Ideology in the clinical context: chronic illness, ethnicity and the discourse on normalisation

Abstract

This paper is based on a comparative study examining how Chinese and white families manage the care of a chronically ill child. The circumstances of their lives that shape their experience of illness are explored. It is argued that the ideologies which underpin Western health care practices, in this case, the 'ideology of normalisation', often differ from the perspectives held by non-Western immigrants, and others who do not have access to the ideology. The discrepancies in viewpoints between patients and practitioners can lead to a different set of goals in the treatment encounter, with the possibility of misunderstandings in the clinical context. The 'ideology of normalisation' is used to show how professional ideologies serve as a means of separating out families into those who comply and those who do not. In other words, the ideology, and the moral discourse on normalisation, permit professionals to evaluate families and to categorise them. This categorisation has consequences for patient care, they might be refused treatment. Yet, this ideology is not based merely on 'value-free professional theories', but is located within the moral order. The socio-political, economic and historical factors that underpin the ideology are discussed.

Constructions of chronic illness

“…Underlying the desire for normalisation is a drive to ensure people are productive elements in society (Anderson et al, 1989) and health care workers have become agents in that quest. Discourses of normalisation have become dominant in the practice of health care workers, enshrining expectations of selfresponsibility from individuals who are sick and/or disabled (Anderson et al, 1989).…”

Controllers and controlled: an analysis of participant constructions of outpatient commitment

“…Normalisation is thus a new strategy for social control, well exemplified by OPC as a new mechanism for community based treatment where the image upheld is of a normal life where clients are independent (Anderton et al 1989). Normalisation reduces choice by assuming the values and roles upheld by society are indeed worth striving for (Bayley 1991, Hattersley 1991.…”

The experience of health and illness

“…1,5,7,8 It also covers how they can serve various purposes for both individuals and sociology. 1,6,7,9,10 The literature therefore maps the consequences of illness for those suffering from various conditions and those undergoing complex treatments. 1,6,7,9À11 Much less discussed has been the structural aspects of illness accounts.…”

“…The goal of their work is to expose the "complex historical, social, political, and economic nexus" 10 (p. 254) that underpins the differences in the accounts of illness between Chinese and white families. 10 They propose that "ideologies of normalization" operate to separate "compliant" from "noncompliant" families. Following Smith, 27 ideology originates from a "definite position of dominance in the society" and not the "neutral floating thing" called culture 10 (p. 255).…”