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This chapter discusses ways of talking about the fears of chronically ill patients, describing the case of a 55-year-old man who had negative feelings about his hospitalization. It explains that talking about fears usually reduces them and that keeping secrets isolates both the dying person and the support system. The chapter also highlights the importance of hearing the patient's language and way of speaking, and responding to them in the same language.

Cases illustrating variables relevant to pregnant women’s noncompliance with medical recommendations intended to benefit the fetus or potential child are presented. These involve refusal of hospitalization, refusal to comply with dietary recommendations, and refusal of cesarean section delivery. For each topic, empirical and theoretical factors relevant to the cases are discussed from an “egalitarian perspective” that imputes privileged status to the standpoint of those who are “nondominant”. Implications of different positions about the moral status of the fetus are also considered.

This chapter asks how well Baby Boomers are protected against later-life health shocks. While exposure to such shocks is relatively high, the realization of risk appears unlikely and relatively little wealth is at risk. Almost one-quarter of the original Health and Retirement Study cohort was uninsured at some point in the six-year window before Medicare eligibility, but only 2% had an uninsured hospitalization in this window. Moreover, the amount at stake for the median uninsured person is relatively low. Since many in this age bracket approach old age in poor financial shape, lack of assets may be a larger problem than lack of health insurance. Policies aimed at preventing poverty among the elderly may be more important than policies to expand health insurance coverage among those on the verge of retirement.

This chapter describes Prokofiev's gradual rehabilitation within the Stalinist cultural and political establishment, his successful fulfillment of commissions for pallid works on themes of youth (notably Winter Bonfire and On Guard for Peace), and his collaborations with the cellist Mstislav Rostropovich. It also chronicles Prokofiev's hospitalizations and his solitary existence with his second wife Mira Mendelson in Nikolina Gora, where, in his final months, he conceived a series of works in the spirit of Bach. The chapter concludes with an assessment of Prokofiev's posthumous legacy.

This chapter highlights the methodological challenges and potential benefits of examining archival psychiatric records to collect valuable information about the individual and family context of hospitalization, and to illuminate the processes that shape short- and long-term adaptation following psychiatric hospitalization. It presents the system used to evaluate the feasibility of employing archival psychiatric records to capture important differences among patients, describes the “life chart” technique used to distill the voluminous information, and demonstrates that a measure created for use with contemporaneous data can be reliably and validly used with archival materials to address important and substantive questions about the precursors and sequelae of adolescent psychiatric hospitalization.

This chapter presents UK legislation concerning people with mental disorders. It provides an account of both Statute and Case Law, and It explains issues such as competence and coercive treatment in cases of mental disorders. It then focuses on the particular case of eating disorders, and looks at issues of competence to refuse treatment for eating disorders and legislation relating to force-feeding. The legal account is accompanied by a punctual philosophical and ethical critique of UK jurisdiction. It suggests that the Mental Health Act should be abolished.

This chapter provides an overview of the significant challenges imposed by admission of a patient to an in-patient setting in hospitals and palliative care units and strategies for supporting family carers in these settings. The findings reveal that the intensive care unit (ICU) is an especially stressful environment for family carers and they often experience a sense of helplessness and a loss of control during hospitalization. To address this issue, well-orchestrated family conference and strategies to enhance professional-caregiver communication are essential.

This chapter starts by discussing older patients, and by presenting the aspirations of patients with heart failure (HF) and specific age-related problems. The aetiology of HF in the elderly and the significance of the normal aging process are reported. It is more difficult to diagnose the elderly because symptoms are often mild or difficult to interpret and echocardiography is frequently less informative because of the high prevalence of HF with preserved systolic function (HF-PSF). The recommended treatment for HF in the elderly is, as in younger patients, based on national and international guidelines for medication regimes, non-pharmacological advice, and interventional and surgical procedures. In addition, the rationale for guideline-based medications in elderly patients is given. Medication for patients with HF with preserved left ventricular systolic function is then shown. Moreover, the quality of life, hospitalization, disease management programmes, and end-stage HF and end-of-life care are emphasized.

If there has been any constant in modern mental disability law in its near-forty-year history, it is the near-universal reality that counsel assigned to represent individuals at involuntary civil commitment cases is likely to be ineffective. In many nations, there simply is no mental disability “law,” and, even where there is such a law “on the books,” the promise of counsel is often little more than an illusion. Moreover, the lack of meaningful judicial review makes the commitment hearing system little more than a meretricious pretext. Encouragingly, though, a variety of interrelated factors may shed some light on this scandal and lead to positive social change in this area: the new, robust case law from the European Court on Human Rights on virtually all aspects of mental disability law, the ratification of the CRPD, and the publication of the World Health Organization Resource Book on Mental Health; the work done by mental disability law–specific NGOs (e.g., Mental Disability Rights International; Mental Disability Advocacy Center) on institutional conditions in central and eastern Europe and in Central and South America, and greater interest globally in what can broadly be called “access to justice” issues. This chapter surveys an array of international jurisdictions (common law, civil law, and mixed) and considers the range of findings (from nations in which there is no counsel, to perfunctory-at-best counsel, to almost-adequate counsel). It considers other major legal, political, and social developments that might illuminate these issues, and the impact of sanism and pretextuality on these developments. It concludes that the legislative and judicial creation of rights—both positive and negative—is illusory unless there is a parallel mandate of counsel that is (1) free and (2) regularized and organized. Without the presence of such counsel, any rights articulated by a court, human rights commission, or legislature become, again, merely “paper victories.” The presence of sanism and the technical complexity of most mental disability law cases (involving, often, expert testimony by mental health professionals and subtle predictions about “future dangerousness” or about institutional conditions) further augments the necessity and importance of adequate representation in such cases.

This chapter considers the individual and the population approaches to assessing health outcomes. Death, hospitalization, quality of life, cost, disability, inequality, and health literacy are considered and compared as health outcomes. A scheme for the critical appraisal of outcome measures is presented. The importance of focusing on outcomes, rather than process, in assessing a health policy is stressed.

This chapter studies the author's trip to Chkalovskiy rayon in order to start interviewing the families of the outbreak victims, a region which is named after Chkalov, a famous Russian pilot, and describes the locale, from its industrial factories to the arrangement of the houses. From here the discussion shifts to the author's search for the families of Anna Komina and Mikhail Markov, who give some information on the circumstances surrounding the hospitalization, death, and burial of the two victims.

This book introduces the lives of forty-three people who participated in a community treatment program intended as an alternative to their psychiatric hospitalization. It also aims to discover their worlds and individual lives to gain a human, sociocultural understanding of psychiatric de- and non-institutionalization as practiced and experienced in culture. The lure of cultural anthropology has been its lack of restriction in subject matter combined with its human focus shot through with curiosity, the pursuit of commonsense understanding, and enthusiasm for variety, diversity, creativity, and underlying pattern. It would appear that psychiatric anthropology, rather than being an exotic subspeciality of cultural anthropology, represents a deeply traditional anthropological exercise. Fieldwork and intimate inter- and intrapersonal experience in the process of inquiry and understanding seem powerfully present in the psychiatric arena.

This chapter argues that as the health care system increasingly confronts problems such as alcohol abuse and automobile accidents, the socialization function of medicine assumes greater importance and the medical role increasingly becomes one of defining a variety of social conditions as health problems. Social organization is linked to the hospitalization of the elderly. The role of medicine as legitimate labeler of problems has increased in stature based upon therapeutic successes in the past. There can be no doubt that social institutions profoundly affect the causes and levels of mortality and morbidity. There is also no doubt that in the twentieth century specific medical measures have been significant in decreasing some significant causes of morbidity and mortality, even in the face of little or no social change.

This chapter addresses how homelessness affects health. The disordered lives of homeless patients disrupt appointment-keeping and medication adherence, even as they generate need for more treatment by driving health challenges like depression, high blood pressure, and hospitalizations. As such, some health systems have begun to address the link between homelessness and health. One Boston health system, for example, announced plans to subsidize housing for the patients for whom it is accountable, to give this population some measure of the shelter and stability necessary for good health. As a society, people tend to forget that health is a public good supported by their collective investment in resources such as education, the environment, and, indeed, housing. Health systems can help people remember, by investing in these resources, to improve the health of patients. Indeed, health systems can direct people toward a better understanding of what truly shapes health, but it is ultimately the people’s responsibility to act on that knowledge and build a world that generates health.

This chapter explores medical bankruptcy, which is a much-debated topic, with most questions focused on exactly how many people file for it and how often it occurs. In 2005, Elizabeth Warren and her colleagues found that medical costs led to over 40% of bankruptcies in the United States. This was followed by an update in 2009, pushing the proportion of bankruptcies due to medical expenses to 62%. The Consumer Financial Protection Bureau’s 2014 report conflicts with this causal attribution, citing that less than 1% of adults in the United States file for bankruptcy, even though 20% of the population has great medical debt. In 2018, a group of economists reexamined this issue, concerned that the discrepancies in statistics were causing a misunderstanding of the problem. Their findings show an increase in people filing for bankruptcy after hospitalization. The researchers suggest that paying for medical bills out of pocket and losing income because of missed work are key reasons people file for personal bankruptcy. Ultimately, one thing is clear: the better people understand the causes of medical bankruptcy, the easier it is to see that an investment in disease prevention could boost Americans’ financial health, as well as their physical and mental well-being.

Hospitals are both potentially life-saving and dangerous. For vulnerable older people, the hospital poses the risk of developing acute confusion, adverse drug reactions, falls, and loss of independence. It is a technologically-intensive, unfamiliar environment that is often disorienting to elderly patients.

This chapter tells the story of a palliative care nurse, Linda, and the generosity of the care she offers. Linda, speaking in a brief interview excerpt, describes her relationship with a patient named Miriam Lambert, whose suffering could not be relieved as well as what Linda wants to believe she and her colleagues usually can provide for people who are dying. Linda speaks within the immediacy of the work she describes; she does not write, edit, and revise. Her story evokes the chaos of generosity while it is being practiced, yet she carries on. One can recognize the generosity of her perseverance only when one feels the chaos of her work. Linda's story is told as one part of an ethnography of Miriam Lambert's final hospitalization and death narrated by Anna Towers, a palliative care physician in Montreal.

In this chapter, pediatric diseases are defined as “illnesses that affect a person for an extended period of time, often for life, and that require medical care attention above and beyond the normal requirements for a child or adolescent” (American Academy of Pediatrics 1993). The prevalence of such chronic illnesses has steadily increased over the past 20–30 years (Downs et al. 2001; Vincer et al. 2006; Marelli et al. 2007), with estimated rates ranging from below 1% to 44% depending on the definition, method, and sample included in the different studies (van der Lee et al. 2007). Several theoretical frameworks and models have been presented to explain how diagnosis-specific effects and generic factors across disorders affect cognition and behavior. The transactional stress and coping model (TSC) is one of the most cited theories on psychological adaption in children with a chronic illness, encompassing both specific and generic effects (Thompson and Gustafson 1996). Dennis (2000) has presented a similar model of factors affecting cognitive outcome in chronically ill children. The models describe how disease-related variables interact with child characteristics, developmental level, family resources, and peer relationships, and provide a useful framework to the present chapter. Several epidemiological and clinical studies have documented that children with pediatric diseases have an increased risk of emotional and behavioral problems (Lavigne and Faier-Routman 1992; Glazebrook et al. 2003; Hysing et al. 2007). Symptoms of internalizing and externalizing disorders are frequently found across the diseases but illness-specific manifestations also exist. Externalizing symptoms of hyperactivity and social problems are most often shown by children with neurological disorders (Rodenburg et al. 2005), while the rate of emotional problems has been reported to be especially high in children with asthma (Vila et al. 2003). Peer interaction and social functions are often affected in children with pediatric disorders. Investigations of the impact of social functioning is a growing research field in pediatric psychology, as part of a general trend in developmental psychology that focuses on close peer relationship as a moderator of nonoptimal functioning (Bukowski and Adams 2005; Burt et al. 2008).