Anticipatory Accounts

C. Wright Mills called for a truly sociological analysis of actors’ “motive talk,” which decouples the commonsense link between the reasons actors give for their actions and their mental state prior to those actions. Subsequent theoretical and empirical work has focused almost entirely on actors’ retrospective accounting for untoward conduct that has already taken place. The other aspect of Mills’s program, the reasons actors give for potentially untoward future conduct and in particular the empirical investigation of the link between the availability of an acceptable vocabulary of motives for anticipated conduct and the eventual enactment of that conduct, has been largely ignored. This article seeks to rehabilitate these lost dimensions using data from a longitudinal study of mothers’ infant feeding choices and practices. It examines how mothers account, in advance, for the possibility that they may eventually feed their babies in ways they consider suboptimal. Thirty of the thirty-six women interviewed indicated that they intended to breastfeed, emphasizing the benefits of this practice to their babies. However, seventeen of these women also anticipated that they might abandon breastfeeding and presented elaborate accounts of the motives that could lead them to do so. The findings support Mills’s claim that the availability of an acceptable vocabulary of motives for untoward conduct increases the probability that one will engage in such conduct. Mothers who had offered elaborate anticipatory accounts for abandoning breastfeeding were much more likely to do so than those who did not offer such accounts.

Expertise and forms of knowledge in the government of families

This paper examines the relationship between the state and the individual in relation to an aspect of mundane family life – the feeding of babies and young children. The nutritional status of children has long been a matter of national concern and infant feeding is an aspect of family life that has been subjected to substantial state intervention. It exemplifies the imposition upon women the ‘biologico-moral responsibility’ for the welfare of children (Foucault 1991b). The state’s attempts to influence mothers’ feeding practices operate largely through education and persuasion. Through an elaborate state-sponsored apparatus, a strongly medicalised expert discourse is disseminated to mothers. This discourse warns mothers of the risks of certain feeding practices and the benefits of others. It constrains mothers through a series of ‘quiet coercions’ (Foucault 1991c) which seek to render them self-regulating subjects. Using data from a longitudinal interview study, this paper explores how mothers who are made responsible in these medical discourses around child nutrition, engage with, resist and refuse expert advice. It examines, in particular, the rhetorical strategies which mothers use to defend themselves against the charges of maternal irresponsibility that arise when their practices do not conform to expert medical recommendations.

The everyday life of the revolution: gender, violence and memory

The ‘heroic life’ or the life of the revolutionary is one that resists or even seeks to transcend the everyday and the ordinary. The ‘banal’ vulnerabilities of everyday life, however, continue to constitute the unseen, often unspoken background of such a heroic life. This article turns to women’s memories of everyday life spent ‘underground’ in the context of the late 1960s radical left Naxalbari movement of Bengal. Drawing upon recent published memoirs and my own field interviews with middle class female (and male) activists, I outline the ways in which revolutionary femininity was imagined and lived in the everyday life of this political movement. I focus, in particular, on the gendered and classed nature of political labour, the gendering of revolutionary space, and finally, the extent to which everyday life in the ‘underground’ was a site of vulnerability and powerlessness, especially for women. I also signal how these memories of interpersonal conflict and everyday violence tend to remain buried under a collective mythicisation of the ‘heroic life’.

Using Needs Assessment to Understand Continuing Disability in Patients with Enduring Mental Illness. Implications for Considerations of Service Development

Particular strengths of the MRC Needs for Care Assessment Schedule have been used to investigate the treatment status of patients with persistent psychiatric disability in ways that other needs assessment tools are unable to. One hundred and seventy-nine such patients from three settings; a private sector psychiatric hospital, two public sector day hospitals situated in the same town, and a high security hospital, were found to have a high level of need. Although there were differences between settings, overall these needs were well met in all three. The high level of persistent disability found amongst these patients could not be attributed to failure on the part of those treating them to use the best available methods, or to failures to comply or engage with treatment on the patient's part. In some two thirds of instances persistent disability was best explained by the fact that even the most suitable available treatments have to be considered only partially effective.

A Letter of Consequence: Referral Letters from General Practitioners to Secondary Mental Health Services

The referral letter is a key instrument in moving patients from primary to secondary care services. Consequently, the circumstances in which a referral should be made and its contents have been the subject of clinical guidelines. This article is based on a project that demonstrated that physicians do not adhere to clinical guidelines when referring patients to secondary mental health services. This research supports earlier findings into noncompliance with guidelines by general practitioners (GPs). The authors briefly note possible reasons, which have been the subject of some debate. They also present a content analysis of referral letters to demonstrate the important ways in which they differ from guideline criteria. However, their central argument is that the role of the referral letter in relation to the GP’s repertoire of treatments has not been understood fully. Such understanding implies the need for a reexamination of the support available for GPs.

A Utilitarian Perspective of Social and Medical Contributions to Three Illustrative Conditions, and Recent UK NHS Policy Initiatives

Background: To date debate concerning the relative merits of social and medical sciences has been largely academic. Aims: To outline and critically appraise a utilitarian approach to mental health research that reflects a critical realist perspective. Method: Consideration of the relative utility of differing approaches to illustrative ‘‘psychiatric’’ disorders, and recent policy initiatives. Results: Socially relevant outcomes of Bipolar Affective Disorder are determined by influences that operate independently of the characteristic instability of mood. There is now a highly specific and effective psychological treatment for Panic Disorder. Its benefits are still not fully exploited because of continuing lay and professional focus upon the condition’s social manifestations. Great numbers of people presenting in primary care are unhelpfully caused to adopt the role of ‘‘patient’’ due to practices limiting the professional response to a medical one. Such practices reflect public and professional perceptions of the nature of ‘‘mental health difficulties’’ much more than they do the achievements of medicine. Recent policy-supporting initiatives influencing UK NHS mental health services are much more likely to be supported by social sciences than by medical research. Conclusions: There is considerable scope for a contribution to applied mental health research from frameworks and methodologies that are rooted in a social sciences perspective.

Critical Psychiatry

Critical psychiatry appraises and comments upon psychiatric services as they are usually provided. This article, prompted by the publication of a recent book, considers the place of critical psychiatry historically and in the context of contemporary mental health care and treatment.

New Ways of Working in Acute Care: A Case for Change

This position paper focuses on the current tensions and challenges of aligning inpatient care with innovations in mental health services. It argues that a cultural shift is required within inpatient services. Obstacles to change including traditional perceptions of the role and responsibilities of the psychiatrist are discussed. The paper urges all staff working in acute care to reflect on the service that they provide, and to consider how the adoption of new ways of working might revolutionise the organisational culture. This cultural shift offers inpatient staff the opportunity to fully utilise their expertise. New ways of working may be perceived as a threat to existing roles and responsibilities or as an exciting opportunity for professional development with increased job satisfaction. Above all, the move to new ways of working, which is gathering pace throughout the UK, could offer service users a quality of care that meets their needs and expectations.

Emerging Gender Regimes and Policies for Gender Equality in a Wider Europe

This article addresses some implications for gender equality and gender policy at European and national levels of transformations in family, economy and polity, which challenge gender regimes across Europe. Women’s labour market participation in the west and the collapse of communism in the east have undermined the systems and assumptions of western male breadwinner and dual worker models of central and eastern Europe. Political reworking of the work/welfare relationship into active welfare has individualised responsibility. Individualisation is a key trend west − and in some respects east − and challenges the structures that supported care in state and family. The links that joined men to women, cash to care, incomes to carers have all been fractured. The article will argue that care work and unpaid care workers are both casualties of these developments. Social, political and economic changes have not been matched by the development of new gender models at the national level. And while EU gender policy has been admired as the most innovative aspect of its social policy, gender equality is far from achieved: women’s incomes across Europe are well below men’s; policies for supporting unpaid care work have developed modestly compared with labour market activation policies.Enlargement brings new challenges as it draws together gender regimes with contrasting histories and trajectories. The article will map social policies for gender equality across the key elements of gender regimes – paid work, care work, income, time and voice – and discuss the nature of a model of gender equality that would bring gender equality across these. It analyses ideas about a dual earner–dual carer model, in the Dutch combination scenario and ‘universal caregiver’ models, at household and civil society levels. These offer a starting point for a model in which paid and unpaid work are equally valued and equally shared between men and women, but we argue that a citizenship model, in which paid and unpaid work obligations are underpinned by social rights, is more likely to achieve gender equality.

Work stress, smoking status and smoking intensity: an observational study of 46 190 employees

Study objective: To examine the relationship between work stress, as indicated by the job strain model and the effort-reward imbalance model, and smoking. Setting: Ten municipalities and 21 hospitals in Finland. Design and Participants: Binary logistic regression models for the prevalence of smoking were related to survey responses of 37 309 female and 8881 male Finnish public sector employees aged 17-65. Separate multinomial logistic regression models were calculated for smoking intensity for 8130 smokers. In addition, binary logistic regression models for ex-smoking were fitted among 16 277 former and current smokers. In all analyses, adjustments were made for age, basic education, occupational status, type of employment and marital status. Main results: Respondents with high effort-reward imbalance or lower rewards were more likely to be smokers. Among smokers, an increased likelihood of higher intensity of smoking was associated with higher job strain and higher effort-reward imbalance and their components such as low job control and low rewards. Smoking intensity was also higher in active jobs in women, in passive jobs and among employees with low effort expenditure. Among former and current smokers, high job strain, high effort-reward imbalance and high job demands were associated with a higher likelihood of being a current smoker. Lower effort was associated with a higher likelihood of ex-smoking. Conclusions: This evidence suggests an association between work stress and smoking and implies that smoking cessation programs may benefit from the taking into account the modification of stressful features of work environment. Key words: effort-reward imbalance; job strain; smoking. Abbreviations: OR, odds ratio; CI, confidence interval; SES, socioeconomic status