“Health in territory as a shared responsability”

Slides 1

AUTHOR: Eleonora Braga, Gian Piero Turchi,
COAUTHOR: Sara Checchin
SOCIETA’ COOPERATIVA SOCIALE “ALTRE STRADE”, PADOVA

Slides 2
At present, in health psychology field, interventions are aimed to cure, that is a medical purpose.
In fact medical model is applied in this field like in the field of “body”, in which we talk about the sanity concept, that represents an empirically noticeable reality, knowable in an ontological realism.
The medical model application configures health as “absence of illness”, so It dovetails with sanity, implying the production of interventions not distinguishable by illness prevention.
In fact, on an operative level, It happens that we talk about health promotion, considering It as prevention (that is relative to sanity/illness).
Slides 3
This contribution is placed in an epistemological frame called “conceptual realism”, that considers reality not as an ontological entity but as a construction. In particular this research is referred to the narrativistic paradigm, for which reality is constructed by discursive categories used to know it.
From an epistemological analysis emerges that talking about health, means to talk about a construct, that is knowable in a conceptual or hypothetical realism. In fact It’s impossible to identify on an empirical level, a health condition versus an illness one, because in the health field there isn’t an ontological entity as reference. In this sense, “health” is a theorical construct which gets meaning and definition by virtue of knowledge categories used to construct it as such.
So, it is clear that It’s impossible to get recovery and so to apply the medical model praxises (for example dyagnosis) in this field, differently by in the sanity one.
In this sense, using medical model in reference to health, it is done an epistemological mistake: in this way an operative model is transferred from an ontological level (in which It is pertinent), to a conceptual one, in which it is possible to find constructs rather than concepts.
Moreover If in sanity field It’s possible to identify causes and effects connections between events, because all operations are done in reference to a biological body, in health field this operation is not possible: and this is a critical aspect in a methodological sense.
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It is moving by these epistemological reflections, that has been done the following research that has the aim to study the shape of health reality, detecting the knowledge ways used by speakers to construct It.
It has been directed to operators in health field (that are psychiatrics, psychologists, nurses), and not operators. So the sample was composed by 250 subjects.
Slides 5
The methodology used in order to study the construction of health reality has been M.A.D.I.T.¹, that is a methodology of textual processing data analysis, that is coherent with epistemological and paradigmatical assumptions over presented.
This methodology in fact permits to collect and to describe the knowledge ways used by the sample to construct health reality.
In order to research these aspects, ad hoc protocols have been used, constructed with 10 opened questions, that permit to the answerers to explicit the knowledge ways that they use to create their shape of reality. After the administration, It has been done a textual analysis, using the software Spad_T.
Now we’ll pointing out some results of the research.
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In order to do It, It’s necessary to explicit that M.A.D.I.T. application implies the denomination, in the text, of discursive repertoires, that are the knowledge ways used by the sample to answer the questions.
So, the attention of the researchers has been paid to the processes of reality construction, and at the same time to the contents that substantiate them.
It’s important to consider that moving by the research results, It’s possible to product interventions in the territory, using the same methodology (M.A.D.I.T.).
In particular, we are going to consider the first question of the questionnaire in two different forms, depending of the recipient.

To operators It has been asked:

1) As operator, what kind of health definition do you refer to?

To not operators It has been asked:

2) In your ordinary life, what kind of health definition do you refer to?

This graph represents the output of the software Spad_T. Analysis.
As we can see after questionnaires administration, the respondents gave health definitions like a psychic wellness state, a physical wellness state, a social wellness state.
Deepening these answers, the term wellness is referred to aspects that are different by the organic ones, and so not empirically noticeable. So It represents a construct, that needs theorical hypothesis to get a meaning. Because of It, wellness belongs to an hypothetical/conceptual realism. In this contest instead, this term is configured as a “state”, that is referred to the biological conditions of body, and so It represents an ontological reality.
In this way, the answerers made an epistemological confusion, between these two different levels, so health is considered as an ontological reality.
Moreover, looking again at the graph, we can consider that all the respondents used terms like functioning, body, illness, organs, that are referred to biological aspects of body functioning. So in order to answer the question, they used knowledge modalities that belong to medical model (discursive repertory of reference to medical model), and in this way they consider health (used as sanity) in sense of normality versus pathology.
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In this way, operators and not operators generated a reality in which health is configured as a state, applying an antinomic dualism in which one of the polarity is represented by health and the other one is represented by illness.
But, as pointed out from the theoretical reflection over described, health doesn’t complete itself in an organic field, because Its meaning is constructed by the knowledge ways used by speakers to know It, and to construct It as such: so It belongs to a discursive reality and not to an organic one.
It results that, specialists of health field and common people gave an health definition doing a scientifically unfounded operation, that belongs to the common sense.
This unfounded definition isn’t scientifically usable.
Now we can consider another question of the questionnaire:
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2) What should be, on your opinion, the aim of interventions in ‘health’ field?

Moving from the theorical level of the question we considered before to the operative level of this question, and looking at the graph, it is possible to underline that in this answer, interventions in health field have the aim to safeguard, improve, avoid and preserve, using medical praxises like prevention, diagnosys, therapy, rehabilitation.
So the answerers identify interventions as sanitary, with the aim to fight a pathological condition.
Moreover they identify factors that determine health, but looking at the graph, we can consider that these factors are biological-organic, referred to the body, and social-psychic, referred to aspects that are different by the organic ones.
So, these answers produce again an epistemological confusion, a superimposition between two different epistemological levels.
As It has been pointed out by theorical reflection, moving from this unfounded production, there will be done a methodologically uncorrected interventions.
In fact, these answers imply the possibility to apply medical praxises in health field, doing an isomorphous correspondence between the sanity field and the health one.
On an operative level, the defined aim of interventions is wellness, that represents a different reality by cure, that is the aim of interventions in medical field.
Moreover, when praxises like diagnosys, prevention, rehabilitation, evaluation have been applied in health field, like in organic field, they have been referred to aspects of an ipothetical realism, and It points out critical aspects to a methodological level.
For example, in medical field diagnosys represents the topic praxis, because medical praxises of interventions have been applied by virtue of diagnostycal result.
Diagnosys has been formulated by virtue of empirical survey of aspects that cause pathological condition, identifying in this way a pathology.
But in health field, there isn’t an ontological reality, empirically noticeable, and so It’s not possible to use objective tools that permit to recognize determinant aspects, and so a pathology.
So It’s not possible also to apply the successive medical praxises, like for example the formulation of a therapy or the aim of cure, that are based on diagnosys result.
Slides 9
So, the epistemological confusion, pointed out from the first answer, implies the production of interventions that try to apply medical model, so health promotion interventions dovetail with prevention praxis.
But It is possible to see that moving medical model to the health field is only a rhetorical operation, in the sense that here is not possible to apply in a correct way the medical praxises.
So, interventions based on this operation, are methodologically incorrect.
This research so, points out that nowadays, according to theoretical reflections interventions are based on methodological incorrectnesses, and so, without efficacy.
Slides 10
Then, It is necessary to produce a paradigmatic shift, that implies a new health definition, pertaining to a discursive, dialogical, processual field.
In this way It’s possible a discursive definition of health and of sanity, in the sense that the ontologically entity is included in a reality construction that incorporates It, without being determined by It.
The meaning, that is the theory produced about health, is a part of the person identity, that is dialogically constructed by narrative voices of the territory around the person.
In this sense, interventions in this field become health promoters, because the aim consists in promoting knowledge ways that construct identity in health sense.
Given that, coherently to theorical assumption as reference, we consider that identity is constructed by interaction between the different narrative voices (in fact we say “dialogical identity”), health promotion becomes a responsability that is shared by the different voices that constructthe identity².
Slides 11

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¹ G. P. Turchi, “M.A.D.I.T. Methodology of Textual Processing Data Analysis”, Aracne, Padova, 2007.
² CONNECTED TO THIS PAPER YOU CAN FIND:
IN THE DIALOGICAL MODEL SESSION “Epistemological foundation and methodological exactness regarding research in the discursive science” symposium and slides files
IN THE ORGANISATIONS PSYCHOLOGY SESSION “The architecture of services as a tool for the health promotion within the territory” paper and sides files

CONTACT: labsalute.psicologia@unipd.it