Self Care

“Power is war, the continuation of war by other means”: Foucault’s reversal of Clausewitz’s formula has become a staple of critical theory — but it remains highly problematic on a conceptual level. Elaborated during Foucault’s 1976 lectures (“Society Must Be Defended”), this work-hypothesis theorises “basic warfare” [la guerre fondamentale] as the teleological horizon of socio-political relations. Following Boulainvilliers, Foucault champions this polemological approach, conceived as a purely descriptive discourse on “real” politics and war, against the philosophico-juridical conceptuality attached to liberal society (Hobbes’s Leviathan being here the prime example).
However, in doing so, Foucault did not interrogate the conceptual validity of notions such as power and war, therefore interlinking them without questioning their ontological status. This problematic conflation was partly rectified in 1982, as Foucault proposed a more dynamic definition of power relations: “actions over potential actions”.
I argue, somewhat polemically, that Foucault’s hermeneutics of power still involves a teleological violence, dependent on a polemological representation of human relations as essentially instrumental: this resembles what Derrida names, in “Heidegger’s Ear”, an “anthropolemology”. However, I show that all conceptualisation of power implies its self-deconstruction. This self-deconstructive (or autoimmune) structure supposes an archi-originary unpower prior to power: power presupposes an excess within power, an excessive force, another violence making it both possible and impossible. There is something within power located “beyond the power principle” (Derrida). This (self-)excess signifies a limitless resistantiality co-extensive with power-relationality. It also allows the reversal of pólemos into its opposite, as unpower opens politics and warfare to the messianic call of a pre-political, pre-ontological disruption: the archi-originary force of différance. This force, unconditional, challenges Foucault’s conceptualisations of power, suggesting an originary performativity located before or beyond hermeneutics of power-knowledge, disrupting theoreticity as well as empiricity by pointing to their ontological complicity.
The bulk of this essay is dedicated to sketching the theoretical implications of this deconstructive reading of Foucault with respect to the methodology and conceptuality of political science and social theory.

In the management of hypertension, blood pressure (BP) monitoring and medication use are key strategies, but they are dependent on patients' motivation to practice self-care. To gauge patients' approaches to monitoring their blood pressure, as well as explore their attitudes toward, and actions relating to, high blood pressure readings, as the key components of their self-management of hypertension. This qualitative study, comprising individual telephone interviews, involved patients attending community pharmacies in Sydney (Australia). Patients' perspectives were elicited using a purpose-designed, semi-structured interview guide. The verbal responses were audio-recorded, transcribed verbatim, and thematically analysed. Three key themes arose: (1) approaches to monitoring blood pressure, (2) attitudes to variability in BP, (3) responses to high BP readings. Many patients self-regulated the frequency of monitoring based on perceived need and/or opportunity. Most were indi...

Qualitative research on self-management for people with Type 2 Diabetes Mellitus (T2DM) has typically reported one-off retrospective accounts of individuals' strategies. The aim of this research was to identify the ways in which self-management strategies are perceived by people with T2DM as being either supportive or unsupportive over time, by using qualitative findings from both longitudinal intervention studies and usual care.

Aims We carried out a survey of important nonclinical issues including awareness and self-management of diabetes on a group of South Asian and Caucasian patients attending diabetic clinics within a set period.Methods A structured questionnaire examined various issues including demographics, perceived knowledge and awareness of diabetes, perceived self-help/support, and psycho-social factors. A total of 500 patients (268 South Asians and

To investigate whether attending a six-week stress management course in a rural adult education centre is effective in reducing participants' levels of stress, anxiety and depression. Repeated measures design using self-report measures of stress, anxiety and depression at commencement and completion of a six-week stress management course, and six months post-completion follow up. One hundred and thirty-two adults (age range 18-73 years) living in a rural community who self-enrolled in the stress management course at adult education centres. The course consisted of six weekly group sessions. Each two-hour session conducted by mental health professionals, included teaching cognitive behavioural strategies targeted at reducing individual symptoms of stress. Comparative analysis of pre- and post-test and six-month follow up on measures of stress (Stress Symptom Checklist), anxiety and depression (Hospital Anxiety and Depression Scale). RESULTS indicated a significant reduction in stress symptoms (F(7,90) = 34.92, P < 0.001), anxiety and depression (F(3,95) = 87.92, P < 0.001) from course commencement to course completion. These improvements were sustained six months after course completion for stress symptoms (F(11,65) = 22.40, P < 0.001), anxiety and depression (F(5,73) = 41.78, P < 0.001). Findings demonstrate the stress management course is an effective community intervention in a rural community. Challenges for future implementation of the program are discussed.

Objective: To investigate the occurrence and management of teething symptoms during the first year of life and associated factors. Study design: 500 children were recruited at birth. Research assessments including structured interviews, anthropometric measurements and dental examination were carried out after birth, at 6 months and at one-year of age. The primary outcome of this study was defined as the occurrence of one or more teething symptoms within the first year of life, as reported by the mother. Results: Teething symptoms were reported in 73% of the children analyzed (273/375). The symptoms most frequently reported were irritability (40.5%), fever (38.9%), diarrhoea (36.0%) and itching (33.6%). Dentists had little influence on the management of symptoms and self-medication to relieve them was a common practice. The risk of reporting teething symptoms was higher for children from nuclear families (p=0.040) and for children from families with higher income (p=0.040). Conclusio...

Auditory verbal hallucinations (AVH) are prevalent experiences that can induce distress and impede social functioning. While most voice hearers benefit from antipsychotic medication or cognitive-behavioural therapy, additional effective interventions are needed to reduce the burden of experiencing AVH. 'Temstem' is an easily accessible and useable smartphone application that was developed by designers in close cooperation with voice hearers and experts. By using language games, Temstem aims to reduce distress and improve social functioning. This is a single-blind multicentre randomised controlled trial with two arms: 'Temstem+AVH monitoring' versus 'AVH monitoring' (total n=100). Participants are adult patients who suffer daily from AVH and will be recruited in outpatient units. Primary assessment in daily life is made by the Experience Sampling Method (ESM) and daily monitoring with the PsyMate app. During an ESM period of 6 days, participants assess their m...

The aim of this study was to illuminate the meaning of older people's dependence on caregivers' help, and of their opportunity to make independent decisions. Throughout the world, the older population is growing, and in Sweden, the system of care for older people is currently undergoing change. Older people in the need of care are expected to live at home for as long as possible. A qualitative and life world approach was used. Audio-taped interviews were conducted with twelve older persons living at home, dependent on daily municipal home help service. A phenomenological hermeneutic method was utilised to disclose the meanings of lived experiences. The findings revealed three themes: being facilitated to make one's own decisions, being hindered from making one's own decisions, struggling for vs. resigning oneself to losing the opportunity to make one's own decisions. The comprehensive understanding revealed that as older people become more dependent on caregivers...

Rising concern over the poor level of blood-pressure (BP) control among hypertensive patients has prompted searches for novel ways of managing hypertension. The objectives of this study were to develop and pilot-test a home BP tele-management system that actively engages patients in the process of care.Phase 1 involved a series of focus-group meetings with patients and primary care providers to guide the system’s development. In Phase 2, 33 diabetic patients with uncontrolled ambulatory hypertension were enrolled in a 4-month pilot study, using a before-and-after design to assess its effectiveness in lowering BP, its acceptability to users, and the reliability of home BP measurements.The system, developed using commodity hardware, comprised a Bluetooth-enabled home BP monitor, a mobile phone to receive and transmit data, a central server for data processing, a fax-back system to send physicians’ reports, and a BP alerting system. In the pilot study, 24-h ambulatory BP fell by 11/5 (±13/7 SD) mm Hg (both P < .001), and BP control improved significantly. Substantially more home readings were received by the server than expected, based on the preset monitoring schedule. Of 42 BP alerts sent to patients, almost half (n = 20) were due to low BP. Physicians received no critical BP alerts. Patients perceived the system as acceptable and effective.The encouraging results of this study provide a strong rationale for a long-term, randomized, clinical trial to determine whether this home BP tele-management system improves BP control in the community among patients with uncontrolled hypertension.

This article is designed for primary care physicians, cardiovascular specialists, medical directors, and other managed care administrators responsible for heart failure patients. To provide the reader with a basic understanding of heart failure epidemiology, heart failure management, and different strategies for the management of this particular patient population. 1. To describe the impact of heart failure on the healthcare system in the United States. 2. To briefly describe the current practice for managing heart failure. 3. To describe the evidence for care by cardiologists of heart failure patients. 4. To describe the different disease management strategies being utilized in heart failure management.

The Diabetes Initiative of the Robert Wood Johnson Foundation includes 14 demonstration projects in primary care settings and in community-clinical partnerships. Projects serve predominantly indigent populations from varied cultural and linguistic backgrounds in urban, rural, and ...

We conducted a feasibility study of an innovative Internet-based system, designed to support collaboration between patients and providers around cancer related symptom management. Our objective was to demonstrate the system&#39;s potential to enhance communication and clinical decision making between patients and their providers. Considering the high prevalence of cancer related symptoms and their impact on patients&#39; quality of life, enhanced collaboration regarding assessment and treatment could significantly reduce illness burden. Twenty-seven patients with known malignancy and twenty-nine oncology clinicians were interviewed to identify functional requirements for the system. Patients reported the ability, willingness and desire to use a computer to help them manage their cancer related symptoms. Physicians recognized the potential of this system to improve communication and collaboration around symptom management, but voiced concern regarding a potential increased workload. ...

In this article, we examine the apparent resistance of elderly Russian Jewish émigrés to the dominant U.S. biomedical model of diabetes treatment. Cultural competence on the part of medical professionals who make assumptions about Russian culture tends to be based on particularly American values of self-control and individual agency. The American consumer model of health care incorporating risk, individual responsibility, autonomy, and choice, when applied to elderly Russian Jewish émigrés, results in a reading of different values and choices as failed self-management or noncompliance. This article argues for a more reflexive understanding of U.S. biomedical culture as a replacement for the current “sound bite” model of cultural diversity.