Oute Jeppe, Tondora Janis, Glasdam Stinne
Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Centre for Alcohol and Drug Research, Aarhus University, Denmark.
Yale Program For Recovery and Community Health, Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA.
Nurs Inq. 2018 Jul;25(3):e12241. doi: 10.1111/nin.12241. Epub 2018 Apr 6.
Little is known about how gendered understandings of patients can inform professionals' discretionary actions and decisions to include or exclude in clinical practice. Using Connell's poststructuralist perspectives on gender as an analytic framework, this article aims to investigate how professionals' articulations of depression are framed by signs of masculinity and femininity, and how these articulations inform service provision to patients with depression in clinical psychiatry. Building on interview data drawn from an ethnographic study, the article shows how the professionals' articulations reflected a gender binary that framed how the feminized patients were often connected to psychiatric care while masculinized patients were referred to separate alcohol or substance use treatment outside the psychiatric institution. The article discusses the societal and institutional conditionality of gendered understandings in psychiatry. In spite of several limitations, the article elucidates how professionals' understandings might have wide-ranging implications for the accuracy of epidemiological research and policy, and how they reflect a power struggle between patients and professionals about the legitimate right to interpret patients' conditions and efforts to manage their illness-related problems.
对于患者的性别化理解如何影响专业人员在临床实践中的自由裁量行为及纳入或排除的决策,我们知之甚少。本文以康奈尔的后结构主义性别视角为分析框架,旨在探究专业人员对抑郁症的表述如何由男性气质和女性气质的特征构建而成,以及这些表述如何影响临床精神病学中为抑郁症患者提供的服务。基于一项人种志研究的访谈数据,本文展示了专业人员的表述如何反映出一种性别二元论,这种二元论构建了女性化患者如何常常与精神科护理相关联,而男性化患者则被转介到精神病院外单独的酒精或物质使用治疗。本文讨论了精神病学中性别化理解的社会和制度条件性。尽管存在若干局限性,但本文阐明了专业人员的理解如何可能对流行病学研究和政策的准确性产生广泛影响,以及它们如何反映患者与专业人员之间关于解释患者病情的合法权利以及管理其疾病相关问题的努力的权力斗争。