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Demedicalisation of oppression.
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Health insurance as a catalyst to change in former communist countries?
A large number of former communist countries are currently undergoing a process of insurance led health sector change. Social health insurance is seen as a major source of income for the health sector, as a way of inducing fundamental restructuring of provision and of encouraging greater individual awareness of the costs (and benefits) of publicly financed health care. Attempts to introduce social medical insurance have generally been criticized by western policy analysts yet continue to have much appeal in each country. Obtaining additional revenue for the health sector is clearly a major motivation for these reforms. Yet available evidence suggests that many countries will obtain revenue that is lower and less stable than envisaged. For some countries other reasons for insurance may be as important. One of the most important is the greater autonomy given to the national Ministry of Health and local health departments over expenditure allocation. Recent experience of voluntary insurance in Turkmenistan confirms many of the fears about the feasibility and impact of social health insurance. Yet establishing an attractive but contained benefits package has been popular with the population and offers a potentially useful approach for inducing more fundamental reform.
The M-C-M' cycle and social capital.
Social capital has become a popular term over the past two decades amongst researchers, policy makers and practitioners from varied disciplines. This popularity, however, has resulted in a great deal of confusion over the nature and application of social capital in different contexts. This confusion has made it difficult to identify and measure social capital within the evaluation of specific social and health programmes, one of the aims of which may be to stimulate social capital. This paper identifies a theoretical model that seeks to capture the dynamic nature of social capital to assist in the development of research methods that will facilitate its measurement and exploration within such programmes. The model reported in the paper identifies the key components of social capital and expresses the relationship between those components in a dynamic system based on Marx's description of the process of capital (economic) exchanges expressed in the M-C-M' cycle. The M-C-M' cycle is the transformation of money (M) into commodities (C), and the change of commodities back again into money (M') of altered value. The emphasis within the paper is on the capital element of the concept and its transactional nature with the aim of avoiding the pitfall of attributing social capital in relation to social behaviours in isolation of context and interaction. Importantly, the paper seeks to distinguish the central elements of social capital from some of the antecedent factors and outcomes often attributed to and confused with social capital adding to the problem of providing valid measurement. The model is presented as the basis for the measurement of social capital within a transactional process involving the investment of social resources in a cyclical process, which may result in net gains or losses. This process is described as the R-C-R' cycle following Marx's model of economic capital, with the focus being on the transfer of social resources (R) rather than money (M). R represents an internal resource held by individuals, C the external resource or commodity they obtain from the network and the R' the internal resource of altered value. The possibilities of the model in assisting in the measurement of social capital specifically in assessing formal networks are explored.
Social representations of HIV/AIDS in Central and Eastern Europe.
Although a relatively recent epidemic, HIV is now increasing in Eastern Europe faster than anywhere else in the world. In the study reported in this paper, we interviewed 511 business people and health professionals in five Central and Eastern European nations: Estonia, Georgia, Hungary, Poland and Russia, deriving our questions primarily from a Social Representations perspective. Respondents also freely completed their associations with the stimulus word 'AIDS'. Our findings indicate that, although there is considerable agreement about the threat posed by the epidemic, there are also notable cultural differences in attributions about the origin and spread of the virus and the nature of those groups at risk of infection. These findings are interpreted in the light of the historical legacies of the Communist era, as well as the real economic and social challenges faced by the population of this region.
"Popular" health and the state: dialectics of the peace process in El Salvador.
The poor performance of large-scale "vertical" rural health programs tied to state Ministries of Health in Third World countries has often been attributed to a lack of "political will". But that term tells little about the conditions that favor health reform and may obscure disparate power relations and struggles over development. This work explores such a struggle over community health that emerged as part of the peace process in a former war zone of El Salvador since the 1992 ceasefire. The formalized negotiations (and behind-the-scenes confrontations) over health in Chalatenango province took place between Ministry of Health administrators and proponents of a "popular" health system that has functioned in repopulated villages of rebel-controlled Chalatenango since 1987. The Ministry has set up its own national (U.S. AID-designed) community health worker program, and agreed in theory with the popular system's emphasis on village-based lay health promoters; however, in negotiations and efforts at collaboration in Chalatenango the Ministry has been unwilling to support the promoters in the popular system, to accommodate local participation in health decision-making, or to restructure its own physician-centered practices around the need for more comprehensive approaches to health.
Case management's role in a Communist health care system.
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Lysenko and Stalin: commemorating the 50th anniversary of the August 1948 LAAAS Conference and the 100th anniversary of T.D. Lysenko's birth, September 29, 1898.
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The deinstitutionalization movement in Italy. Ideological thrust to cultural error.
The Basaglia movement in Italian psychiatry is described and analyzed in several contexts: the historical, the cultural, and the "practical" in terms of outcomes. Those who began the movement of democratic psychiatry grasped interesting elements of "critical theory": the definitions of madness, power structures, and medical discourse itself. A backward look at the sea change, however, reveals states and rates of dysfunction that disappoint and indicate that political ideology divorced from cultural awareness can often harden the opposition.
The philosophical foundations of Aleksandr R. Luria's neuropsychology.
This article attempts to show that the cultural-historical psychological theory of Aleksandr R. Luria (Luriya) and his colleagues is based on the foundations of historical materialism. It argues in particular that Luria's psychology, neuropsychology, and brain theory are integrated in the same scientific research program and are based on the same philosophical premises, and that his theories must be interpreted in the Marxist context in which they are embedded. Luria's research program asserts that the development of higher mental functions depends on the appropriation of cultural means, particularly language, within social practice. Moreover, the brain structures underlying mental functions are also dependent on the appropriation of cultural means. Luria's clinical diagnosis and his program for rehabilitation of patients with brain lesions are based on his psychological theory and brain theory. The following analysis of Luria's comprehensive program will show that a socio-cultural non-reductive explanation of mental functions and their underlying brain structures may have implications for the philosophical discussion of the mind-brain problem.
Must good causes compete?
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Toward a bioethics in post-communist Russia.
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Bioethics in Eastern Europe: a difficult birth.
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Ideology and community social psychology: theoretical considerations and practical implications.
This paper addresses the importance of the concept of ideology in community work. The implications of a Marxist approach to ideology in community practice are analyzed in terms of the concepts of problematization (P. Freire, 1979) and consciousness-raising (J. Barreiro, 1976), illustrating the point with some examples. The traditional Marxist perspective is also examined in relation to the perspectives of social constructionism (I. Ibáñez, 1996), cultural studies (A. McRobbie, 1992), post-Marxism (E. Laclau & C. Mouffe, 1985), and feminism (D. Haraway, 1991). It is argued that the concepts of hegemony and habitus (P. Bourdieu, 1985) can be useful to community social psychology theory and practice. A "situated perspective"--in which it is possible to dialogue from different "subject positions," and articulate transformation and political action--is argued. The implications of this shifting in the concept of ideology by means of theoretical developments outside social communitypsychology can help to define the external (outside) agent's position in community practice.
Suicide in the Ukraine: epidemiology, knowledge, and attitudes of the population.
For several decades suicidology could not be discussed in the Ukraine, and so this is one of the first papers on suicide in this country. After a brief discussion of the epidemiology of suicide in the Ukraine, the authors present the results of research investigations on caregivers' knowledge about suicide, as well as an investigation of attitudes towards suicide. The principal conclusions are: 1. The frequency of suicide in the Ukraine is relatively high (24 per 100,000). The rate of suicide is much higher in rural areas than in the cities. The frequency of completed suicide is not the same in different regions of the country. 2. Sociopsychological processes in the post-totalitarian society have resulted in the development of the "Soviet syndrome" in the population. 3. Suicidal behavior in the post-totalitarian society exists in a special social, psychological, and cultural context that creates obstacles for its effective prevention. 4. Research on the level of suicide knowledge revealed a high prevalence of mythical ideas, even in those groups of the population or professional groups that should be directly involved in education and participate in suicide prevention. 5. An assessment of the attitude of the respondents toward suicide revealed an ambivalence of their feelings and attitudes that could have a negative influence on their practical involvement in helping to deal with suicidal clients.
A clinical-psychological approach to suicidal behavior in depression from Moscow.
This contribution strives to familiarize Western readers with the theoretical concept of suicidal behavior which was developed at the Department of Suicidology of Moscow Psychiatric Research Institute and has been in use there for the last two decades. In describing this approach the paper concentrates on what differentiates it from traditional Western management without making value judgments about either approach. Such an account of the concept and its development will hopefully afford the reader an opportunity to arrive at his or her own conclusions regarding its clinical value.
The posttotalitarian pattern of suicidal behavior: impact on youth.
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