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By E. Mojok. Holy Cross College, Notre Dame Indiana.

What is central to both types of identity-change experienced by the people who spoke with me is the ideology contained within the alternative model of health and healing purchase 60 mg dapoxetine overnight delivery. This ideology is both the motivator for taking on the identity of an alternative healer and the mechanism through which they construct a healthy sense of self generic dapoxetine 90 mg on line. Notwithstanding the fact that these informants experienced positive changes to self through adoption of alternative ideologies of health and 94 | Using Alternative Therapies: A Qualitative Analysis healing, participation in these forms of health care can also have a negative impact on identity. More precisely, a consequence of participation in alternative therapies is that people are often stigmatized for their use of what have been labelled “deviant systems of medicine” (Saks 1995:119). Therefore, while using alternative therapies can allow the individual to change their self-perceptions and transform their identities for the better, these benefits to self can come at the price of acquiring a deviant identity. My intent here is not an in-depth examination of the components of the alternative healer identity. Rather, I am concerned with what motivates these informants to begin, continue, or complete the process of adopting a healer identity. Interested readers should see Boon (1998); Cant and Calnan (1991); and Lowenberg (1992) for analyses of alter- native practitioner identity. Glik’s (1990) characterization of the changes to self experienced by her informants as imagined is problematic. As Thomas and Thomas (1970:154) made plain, “If [people] define situations as real they are real in their consequences. While Lindsey (1996:466) does not identify the source of the beliefs that allowed her informants to find “health within illness” as alternative healing ideology, much of the data she presents in illustrating how her informants describe health are analogous to many of the components which make up the alternative model of health espoused by the people who spoke with me. For example, one woman who took part in her research defined health as “being in control of myself and making my own decisions” (Lindsey 1996:468). CHAPTER SEVEN Using Alternative Therapies: A Deviant Identity The use of alternative therapies as deviant behaviour is neglected as an area of research, despite the fact that people who use so-called unortho- dox therapies have consistently been ridiculed (Johnson 1999; Leech 1999; Miller et al. For example, Hare (1993:40) equates a patient’s disclosure of her use of acupuncture to her doctor with the Catholic confessional, and the use of alternative therapies with a sin that must be absolved: “She is confessing to her physician who absolves her, even confessing his own foray into the domain of the ‘other. My focus here is on the means used by informants to reduce the stigma associated with their participation in alternative approaches to health and healing. In addition to describing the use of perennial methods of coping with stigma, such as managing disclosure and using humour (Davis 1961; Goffman 1963), I analyse informants’ use of accounts as a technique of stigma management (Scott and Lyman 1981). In particular, I reflect on their use of retrospective reinterpretation of biography employed in their accounts of their participation in alternative therapies. One’s self-defined biography is neither static nor fixed; rather, as Goffman (1963:62) points out, a salient feature of biographies is that they “are very subject to retrospective construction. As we remember the past, we reconstruct it in accordance with our present ideas of what is important and what is not. In Scott and Lyman’s (1981:357) words: “Every account is a manifestation of the under- lying negotiation of identities,” and is no less so in negotiating deviant identities (emphasis theirs). According to Scott and Lyman (1981:343–344), “An account is a linguistic device employed whenever an action is sub- jected to valuative inquiry.... A statement made by a social actor to explain unanticipated or untoward behavior. These categories differ in that justifications are accounts in which the actor “accepts responsibility for the act... For Scott and Lyman (1981:348) the crucial distinction between excuses and justifications is that in the former case the individual accepts that the behaviour in question is wrong, while in the latter case he or she “asserts its positive value in the face of a claim to the contrary. Self-fulfillment accounts justify behaviour through the rationale that the act is not wrong if it corresponds with the actor’s notion of what is necessary to his or her self-fulfillment, whereas “The sad tale is a selected (often distorted) arrangement of facts that highlight an extremely dismal past, and thus explain the individual’s present state” (Scott and Lyman 1981:349). Below, Using Alternative Therapies: A Deviant Identity | 97 I critically apply Scott and Lyman’s (1981) notions of justifications and excuses, as well as Sykes and Matza’s (1957) techniques of neutralization, in analysing informants’ accounts of their experiences with alternative therapies. Further, I argue that the concept of retrospective reinterpretation of biographies can also be used to shed new light on how people who use alternative therapies reduce the stigma associated with their participation in alternative forms of health care. ALTERNATIVE THERAPY USE AS DEVIANT BEHAVIOUR The language used in the literature to describe alternative therapies has been and remains largely derogatory and pejorative. For example, consistently and over time, alternative therapies have been styled unconventional, nonconventional, unorthodox (Dunfield 1996); unscientific and unproven (Feigen and Tiver 1986); “fuzzy stuff” (Monson 1995:170); or “deviant forms of health service” (Cassee 1970:391). One extreme example concerns Leech’s (1999:1) pronouncement that alternative therapies are “snake oil [which] belongs in the last century, not this or the next. For example, while she uses the term alternative medicine, Monson (1995:168) refers to allopathic health care as “proper orthodox medicine,” implying that alternative therapies are unorthodox and improper.

This is held in the left hand with the baby’s neck gently extended buy cheap dapoxetine 60mg line, if necessary by the Reassess heart rate every 30 seconds trusted 60mg dapoxetine. The laryngoscope is passed to the right of the tongue, ensuring that it is swept to the left of the blade, which is Algorithm for newborn life support. Adapted from Newborn Life Support advanced until the epiglottis comes into view. The tip of the Manual, London: Resuscitation Council (UK) 40 Resuscitation at birth blade can then be positioned either proximal to or just under the epiglottis so that the cords are brought into view. As the upper airway tends to be filled with fluid it may have to be cleared with the suction catheter held in the right hand. Once the cords are visible, pass the tracheal tube with the right hand and remove the laryngoscope blade, taking care that this does not displace the tube out of the larynx. Most people find it necessary to use an introducer to stiffen straight tracheal tubes. It is then essential to ensure that the tip of the introducer does not protrude, to avoid tracheal and mediastinal perforation. If intubation proves difficult, because the anatomy of the upper airway is abnormal or because of a lack of adequately trained personnel, then a laryngeal mask may be inserted. Attach the tracheal tube either to a T-piece system incorporating a 30-40cmH O blow-off valve (see above) or to a Neonatal tracheal intubation equipment 2 neonatal manual resuscitation device. If a T-piece is used, maintain the initial inflation pressure for two to three seconds. The baby can subsequently be ventilated at a rate of 30/min, allowing about one second for each inflation. Inspect the chest during the first few inflations, looking for evidence of chest wall movement, and confirm by auscultation that gas is entering both lungs. If no air is entering the lungs then the most likely cause is that the tip of the tracheal tube is lying in the oesophagus. If this is suspected, remove the tube immediately and oxygenate with a mask system. If auscultation shows that gas is entering one lung only, usually the right, withdraw the tube by 1cm while listening over the lungs. If this leads to improvement, the tip of the tracheal tube was lying in the main bronchus. If no improvement is seen then the possible causes include pneumothorax, diaphragmatic hernia, or pleural effusion. Severe bradycardia If the heart rate falls below 60 beats/min, chest compression must be started by pressing with the tips of two fingers over sternum at a point that is one finger’s breadth below an imaginary line joining the nipples. If there are two rescuers it is preferable for one to encircle the chest with the hands and compress the same point with the thumbs, while the other carries out ventilation. The chest should be compressed by about Bag mask for neonatal resuscitation one third of its diameter. Give one inflation for every three chest compressions at a rate of about 120 “events” per minute. If no improvement is seen within 10-15 seconds the umbilical vein should be catheterised with a 5 French gauge catheter. This is best achieved by transecting the cord 2-3cm away from the abdominal skin and inserting a catheter until blood flows freely up the catheter. The same dose of adrenaline (epinephrine) can then be given directly into the circulation. Although evidence shows that sodium bicarbonate can make intracellular acidosis worse, its use can often lead to improvement, and the current recommendation is that the baby should then be given 1-2mmol/kg of body weight over two to three minutes. Those who fail to respond, or who are in asystole, require further doses of adrenaline (epinephrine) (10-30mcg/kg). This can be given either intravenously or injected down the tracheal tube.

Later experi- ments confirmed osseous healing of hypertrophic pseudarthroses by stabilization using only a com- pression plate and without bone grafting discount 90 mg dapoxetine amex. Willenegger realized that by perform- ing an osteosynthesis in a suboptimal way buy dapoxetine 90 mg on-line, cata- strophic complications could be created. Being Philip Duncan WILSON willing to help such patients, Liestal became a center for the treatment of post-traumatic 1886–1969 osteomyelitis, pseudarthrosis and malunion. Willenegger initi- Philip Wilson was born in Columbus, Ohio, on ated the worldwide teaching of the AO principles, April 3, 1886, the son of Dr. Edward Wilson, a becoming the first president of AO International much respected family physician who also held in 1972. This event marked the starting point for the chair of obstetrics in the Starling Medical many years of global traveling, teaching AO in all School of that city. He differentiated several teaching Philip entered Harvard College in 1904 and grad- activities: (1) direct teaching, (2) teaching for uated with the degree of AB in 1909. From the teachers, enabling future teachers to continue College, where he enjoyed those carefree under- their work of training locally, and (3) selecting graduate years in the first decade of the twentieth adequate people to profit from an AO fellowship century, he moved naturally to the Harvard for 1–4 months in an established and recognized Medical School. Here he began to show his con- AO center, tailored to the needs of the fellow. With such teachers, carefully and paternally explaining the qualifications he was a strong candidate for a basic principles underlying each one. Gallen was supported in his interest in Hospital, a post he held for 2 years. Burri in Ulm encour- At that time the residency system had yet aged in his work on post-traumatic infections. After leaving the Massa- to open new possibilities of development to the chusetts General Hospital, Philip returned to recipient of his message, without claiming any Columbus ready to embark on surgical practice. But with the outbreak of World War I, things Shortly before Christmas in 1998, Hans began to happen in Boston, and it was not long Willenegger passed away, after months of pro- before he was invited to join the Harvard Unit, gressive illness, during which time he was then assembling under Harvey Cushing. The story of the creation of that unit and of its early experiences in France in 1915 at Neuilly, where it was housed in the Lycée Pasteur, is vividly recounted in Harvey Cushing’s A 361 Who’s Who in Orthopedics Surgeon’s Journal. The story is also told in chap- ative procedures in the surgery of arthritis— ters of the unpublished wartime diary of Robert posterior capsuloplasty in flexion contracture B. Osgood, who was the senior orthopedic of the knee and arthroplasty of the elbow joint. Among the members of the 1921 he became a recognized clinical teacher at unit who, with Philip Wilson, were to make sur- Harvard Medical School. Great Britain and in the United States to embrace The months in Neuilly at the American Ambu- the treatment of recent fractures and dislocations lance were to be a turning point for Philip Wilson; and allied injuries of the locomotor system. At the perhaps the one influence above all others that Massachusetts General Hospital, the surgical rev- shaped his life. A combined fracture Red Cross nursing aide, Miss Germaine Parfouru- service was set up, in which both general and Porel. It did not take long for Philip and Germaine orthopedic surgeons shared the responsibilities. At 1925 a monograph on Fractures and Dislocations the end of a 3-month tour of duty with the unit, appeared under the joint authorship of Philip Philip returned to the United States, but was back Wilson and W. On July 6, to become the first orthopedic surgeon to be 1916, Philip and Germaine were married. To this appointed to the Edinburgh Royal Infirmary, marriage, which was to last for nearly 53 years, had worked both with Dr. As department at the Massachusetts General Hospi- the daughter of Madame Réjane, the great tal. This textbook enjoyed considerable popular- French actress, in her mother’s entourage she had ity; it was written in simple and lucid style, and enjoyed meeting important personages in many it proved to be a useful book of reference for those European countries. In the bilingual, having been educated by English gov- years that followed, the breadth of Philip Wilson’s ernesses, and was deeply interested in the theater, interests is shown in the long list of his contribu- in music, and in literature. Brackett, Robert responsive to such an ambiance, which was later Osgood became chief of the orthopedic service, to be reflected in their three gifted children—Paul but when elected to the John B. The orthopedic surgeon entirely on his own merits; gap was filled for a few years only by Nathaniel and Marianne Finckel, now a member of the Allison, who was looking toward Chicago, where Faculty of Music at Bennington College. The Mass- Philip and Germaine Wilson crossed the achusetts General Hospital was now faced by the Atlantic for a brief spell, but were soon back in choice between two outstanding men already in France, with Philip now a major in the United the orthopedic department—the brilliant virtuoso States Army Medical Corps. In this capacity he Marius Smith-Petersen and the gifted all-rounder served from July 1917 to August 1919, latterly as Philip Wilson.

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