Brijnath Bianca, Antoniades Josefine
Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Australia.
Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Australia.
Soc Sci Med. 2016 Mar;152:1-8. doi: 10.1016/j.socscimed.2016.01.022. Epub 2016 Jan 18.
The current study examines how the neoliberal imperative to self-manage has been taken up by patients, focusing specifically on Indian-Australians and Anglo-Australians living with depression in Australia. We use Nikolas Rose's work on governmentality and neoliberalism to theorise our study and begin by explicating the links between self-management, neoliberalism and the Australian mental health system. Using qualitative methods, comprising 58 in-depth interviews, conducted between May 2012 and May 2013, we argue that participants practices of self-management included reduced use of healthcare services, self-medication and self-labour. Such practices occurred over time, informed by unsatisfactory interactions with the health system, participants confidence in their own agency, and capacity to craft therapeutic strategies. We argue that as patients absorbed and enacted neoliberal norms, a disconnect was created between the policy rhetoric of self-management, its operationalisation in the health system and patient understandings and practices of self-management. Such a disconnect, in turn, fosters conditions for risky health practices and poor health outcomes.
当前的研究考察了患者是如何接受自我管理这一新自由主义要求的,特别关注澳大利亚的印度裔澳大利亚人和英裔澳大利亚抑郁症患者。我们运用尼古拉斯·罗斯关于治理术和新自由主义的研究成果来构建我们的理论框架,并首先阐述自我管理、新自由主义与澳大利亚心理健康系统之间的联系。我们采用定性研究方法,于2012年5月至2013年5月期间进行了58次深度访谈,我们认为参与者的自我管理行为包括减少医疗服务的使用、自我用药和自我劳作。这些行为随着时间的推移而出现,其受到与医疗系统的不满意互动、参与者对自身能动性的信心以及制定治疗策略能力的影响。我们认为,随着患者吸收并践行新自由主义规范,在自我管理的政策言辞、其在医疗系统中的实施以及患者对自我管理的理解和实践之间产生了脱节。反过来,这种脱节为危险的健康行为和不良健康结果创造了条件。