"It was as if I wasn't there" - Experiences of everyday racism in a Swedish medical school.

The aim of this study was to explore and analyze how cultural/ethnic minority students at a Swedish medical school perceive and make sense of educational experiences they viewed as related to their minority position. We interviewed 18 medical students (10 women, and 8 men), who self-identified as coming from minority backgrounds. Data were collected and analyzed simultaneously, inspired by constructivist grounded theory methodology. The concepts 'everyday racism' and 'racial microaggressions' served as a theoretical framework for understanding how inequities were experienced and understood. Participants described regularly encountering subtle adverse treatment from supervisors, peers, staff, and patients. Lack of support from bystanders was a common dimension of their stories. These experiences marked interviewees' status as 'Other' and made them feel less worthy as medical students. Interviewees struggled to make sense of being downgraded, excluded, and discerned as different, but seldom used terms like being a victim of discrimination or racism. Instead, they found other explanations by individualizing, renaming, and relativizing their experiences. Our results indicate that racialized minority medical students encounter repeated practices that, either intentionally or inadvertently, convey disregard and sometimes contempt based on ideas about racial and/or cultural 'Otherness'. However, most hesitated to name the behaviors and comments experienced as "discriminatory" or "racist", likely because of prevailing ideas about Sweden and, in particular, medical school as exempt from racism, and beliefs that racial discrimination can only be intentional. To counteract this educational climate of exclusion medical school leadership should provide supervisors, students, and staff with theoretical concepts for understanding discrimination and racism, encourage them to engage in critical self-reflection on their roles in racist power relations, and offer training for bystanders to become allies to victims of racism.

Experiences of the gender climate in clinical training - a focus group study among Swedish medical students.

BACKGROUND: Research shows that medical education is characterized by unequal conditions for women and men, but there is a lack of qualitative studies investigating the social processes that enable and maintain gender inequalities that include both male and female students. In this focus group study, we therefore explored male as well as female medical students' experiences of the gender climate - i.e., how beliefs, values, and norms about gender were communicated - during clinical training and how the students dealt with these experiences. METHODS: Focus group interviews were conducted with 24 medical students (nine men) at Umeå University, Sweden. The interviews were structured around personal experiences in clinical training where the participants perceived that gender had mattered. Data were analysed using qualitative content analysis. RESULTS: The students described gender-stereotyped expectations, discriminatory treatment, compliments, comments, and demeaning jargon. Female students gave more personal and varied examples than the men. The students' ways of handling their experiences were marked by efforts to fit in, for example, by adapting their appearance and partaking in the prevailing jargon. They felt dependent on supervisors and staff, and due to fear of repercussions they kept silent and avoided unpleasant situations and people rather than challenging humiliating jargon or supervisors who were behaving badly. CONCLUSIONS: Everyday communication of gender beliefs combined with students' adaptation to stereotyped expectations and discrimination came across as fundamental features through which unequal conditions for male and female students are reproduced and maintained in the clinic. Because they are in a dependent position, it is often difficult for students to challenge problematic gender attitudes. The main responsibility for improvements, therefore, lies with medical school leadership who need to provide students and supervisors with knowledge about gendered processes, discrimination, and sexism and to organize reflection groups about the gender climate in order to improve students' opportunities to discuss their experiences, and hopefully find ways to protest and actively demand change.

Well, I'm healthy, but --lay perspectives on health among people with musculoskeletal disorders.

PURPOSE: The purpose was to investigate lay perspectives on health among people with musculoskeletal disorders. METHOD: Semi-structured interviews were performed with 39 women and 30 men, (aged 22-63 years) with long-term, non-specific musculoskeletal disorders in the neck, shoulder and/or low back. Data was analysed using qualitative content analysis. RESULTS: These people experienced health as "having resources and opportunities to lead the life one wants". Three categories, "a good enough physical and psychological functioning, freedom of action, and a positive state of emotion and an enriching life", illustrate the different resources and opportunities that the informants described as important for them to perceive themselves as healthy. The informants also reflected on "being ill" and "being well" and what makes the difference. Five aspects influenced the dynamics of their health experiences: "body and soul, prognosis, character of symptoms, physical and social activity, and emotional state". Consequently, the informants expressed a holistic view of health, where the focus lies on the opportunity and the ability to lead their lives the way they want. CONCLUSIONS: This study points at the value of taking lay perspectives on health into account, as it might increase the opportunity to design effective, personalized rehabilitation strategies. IMPLICATIONS FOR REHABILITATION: Musculoskeletal disorders (MSDs) are difficult to cure and actions to alleviate suffering are of most importance to increase wellbeing and thereby work ability. Research on lay perspectives can contribute towards a deepened understanding of the health experiences of the affected, and thereby the development of the goals and activities of rehabilitation. Our models, that present the view of health and aspects important for achieving wellness among people with MSDs, can contribute in the development of multimodal rehabilitation. The results can also be useful as a base in the evaluation of clinical practice.

"He just has to like ham" - The centrality of meat in home and consumer studies.

This study aimed to describe Discourses on meat in the school subject Home and Consumer Studies in five different northern Swedish schools. Fifty-nine students and five teachers from five different schools were recorded and in some cases video-taped during lessons. Results indicate that meat was seen as central to nutritional health, sensory experience, culture and social relationships. This positive view was challenged by an alternative Discourse where meat was threatening to health, sensory experience and psychological comfort, but this was not strong enough to affect centrality. Even when participants sought to promote the health advantages of reducing meat consumption, the dominant centrality Discourse was strengthened. This implies that the possible tension between physical and psychosocial/emotional health can make the benefits of a reduction difficult both to convey and accept. A form of critical food literacy may help teachers deconstruct the arbitrary power of the centrality Discourse, but it may also strengthen meat-eater identities because the social norms that guide food choice become salient. A redesign of Discourses might facilitate a reduction in meat consumption, but such a paradigm shift is dependent on the development of society as a whole, and can only be briefly touched upon within the limited time frames and resources of Home and Consumer Studies.

"My greatest dream is to be normal": the impact of gender on the depression narratives of young Swedish men and women.

Depression is common among young people. Gender differences in diagnosing depression appear during adolescence. The study aim was to explore the impact of gender on depression in young Swedish men and women. Grounded theory was used to analyze interviews with 23 young people aged 17 to 25 years who had been diagnosed with depression. Their narratives were marked by a striving to be normal and disclosed strong gender stereotypes, constructed in interaction with parents, friends, and the media. Gender norms were upheld by feelings of shame, and restricted the acting space of our informants. However, we also found transgressions of these gender norms. Primary health care workers could encourage young men to open up emotionally and communicate their personal distress, and young women to be daring and assertive of their own strengths, so that both genders might gain access to the positive coping strategies practiced respectively by each.

Young women facing multiple and intersecting stressors of modernity, gender orders and youth.

This article aims to explore stressors experienced by Swedish adolescent girls and young women, specifically understood in relation to social context and gender theory. Interviews were conducted with 40 young Swedish women, aged 16-25 years, who had sought help at a youth health centre for stress problems. Using qualitative content analysis we identified three clusters of stressors: "the stressors of modernity", "the stressors of gendered orders", and "the stressors of youth". The results revealed that multiple and intersecting discourse-shaped stressors and demands connected to essential life spheres contribute not only to experiences of distress but also to feelings of constraint. Gendered individualism and healthism proved to be essential in understanding the young women's experienced stress. Failing social support from adults, gendered demands and responsibility taking were also illuminated. This calls for a broad contextualized and gender-sensitive approach to young women's stress and health problems.

"The Western gaze"--an analysis of medical research publications concerning the expressions of depression, focusing on ethnicity and gender.

Our aim of this study was to explore how authors of medical articles wrote about different symptoms and expressions of depression in men and women from various ethnic groups as well as to analyze the meaning of gender and ethnicity for expressions of depression. A database search was carried out using PubMed. Thirty articles were identified and analyzed using qualitative content analysis. Approaches differ with regard to how depression is described and interpreted in different cultures in relation to illness complaints, illness meaning, and diagnosis of depression. Articles often present issues based on a Western point of view. This may lead to "cultural or gender gaps," which we refer to as "the Western gaze," which may in turn influence the diagnosis of depression.

"He messed me up": Swedish adolescent girls' experiences of gender-related partner violence and its consequences over time.

This article illuminates two Swedish adolescent girls' experiences of living in a violent relationship as teenagers and how this has affected their lives and health over time. Interviews were conducted in a youth health center. A combination of qualitative content analysis and narrative analysis describes violation, stress, trauma, coping, and agency during the period of adolescence and transition into adulthood. Despite Swedish progressive public policies on men's violence against women, teenage girls are exposed to male partners' violation, a severe gendered stressor. There is a need for the development of health policy and gender-responsive interventions geared specifically toward adolescent girls.

Struck by lightning or slowly suffocating - gendered trajectories into depression.

BACKGROUND: In family practice depression is a common mental health problem and one with marked gender differences; women are diagnosed as depressed twice as often as men. A more comprehensive explanatory model of depression that can give an understanding of, and tools for changing, this gender difference is called for. This study explores how primary care patients experience, understand and explain their depression. METHODS: Twenty men and women of varying ages and socioeconomic backgrounds diagnosed with depression according to ICD-10 were interviewed in-depth. Data were assessed and analyzed using Grounded Theory. RESULTS: The core category that emerged from analysis was "Gendered trajectories into depression". Thereto, four categories were identified - "Struck by lightning", "Nagging darkness", "Blackout" and "Slowly suffocating" - and presented as symbolic illness narratives that showed gendered patterns. Most of the men in our study considered that their bodies were suddenly "struck" by external circumstances beyond their control. The stories of study women were more diverse, reflecting all four illness narratives. However, the dominant pattern was that women thought that their depression emanated from internal factors, from their own personality or ways of handling life. The women were more preoccupied with shame and guilt, and conveyed a greater sense of personal responsibility and concern with relationships. CONCLUSION: Recognizing gendered narratives of illness in clinical consultation may have a salutary potential, making more visible depression among men while relieving self-blame among women, and thereby encouraging the development of healthier practices of how to be a man or a woman.

Gaps between patients, media, and academic medicine in discourses on gender and depression: a metasynthesis.

For reasons that are not yet fully understood, depression affects women twice as often as men. In this article we describe an investigation of how depression is understood in relation to men and women by the patients themselves, the media, and the medical research establishment. We do this by undertaking a metasynthesis of data from three different sources: interviews with depressed patients, media portrayals of depressed individuals in Sweden, and international medical articles about depression. The findings reveal that there are differences in (a) the recognition of depression, (b) the understanding of the reasons for depression, and (c) the contextualization of depression. Although women and men describe different symptoms and reasons for falling ill, these gendered expressions are not acknowledged in articles coming from Western medical settings. We discuss the implications of these findings and conclude that an integrated model for understanding biological, gender, and cultural aspects of depression has yet to be developed.

Gendered portraits of depression in Swedish newspapers.

Mass media are influential mediators of information, knowledge, and narratives of health and illness. In this article, we report on an examination of personal accounts of illness as presented in three Swedish newspapers, focusing on the gendered representation of laypersons' experiences of depression. A database search identified all articles mentioning depression during the year 2002. Twenty six articles focusing on personal experiences of depression were then subjected to a qualitative content analysis. We identified four themes: displaying a successful facade, experiencing a cracking facade, losing and regaining control, and explaining the illness. We found both similarities and differences with regard to gendered experiences. The mediated accounts of depression both upheld and challenged traditional gender stereotypes. The women's stories were more detailed, relational, emotionally oriented, and embodied. The portrayal of men was less emotional and expressive, and described a more dramatic onset of depression, reflecting hegemonic patterns of masculinity.