The challenges of coeliac disease at work: A contestation of the politics of inclusion.

By focusing on the experiences of employees living with coeliac disease as evidenced in UK employment tribunal cases, this paper interrogates the way practices of exclusion are performed in legal and organisational contexts that purport to promote values of inclusion. In paying attention to how differences are constructed and negotiated, the paper unpacks the way organisational practices mobilise an array of workplace mechanisms to produce complex dynamics of exclusion. Applying Laclau and Mouffe's logics of equivalence and difference, we show how questionable impulses and practices emerge in a workplace environment characterised by unclarity and vagueness. One impulse, for example, involves privatising and individualising the condition of employees with coeliac disease, giving rise to patronising and stigmatising attitudes that can turn them into victims. However, we also identify workplace mechanisms countering these tendencies, which can underpin forms of collective support in the struggle for recognition. Our study thus contributes to the body of sociological literature that pays attention to health-related workplace injustices by challenging the purported promotion of health-based inclusion through a focus on tribunal cases, leading to suggestions for further research into the way medical conditions are theorised and 'lived' at work.

Compassionate Othering: the construction of refugee patients in medical students' narratives - a qualitative study using story completion.

BACKGROUND: Refugees remain a marginalized population and are exposed to a variety of discriminatory processes, among them Othering which categorizes people as belonging or not-belonging according to certain ascribed characteristics. We explored how the narrative construction of refugee patients by medical students constitutes a form of Othering. METHODS: Using story completion, 124 5th year medical students at the Martin- Luther- University Halle-Wittenberg in October 2019 wrote a fictional story in response to a story stem situated in a medical practice. In a comparative approach, one patient presenting with abdominal pain lacks further characterization (version A) and the other is a refugee (version B). The stories were coded using qualitative content analysis by Mayring with a focus on content and narrative strategies (plot structure and perspective). RESULTS: We identified four themes: characters, medical condition, access to care and provision of substandard care. The stories were predominantly framed with a medical or an interaction-based plot structure and written from a process-oriented perspective. The themes in version B, supported by their use of narrative strategies, were largely contextualized within the patients' history of migration. An empathic depiction of patient B and the students' compassion for the patients facing substandard care were key motifs as well. CONCLUSION: The perception of the version B patients predominantly as refugees establishes their construction as an Other. The students' compassion acts as a representation of societal inequalities and remains an inept response without the tools to counter underlying discriminatory structures. Based on a discourse of deservingness, compassion alone therefore perpetuates Othering and highlights the need for structural competency training in medical school.

Centering and collaborating with community knowledge systems: piloting a novel participatory modeling approach.

BACKGROUND: Systems science approaches like simulation modeling can offer an opportunity for community voice to shape policies. In the episteme of many communities there are elders, leaders, and researchers who are seen as bearers of historic knowledge and can contextualize and interpret contemporary research using knowledge systems of the community. There is a need for a systematic methodology to collaborate with community Knowledge Bearers and Knowledge Interpreters. In this paper we report the results of piloting a systematic methodology for collaborating with a community Knowledge-Bearer and Knowledge-Interpreter to develop a conceptual model revealing the local-level influences and architecture of systems shaping community realities. The use case for this pilot is 'persistent poverty' in the United States, specifically within the inner-city African American community in Baltimore City. METHODS: This pilot of a participatory modeling approach was conducted over a span of 7 sessions and included the following steps, each with an associated script: Step 1: Knowledge-Bearer and Knowledge-Interpreter recruitment Step 2: Relationship building Step 3: Session introduction, Vignette development & enrichment Step 4: Vignette analysis & constructing architecture of systems map Step 5: Augmenting architecture of systems map RESULTS: Each step of the participatory modeling approach resulted in artifacts that were valuable for both the communities and the research effort. Vignette construction resulted in narratives representing a spectrum of lived experiences, trajectories, and outcomes within a community. The collaborative analysis of vignettes yielded the Architecture of Systemic Factors map, that revealed how factors inter-relate to form a system in which lived experience of poverty occurs. A literature search provided an opportunity for the community to contextualize existing research about them using realities of lived experience. CONCLUSION: This methodology showed that a community Knowledge Bearer can function as communicators and interpreters of their community's knowledge base, can develop coherent narratives of lived experiences within which research and knowledge is contextualized, and can collaboratively construct conceptual mappings necessary for simulation modeling. This participatory modeling approach showed that even if there already exists a vast body of research about a community, collaborating with community gives context to that research and brings together disparate findings within narratives of lived experience.

"Otherness", otherism, discrimination, and health inequalities: entrenched challenges for modern psychiatric disciplines.

Identity is a complex concept that can be informed by various factors, involving biological, psychological, experiential, and social influences. Specifically, one's social identity refers to the ways in which individuals can adopt attributes from established collective categories, like cultural identities, ethnic identities, gender identities, and class identities, amongst others. Social identity can encompass unique and diverse interactions at an individual level, known as micro-identities, that may be selectively expressed, hidden, or downplayed, contingent on distinct sociocultural settings. However, the formation of social identity is recurrently defined in opposition to perceptions of the Other, which can entail adverse paradigms of marginalisation, stigma, and discrimination. Although this theory of Otherness has been developed across different fields, particularly sociology, it may be important in psychiatric contexts as it can engender inherent risk factors and mental health inequalities. Consequently, this paper seeks to bring attention towards these issues, exploring the construction of Otherness and its detrimental outcomes for psychiatry, such as systemic discrimination and disparities in therapeutic support, alongside recommended initiatives to mitigate against the effects of Otherness. This may require multifactorial approaches that include cultural competency training, interventions informed by micro-identities and intersectionality, patient advocacy, and structural changes to mental health policy.

Unpacking the Social Constructs of Discrimination, Othering, and Belonging in Medical Schools.

ISSUE: Triggered by the lived experiences of the authors-one junior career, female, and black; the other senior career, male, and black-we provide a critical, sociological overview of the plight of racial/ethnic minority students in medical education. We analyze the concepts of categorization, othering, and belonging in medical education, which we use to shed light on the psychological and academic consequences of overgeneralizing social categories. EVIDENCE: The ability to categorize people into different social groups is a natural, subconscious phenomenon. Creating social groups is believed to aid people in navigating the world. This permits people to relate to others based on assumed opinions and actions. Race and gender are two primary dimensions of categorization, with race or ethnicity being a particularly salient category. However, over-generalization of social categories can lead the categorizer to think, judge, and treat themselves and members of a perceived group similarly, leading to prejudice and stereotyping. Social categorization also occurs in educational settings across the globe. The consequences of categorization may influence a student's feelings of belonging and academic success. IMPLICATIONS: Our analysis reflects on how to promote equitable opportunities for ethnic minority medical trainees through the lens of those who have experienced and succeeded in an inequitable system. By revisiting the social and psychological constructs that determine and influence the academic progress and success of minority students in medical education, we discovered that more engagement is (still) needed for critical discourse on this topic. We expect such conversations to help generate new insights to improve inclusion and equity in our educational systems.

Medical cannabis and stigma: A qualitative study with patients living with chronic pain.

AIMS AND OBJECTIVES: To explore the ways in which stigma is experienced, and what strategies are used to manage stigma among patients using medical cannabis to ease suffering from chronic pain. BACKGROUND: Various jurisdictions have legalised medical cannabis in recent decades. Despite increasing prevalence and more liberal attitudes towards medical cannabis, it is possible that patients who use medical cannabis experience stigma. DESIGN: A phenomenological qualitative study. METHODS: Fifteen patients living with chronic pain and licensed by the Israeli Ministry of Health to use medical cannabis to treat pain symptoms for at least 1 year participated in semi-structured interviews. Transcribed data were analysed using thematic analysis to identify themes related to stigma. The manuscript is in correspondence to SRQR EQUATOR checklist. RESULTS: Expressions of stigma were more related to 'felt' than 'enacted' stigma. Stigma related to decisions to delay onset of medical cannabis treatment and the ways in which participants managed medical cannabis use during their everyday lives. Participants dissociated themselves from recreational cannabis users, by presenting themselves as responsible normative individuals and engaging in a form of normalisation known as 'normification', emphasising their own discrete and controlled medical cannabis use and cannabis' benefits. CONCLUSIONS: Patients experienced 'felt' stigma which had consequences for their self-presentations and medical cannabis use. This suggests that medical cannabis is not normalised in Israel and interventions may be needed to handle stigma related to medical cannabis. RELEVANCE TO CLINICAL PRACTICE: The findings emphasise the effects of 'felt' stigma on patients. Aiming to increase the effectiveness of medical cannabis treatment and reducing harms, we suggest that particular focus should be placed on managing stigma at the intrapersonal level. In addition, there may be a need to address stigma at the societal level including social interactions with friends, family and medical personnel.

Exposing othering in nursing education praxis.

This paper defines and analyzes the processes of "othering" as they manifest in the practice and praxis of nursing education. Othering is bound up in the establishment and reinforcement of norms, and shores up power inequities that negatively impact faculty, students, and patients. While previous analyses have addressed othering in nursing more broadly, this paper adds a consideration of the multiple processes of othering that operate within the context of nursing education spaces. Cases from recent nursing education literature are interpreted through the frameworks of exclusionary, inclusionary, and structural othering, and provide specific illustrations of the concepts described. The paper concludes by arguing for an application of norm-critical pedagogical practice to counteract, disrupt and dismantle othering processes within nursing education.

[Othering in the context of migration: how Others emerge from social categories]. / Othering am Beispiel von Migration: Wie aus sozialen Kategorien die Anderen entstehen.

'Migrants' and 'refugees' are often categorized as Other, in a process called Othering. Using the example of forced migration, we develop a definition of Othering to make it useful for the analysis of health inequalities. We consider Othering as a social process that constructs and classifies differences in such a way that certain groups become socially visible as essential Others. On one hand, the process of Othering operates through a discursive practice that constructs differences, thereby transforming individuals into visible Others. On the other hand, it is based on a power asymmetry that enables the categorization of people, thereby marking them as different.Othering is not solely based on negative attitudes of individuals or groups. Rather, Othering is the result of a broad and historically evolved system of beliefs that gain credibility through power relations. Thus, we understand Othering as a powerful process that goes substantially beyond concepts of discrimination based on mere categorization processes. The concept of Othering stands out from other concepts of inequality by including the epistemic level as a key factor for inequality. Othering not only produces the Other epistemologically, but at the same time establishes a discursive legitimation for the unequal treatment of the Other.Drawing upon our understanding of Othering, we present practice-related findings on the consequences of Othering for the healthcare of 'migrants' and 'refugees'.

The unsanitary other and racism during the pandemic: analysis of purity discourses on social media in India, France and United States of America during the COVID-19 pandemic.

The global rise of populism and concomitant polarizations across disenfranchised and marginalized groups has been magnified by so-called echo chambers, and a major public health crisis like the COVID-19 pandemic has only served to fuel these intergroup tensions. Media institutions disseminating information on ways to prevent the propagation of the virus have reactivated a specific discursive phenomenon previously observed in many epidemics: the construction of a defiled 'Other'. With anthropological lenses, discourse on defilement is an interesting path to understand the continuous emergence of pseudo-scientific forms of racism. In this paper, the authors focus on 'borderline racism', that is the use of an institutionally 'impartial' discourse to reaffirm the inferiority of another race. The authors employed inductive thematic analysis of 1200 social media comments reacting to articles and videos published by six media in three different countries (France, United States and India). Results delineate four major themes structuring defilement discourses: food (and the relationship to animals), religion, nationalism and gender. Media articles and videos portrayed Western and Eastern countries through contrasting images and elicited a range of reaction in readers and viewers. The discussion reflects on how borderline racism can be an appropriate concept to understand the appearance of hygienic othering of specific subgroups on social media. Theoretical implications and recommendations on a more culturally sensitive approach of media coverage of epidemics and pandemics are discussed.

Ethnic minority patients in healthcare from a Scandinavian welfare perspective: The case of Denmark.

The Scandinavian welfare states are known for their universal access to healthcare; however, health inequalities affecting ethnic minority patients are prevalent. Ethnic minority patients' encounters with healthcare systems are often portrayed as part of a system that represents objectivity and neutrality. However, the Danish healthcare sector is a political apparatus that is affected by policies and conceptualisations. Health policies towards ethnic minorities are analysed using Bacchi's policy analysis, to show how implicit problem representations are translated from political and societal discourses into the Danish healthcare system. Our analysis shows that health policies are based on different ideas of who ethnic minority patients are and what kinds of challenges they entail. Two main issues are raised: First, ethnic minorities are positioned as bearers of 'culture' and 'ethnicity'. These concepts of 'othering' become both explanations for and the cause of inappropriate healthcare behaviour. Second, the Scandinavian welfare states are known for their solidarity, collectivism, equality and tolerance, also grounded in a postracial, colour-blind and noncolonial past ideology that forms the societal self-image. Combined with the ethical and legal responsibility of healthcare professionals to treat all patients equally, our findings indicate little leeway for addressing the discrimination experienced by ethnic minority patients.

Far-right boundary construction towards the "other": Visual communication of Danish People's Party on social media.

This paper explores how images are used in online far-right political communication to create distinct groups of "otherness." Focusing on the Danish People's Party, we look at how symbolic boundaries are constructed through images to emphasize an exclusive conception of the nation and its citizens, who need protection from the threatening "others." In order to understand the global rise of the far right, scholars of social movements and digital media have called for new research on how visual images serve the mainstreaming of extremist and nationalist beliefs online. We look at images communicated by the Danish People's Party on their Facebook page, exploring how digital images visually communicate the party's slogan of "Safety and trust" (in Danish: "Tryghed og tillid"). With a focus on boundary construction, we present a multimodal visual analysis of 1120 images posted by the party from 2012 to 2020. The data shows how the party constructs an imaginary of Danishness through an exclusionary impermeable boundary construction of a trusted in-group's values and traditions in opposition to culturally distinct "others."

Sanitizing the national body: COVID-19 and the revival of Japan's "Closed Country" strategy.

Japan's handling of border control measures during the COVID-19 pandemic has become known as sakoku-approach. Sakoku literally means "closed country" and generally refers to a historic period when the Tokugawa Shogunate (1603-1868) kept Japan's borders shut because international contacts were feared to cause public upheaval and political instability. While these times have long passed, contemporary Japan, too, is known for its tight management of immigration avenues. In the light of the COVID-19 pandemic, most of these avenues were cut off, and despite much criticism, have remained largely inaccessible for two years now. In this paper, we build on concepts from authoritarian populism and the performance of crisis to analyze how and why Japan revived its isolationist strategy. We decipher the discursive framings that Prime Minister Abe applied to illustrate the disruptive influence that open borders would have on Japan's public health, social stability and by extension, on the national body itself. We argue that from the onset of the pandemic on, the ethnic others were portrayed as a risk mainly for two intertwined reasons: Firstly, Japan's pandemic management relies on self-constraint rather than rules and sanctions, and the ethnic others' compliance was not fully trusted. Secondly, this exclusionary strategy fed into populist discourses and was presumed to result in favorable support rates for the administration.

Skin color and race.

Skin color is the primary physical criterion by which people have been classified into groups in the Western scientific tradition. From the earliest classifications of Linnaeus, skin color labels were not neutral descriptors, but connoted meanings that influenced the perceptions of described groups. In this article, the history of the use of skin color is reviewed to show how the imprint of history in connection with a single trait influenced subsequent thinking about human diversity. Skin color was the keystone trait to which other physical, behavioral, and culture characteristics were linked. To most naturalists and philosophers of the European Enlightenment, skin color was influenced by the external environment and expressed an inner state of being. It was both the effect and the cause. Early investigations of skin color and human diversity focused on understanding the central polarity between "white" Europeans and nonwhite others, with most attention devoted to explaining the origin and meaning of the blackness of Africans. Consistently negative associations with black and darkness influenced philosophers David Hume and Immanuel Kant to consider Africans as less than fully human and lacking in personal agency. Hume and Kant's views on skin color, the integrity of separate races, and the lower status of Africans provided support to diverse political, economic, and religious constituencies in Europe and the Americas interested in maintaining the transatlantic slave trade and upholding chattel slavery. The mental constructs and stereotypes of color-based races remained, more strongly in some places than others, after the abolition of the slave trade and of slavery. The concept of color-based hierarchies of people arranged from the superior light-colored people to inferior dark-colored ones hardened during the late seventeenth century and have been reinforced by diverse forces ever since. These ideas manifest themselves as racism, colorism, and in the development of implicit bias. Current knowledge of the evolution of skin color and of the historical development of color-based race concepts should inform all levels of formal and informal education. Awareness of the influence of color memes and race ideation in general on human behavior and the conduct of science is important.

Resisting the muddy notion of the 'Inclusionary Other': A re/turn to the philosophical underpinnings of Othering's construction.

The notion of 'Inclusionary Othering,' in garnering uptake within diverse nursing spheres, muddies a critical understanding of Othering by obscuring the colonial production, exploitation and perpetuation of the Other for economic and political gain. The ongoing genocide of Indigenous women and girls in Canada is a direct manifestation of the Othering process and in response to the report's Calls for Justice, it is an apt time to re-enliven the conversation of the process of Othering's philosophical construction. The purpose of this article is to re/turn to the philosophical underpinnings of the process of Othering in hopes of enlivening a new wave of resistance within nursing and elsewhere to the means by which the Other is constructed as well as to the notion of Inclusionary Othering itself. Perhaps this re/turn to the philosophy of Edward Said and Sylvia Wynter can result in further thwarting the Othering construct by highlighting its colonial construction and usher in a pragmatic shift, increasing critical engagement with the construct as well as inspiring a re/newed resistance toward Othering in nursing practice.

The constitution of space in intensive care: Power, knowledge and the othering of people experiencing mental illness.

A sociological conceptualisation of space moves beyond the material to the relational, to consider space as a social process. This paper draws on research that explored the reproduction of legitimated knowledge and power structures in intensive care units during encounters, between patients, who were experiencing mental illness, and their nurses. Semi-structured telephone interviews with 17 intensive care nurses from eight Australian intensive care units were conducted in 2017. Data were analysed through iterative cycling between participants' responses, the literature and the theoretical framework. The material and relational aspects of space in this context constitute a dynamic process that is concerned with the reproduction of everyday life, the preservation of the biomedical authority of intensive care, and the social othering of people experiencing mental illness. The work of theorists such as Löw, Harvey and Foucault underpins the exploration of space as a multi-dimensional, malleable social process that both produces and is the product of social interaction and the social world. In this paper, we argue that the performative work of knowledge and power production and reproduction, considered here in relation to intensive care spaces, enables ongoing othering and disenfranchisement of people experiencing mental illness.

Finding Common Ground in the Context of Difference: A South African Case Study.

In a rapidly transforming world, cultural assimilation and the hybridity of clients and therapists are increasingly acknowledged. Juxtaposed against universalist and relativist discourses in Cultural Psychiatry, the elucidation of perceived "difference" from cultural norms, constructed as being observed in the lives of either the client, or therapist, or both, requires critical reflection on how such norms are derived and by whom. This cultural case study describes a clinical encounter between a Muslim South African woman, and a South African man of Afrikaner descent. A shared experience of marginalization led to surprising similarities and common ground against obvious cultural differences, which have contributed to the strengthening of the therapeutic relationship and consolidation of trust. Beside the more parsimonious focus on "shared marginalization" as a potential bridge to move towards transcending overt cultural differences, the case study's emphasis on a shared humanity within the interwoven texture of perceived difference go beyond dichotomous discourses that sharply dissect "sameness" from "otherness". This may well have relevance to any clinical encounter in which identity is dynamically presented and re-presented in complex ways.

"Aspirations of people who come from state education are different": how language reflects social exclusion in medical education.

Despite repeated calls for change, the problem of widening access (WA) to medicine persists globally. One factor which may be operating to maintain social exclusion is the language used in representing WA applicants and students by the gatekeepers and representatives of medical schools, Admissions Deans. We therefore examined the institutional discourse of UK Medical Admissions Deans in order to determine how values regarding WA are communicated and presented in this context. We conducted a linguistic analysis of qualitative interviews with Admissions Deans and/or Staff from 24 of 32 UK medical schools. Corpus Linguistics data analysis determined broad patterns of frequency and word lists. This informed a critical discourse analysis of the data using an "othering" lens to explore and understand the judgements made of WA students by Admissions Deans, and the practices to which these judgments give rise. Representations of WA students highlighted existing divides and preconceptions in relation to WA programmes and students. Through using discourse that can be considered othering and divisive, issues of social divide and lack of integration in medicine were highlighted. Language served to reinforce pre-existing stereotypes and a significant 'us' and 'them' rhetoric exists in medical education. Even with drivers to achieve diversity and equality in medical education, existing social structures and preconceptions still influence the representations of applicants and students from outside the 'traditional' medical education model in the UK. Acknowledging this is a crucial step for medical schools wishing to address barriers to the perceived challenges to diversity.

Distrust and patients in intercultural healthcare: A qualitative interview study.

BACKGROUND: The importance of trust between patients and healthcare personnel is emphasised in nurses' and physicians' ethical codes. Trust is crucial for an effective healthcare personnel-patient relationship and thus for treatment and treatment outcomes. Cultural and linguistic differences may make building a trusting and positive relationship with ethnic minority patients particularly challenging. Although there is a great deal of research on cultural competence, there is a conspicuous lack of focus on the concepts of trust and distrust concerning ethnic minority patients, particularly in relation to the concept of 'othering'. AIM: To study which factors help build trust or create distrust in encounters between healthcare professionals and hospitalised ethnic minority patients, as well as study the dynamic complexities inherent within the process of 'othering'. RESEARCH DESIGN: Qualitative design, in-depth interviews and hermeneutic analysis. Participants and research context: The interviewees were 10 immigrant patients (six women and four men - eight Asians, two Africans - ages 32-85 years) recruited from a south-eastern Norwegian hospital. Ethical considerations: Study approval was obtained from the hospital's Privacy Ombudsman for Research and the hospital's leadership. Participation was voluntary and participants signed an informed consent form. CONCLUSION: Distrust and othering may be caused by differences in belief systems, values, perceptions, expectations, and style of expression and behaviour. Othering is a reciprocal phenomenon in minority ethnic patient-healthcare personnel encounters, and it influences trust building negatively. Besides demonstrating general professional skill and competence, healthcare personnel require cultural competence to create trust.

"This Man with Dementia"1-'Othering' the Person with Dementia in the Court of Protection.

In recent years, dementia has been subjected to an increasing ethical, legal, and political gaze. This article analyses how the Court of Protection considers the perspective of the person with dementia when making best interests decisions on their behalf under the Mental Capacity Act 2005. The article draws upon feminist and disability literature to highlight how the Court has, on occasions, 'othered' the person with dementia during the process of making best interests decisions. This is despite law and policy increasingly emphasising that the views of the person who lacks capacity should be central to any best interests decision, as well as emphasising the importance of de-stigmatisation of cognitive impairments, such as dementia. Finally, using examples from recent cases, it is argued that by adopting an intersubjective approach, and by recognising and exploring the complexity of the relationships that the person with dementia has, the Court can go some way to avoiding the process of 'othering'.

Understanding Refugees Health Experiences in Host Countries: Three Theoretical Perspectives.

Healthcare providers working with forcefully displaced populations often have limited knowledge and skills regarding the care of this population. The reasons are twofold. First, most of the research on refugee health does not consider refugees' adaptive skills, diversity of experiences, and daily life context. Second, healthcare providers' knowledge of how the sociopolitical environment shapes health research and practice in the context of refugee care is often limited. This work aims to specify gaps in refugee healthcare and research by applying a relational approach to three theoretical frameworks. The relational approach supports a pragmatic, in-depth understanding of healthcare practices by shifting the focus of the inquiry from description of social structures toward exploration of processes and relations that propagate and sustain such structures. The focus is on the threefold interaction between refugees, healthcare providers, and healthcare institutions. The three theoretical frameworks are as follows: First, using concepts from the Theory of Practice by Bourdieu, we examine how gaps in care can result from a mismatch between the dispositions and skills that refugees develop through life experience and the cultural-professional practices of healthcare providers in host countries. Second, the Cultural Determinants of Help Seeking by Saint Arnault is applied to posit that gaps in care can result from differences in the meanings that healthcare providers and refugees assign to their interactions. Finally, we use the concept of Othering as described in nursing by Canales to explain how power dynamics inherent in the interaction between refugees and healthcare systems can affect refugee healthcare and research. This relational approach helps to elucidate some of the culture-bound mechanisms of health maintenance and help-seeking and brings attention to the sociopolitical context that shapes the way we care to refugees.