BackgroundInternational codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for (...) the relevance and cogency of an ethical code in occupational health for an African context through an iterative consultative process.DiscussionFirstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address workplace hazards demand that actions for occupational health extend beyond just the workplace.SummaryA stronger articulation of occupational health practice with advocacy for prevention should be an ethical norm. Ethical codes should ideally harmonize and balance individual and community needs so as to provide stronger moral authority guidelines. There is a need to consider an African Charter on Bioethics as complementary and strengthening of existing codes for the region. (shrink)

Industrial wind turbines (IWTs) are being installed at a fast pace globally. Researchers, medical practitioners, and media have reported adverse health effects resulting from living in the environs of IWTs. While there have been some anecdotal reports from technicians and other workers who work in the environs of IWTs, little is known about the occupational health sector. The purpose of this case study is to raise awareness about the potential for adverse health effects occurring among workers. (...) The authors propose that there is a need for research regarding occupational worker exposure relating to IWTs. (shrink)

International codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developing by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an African Working Group addressed key challenges for (...) the relevance and cogency of an ethical code in occupational health for an African context through an iterative consultative process. (shrink)

Teaching is, to date, one of the most prone jobs to experiencing occupational stress and burnout. Owing to burnout’s negative personal, social, organizational and economic impacts, researchers, practitioners and education policy leaders are interested in developing practices and interventions aimed at preventing/reducing its prevalence. With teachers’ main professional demands to be of a social and emotional nature, interventions designed with a view to promote teachers’ social and emotional competence appears to be particularly promising, positively impacting teachers’ well-being and personal (...) accomplishment and contributing to a decrease in their psychological distress, namely emotional exhaustion. However, theoretical and empirically grounded interventions with ecological validity and specifically targeting teachers are still scarce. Thus, to bridge the previously identified gaps, the present study aimed to evaluate the efficacy and the quality of the intervention’s implementation of the A+, an online social and emotional learning intervention for elementary-school teachers. A quasi-experimental study was conducted with a total of 81 participants from three different school contexts. School clusters were similar in size, organizational structure and socioeconomic level, and as regards previous attendance at social and emotional learning interventions; however, they differed with regards to perceived organizational climate. Data on the efficacy of the A+ was collected across four waves using a set of self-report questionnaires that assessed proximal variables and distal variables, and analyzed through Robust Linear Mixed-Effects Models. Coefficient omegas suggested adequate reliability of the measures. Additionally, two trained observers completed an observation grid to evaluate the quality of the A+ implementation, with excellent inter-rater reliability. Results suggested that, over time, the A+ had positive impacts across proximal and distal variables favoring the experimental group. However, results differed across the school contexts. These findings were accompanied by good implementation quality indicators, namely high fidelity in the delivery of the A+ contents and high participants’ responsiveness. Despite its limitations, this study contributes to a growing body of research which reinforces the importance of investing in social and emotional learning interventions to prevent teachers’ burnout and improve their occupational health. Furthermore, it highlights the importance of implementation quality research as a component of program planning with a view to enhancing programs’ efficacy, as well as the need to adapt and consider context variables in research and practice. (shrink)

OBJECTIVES: To identify ethical dilemmas experienced by occupational and physical therapists working in the UK National Health Service (NHS). To compare ethical contexts, themes and principles across the two groups. DESIGN: A structured questionnaire was circulated to the managers of occupational and physical therapy services in England and Wales. SUBJECTS: The questionnaires were given to 238 occupational and 249 physical therapists who conformed to set criteria. RESULTS: Ethical dilemmas experienced during the previous six months were reported (...) by 118 occupational and 107 physical therapists. The two groups were similar in age, grade, and years of experience. Fifty of the occupational therapy dilemmas occurred in mental health settings but no equivalent setting emerged for physical therapy. Different ethical themes emerged between the two groups, with the most common in occupational therapy being difficult/dangerous behaviour in patients and unprofessional staff behaviour, and for physical therapists resource limitations and treatment effectiveness. No differences were found in the ethical principles used. CONCLUSION: The ethical dilemmas reported by the therapists were primarily concerned with health care ethics, rather than the more dramatic ethics reported in much of the biomedical ethics literature. Differences were found between the two professional groups when ethical contexts and themes were compared but not when ethical principles were compared. This suggests that educators and researchers need to be aware of work settings and the interdisciplinary nature of employment as well as ethical principles held by individual therapists. (shrink)

Prior research has consistently established the pragmatic nature of literature regarding occupational injuries and accidental happenings faced by nursing professionals. However, current realities require a subjective approach to identify preventative measures that could influence occupational health and safety in healthcare sectors. A qualitative design followed a descriptive approach to assess unbiased opinions towards occupational obstructions that lead to accidental happenings. This study used the social capital framework in particular as a support resource to eliminate its detrimental (...) effects on nurse's capacity to serve their patients. The findings extended the fundamental understanding of social capital from social ties to workplace and personal ties as potential mechanisms of support. Healthcare organizations need to redefine their control policies to provide the ultimate support to their care agents. A social capital model offers nursing practitioners and nursing managers an approach for building evidence‐based policies with implications for nurse's safety, education and training. (shrink)

Clinical Ethics, Ahead of Print. ObjectiveThe purpose of this study was to assess if a relationship existed between audiologists’ perceptions of moral distress, occupational wellbeing, and patient-practitioner orientation.DesignThe Moral Distress Thermometer, Health and Safety Executive Management Standards Indicator Tool and Patient-Practitioner Orientation Scale was sent out to all audiologists registered with the professional body Audiology Australia.Study sample: A total of 43 audiologists completed the questionnaires.ResultsUsing a multiple linear regression model there was no evidence of a relationship (...) between patient-practitioner orientation and either moral distress or occupational wellbeing. However, an association between higher moral distress and lower occupational wellbeing was demonstrated. The occupational wellbeing subscales of ‘managerial support’, ‘peer support’, ‘relationships’, ‘role’, and ‘change’ were strongly associated with poorer scores on moral distress.ConclusionFor our sample of audiologists, ethical conflict appeared to be linked to reduced job satisfaction. There is a need to consider ways of providing supportive organisational structures in which ethical conflicts can be openly discussed and negotiated in order to improve occupational wellbeing in the profession. (shrink)

Despite growing advances in medical technologies, health status inequalities continue to increase across the globe. Developing countries have been faced with declining expenditures in health and social services, increasing burdens posed by both communicable and non-communicable diseases, and economic systems poorly geared to fostering sustainable development for the poorest and most marginalized. Under such circumstances, the challenges facing health practitioners in countries in transition are complex and diverse, and require the balancing of many conflicting imperatives. This is (...) particularly so in relation to the development of public health policy, where equity, redress of past inequalities, and the god of social justice may seemingly be pitted against macroeconomic adjustments required for national economic development in an increasingly globalized economic order.For example, pressures to deregulate as part of a market-oriented development philosophy will increase the risks from occupational hazards in populations desperate for paid employment. (shrink)

Despite growing advances in medical technologies, health status inequalities continue to increase across the globe. Developing countries have been faced with declining expenditures in health and social services, increasing burdens posed by both communicable and non-communicable diseases, and economic systems poorly geared to fostering sustainable development for the poorest and most marginalized. Under such circumstances, the challenges facing health practitioners in countries in transition are complex and diverse, and require the balancing of many conflicting imperatives. This is (...) particularly so in relation to the development of public health policy, where equity, redress of past inequalities, and the god of social justice may seemingly be pitted against macroeconomic adjustments required for national economic development in an increasingly globalized economic order.For example, pressures to deregulate as part of a market-oriented development philosophy will increase the risks from occupational hazards in populations desperate for paid employment. (shrink)

In this article we illustrate, and argue for, the importance of researching the social context of health professionals’ ethical agendas and concerns. We draw upon qualitative interview data from 20 nurses working in two occupational health sites, and our discussion focuses mainly upon aspects of the shifting ‘ethical context’ for those nurses with a health promotion remit who are working in the British National Health Service. Within this discussion we also raise a number of potentially (...) substantive issues, including the risks of colluding in ‘double standards’, and the tensions between the practitioner and managerial roles in nursing. Overall, we hope to pose questions about the best ways to understand the ethical agency and responsibilities of health professionals. (shrink)

Professional ethics has currently raised its public profile in the UK as part of social anxiety around governance of health and social care, fuelled by catastrophically bad practice identified in particular healthcare facilities. Professional ethics is regulated by compliance with abstracted, normative codes but experienced as contextualised exercise of personal qualities, understanding and engagement. This study examined how practitioners from one speciality of occupational therapy, an Allied Health Profession, develop ethical practice through dialogical engagement in local OT (...) communities of practice, supporting and modifying understanding of and approaches to specific situations experienced as ethically difficult and individual reflection on the personal bildungsroman underpinning their own professional practice. Engagement in community of practice and personal reflection contributed to ethical development for participating OTs. Opportunities to engage in peer OT groups and professional reflection should be considered by employers as integral to productive practice and not a distraction from it. (shrink)

This study investigated the reasons that leaders have given for their leader role occupancy. By using a mixed-method approach and large leader data, we aimed to provide a more nuanced picture of how leader positions are occupied in real life. We examined how individual leadership motivation may associate with other reasons for leader role occupancy. In addition, we aimed to integrate the different reasons behind leader role occupancy into the framework of sustainable leader careers and its two indicators: leader’s (...) class='Hi'>health and performance. The survey data consisted of 1,031 leaders from various sectors of working life. Qualitative analysis revealed that leaders mention various factors behind their leader role occupancy, resulting 26 themes. After inductive investigation of the data, theory-driven analysis focused on the sustainable career components and agency vs. non-agency. Qualitative data was quantitized based on the theory-driven categories for statistical analysis. Based on the these analysis, we found out that only Affective-Identity MTL predicted all of the studied reasons behind leader role occupancy, whereas the other motivation types did not. All of the reasons for leader role occupancy except non-agentic ones were related to both leaders’ own and their followers’ occupational well-being. Leaders with more person-related and agentic reasons for leader role occupancy experienced better occupational well-being. Person- and context-related and agentic reasons behind leader role occupancy associated also with followers’ occupational well-being, but the associations differed from those of leaders’ well-being: person-related and agentic reasons associated with followers’ exhaustion, but this association was not found among leaders. Our study provided important information for practitioners in the field of human resources and development, as it has shown that if the reasons for leader role occupancy mainly reflect circumstances or other non-person-related reasons, the experienced occupational well-being and person-career fit may remain weak. It is necessary to try to support the leadership motivation for those leaders, or to shape the job description in such a way that it can also offer the experiences of meaningfulness from aspects other than self-realization through a managerial role. (shrink)

This discussion paper offers a critical provocation to my mental health nursing colleagues. Drawing upon David Graeber's account of bullshit work, work that is increasingly meaningless for workers, I pose the question: Is mental health nursing a bullshit job? Ever‐increasing time spent on record keeping as opposed to direct care appears to represent a Graeberian bullshitisation of mental health nurses' work. In addition, core aspects of the role are not immune from bullshit. Professional rhetoric would have us (...) believe that mental health nursing is a therapeutically beneficent occupation organised around ideals of care and compassion and providing fulfilling work for practitioners. Yet, there are some key characteristics of the experience of mental health nursing work that afford alternative judgements on its value and meaningfulness. Not least of these is the fact that many mental health nurses feel quite existentially unsettled in the practise of their work and many service users do not recognise the professional ideal, especially when compelled into increasingly coercive and restrictive services. In this context, Graeber's thesis is explored for its applicability to mental health nursing with a conclusion that many aspects of mental health nursing work are commensurate with bullshit but that mental health care can possibly be redeemed from bullshitisation by authentically democratising reforms. Engaging with posthumanist ideas, this exploration involves a flexing of aspects of Graeber's theory. (shrink)

The Tidal Model represents a significant alternative to mainstream mental health theories, emphasizing how those suffering from mental health problems can benefit from taking a more active role in their own treatment. Based on extensive research, The Tidal Model charts the development of this approach, outlining the theoretical basis of the model to illustrate the benefits of a holistic model of care which promotes self-management and recovery. Clinical examples are also employed to show how, by exploring rather than (...) ignoring a client's narrative, practitioners can encourage the individual's greater involvement in the decisions affecting their assessment and treatment. The Tidal Model 's comprehensive coverage of the theory and practice of this model will be of great use to a range of mental health professionals and those in training in the fields of mental health nursing, social work, psychotherapy, clinical psychology and occupational therapy. (shrink)

Occupational health and safety (OHS), as a fundamental human right, forms the basis of the obligation of employers to employees, requiring employers to do what is right. Responsible management practices encompass cognisance of sustainability, responsibility as well as legal, financial and moral aspects related to OHS compliance. As point of departure, an overview of core OHS criteria for small businesses is provided, with reference to awareness of these criteria in the G20 countries. This article utilises quantitative and qualitative (...) data analysis to examine the reasons why small business owners/managers comply with occupational health and safety directives, such as the Occupational Health and Safety Act (OHS Act) and the Compensation for Occupational Injuries and Diseases Act (COIDA) in South Africa, determine if such reasons for compliance culminate in actual compliance, and determine the perceived effect of direct and indirect costs of OHS incidents. A total of 350 small business owners/managers took part in this study. The findings indicate that whilst small business owners/managers realise the rationale behind OHS compliance in terms of moral, legal and financial components, moral aspects related to OHS compliance are deemed most important. Small business owners/managers thus seem to realise the importance of OHS compliance. However, when it comes to adhering to their responsibility in terms of general safety regulations of the OHS Act and registration with the Compensation Fund as specified in the COIDA (as examples of actual compliance), small business owners/managers’ compliance does not reflect such realisation. A model to enhance OHS standards in small businesses, encompassing legal, moral and financial rationales, is proposed. (shrink)

Settler colonisation continues to cause much damage across the globe. It has particularly impacted negatively on Indigenous peoples’ health and wellbeing causing great inequity. Health professional education is a critical vehicle to assist in addressing this; however, non‐Indigenous educators often feel unprepared and lack skill in this regard. In this qualitative study, 20 non‐Indigenous nursing, physiotherapy and occupational therapy educators in Australia were interviewed about their experiences and perspectives of teaching Indigenous health. Findings from the inductive (...) thematic analysis suggest educators require skill development to: identify their discomfort in teaching cultural safety; contextualise the sources of this discomfort and; reflect on how this understanding can improve their teaching. Additionally, educators require professional training to become practitioners of cultural humility and to be facilitators and colearners (rather than experts) of the Aboriginal‐led curriculum. Of relevance to this is educator training in how to decentre non‐Indigenous needs and perspectives. Educators can also renew their teaching practices by understanding what a dominant settler paradigm is, identifying if this is problematically present in their teaching and knowing how to remedy this. Crucial to improved cultural safety teaching is institutional support, which includes Indigenous leadership, institutional commitment, relevant policies, and well‐designed professional development. (shrink)

Privacy is a key ethical principle in occupational health services. Its importance is emphasised in several laws, in ethical codes of conduct as well as in the literature, yet there is only very limited empirical research on privacy in the occupational health context. Conceptual questions on privacy in the occupational health context are discussed. The baseline assumption is that, in this context, privacy cannot be approached and examined only from the employee’s vantage point but (...) the employer’s point of view must also be taken into account, and that the concept has several dimensions . Even though privacy is a basic human need, there is no universally accepted definition of the concept and no consensus on whether an organisation can have privacy in the same way as people do. Many of the challenges surrounding privacy in the context of occupational health seem to be associated with the dual loyalties of occupational health professionals towards the employee and employer and with their simultaneous duties of disseminating and protecting information . Privacy is thus not an absolute value, but more research is needed to understand its multidimensional nature in the context of occupational health. (shrink)

The aim of this study was to gain a deeper understanding of privacy in occupational health services. Data were collected through in-depth theme interviews with occupational health professionals (n=15), employees (n=15) and employers (n=14). Our findings indicate that privacy, in this context, is a complex and multilayered concept, and that companies as well as individual employees have their own core secrets. Co-operation between the three groups proved challenging: occupational health professionals have to consider carefully (...) in which situations and how much they are entitled to release private information on individual employees for the benefit of the whole company. Privacy is thus not an absolute right of an individual, but involves the idea of sharing responsibility. The findings open up useful new perspectives on ethical questions of privacy and on the development of occupational health practices. (shrink)

This paper reports the responses of 251 mental health care practitioners to a mail survey examining their views concerning ethical conflicts and practices within their work environments. Besides identifying the sources and types of conflicts they experience, respondents were asked how ethical standards have changed over the last 10 years as well as the factors influencing these changes. Conclusions and implications are outlined and future research needs are described.

This article analyses occupational health and safety discourse, bringing special attention to dilemmas that emerge as employees name and negotiate particular risks and safety measures. The study is based on 46 interviews conducted with employees in three chemical factories, and combines Michel Foucault’s conception of governmentality with a discursive psychology approach. The study demonstrates how dilemmas emerge when 1) respondents make others responsible for health and safety risks; 2) they personally assume responsibility as ‘risky’ workers; and 3) (...) different rationalities – such as environmental and behavioural or hierarchical – appear in the same set of statements. Overall, occupational health and safety management tends to exclude egalitarian beliefs, which creates dilemmas that become visible as speakers find themselves compelled to excuse, ironize or systematically downplay discursive moves that may diminish or exclude themselves or others. Given that previous research suggests that behavioural approaches to health become increasingly widespread in working life, this article contributes by highlighting the presence of dilemmas that implies some flux and openness to change. (shrink)

ln the Netherlands, as in other Western countries, there is a great time lag between the evidence of the carcinogenicity of asbestos (1949) and the launching of first legislation that reduces the occupational exposure (1971) and finally, the complete ban of the production and application of asbestos (1993). So, between 1949 and 1970 there was a serious health risk while effective protective regulations were lacking. This implied a serious ethical dilemma for occupational health professionals: according to (...) their code of ethics, they ought to contribute to a safe and healthy working environment while companies are not strictly obliged to do so. This study explores retrospectively the position of health and safety professionals with regard to asbestos between 1930 and 1990; specifically with respect to the prevention of harmful health effects for exposed workers, which is a central value in their professional ethics. It turns out that the associations of safety and health professionals did not promulgate any position on the prevention of harm due to asbestos. Nor did the uncertainty about the health impact of asbestos obviously cause an ethical dilemma for individual professionals. Professionals were usually involved in discussions on diagnostic methods of asbestos exposure in the human body (X-ray or detection in sputum), the existence of safe limits, the scientific basis of risk assessment and effective prevention strategies. Only a single professional was seeking attention to the severe health risks and advocated for preventive action. (shrink)

This paper discusses the occupational health nurse's dilemmas by illustrating two cases faced by nurses in occupational health practice and setting out their analysis according to a decision-making model. The counter-interests, which may offend the principles of conserving professional occupational ethics among service consumers and employers as well as fellow professionals, are emphasized. This paper also describes the complex problems involved in the worker's safety and the safeguarding of their autonomy, while preserving interpersonal relations among (...) the various people concerned. (shrink)

The present study aims to survey Chinese mental health professionals’ attitudes toward therapeutic confidentiality with adolescent patients in specific clinical situations, and compare Chinese adolescents’ and parents’ beliefs about when most mental health professionals would breach confidentiality. A sample of 36 mental health practitioners, 152 parents, and 164 adolescents completed a survey to assess their opinions about when confidentiality should be breached in 18 specific clinical situations. Nearly half of the parents and adolescents and 78% of the (...) therapists in our sample selected “yes” in response to the question of whether the principle of confidentiality applies to adolescents. However, 49% of parents indicated “no,” and 53% of adolescents indicated “not sure.” Compared to adolescents, parents were significantly more likely to believe that therapists would breach confidentiality for the high-breach-likelihood items. For the low-breach-likelihood items, adolescents and parents were significantly more likely than therapists to believe confidentiality should be breached. Results from this study provide data to inform the development, refinement, practical implementation, and communication of guidelines and recommendations specific to adolescents receiving psychotherapy in China. (shrink)

This survey set out to explore occupational health professionals' courses of action with respect to privacy in a situation of dual loyalty between employees and employers. A postal questionnaire was sent to randomly selected potential respondents. The overall response rate was 64%: 140 nurses and 94 physicians returned the questionnaire. Eight imaginary cases involving an ethical dilemma of privacy were presented to the respondents. Six different courses of action were constructed within the set alternatives proposed. The study indicated (...) that privacy as an absolute value is not in the interest of either employees or employers. It also showed that, where dual loyalty is concerned, the most valid course of action in dealing with sensitive subjects such as drug and work community problems, sexual harassment and sick leave is to rely on tripartite co-operation. If they maintain their professional independence and impartiality, health professionals are well placed to succeed in this challenging task; if not, there are bound to be severe violations of privacy. (shrink)

In spite of doubts in many quarters there seems to be considerable confidence in the benefits of health examinations. In my opinion it is important to analyze the structure and the purpose of the examinations in order to elucidate the practical thinking and logical quality of OHS. In this article I will conceive health examination as an information process and offer types of inference, i.e. prediction, abduction and induction, feasible for the analysis. I will study the logical conditions (...) and possibilities to draw conclusions using these inference methods and try, in a preliminary way, to show how the qualitative or quantitative formulations of presuppositions affect the formulation of the conclusion. Finally I will explicate the implicit purposes of the health examinations stipulated by Finnish legislation with the aid of the above inference methods. I find the methods feasible for analyzing the information process, and will set forth some conditions for presuppositions used with inference and point out the alternative purposes of Finnish occupational health examinations. (shrink)

From the ethics perspective, “duty of care” is a difficult and contested term, fraught with misconceptions and apparent misappropriations. However, it is a term that clinicians use frequently as they navigate COVID-19, somehow core to their understanding of themselves and their obligations, but with uncertainty as to how to translate or operationalize this in the context of a pandemic. This paper explores the “duty of care” from a legal perspective, distinguishes it from broader notions of duty on professional and personal (...) levels, and proposes a working taxonomy for practitioners to better understand the concept of “duty” in their response to COVID-19. (shrink)

The COVID-19 global pandemic has led to significant disruptions in the lives of high-performance athletes, including the postponement of the Tokyo Olympic and Paralympic Games, the cancellation of many international and national competitions, and drastic changes in athletes’ daily training environment. The purpose of this research was to examine the interplay between the mental health and mental performance of Canadian national team athletes and the impact of the COVID-19 pandemic on these variables from the perspective of mental performance consultants (...) and mental health practitioners. Twelve individuals working in these roles with national team athletes participated in focus groups and interviews during the second wave of the COVID-19 pandemic in Canada. Findings from the inductive reflexive thematic analysis revealed three main themes: factors impacting athlete mental health, consequences of COVID-19 for athletes, and impact of the pandemic on practitioners. Interestingly, athletes with prior good mental performance skills were perceived to be more equipped to cope with challenges related to the pandemic, which concurrently seemed to facilitate good mental health throughout the pandemic. Furthermore, even though the pandemic had several debilitative consequences on athletes’ mental health, it imposed a break from training and competition that allowed them to rest and enjoy their life outside of sport. Finally, participants discussed the need for more mental health resources and better access to practitioners supporting mental performance and mental health in the Canadian sport system. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 3. © 2015 by Feminist Studies, Inc. 623 Jaye Cee Whitehead, Kath Bassett, Leia Franchini, and Michael Iacolucci “The Proof Is in the Pudding”: How Mental Health Practitioners View the Power of “Sex Hormones” in the Process of Transition In the United States today, popular discourse touts the power of “sex hormones” and hormone receptors in the brain to chemically produce gender expressions (manifested (...) in physical sex traits, behaviors, and attitudes) and identities (a sense of self as feminine or masculine). These accounts range from common assumptions that Western ideals of femininity (such as empathy understanding, cooperative orientation, nurturing behavior) and masculinity (rational/spatial understanding, competitive orientation, violent behavior) are produced by corresponding sex hormones, to studies that reduce complex gender identities and macrosocial economic phenomena to presocial, binary, hormonal processes.1 For sociologists, accounts that reduce complex identities to internal hormonal reactions are problematic for two primary reasons: first, they are inaccurate because they fail to examine how hormonal reactions are embedded in a complex cultural process of meaning and interpretation; second, they operate as bioreductive ideologies that obscure the social power inherent to the process of gender identity construction. In what follows, we extend both of these insights by examining mental health 1. For an example of a hybrid popular-scientific account of the power of sex hormones to destabilize economic structures, see Jon Coates and Joe Herbert, “Endogenous Steroids and Financial Risk Taking on a London Trading Floor,” Proceedings of the National Academy of Sciences 105, no. 16 (April 2008): 6167–72. 624 Whitehead, Bassett, Franchini, and Iacolucci practitioners’ divergent interpretations of the power of sex hormones in the process of gender transition.2 In doing so, we examine the cultural power of sex hormones in crafting gender identities without reproducing reductionist interpretations of trans embodiment. Perhaps what is most perplexing about the way we speak of sex hormones is that we know it is inaccurate to describe these hormones as sexed; scientists have acknowledged since the 1930s that they are neither sex specific in their function, nor in terms of their location in male or female bodies.3 In her extensive historicization of sex hormones, Anne Fausto-Sterling concludes that it is more accurate to call androgen- and estrogen-based hormones, “steroid hormones” as they have functions that are not confined to corresponding sexed bodies. In fact she urges scientists to “break out of the sex hormone straightjacket” and to look at steroids as just one of a number of components that are important to the creation of sex and gender, including environment and experience.4 Scholars also point to an inextricable link between the chemical operation of hormones and the social process of constructing meaning, both at the level of social interaction and macrocultural constructions of sex categories and gender ideologies.5 While brain organization/activation theory attributes sex and gender differences to hormonal interactions within the developing brain, Fausto-Sterling questions the distinction between activation and organization by pointing out how “the brain can respond to hormonal stimuli with anatomical changes…hormonal systems, after all, respond exquisitely to experience, be it in the form of nutrition, stress, or sexual activity (to name but a few possibilities ).”6 Drawing from Elizabeth Grosz, Fausto-Sterling argues that the power of hormones is best understood according to the model of the 2. “Gender transition” is a controversial phrase, as it implies that transgendered individuals who receive hormone therapy are changing identities. We are only using it for lack of clear alternative phrasing, not because we believe body modifications change gender identities. 3. See Anne Fausto-Sterling, Sexing the Body: Gender Politics and the Construction of Sexuality (New York: Basic Books, 2000); Rebecca Jordan-Young, Brainstorm: The Flaws in the Science of Sex Differences (Cambridge, MA: Harvard University Press, 2010); and Nelly Oudshoorn, Beyond the Natural Body: An Archeology of Sex Hormones (New York: Routledge, 1994). 4. Fausto-Sterling, Sexing the Body, 193–94. 5. Fausto-Sterling, Sexing the Body. 6. Ibid., 232. Whitehead, Bassett, Franchini, and Iacolucci 625 Möbius strip, wherein internal components of the self are always connected to and continuous with outer components such as culture and environment.7 In other... (shrink)