaction and its relationship to inequitable health outcomes in the US.</p>