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The paper is based on semi-structured interviews with a series of rheumatoid arthritis patients. Chronic illness is conceptualised as a particular type of disruptive event. This disruption highlights the resources (cognitive and material) available to individuals, modes of explanation for pain and suffering, continuities and discontinuities between professional and lay thought, and sources of variation in experience.

This paper provides a review of research and debate in the held of chronic illness, it lirstoutlincs some gerscral features of a st)cit>logicai approach, and then goes on to use recent empirical studies of chronic illness to illustrate sotnc of the main stages involved. These include: onset and the problems ot explanation and legitimation, the impact of treatment, and the development of adaptive responses. An attempt is made todisttngutsh the use of the terms 'copmg'. 'strategy' and 'style' in describing adaptation. The paper argues that a sociological approach needs to recognise the positive actions people take, as well as the problems they face. In this way. diversity iti managing chrome illness, and the continuing need for a person-baseti approaeh to sociological work, are underlined

There is currently considerable renewed interest in narrative analysis in the humanities, social sciences and medicine. Illness narratives, particularly those of patients or lay people, are a particular focus in health related settings. This paper discusses the background to this interest, especially its roots in critiques of medical dominance and distinctions between disease and illness, drawn by sociologists and anthropologists in the 1970s. The current emphasis on patient or personal narratives can also be seen to stem from changes in morbidity patterns, the expansion of information about disease and illness, and in public debates about the effectiveness of medicine. The paper then goes on to outline a framework for analysing illness narratives. This involves exploring three types of narrative form:`contingent narratives' which address beliefs about the origins of disease, the proximate causes of an illness episode, and the immediate effects of illness on everyday life;`moral narratives' that provide accounts of (and help to constitute) changes between the person, the illness and social identity, and which help to (re) establish the moral status of the individual or help maintain social distance; and`core narratives' that reveal connections between the lay person's experiences and deeper cultural levels of meaning attached to suffering and illness. Here, distinctions are drawn between such sub forms as heroic, tragic, ironic and comic, and regressive/progressive narratives. Finally, the paper discusses some of the methodological issues raised by narrative analysis. Given the complex character of illness narratives, their social and psychological functions, together with the motivational issues to which they relate, it is suggested that they constitute a major challenge for sociological analysis. From this viewpoint current claims about narrative analysis in medicine need to be treated with caution.

During the last century demographic and epidemiological transitions have had a radical impact upon health and health service provision. A considerable body of research on the sociological aspects of living with chronic illness has accumulated. Debate has focused on how social environments shape disabilityrelated experiences, and the extent to which individual responses define health outcomes. Through the establishment of the Expert Patients Programme (EPP) in 2001, the Department of Health has sought to enhance NHS patients' self-management capacities. This paper discusses three areas relevant to this: the policy formation process leading up to the EPP's present stage of development; the evidence base supporting claims made for its effectiveness; and the significance of psychological concepts such as self-efficacy in approaches to improving public health. The conclusion discusses NHS developments in primary care and public involvement in health and healthcare, and the implications that initiatives such as the EPP carry for the future. It is argued that to facilitate a constructive process of 'care transition' in response to epidemiological and allied change, awareness of cognitive/psychological factors involved in illness behaviours should not draw attention away from the social determinants and contexts of health.

Utis paper offers a review of recent approaches in the 'social constnictionism' of medical knowledge. It argues that 'coitstructiotiist' propositiom offer a bold attempt to resolve some of the problems in earlier formulations of the sociology of medical knowledge, particularly those of Eliot Freidson. However, the paper goes on to argue that social constructionism has failed to tackle the inherent relativism in its stance and that it frequently rests on contradictory intellectual and value premises. The paper concludes that both policy considerations and theoretical consistency require a critical appraisal of social contnictionism and its future role in medical sociology.

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Despite the potential benefits of enhanced self-management, the review of the literature presented here suggests several possible problems associated with the presentation and implementation of initiatives such as the EPP programme. These include the possibility that advocates of public service improvements have on occasion been tempted to overstate the evidence for the relative and absolute effectiveness of lay-led self-management programmes. In addition, the varied experiences of those living with a chronic illness warn against promulgating rigid prescriptions about what patients -should think and do. The evidence to date is indicative of short-term benefits being derived from the provision of lay-led self-management programmes.