University of Warwick institutional repository: http://go.warwick.ac.uk/wrap A Thesis Submitted for the Degree of PhD at the University of Warwick http://go.warwick.ac.uk/wrap/34623 This thesis is made available online and is protected by original copyright. Please scroll down to view the document itself. Please refer to the repository record for this item for information to help you to cite it. Our policy information is available from the repository home page. Health Concepts and Illness Behaviour: the rage of same Pathan 14others in Britain. Caroline Mary Currer. Thesis subraitted for the Degree of Doctor of Philosopay. University of iliarwick Department of Sociol)gy. Mar-n 1986. Table of Contents. List of Tables. Acknowledgements. Declaration. Summary. Note concerning foreign words. XV Chapter One. Introduction: 1 1. The Scope and Contribution of this Work. 1 2. Background to the Study. 9 3. Theoretical Perspectives and Assumptions. 11 A. The Nature of Concepts. 12 B. Lay or Medical Concepts. 14 C. Health Care Encounters: An Interactive Perspective. 16 4. Analytic Framework. 20 5. Definitions. 25 A. Concepts. 25 B. Culture, Ideology, Social Structure. 26 i) Culture. 29 ii) Ideology. 30 iii) Social Structure. 30 C. Ethnicity. 32 D. Mental Illness. 32 6. Layout. 32 PART I. RESEARCH AND SOCIAL PROCESS: ISSUES OF METHODOLOGY. 34 Chapter Two. Drawing up the Research Project. 41 1. Identifying the Research Problems. 41 2. Towards a Research Strategy. 44 3. Research Techniques and Instruments. 46 4. The Ordering of the Work. 49 Chapter Three. Entering the Field. 51 1. Discussions with Health Care Practitioners and Research Colleagues. 52 2. The Recruitment of a Research Assistant. 55 3. The Population under Study. 58 4. Translation. 61 Chapter Four. Issues and Revisions. 66 1. Same Unresolved Issues. 66 2. Sampling. 66 3. The Concept of 'Piloting'. 67 4. Initial Contacts. 68 5. Issues that Emerged and their Effects. 69 A. The Consequences of relationships. 69 B. The Issue of Permission. 70 C. The Tape Recording of Material. 73 6. Revision of Research Strategy and Instruments. 74 A. The Issue of Group Discussions: Focus and Additional Respondents. 74 B. Revised Research Instruments and Recording Systems. 75 Chapter Five. The Interviews. 77 1. The Women Included. 77 2. Length of Contacts. 79 3. Ongoing Issues of Relationship and Permission. 81 4. Termination. 82 Chapter Six. The Methodological Issues Reviewed. 84 1. The Overall Definition of the Encounter. 85 2. Language and Concepts. 87 3. The Meaning of the Encounter: the'game which we play' or Meaningful Relationships? 89 4. Individualism in Research. 91 5. What is Learned from this Study? 94 PART II. SOCIAL SITUATION AND INTERACTION. 97 Chapter Seven. Pathan Culture Ideology and Overall Social Structure. 102 1. The Honourable Pursuit of Public Affairs. 104 2. The Honourable Use of Material Goods and Hospitality. 105 3. The Honourable Organisation of Domestic Life: the Seclusion of Wbmen. 108 Chapter Eight. The Social Context of Respondents Lives: the Women in Public Domain Terms. 114 1. The Women themselves. 114 2. Their Family of Origin. 116 3. The Families' Status in Britain. 117 A. Employment. 120 B. Housing. 121 C. Standard of Living. 121 Chapter Nine. Patterns of Social Interaction within the Home and Outside. 123 1. The Division of Labour within Households. 123 2. The Women's Social Networks. 126 3. Discussion: Uniformity fram Without; Differences Within. 132 Chapter Ten. Factors Influencing Interaction and Purdah Observance. 134 1. Concepts of Purdah or of Wbaanly Behaviour. 135 A. The Women's own Dress and Demeanour. 135 B. The Sexual Division of Labour. 136 C. MOvement outside the Home. 138 2. Factors Influencing Concepts. 139 A. Sub-Cultural Variations. 1_4(1 B. Differences of Formal Status. 140 C. The Husband's Views. 142 D. Religious Identification. 142 3. Options: Circumstantial Factors Influencing Social Behaviours. 144 . A. Arrangement and Location of Houses. 144 B. Migration and Membership of a Minority Ethnic Group. 144 4. Discussion: A Massing Factor? 148 Chapter Eleven. Interests. 149 1. The Maintenance of Social Relations. 150 2. The Receipt of Health Care. 153 3. Learning English. 154 4. Purdah Observance in Context: A Positive View. 157 Chapter Twelve. Work, Seclusion and Isolation. 160 1. The Women's Work. 160 2. Seclusion and Isolation. 164 3. Conclusions. 168 PART III. THE WOMEN AS MOTHERS. 170 Chapter Thirteen. Conception and Contraception. 175 1. Overall Ideology Concerning Child Bearing. 175 2. Concepts of Contraception: Process and Change. 175 3. Contraceptive Options. 178 4. Interests. 180 5. Discussion. 182 Chapter Fourteen. Pregnancy and Antenatal Care. 185 1. Behaviour during Pregnancy. 185 A. Awareness, announcement and discussion of pregnancy. 185 B. Preparations for the New Baby. 187 C. Eating and General Activity. 188 D. Attendance at Antenatal Clinic. 190 2. Discussion. 192 Chapter Fifteen. Experiences of Childbirth. 196 1. The Effect of Past Experiences on Concepts and Interests. 196 2. Recent Birth Experiences in Bradford. 199 A. Anaesthesia. 200 B. Communication and Attention. 200 C. Food. 201 D. Company and Visitors. 201 3. Back to the Domestic Domain. 202 4. Discussion. 205 Chapter Sixteen. On Being a Pathan Mother in Britain. 208 1. Overall Determinants. 209 2. An Extended Sense of Mothering: Informal Placement of Children with other Family Members. 210 3. The Practicalities of Mothering. 212 4. Mutual Support in Respect of Mothering. 214 5. Discussion. 216 Chapter Seventeen. Child-Rearing Practices. 219 1. Infant Feeding. 220 A. Breast feeding. 220 B. Bottle feeding and Weaning. 223 2. Sleep times of Children. 224 3. Nappies and Toilet Training. 226 4. Developmental Play. 226 5. Milestones, Behaviour, Schooling and Aspirations. 229 6. Discussion. 233 Chapter Eighteen. Mothering: Medicalisation, Migration and Mental State. 239 1. Concepts. 240 2. The Issue of Medicalisation. 240 3. Migration. 242 4. Mental State. 243 5. Interactions with Health Workers. 244 PART IV. GENERAL AND MENTAL ILLNESS: DEFINITIONS OF NORMALITY AND OF APPROPRIATE BEHAVIOUR. 246 Chapter Nineteen. The Literature Concerning Concepts of Health and Illness: some Major Themes and Questions. 249 1. Disease, Health and Illness. 250 2. Illness and Normality. 252 3. The Distinction Between Medical and Lay Concepts. 253 4. Factors Influencing Popular/Lay Concepts. 256 5. Different Medical Perspectives: the Case of Transcultural Psychiatry. 258 6. Questions of Causality. 262 Chapter Twenty. General Illness: Treatment Options. 267 1. The General Practitioner. 268 2. The Child Health Clinic. 272 3. The Health Visitor. 274 4. Hospital Services. 277 5. Religious and other 'folk' healers. 278 6. Illnesses for which treatment was not sought, or where Options were Ineffective. 281 7. Womens' Perceptions of Health Workers. 283 Chapter Twenty-One. Concepts of Health and Illness. 286 1. Disease, Health and Illness. 286 2. Illness and Normality. 287 3. The Distinction Between Medical and Lay Concepts. 288 4. Factors Influencing the Women's Concepts. 292 5. Different Medical Perspectives. 296 6. Questions of Causality. 296 Chapter Twenty-Two. Assessments of Mental State. 300 1. The Bases of Assessment: Medical and Lay EMs. 300 2. Results of Assessment. 305 A. The Existence of Illness/Disease. 305 i) The Women's Self-Assessments. 305 ii) The Research Workers' Assessments. 306 iii) The Test Scores. 307 B. Causative Factors. 309 i) Isolation. 309 ii) The Accounts of the Sufferers Themselves. 311 Peer Views of Causation. 312 iv) An Outside View. 313 C. Desire for Treatment. 315 vii 3. Discussion of the Test Items: the Translation of Meaning. 316 A. Items and Concepts that were Difficult to Translate or were Queried. 317 B. Points of Similarity and Difference Between Pathan and Psychiatric Views. 322 C. Can we Use Such Measures Cross-Culturally? 325 Chapter TWenty-Three. Concepts of Mental Well - and Ill-Being. 330 1. Disease, Health and Illness. 330 2. Illness and Normality. 335 3. Factors Influencing the Wbmens' Concepts. 338 4. Questions of Causality and the Issue of Somatisation. 339 Chapter TWenty-Four. Common Themes in Relation to Physical and Mental Disorder. 343 1. Concepts of Pathan Respondents. 344 2. Options. 346 3. Interests. 347 4. The Importance of Social Relations. 348 5. Normality. 350 6. A Relative View of Physical and Mental Ill-Being. 351 Chapter Twenty-Five. Overall Conclusions. 352 1. The Initial Questions Relating to Practice. 355 2. Collective Influences on Individual Experience and Behaviour. 358 3. Theoretical Conclusions. 365 A. The Nature of Concepts. 365 B. The Framework. 366 C. my Aims and Theoretical Perspective. 367 viii Bibliography. 310 Glossary. 3ci1 1. Terms of Central Importance. 391 2. Places. 393 3. Languages. 311f- 4. Other Words and Phrases Used in the Text. Appendices. A. Statement of my own Assumptions and Values. Al —Pig B. Research Assistant: Job Description and Criteria for Selection. Bl-g3 C. The Psychiatric Test Scales and Translations Cl D. Interview Guidelines and Recording Sheets. D1-1.32. List of Tables. (i) Number of Visits and Duration of Contacts. 79a (ii) Public Domain Social Facts - the women. 114a,114. (iii) Public Domain Social Facts - husbands' employment, housing. 122a (iv) Nature of Household and Division of Labour. 126a (v) Women's Patterns of Interaction and Purdah Observance. 127a)121b- (vi) Contraceptive Practices and Views. 182aIsib. (vii) Live Births in England and in Pakistan. 196a (viii) Women's Experiences During Delivery and Hospital Stay. 199a1 I9TD, 199c-• (ix) Numbers of Children Currently in each Mother's Care, with Ages. Other Children Elsewhere, and Experience of Childrearing in Pakistan. 209a (x) Mutual Support in Respect of Mothering. 214a (xi) Breast Feeding. 220a (xii) Sleep times of Children. 224a1ZZ1. (xiii) Use of N.H.S. Services. 268a (xiv) The Use of Alternative Facilities in Sickness. 278a (xv) Long standing Health Complaints. 282a (xvi) Assessment of Mental State.