Normality, confession and identity

By Eva Palmblad

Abstract: The aim of this article is to analyse the expanding autobiographical literature concerned with neuro-psychiatric problems from a of knowledge perspective. The literature shows a tendency towards objectivity and distancing, which supports a thesis of proto-professionalisation. But the accounts are impregnated with frames of understanding other than only scientific ones, with regard to both form and content. The confe ssional character of the accounts and the prevalence of themes such as truth, falsehood, guilt, , trial, redress and reconciliation indicate that moral, existential and even religiously coloured perspectives of interpretation are being applied. By way of conclusion, these autobiographies will be discussed against the background of socio-political changes in recent times, and also against the background of basic cultural features in modern societies.

Background and problem are to be remedied by intervention by behavioural experts of a suitable kind, The maintenance of normality in our such as doctors, teachers, psychotherapists, modern society is a painstaking, social workers, etc. Organisational everlasting task. New generations of rationality is a given, as is the idea of citizens must be brought up to function . optimally, that is, learning to do the right thing at the right place, and at the right Expert-based normalization efforts have time. Deficiencies of function should, gradually increased in scope and have according to this way of thinking, be partly changed in character over time. discovered as early as possible in order During recent decades one has been to facilitate correction. Prevention and able to witness an increased slant early intervention minimize the risk of towards working on the individual's spanners being thrown in the workings identity. Normalization nowadays operates of society's machinery. The necessary primarily within the individual citizen, premises for normalization efforts have something that tends to make externally long been socially accepted. The socio- applied regulations redundant. In a pathological frame of reference is by historically comparative perspective, it now well established. This frame of is now a question not so much of reference holds that personal shortcomings regulated intervention, but instead a

SJDR - Volume 4, No.2 - 2002 95 Eva Palmblad question of change coming from within standards. Professional knowledge is the individual him or herself. One can disseminated not only through the see this tendency reflected in messages educational system. Mass media have that emphasize the importance of having become an increasingly important link a correct sense of ' awareness' in the dissemination of knowledge from and 'problem insight'. Working on the experts to lay people. individual's own identity is seen as the key phase in the process leading towards Proto-professionalization has obvious an adequate self-understanding. advantages. It increases the flexibility of professional help and support One thesis of this study is that experts systems. Well-informed lay people, are gaining a stronger hold in post- who are able to articulate their problems modern society. This is done through in a way that corresponds with the entering into new alliances and in new functioning of the system, are more contexts. Expert dominance is no longer likely to receive an appropriate so strongly linked to principles of response from professionals. The professional exclusivity and the staking inclination of the professional helpers is of claims. The strengthened position of likely to increase when they meet the experts is rather to do with a sense clients who are perceived to present of generosity, a desire to disseminate their problems as subjects for profes- models of explanation, judgement sional attention. The lay people feel criteria and therapeutic techniques to affirmed by the experts. The risk of increasingly numerous groups of prac- misunderstandings and subsequent mis- titioners, relatives and those affected by takes in the approach to and treatment the conditions in question, that is, to of the individual is reduced. Simply interested members of the public in stated, flexibility increases through a general. This tendency describes a diminished social distance between the movement towards proto-professionali- expert and the lay person (de Swaan sation. 1988: 245-246).

The tendency towards proto-profes- The matter however has another side. In sionalisation means that lay people to the context of modern society, which is an increasing extent are becoming aimed at separating and remedying orientated towards professional pers- deviancy and that which is undesirable, pectives, concepts and categories. an increasing convergence between the People will increasingly understand and experts and the state is taking place. organise their every day life in Social control, professionalism and accordance with scientific principles. science are all parts of the same project: This also means a gradual adjustment to to highlight the problem of maladjust- ment. When individuals are found to be professional behavioural norms and

96 SJDR - Volume 4, No.2 - 2002 Normality, confession and identity poor, mentally unbalanced, criminal, on mbd/damp and related diagnoses has delinquent or in other ways behaving in been published. They address themselves a socially disturbing manner, society's to groups of professionals who come functionaries intervene with an officially into contact with the problems, to those sanctioned mandate. Authorities are affected and their families, as well as to focused on placing troublesome indi- interested members of the public viduals into categories, designed to (Palmblad 2000). We can speak of a make disciplining and normalizing neuro-psychiatric campaign in the intervention work more effectively. The Swedish daily press in the late nineties, problem formulation and the labelling with an aim of influencing public used by the different disciplines serve opinion in a pro-diagnostic direction. In to meet the power of public authority addition to journalistic and public half way. A rational debate articles, there have been contri- policy, criminal policy etc., needs a butions highlighting the story of the secure knowledge base. Research uses lives of individuals and their families: knowledge about individuals gained by these make up a kind of testimonies of public authorities in the process of children and the parents and their dealing with norm breakers (Borjesson respective situations (Borjesson 1999). 1997). Against the backdrop of this constitutional link between experts and As the diagnostic culture has been society's control structures, the tightening gaining ground, a stream of auto- alliance between experts and lay biographical literature where those persons emerges in new relief. defined as functionally impaired and their families 'come out', has also reached the market. These autobio- Sources and implementation graphies can all be characterized as pro- diagnostic. This literature can be used The medical perspective on deviation is to shed light on the rationalization gaining ground in Sweden, something process mentioned above. In this study, which is evident in the approach to a I want to consider the rather abundant variety of problems in education, for autographical literature concerned with example with regard to children's neuro-psychiatric problems such as reading and writing difficulties (Zetterqvist mbd/damp, adhd, Asperger's and Nelson 2000). This is increasingly the Tourette's Syndromes from the per- case also with regard to problems of spective of a sociology of knowledge. concentration and activity. Swedish To be more specific, this is a public discourse on disturbances of perspective that treats the accounts as concentration and activity is characterised narratives with a specific structure and by uniformity and consensus. In the last content that say something about how decade a number of popularised books they have been socially produced. The

SJDR - Volume 4, No.2 - 2002 97 Eva Palmblad autobiographies represent a bottom-up relate to the professional frameworks of perspective on the problems of con- interpretation, that is, how subjective centration and activity, which are experiences and insights relate to the currently the focus of much attention in objective facts and findings of the our country. experts. I will conclude with a discussion of these autobiographies against a The source material can be divided into background that is in part related to two main categories. One is parent- recent socio-political changes and in biographies written by parents of part to basic cultural features of modern children and young people with society. problems, where they describe their experiences. The other is what I call, The focus of the study is, to summarise for want of a better term, child- how the narrative forms within which biographies, where those personally individual life stories are told are affected by a neuro-psychiatric condition related to professional/scientific frames relate their experiences. Currently this of reference, to the allocation principles topic is dominated by parents' accounts, of the socio- and neo-liberal state, and since the relatively new diagnostics to the centrality of confession in the have thus far been applied mainly to normality efforts of our society. today's children and young people. It is a literature that is characterized sim- ultaneously by closeness and distance. The testimonial characteristics The accounts are personal in style and at times very open and revealing. A The life stories that we will encounter, striking feature is that difficulties and and which concern themselves with problems are described in a factual troubled lives, are characterized by a manner. Not infrequently, forewords or certain stereotyping (for an introduction post-scripts by acknowledged experts in to narrative theory and method as the field are included in the publications. research tools in social science and , see Hyden & Hyden 1997). The intention of this article is to attempt Several studies have analysed how a reconstruction of the conceptual frame- narrators construct their account around work of these autobiographies. A a basic moral plot, including a dramatic comparison between the parents' bio- turning point and also the justification graphies and those of the children with of significant life choices (see Klein- regard to form and content, including mann 1988). When it comes to stories structure, lines of argument, emphasis about illness or functional impairment, and themes, is central. This means the research has shown them to be related seeking to understand with greater to the struggle for acceptance and to the attention to detail how personal experiences finding of a moral justification for the

98 SJDR - Volume 4, No.2 - 2002 Normality, confession and identity condition (Radley 1993; Williams third phase is about meaning and 1984). The life story is a way for the redress (cf. Borjesson 1999). person affected and his or her family to understand what has happened, through The parents invite their readers to gain chronology and causality. In the process insight into how life with a child who is of making sense of their lives, attempts different may turn out, insights that can to create some form of history and a be ruthlessly revealing of the parents basic plot are a part of the authors' themselves, but even more so of their efforts. The writing of each autobiography child. The questions around the norm- has as its purpose the creation of a ality of the child recur with painful consistent life narrative. The separate regularity all through the childhood of parts of a life must hang together, and the son or daughter (Tikkanen 1982: 29, each part should lead to a necessary 42, 62, 71). Moods of guilt, shame, conclusion. The dramatic form, which troubled conscience, doubts, resignation, aids in the chiselling out of individual and anxiety characterize their retro- as well as collective identities, characterizes spection into the chaotic days (Beckman the narratives. It is about shaping one's 1997; 35; Boethius & Rydlund 1998: 39, own life story into a stereotype that is, 41, 89, 148, 177; Gravander & Suominen to a large extent, culturally determined. 1998: 53, 135; Gravander & Widerlov Personal narratives are not only a way 1999: 78; Tikkanen 1982: 51; Widerlov of telling about one's life; they also & Alkehag 1999: 51, 61, 84 ff, 111 ff). represent means by which identities are The time before the turning point is formed. People with similar problems described as "nightmarish" and endured tend to tell similar life stories, where as if in "a shrouded no man's land" the main stay is turning points and life (Boethius & Rydlund 1998: 69. My goals, and where the past is re- translation). It is entirely a matter of interpreted in the light of events that enduring until such time that help have led to change and have been arrives, and it appears in retrospect as decisive for the person's identity "an immense waste of our time" (regarding personal narratives as a way (Gravander & Suominen 1998: 46. My of forming identities, see for example translation). It is a matter of surviving Kohler-Riessman 1993). day to day and, as far as possible, bringing some order into a life lived as Parents' biographies if in an eternal quagmire. The biographical course of events in the parents' biographies can be divided into The climax of the drama is brought three phases. The first phase is chara- about with the giving of a diagnosis. cterized by despair, degradation, and This marks the starting point where a chaos. The second constitutes the climax re-shaping of the identity, in the light of of the drama, the turning point. The the diagnosis, is made with the help of

SJDR - Volume 4, No.2 - 2002 99 Eva Palmblad medical expertise. Sometimes it is a Suominen 1998: 66-67, 68. My matter of confirmation, at last, of a translation). longstanding notion. Let us listen to some parental voices: "For us the day of Sofia's diagnosis was D-day. I have met a considerable "At last the turning point was number of parents of mbd-children in reached!...The younger sister was recent years, and I have not yet met going for her injection against anyone who did not share the same measles at the child health centre. view: that it was with a great sense of This provided the right opportunity. I relief that they received the told the nurse I wanted to see the diagnosis, to know at last." (Tikkanen doctor and was able then to take 1982:85. My translation). some time to describe everything that felt abnormal and worrying about "The year Ebba was born, Fredric's Torbjorn. The doctor asked Torbjorn investigation was at last completed. to walk back and forth in the room. Prior to receiving the diagnosis we Then he said the words of lived in uncertainty. We were deliverance: 'I am no expert, but I confused, did not know which way to can see that this boy has a problem. I turn, and this put a strain on our will refer him to the child habilitation relationship.... When the day of the clinic, where they are good at dealing diagnosis arrived, the whole world with this kind of problem.' This stopped for a moment, and neither statement changed our lives. Credit is the writing nor the exercising were so due to this doctor!...The day Torbjorn important any longer...We had waited was diagnosed was probably the long for this day, and when it finally happiest in our lives...it gave us a came and a few short words were great sense of relief." (Boethius & said, our whole existence changed. It Rydlund 1998: 33, 70, 91. My was such a relief to receive translation). confirmation that there was a problem. To us, the diagnosis was a "I had had enough, yet again. I turning point of great importance." booked an appointment at the (Widerlov & Alkehag 1999: 98, 100. paediatric clinic.After ten minutes My translation). with the doctor, this guardian angel told me that Johan did not suffer The struggle ends with a sense of from a relation disturbance. It was a liberation and a feeling of completeness. biological problem. Bingo!.... This The diagnosis means understanding, was the diagnosis I had been waiting often described in terms of 'seeing the to get for six years." (Gravander & light'. The pieces fall into place. It transpires that there is a concrete and

100 SJDR - Volume 4, No.2 - 2002 Normality, confession and identity tangible reason for the child's difficulties. loved. My child is not bad. I have not The relationship between cause and created these difficulties. My child effect is established. Diagnosis also too wants to know how to behave to means rights, in the sense that the gates get on with others". (Widerlov & to public resources are opened. But Alkehag 1999: 57. My translation). above all the diagnosis means redress. This particular aspect of the meaning of Viewed from this perspective, the use the diagnosis is often expressed in of diagnostics becomes a necessary strongly emotional terms by the tried adjustment to existing conditions of and tested parents. The sense of guilt is society and the prevailing family and relieved when the problems no longer education system. Since our society appear to be due to poor parenting or will not adjust to the children, the problematic family relationships. The children have to adjust to society parents dare at last to believe in their (Tikkanen 1982: 101; Widerlov & own abilities. It is not mummy or daddy Alkehag 1999: 83). who has provoked the problems (Beckman 1997: 149, 203; Boethius & The final chord is however not entirely Rydlund 1998: 42; Tikkanen 1982: 80, one of harmony. The worries about the 85, 89). Sometimes the presence of future of the children are present in the feelings of revenge and even retaliation depictions. The parents' biographies can be discerned (Boethius & Rydlund reveal some (mostly diffuse and 1998: 91; Gravander & Alkehag 1998: unarticulated) doubt over existing 67). Human dignity is reinstated and frameworks of understanding imposed with it the sense of self-confidence and by social norms, a vague awareness of meaning. The parents now feel able to the flip side of diagnostics. Diagnosis openly acknowledge the otherness of means pointing out difficulties and their child, a sense of otherness, which limitations and can thereby cause by way of the intervention of scientific serious crises of identity in the child. expertise has now become legitimised. The factual descriptions by the experts can be perceived as distancing and even As a subtext to a number of passages as offensive. In descriptions such as about adjustment to reality lays the idea "minus variants", the parents, not that human beings are endowed with an unexpectedly, find it difficult to instinct to fit in. Some children lack or recognise their children (Tikkanen suffer a disturbance in regard to this 1982: 130). But in order to get instinct: understanding, help and support from society, the parents require a diagnosis "Children want to fit in with the of their child's difficulties. Diagnosis 'pack', their family and the means focusing on a shortcoming community, and they want to be which in some way needs compensating

SJDR - Volume 4, No.2 - 2002 101 Eva Palmblad for. The parents are driven into painting The first phase of the drama concerns a black picture of their own child. Their the years of judgemental and ignorant guilt feelings return. The predicament treatment from people around them. It of the parents is ambiguous. Their can be relatives, friends and acquaintances contradictory feelings are explicable that become increasingly irritated by against this background. Relief is mixed the child's conduct and pass on with grief. The parents may hesitate to criticism of the parents' ability to give take prescribed routes for dealing with their child a proper upbringing. People their children. At the same time, they believe that the child with the eternal are forced by despair and by a lack of temper tantrums is spoilt, naughty, real alternatives to take these routes. whinging, ungrateful. They notice all the peculiarities of the child, which, in A characteristic feature of the parents' our culture, are associated with the idea accounts is that the events unfold in a of poor parenting. Offensive comments social arena where those present are and conflicts reinforce the parents' divided into friends and enemies. As feelings that they exist light-years away seen earlier, the parents experience from the world of normality, the world proponents of neuro- as their of the chosen (Beckman 1997: 18, 206; main ally in the struggle against the Boethius & Rydlund 1998: 35, 40, 44, unknowing world that surrounds them. 169, 180; Gravander & Suominen The medical profession is viewed not 1998: 56; Gravander & Widerlov 1999: only as representing the latest in 76; Tikkanen 1982: 121; Widerlov & research; its members are also experienced Alkehag 1999: 34, 71, 95, 107-108). as being more understanding towards But it is also about disappointment over the parents, in the sense of being less treatment by staff at the child health moralizing. But who are the enemies? clinic and the attitude from public The drama depicts a battle against authorities. The discontent concerns society's lack of acceptance of their professionals' lack of knowledge as children's conduct and against a well as insensitive procedures. The perceived judgement of their lack of parents react partly against a lack of parental ability. The climax takes place acknowledgement of the problem, and in the encounter with someone who partly against the experience of being understands, who does not judge, and treated with sufferance (Beckman 1997: who assigns the child and the parents 38, 90, 149, 214; Boethius & Rydlund their rightful identities. The chronology 1998:47,187-188). of the account is to a great extent associated with the encounters with The sharpest criticism is directed enemies and friends at the time of need. against the psychiatric services for adolescents. Psychologists, especially those with a psycho-dynamically based

102 SJDR - Volume 4, No.2 - 2002 Normality, confession and identity training, are accused either of trivializing neuro-psychiatric assessments because of the situation or of focusing on the a fear of stigmatising a normal child, is wrong problem. In relation to profess- perceived as an example of a more sionals within the psychiatric services general pedagogic unwillingness to see for adolescents, parents experience the truth about these children's problems themselves being viewed as suspect and (Gravander & Suominen 1998: 86-87). laden with guilt. The autobiographies provide numerous examples of mothers' The division of the world into friends feelings of being questioned by experts and enemies is however not quite as looking for faults in parental ability and uncomplicated as it might first seem. family relations. The discipline of The parents' biographies, which are all psychoanalysis is accused of applying written by mothers, are testimony to the morals to the symptoms of these fact that families can be divided in their children. The longstanding and compact views on the child and its difficulties. dominance of psychoanalysis is con- Fathers can be seen as tending to gloss sidered a significant cause of parents' over the problems, saying the child will feelings of vulnerability and guilt grow out of them with time (Beckman (Boethius & Rydlund 1998: 39, 51, 53, 1997: 53). Sometimes the problem can 60; Gravander & Suominen 1998: 95; lead to deep and prolonged conflicts Widerlov & Alkehag 1999: 81-82, 97). between the parents. A mother describes how the father rejects any definitions The education system too is a target of coached in terms of disturbed function. harsh criticism. Apart from a few In opposition to this view, he underlines teachers who through their own interest the child's originality and independence. have orientated themselves to this area The father's belief in his child's of research, the teaching profession and abilities and his fear of the crushing of teacher training is characterized by a its individuality is vividly described. lack of knowledge and interest in these The counter view of the father contains children's . A lack of under- accusations against the mother: "You standing and a lack of knowledge are have an exaggerated belief in the experts among the most difficult obstacles of the world, he says" (Tikkanen 1982: experienced by the parents when their 73. My translation). And as "Sofia's children start nursery class and school. dad says: All you are doing for your We are here also dealing with the thesis children is dragging them around to about lagging behind, i.e. that the every expert. So that you don't have to teaching profession has not kept up with do anything for them yourself current knowledge (Beckman 1997: 80, (Tikkanen 1982: 76. My translation. 86, 99, 105; Boethius & Rydlund 1998: See also Tikkanen 1998: 23-24, 214- 91,108; Gravander & Suominen 1998: 6, 215). The alliance between the mother 90). Teachers' refusal to participate in and the expert may harbour the obvious

SJDR - Volume 4, No.2 - 2002 103 Eva Palmblad temptation that they, as a step on the as dysfunctional is a process containing way towards obtaining a diagnosis, many obstacles, judging by many collude in 'seeing through" the father, passages in the written accounts. identifying him as an undiagnosed case Children attempt to assert their (for an illustration of this kind of normality, while the adults try to situation, seeTikkanen 1998: 216). imprint the importance of insight into the disability and adjustment to reality. A central theme of the parents' This involves diverting the children from biographies is to do with personal blaming their problems on circumstances insight and adjusting to reality. A or on other people (Beckman 1997: 71, realistic view of the disability among 91, 116, 17, 194; Gravander & Suominen children and parents is seen to be of 1998: 118). The fact that children resist decisive importance for the ability to the idea of abnormality and disability, cope with the functional impairment and show a dislike towards treatment, is (Beckman 1997: 148; Widerlov & not seen as a starting point from which Alkehag 1999: 19). The earlier the to question prevailing models of diagnosis is made, the greater are the understanding. The resistance becomes chances for the child to develop an an obstacle that must be overcome, adequate awareness of his or her gently but with a firm hand, in the disability. A late diagnosis, especially at conquest of a realistic understanding of the sensitive age of puberty, is more self. This is an illustration of the way in difficult to accept (Boethius & Rydlund which the politics of identity operate at 1998: 75). Disability awareness becomes the micro-level. a question of staring the truth in the face, to cease turning a blind eye and glossing The child-biographies over the problems (Beckman 1997: 185). The accounts, which I call the child- Throughout the parents' depictions, biographies, are written by adults understanding is strongly linked to looking back on their own childhood, a diagnosis. Those who do not childhood characterized by strong acknowledge the diagnoses, fail to see experiences of alienation in their lives. the extent of the problems. It is thus only As in the case of the parents, the accounts those who have been initiated who can of their lives are about attempting to correctly understand what the difficulties create meaning and context. The basic entail. plot appears somewhat different in the child-biographies to those of the parents'. One circumstance which is alluded to in The escalating drama of the parents disparate parts of the parents' accounts with its strong focus on a positive is the difficulties the children are turning point, usually in the shape of an having in adjusting to the diagnoses. encounter with neuro-psychiatry, is The children's acceptance of themselves nothing like what one encounters in the

104 SJDR - Volume 4, No.2 - 2002 Normality, confession and identity child's version. In the accounts of the this reversed perspective, is coping with parents, the assumption that an the ever normality-craving surroundings. existence free from disturbed behaviour This problem focus is an explanation of is better for everyone, including the the drama, which does not contain any children, runs as a continuous sub-text. clear phases or clear turning points such The children are assumed to suffer from as is the case with the parents. The not being able to live up to the norms of struggle for permission to be different their friends and the adults around them, but still accepted continues indefinitely; norms that are important if central life there is no final solution. objectives are to be achieved. The authors pinpoint with a strong The child-accounts provide a definition sense of accuracy the attitudes and of the situation that in important aspects dispositions to act that are necessary for deviate from that of the adults' (parents the preservation of our society: and experts'). It is dominated by the submission to authority, the acceptance impression that 'problem children' are of social convention, and contentment young people with a strong sense of with one's place in life. By following integrity and with strong interests of the struggle of children and young their own. Reading the accounts, the people to be respected for their sense of impression is that their suffering is not integrity and individuality, one is made so much caused by an inability to adjust aware of the costs associated with such to the expectations of others and to socialization. Through them, one obtains prevailing norms. Their agonies are a witness account of all the personal instead related to insights about the concessions that are bound up in the deeper social meanings and conse- efforts of the adult world to bring the quences of society's demands and acts, wills and wishes of the young into expectations. harmony with socially accepted goals.

The child-biographies provide central The authors describe how, at an early insights into what it is like to live in a stage, they became aware that ingratiating society where has become a behaviour and obedience reap rewards way of life. The authors are utterly in social life. They see through this aware that the demand for the hypocrisy, which is part of social inter- streamlining of individuals is what course. Their unwillingness to participate prevails in our time. They are also in the sham has led repeatedly to utterly aware of the costs associated tensions and conflicts with others. They with breaking the mould. Having a observe that other people already at an differing way of thinking and being early stage learn to pay to be liked, does not seem to be the largest problem which to them seems impossible to in this context. The main problem, from understand. These children do of course

SJDR - Volume 4, No.2 - 2002 105 Eva Palmblad also want to be loved, but are not "So as not to appear always as the prepared to pay the price. They view 'outsider', I sometimes pretend that the preoccupation with keeping up a I am interested in the conversation front as an expression of a state of of the others. My biggest fear is that imprisonment (Ericsson 1998: 19, 144; the teachers are going to tell my Gerland 1996: 25,166). mum that I am always on my own. During breaks, I hide in the Loneliness can become a shield against corridors, in the toilets, or in the the pressures to conform. Those who bushes. The others say that I am withdraw are however subjected to 'childish', but in reality I am above pressure to learn social intercourse and them, - they with their fashion talk- social competence. The pressure is and am preserving my individuality. strong: As a matter of fact, I am content..." (Schafer 1996: 50-51. My trans- "I did not mind not having contact lation). with others. I could not change things. I just thought it a shame that They know that in the long run, there I had to spend so much time on lurks a danger in trying to be like unimportant things just to survive. everybody else: The worst of it was not that I was on my own (not at all), but that I was "To say things contrary to what I 'persecuted' because of it and believed and experienced, to say threatened with being taken to the things 'the way it wasn't', often psychiatrist. During my youth things became saying what the adults became even worse...I was so afraid wanted to hear. The older I got, the of people...and of them sending me better I became at this technique. away to make me become social: But not even when I thought I knew This was the only reason for my what a lie was, did I think that I lied attempting to 'be with' people my when I said it 'the way it wasn't'. I own age at all". (Schafer 1996: 45. did not lie, I tried to survive. Force My translation). majeur...when it can no longer be counted as a lie. ...But with time [the Even strong personalities are sometimes technique] made me lose contact driven, as a matter of survival, to resort with my sense of identity. I had in to lies and distortions. The solution is to the end said something 'the way it become a friend for the moment. This wasn't' so many times that I began brings immediate rewards in the form to forget how it really was. I of acceptance by others. believed in what I had said, but was left with a diffuse feeling that there was something that was not quite

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right". (Gerland 1996: 53. My subjects despite her having had no real translation). learning difficulties (Gerland 1996: 126). The accounts intimate that the much The ambivalence towards the normal talked about concentration difficulties and world is markedly noticeable. There is problems of hyperactivity disappear as no lack of expression for longing to soon as the assignments become belong to the normal crowd. A stimulating and interesting. Monotony counteracting force is the insight that and a sense of meaninglessness lead adjustment demands concessions. To immediately to the reappearance of the "be a whole movement of resistance in problems (Gerland 1996: 122-123; one single body" costs, but also yields a Schafer 1996: 39). One of the authors, very obvious sense of identity and of who later came to choose a career in independence (Gerland 1996: 83, 161, teaching, delivers the sharpest criticism 211). It might even result in an of the education system. Returning to experience that one (unlike other the world of education after thirty years people, often feeble in their need to be he discovers that much is what it was: loved by all) actually enjoys a greater sense of freedom. The lack of "The only noticeable change sensitivity towards social conventions compared with...earlier was that the can thus be seen as an asset (Gerland pupils were allowed to call the 1996: 245; Schafer 1996: 87). "I do not teachers by their first name and did want to be misunderstood, but the more not have to stand up when I think about it, the more unsure I speaking....I found that many pupils become about wanting to be like the were unhappy, especially boys. For normal at all" (Schafer 1996: 96. My me, it was not at all surprising that translation). The thesis about a natural boys with a strong need for activity instinct in the child to fit in thus has had difficulties with falling in with scant evidence in the child-biographies. the expectations of a single gendered existence dominated by women, To the extent that we can talk of a where stillness, lack of imagination, turning point in the child-biographies, it adjustment and industriousness were is a negative one, and has to do with rewarded, and where needs for reaching school age. The encounter diametrically opposite modes of with the educational system is a shock, behaviour were denied.... I experienced and the time spent in school is a trial to Backskolan [school] as an isolated these children. The retrospective criticism island in society and that the aim of is difficult. What was offered in school this swat-school, far from the was "completely uninteresting", writes intentions expressed by Government, one of the authors. This was the back- was to create uncritical, easily-led ground to her falling behind in academic citizens lacking in imagination....

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The difference between me and my professional problem definitions are pupil copies was that the latter had experienced as providing a certain not learnt to find strategies for sense of relief, notwithstanding the hiding their concerns as successfully determinism embedded in them. One as I had" (Ericsson 1998:167, 169. author has found "a certain comfort in My translation). the thought that it is my determination to be alone" (Schafer 1996: 91. My But the compulsion to conform is not translation). only represented by the educational staff. Pressure from peers is at least as strong. The meeting with the expert in the form There are scarcely any romanticized of neuro-psychiatry does however not pictures of children and childhood that appear as salvation. The children are of emerge in the accounts of these lives. course considerably more seasoned Young people soon learn to notice if through their first hand experiences. someone is different (Schafer 1996: 87). They display more of a wait-and-see Children quickly identify anyone who approach towards the definitions of deviates: "children seem to smell this science. As we have already seen, the long before adults do" (Gerland 1996: 75; central symptoms 'problems of concen- see also p.90. My translation). It is in tration and activity', acquire a new school that awareness of otherness is meaning when they have been filtered really established; experiences of through the experiences of the children mobbing are not unusual (Gerland 1996: themselves. The same applies to the 91, 116). The saviour of the child's self- symptom 'lack of empathy' or confidence may lie in the development of 'empathy disturbance', which appears talents for comedy or sports (Ericsson quite indigestible (Schafer 1996: 82). 1998:18-19,31). This symptom, which is the main one among the 'acronym diagnoses', can The child-biographies contain descriptions actually be questioned from the of meetings with experts and their standpoint of the child-biographies. The problem definitions. In the worst cases, accounts bear witness to their authors' these meetings lead to disappointment, social commitment and their strong be it with psychotherapists (Gerland feeling for vulnerable people both at 1996: 204 ff) or doctors (Ericsson 1998: home and around the world. They are 20 ff). At best, children have met a upset about social injustice. One has to person who is non-judgemental of their ask whether the symptom is not personal characteristics. The neuro- primarily referring to the feeling for psychiatric perspectives and cate- social convention rather than to gorizations also make identification empathy in its deeper moral meaning. possible for the children (Gerland 1996: 234 ff.; Schafer 1996: 74 f, 89ff). The

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The authors are generally more guarded the larger heterogeneous group in order when it comes to their belief in the to have a chance to get it. They require experts' ability to solve their problems. quiet periods to work, and when they They, unlike the parents, do not make a feel the need for such, they should be link between understanding and able to go away at their own initiative diagnostics. From the accounts, it is (Ericsson 1998: 189). The pedagogic clear that the best encounters of their arguments are based on a more lives have been with people who have fundamental ideological position: never heard of the diagnosis (for example, see Schafer 1996: 111). For "I knew that the trouble-makers those affected, acceptance and tolerance were included as part of this context, are not bound up with the acknowledge- a part which could be not be ment of a particular professional pers- separated off without losing the pective. It has to do with human permissive mood. [The trouble- qualities. It is not necessary to belong to makers'] problems were part and the initiated to be able to understand. parcel of everyday life. In the same Ordinary human decency goes a long way as were those of immigrants, way. intellectually-disabled people, homo- sexuals, drug and alcohol abusers, The trend of latter years towards and mentally ill people." (Ericsson individual solutions is, as a rule, wel- 1998: 191. My translation). comed by the parents, and is contrary to official educational policy, which has There is considerable agreement between proposed integration of all disabled the parents' problem descriptions and children, including trouble-makers. The those of the neuro-psychiatrists. At a trend is challenged by one of the superficial level, their models of authors, who himself has chosen understanding are in harmony with and education as his profession. The support one another. The parents adopt possibility of varying the size of apparently willingly the latest scientific teaching groups is all well and good, perspectives on the problems. They but this must apply to all children and develop into experts themselves con- be based on freedom of choice. The cerning their children's diagnoses. type of solution that consists of Those diagnosed have themselves a organising small groups for specially considerably more complex relationship selected problem clients a permanent to current problem definitions. One can arrangement is forcefully rejected. also find here a tendency in the Children lose their creativity in a small individuals to becoming their own group. Being in a small separate group expert, albeit a somewhat toned-down may be good, for all children. But they version. They describe their situation need stimulation and, therefore, need less in clinical terms. The absence of

SJDR - Volume 4, No.2 - 2002 109 Eva Palmblad unanimity between parents on the one light of changes on the socio-political hand, and the diagnosis carriers' arena. Across traditional party lines all perceptions of the problems on the over the Western World, there has been other hand, cannot be ignored. The considerable agreement over the critique dissonance sheds new light on the client of the way in which the welfare states perspective. It demands that one raises have developed. The exercise of the question as to who emerges as the paternalism and power has been part of representative articulator of the difficu- the picture of the welfare state, and has lties. We need to ask ourselves, when been linked with the much-maligned facing the claim of representativeness, ambitions of social engineering. The whose voice it really is that we are efforts of the welfare state to arrange hearing. The task of representing others, the lives of the population for them, it even if it is near and dear ones, is not has been claimed, have caused collectivism, without its problems. a learnt sense of helplessness, and addiction to a sense of security in its There are however certain common citizens. features in the biographies, whether written by children or parents, that In clear rejection of the traditions of the warrant attention. Individuals re-define, welfare state, self-administration is to a varying degree, their difficulties in launched as a life-affirming and liberating terms borrowed from the professional alternative. The state will no longer, apparatus of knowledge. Through inter- according to the same set of conditions, nalising the professionals' perspective define people's needs for them. The they rationalize their predicament. But, new citizen will no longer be obliged to it is striking how, behind the profes- follow religious or moral directives sionally inspired conceptual models, regulating their lives in detail. A central entirely different frameworks for inter- idea is that the individual can learn to pretation are concealed. These have control and administer his or her own origins that are moral, existential, and existence. There is today a clear what could best be described as of political ambition to encourage the religious. The accounts are at times ability of private individuals to in- steeped in themes such as truth, false- creasingly take responsibility for their hood, guilt, shame, trial, redress and own welfare. We can see traces of this reconciliation. policy of individualisation in a number of areas, for example social care, labour market policy, education, the criminal Social policy in advanced liberalism justice system, and also in the field of disability. In the backwash of this Let us consider the expanding genre of socio-political change, a whole new autobiographies of troubled lives in the flora of terms has developed to become

no SJDR - Volume 4, No.2 - 2002 Normality, confession and identity somewhat the buzzwords of the day. But the flora of autobiographies can be Along with self-administration, we understood in more pessimistic terms: have terms such as self-governance, as a response to the attacks on the empowerment, self-determination, personal welfare state and its consequences in responsibility, involvement, influence the form of the dismantling of the and self-actualisation. Citizens are now welfare systems in recent decades. The expected to identify and describe their role earlier taken by the state in own needs. Authorities and experts will advocating for the rights of the resume a listening position and respond underprivileged has gradually been to the wishes of individuals. They will relinquished. Those described as the no longer force their rounds on the weak in society must now, collectively citizenry, but help them taking charge and individually, seek to make their of their own lives. voices heard themselves. In an arena that is constantly threatened by shrinking From this perspective, the autobio- financial resources, the 'weak' are graphies can be seen as one of a range jostling for attention and resources, a of evidences that people have started to struggle with a splintering effect on the lift themselves out of the status of user movement and its members. incompetents. The personal life accounts are confirmation of liberation from the In order to draw attention to an good will and the terms of under- unsatisfactory state of affairs and to standing set by the political establish- give their claim legitimacy and get the ment, the authorities, and the experts. problems onto institutional agendas, People now take their lives into their those affected by the conditions here own hands. Gone are the days when a discussed require the support of disabled person or their relatives resourceful networks. Scientific experts lingered in dark secret rooms. Now they have long been important allies in this appear openly, working to further their context. The question is whether this cause in front of politicians, authorities, dependency on experts can be said to and the public. Citizens empower have diminished over time with regard themselves to define their own needs to the problems of childcare and the and formulate themselves on their own upbringing of children. It could rather conditions. What we see is simply the be said that we are witnessing a further sign of a newly won freedom and step in a long historical process, where strength. Onto the socio-political stage one form of expertise is being tread the empowered citizens. The succeeded by another, and an old set of autobiographies thereby become a labels is being replaced by a new one. symbol or 'self-governance as promise'. But the basic situation remains the same: the deviant (and in the case of children, even the parents) must acquire

SJDR - Volume 4, No. 2 - 2002 111 Eva Palmblad and adequate grasp of the problems. nowadays also to the demands of the They must subject themselves to the media market. The efforts to keep gaze of the professionals. And this is attention focused on the bad conditions not all: they must learn to see them- drive individuals to join in and support selves through the eyes of the profes- the established problem definition, sionals. The experts are the ones who which takes on the character of a can explain the problems, interpret the collective representation. As such it symptoms, and provide the remedy. will interpret and deeply influence the The process means that the person with perception of individuals of themselves the condition must first be made to and the world around them. alienate him/herself from his/her own suffering. Then he or she must let the Through the autobiographical genre, we suffering be filtered through the face not only a new sense of fearlessness, expertise of the professionals. Finally but also the sort of misery involved in the individual must incorporate the having no one else except oneself to turn suffering (in its new professional cloak) to. In order to be seen at all, people are into his or her own personality. In this driven to view themselves through the way an insightful and socially competent eyes of others, not their own. The concept client with a rationalized, pragmatic, of self-power is often used as though it and optimistic approach to his/her had one single meaning. But, as pointed problems is created (Rose 1994). out by one researcher, it has not yet been agreed whether empowerment is a It is also necessary to meet the demands measure of surrender and dependency, or of the media world. The characteristic whether it is a question of increasing media view of the world is very focused independency and autonomy (Cruikshank on the individual, and favours personal 1999). Identity becoming dependent on testimony, but not in just any form. the views of others (those of the world Individuals are expected to put on of medicine and the media above all) is display the most private aspects of their an indication of subordination, a sub- personality, preferably with the spotlight ordination in which the individual him directed upon their darkest secrets, all or herself participates. The voices and done in the name of honesty. Mass eyes of others have become internalised media have appeared as particularly in the personality of the individual. powerful in recent times. With the help of influential actors, those affected get The representation of the problem, the their problems transformed into a illness, the disability etc., now jointly specific problem identification. This is portrayed by neuro-psychiatric expertise done not only with regard to the wishes and parents' organisations, and presented of those in need, but also with regard to in the public arena, is not a separate the demands of the experts, and part of the individual's self. It is not a

112 SJDR - Volume 4, No.2 - 2002 Normality, confession and identity matter of momentarily being able to and writing. Diagnoses have become a enter and exit conditions or states. The prerequisite for access to special help view of the problem will, on the and support. contrary, merge with the individual as a whole. This will become the grid Through the use of diagnoses, individuals through which the whole identity will are separated out from those considered be experienced and understood. This normal and brought together in a really is the deeper meaning of the talk special group. As a group, they are of confessing, accepting, and learning to characterized by problematic conditions handle one's problems. The trend is and features, and are seen as needing remarkable, if seen against the back- treatment in order to achieve normali- ground of many client and family zation and adjustment. Individuals who do organisations' struggle through the not acknowledge their diagnoses, i.e. decades, asking members of the public those who do not acknowledge the see 'the individuals behind the clinically identified problem, become diagnoses'. It is a struggle for relief from problematic. Should they offer alternative being forever viewed in the light of an definitions, they become doubly illness or disability. difficult. Acknowledgement is thus central to the aims of the politics of The social and welfare state has ever identity. since its birth been dependent on client categorization, which is the basic In cases where benefits from the prerequisite for being able to provide welfare state are means-tested, clients help and support for citizens. Each will be subject to regular scrutiny to recipient of benefits from the state has check that they actually are eligible for to relate in some way to these support. In some cases, professional categorizations. In our society these experts become involved with a view to categorizations have primarily had a reforming behaviour, possibly sim- medically defined basis. Authorities ultaneously with providing benefits. depend on some sort of assessment in The client must reform his or her order to distinguish between eligible behaviour in order to qualify for help and ineligible recipients. The medical and support from society, and pre- profession has in this context been ferably change self-perceptions as well. given a central role as the gatekeeper of The citizen's acceptance of being the welfare system. The diagnosis is the categorized according to prevailing key to society's support in many areas. welfare arrangements is the minimum This can be seen very clearly regarding expected of him or her. In our culture children with educational problems, the usual route is via submission to whether it is concentration and activity diagnostics. A diagnosis means that a problems, or difficulties with reading fault has been identified, a deficit that

SJDR - Volume 4, No.2 - 2002 113 Eva Palmblad as far as possible must be corrected. The culture of confession According to diagnostic thinking, corre- ction is a key aspect. The child biographies highlight a culture which celebrates tolerance and The idea of self-help in our era of neo- solidarity rhetorically, but which in liberalism has increasingly gained actuality rewards greed, cynicism, ground. The individual is to be made to ingratiating behaviour, submission, work in a desirable direction, naturally contempt for vulnerability, and lack of with the help of specially authorized independent thought. The child bio- persons. A prerequisite for the successful graphies tell us that the rewards process of correction is that the awaiting those who conform are clear; individual internalises the picture of so too are the costs borne by those who him or herself as inadequate in one do not comply. Out of this feeling of sense or other. In other words, the being split, a yearning to be revealed, to citizen must accept clienthood. But not be found out at last, gains nourishment. passively. In this age of self-admini- Similarly, from the same conditions stration, an active, sensible, and coop- originates the hunger in society for erative client is required. The person confessions. This yearning and this must be educated into the role of hunger are not universal; they are competent client. This is where the new socially constructed phenomena. responsive expert enters the frame. What is being ignored in the staging of The confession genre, to which this supposedly new historical figure is especially the parents' biographies are the following: Notwithstanding the linked through both form and content, good intentions of those who seek to can be viewed from a considerably stimulate and support the citizens to longer historical perspective. We in the empowerment, the empowerment re- West have long had a culture of lation is 'in itself' a power relationship. confession. With its demand for absolute The starting point is that a citizen has truth, our society brings forth hypocrisy been identified as vulnerable and in and lies as well as confessions. The need of some intervention. confession is central to society's normality efforts, and has been ever What one can observe is that the neuro- since the days of the Inquisition. In the psychiatric perspective clearly meets past it was the men of the church who adult citizens' needs. All the attention is administered the confessions; today the on the child. Applying diagnostics and task has been taken over by scientifically changing individuals into clients keep trained experts. the institutions of society (the edu- cational system, the family institution) At the most general level, the safe from critical scrutiny. confession is a link between the private

114 SJDR - Volume 4, No.2 - 2002 Normality, confession and identity conscience and the social order. It is of blame as a result of one and the same this link function that is the cause of the act. This double bind is the explanation ambivalent feelings associated with of the deep ambivalence, which chara- confessions: on the one hand, the cterizes the parents' biographical material. experience of freedom, spontaneity and Not unexpectedly, the admissions carry truth, and on the other, duty, com- mixed feelings in tow, where a sense of pulsion and mistake. The confession joy is mixed with bereavement, and makes possible the healing of a wound faith is mixed with suspicion. On closer that has emerged through individual inspection, it transpires that the redress breaches of the moral regime. The offered comes with reservations. The confession opens up the road to the guilt-relief is offered on condition that individual's re-admission into the social parents as well as the children display a community. This happens along two willingness to show responsibility and a routes. The confession is part of a realistic attitude towards their situations. process of authenticating the self, through which individual suffering The modern society has, in order to deal helps the person to claim his or her with problematic citizens, constructed a worth as a human being, despite whole system of professional helpers, shortcomings. The confession is at the who at all hours of the day and night same time a confirmation of the values, provide paid help. The authorities of norms and assumptions of society our time do not demand obedience and (Hepworth & Turner 1982). compliance; this has largely become a politically impossible strategy. Today's Confessions are nowadays a common authority has to take on the role of feature of the social relationships of our helper, sympathizer, and friend. It is an culture. They are ubiquitous. They are authority that can no longer rest on old embedded in the routine processes of laurels. The authority has to be re- the welfare bureaucracy. But they are created continuously, now in close also brought forth outside of the interaction with 'the vulnerable'. Those bureaucratic apparatus, emerging all by in authority, as has been observed by a themselves, as it were. Personal testi- critical examiner, have only trust at mony in the form of an autobiography their disposal in their construction is approaching the ideal confession: it is work, a trust that originates in a voluntary, spontaneous, and altruistic. yearning for trust and hope in those The confession generally contains a who seek help. Theirs is a need for trust double-bind situation. Through confession, and hope in the ability of others to resolution is possible. But the confession handle and control the situation, which also means an acknowledgement of the is born out of the shortcomings and individual's responsibility. We are failures in themselves. The amount of given relief from guilt and apportioning confidence invested by those seeking

SJDR - Volume 4, No. 2 - 2002 115 Eva Palmblad help is final proof that the models of the psychologists, the criminologists, explanation are correct and that the task the sociologists) are not Gods, and not has been carried out successfully even faith healers. Nor are they (Bauman 1992: 24If). The personal charlatans. What is being offered with testimonies bear witness to loneliness the scientific perspectives and the labels and despair, and to the awareness of the can be compared to the offerings of the impossibility of a cure. Through the astrologists and their horoscopes: the reversed perspective of the child bio- comfort of accounting for some graphies, normality and the costs inexplicable aspects of life. associated with conformism are challenged. The only understanding and pardon that is given, is associated with Acknowledgements submission to the specialist experts and The study has been possible thanks to generous projects grant from Stiftelsen Riksbakkens their dissections. Jubileumsfond, dnr 1998-296.

We probably get closer to the truth observing that, if one is looking for References support for a particular view by the use of experts, there will always be Sources someone to call on. This is the case Beckman, Vanna (1997), Projektet att leva med damp, dyslexi och Aspergber syndrom (The independently of how a particular case project living with damp, dyslexia and has been formulated. This is the look of Asperger 's syndrome). Stockholm, Cura. the professional care expert in our time: Boethius, Gunilla & Christina Rydlund (1998), specialised, pared down, strictly delimited Lycklig varannan onsdag: damp-mammor berättar (Happy every other Wednesday: with regard to competency, and with a damp-mothers tell). Stockholm, Cura. strongly focused perspective. And the Ericsson, Ulrik (1998), Vild källa: Om Tourette focus is on classifications rather than on (Wild source: about Tourette). Stockholm. providing care. In the eyes of both Gerland, Gunilla (1996), En riktig människa (A medical science and the public in real human being). Stockholm, Cura. Gravander, Åsa & Sauli Suominen (1998), En general, diagnostics is the great chal- 'riktig Emil': En mamma till ett barn med lenger in society, that which will solve damp/mbd berättar (A 'proper Emil': a all problems. The idea of caring for mother of a child with damp/mbd tells). people and the associated difficulties Sävedalen, Säve Förlag. Gravander, Åsa & Malin Widerlöv (1999), Att tend essentially to be neglected. Instead, handskas med livet (To cope with life). trust is being placed in the old remedy Västra Frölunda, Gravander & Widerlöv. for problematic children in our society: Schäfer, Susanne (1966), Stjärnor, linser och more socialization, supplemented with äpplen: Att leva med autism (Stars, lenses medication in the particularly difficult and apples: living with autism). Stockholm, Cura. cases. These are not new ideas. But the Tikkanen, Märta (1982/1998), Sofias egen bok: scientific experts (the medical profession, En bok om mbd-barn (Sofia's own book: a

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book about mbd-children). Stockholm, Kohler-Riessman, Catherine (1993), Narrative Trevi/Forum. analysis. Newbury Park, Sage. Tikkanen, Märta (1998), Sofia viaen med sitt Palmblad, Eva (2000), "Diagnostics and mbd (Sofia adult with her mbd). Stockholm, ideology", Scandinavian journal of disability Trevi/Forum. research. Issue 1. Widerlöv, Malin & Eva Alkehag (1999), Alt Rose, Nikolas (1994), "Expertise and the handskas med 'skitungar': Vardags- government of conduct". Studies in law, pedagogik för barn med neuropsykiatriska politics and society 14; 359-397. fiinktionsnedsättningar och Bruksanvisning Swaan, Abram de (1988), In care of the state: sökes...av en mamma till en pojke med adhd health care, education and welfare in och Tourette syndrom (Handling 'little Europe and in the United States in the devils': Every day teaching for children with modern era. Cambridge, Polity. psycho-neurological impairment of function, Zetterqvist Nelson, Karin (2000), På tal om and instructions sought...by a mother of a dylexi: En Studie av hur barn, förädrar icg boy with adhd and Tourette's syndrome). lärare berättar om och ger betydelse åt Karlstad, Gravander & Widerlöv Förlag. diagnoser som dyslexi och specifika läs- och skrivsvärigheter (Speaking of dyslexia: A Other References study of how children, parents and teachers Bauman, Zygmunt (1992), Döden och talk about abd give meaning to diagnoses odödligheten i det moderna samhället like dyslexia and specific reading and (Mortality, immortality and other life writing difficulties). Linköping, Linköping strategies). Göteborg, Daidalos. Studies in Arts and Science 209. Börjesson, Mats (1997), "Klienter och klientel: Om sociala kartläggningar", Kulturella perspektiv 6; 3: 30-39. ("Clients and Client The Author: Eva Palmblad is Associate Groups: About Social Maps", Cultural Professor in Sociology and teaches at the perspectives 6; 3: 30-39). University College of Health Sciences, Börjesson, Mats, (1999), "A newspaper campain Jönköping, Sweden. She has published tells: the launch of Nevro-Psychiatric several books at the intersection of medical Diagnoses in the Swedish Daily Press", sociology and sociology of knowledge. Scandinavian journal of disability research. Issue 2. E-mail: [email protected] Cruikshank, Barbara (1999) The will to empower: Democratic citizens and other subjects. Ithaka & London, Cornell Address: University Press. Eva Palmblad Hepworth, Mike & Bryan S. Turner (1982), University College of Health Sciences Confession: Studies in and Box 1026 religion. London, Routledge & Kegan Paul. S-551 11 Jönkjöping Hydén, Lars-Christer & Margareta Hydén Sverige (1997). Att studera berättelser: Samhällsvetenskapliga och medicinska perspektiv (Studying narratives: Perspectives in social science and medicine). Stockholm, Liber. Kleinman, Arthur (1988), The illness narratives: Suffering, healing and the human condition. New York, Basic Books.

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