‘Trust’ and Power:
Towards A Social Theory of Self
Tony
Gilbert, University of Plymouth
Jason
Powell, University of Liverpool
Introduction
This article sets
out to delve into the relationship trust and professional authority in the context of
health care. Understood in its micro-political terms and conceived as impacting on
individual identity and agency at a number of levels: intrapersonal, personal,
interpersonal, systems or organisational levels and the socio-political; this relationship
stands at the interface of competing pressures working to produce the increasing
complexity of social life. “Trust” is inextricably linked with uncertainty and
complexity while professional authority rests on the specialist knowledge claimed by the
range of experts and technologists that inhabit the spaces through which social life is
governed and complexity managed. Spaces: at once both hidden and visible, which provide
opportunities across the social landscape for the agency of individuals to be exercised
and worked on; producing the self-managing citizen central to neo-liberal forms of
government. In this context the strategies of trust become linked with rival programmes
that come armed with a range of technologies charged with competing and contested truth
claims. As a consequence contradictory positions are provided where selfish desire and
selfless obligation are placed together sharing the same space, thus adding to the
potential for anxiety and provoking searches for predictability, confidence, faith and
ontological security.
It is in these spaces that expertise works
upon the dual project of managing both its conduct and the conduct of others. A reflexive
process where expertise is involved in maintaining systems that do not require personal
knowledge of any other individual in the system but which do require an overall level of
confidence in order to function. In managing systems expertise engages techniques of
impression management, deploying a range of systems of mistrust designed to both reassure
the population of the integrity of the system and the authority of the expertise embedded
there. At the same time this expertise claims the right to accredit and provide the
necessary symbols of authority.
There are increasing attempts to conceptualize the notion of ‘trust’ in
social theory as a pivotal dimension of modernity (Giddens, 1991). However, the early
statement that ‘social science research on trust has produced a good deal of
conceptual confusion regarding the meaning of trust and its place in social life’
(Powell, 2005: 74) seems to be still valid especially as applied to ageing studies. Trust
is on the one hand incompatible with complete ignorance of the possibility and probability
of future events, and on the other hand with emphatic belief when the anticipation of
disappointment is excluded. Someone who trusts has an expectation directed to an event.
The expectations are based on the ground of incomplete knowledge about the probability and
incomplete control about the occurrence of the event. Trust is of relevance for action and
has consequences for the trusting agent if trust is confirmed or disappointed. Thus, trust
is connected with risk (Giddens, 1991).
Up to now there have been few attempts to work out a systematic scheme of different
forms of trust in between older people and individuals, health institutions or policies
that impinge on their identity performance. Social trust tends to be high among older
people who believe that their public safety is high. Since the erosion of public trust in
institutions like the government and the media trust
attracts more and more attention in social sciences
Powell (2005) distinguishes between trust in
contracts between people and State such as pension provision, trust in friendships across
intergenerational lines and trust in love and relationships and trust in foreign issues
associated with national identity. However, sociological theories which suppose a general
change in modernity assume that with the erosion of
traditional institutions and scientific knowledge trust becomes an issue more often
produced actively by individuals than institutionally guaranteed.
Independent from the insight that social action in general is dependent more or
less on trust there empirical results in the context of risk perception and risk taking
indicate:
§
Trust is much
easier to destroy than to built.
§
If trust is
once undermined it is more difficult to restore it.
§
Familiarity
with a place, a situation or a person produces trust.
§
Persons will
develop trust if a person or situation has ascriptive characteristics positively valued.
Trust seems to be something that is produced
individually by experience and over time and cannot be immediately and with purpose be
produced by organizations or governments without dialogical interaction with older people
on issues affecting their lifestyles and life-chances such as care, pensions, employment
and political representation (Lewis 2004).
The reciprocal
relationship between hospitals and the personal lives of patients is central to the
analysis of the role and performance of public services. In a mutually constitutive
process, the social experience and identities of individual patients are produced, in
part, through engagement with services which are then affected by the actions of those
patients (Fink 2004, Lewis 2004). The fact that experiences of mental health services
impact on different spheres of people’s lives implies that the exploration of trust
also has to explore these different domains, but in an integrated multi-disciplinary way
that enables comparison between the different criteria upon which trust is established,
maintained or lost. Such an approach to trust is aided by the existence of similar
concerns across domains. These include: trust as future orientated, trust that occurs
without the guarantee of reciprocity, trust that requires the placing of expectations with
the agency of others, trust that works to reduce complexity and anxiety, and trust that
involves risk and uncertainty. At the same time the observation that mistrust operates as
the functional equivalent to trust provides a means of considering the complex interplay
between expectations and sanctions (Luhmann 1979, Shapiro 1987, Dasgupta 1988, Gilbert
1998)
The decline in the
hegemony of the rational choice models of economic and social behaviour, the limits of the
post-emotionalism thesis and the apparent weakening of community bonds in the late
twentieth and early twenty-first centuries has provoked increasing academic and political
interest in the role and function of trust in contemporary societies (Luhmann 1979,
Giddens 1990, 1991, Putnam 1993, Lane 1998, Seligman 1997, Uslaner 1999, Taylor-Gooby
1999, 2000, Dean 2003). However, trust is a
complex idea which can be explored theoretically and empirically on different levels:
politically in relation to social capital and social norms; sociologically in relation to
abstract systems, complexity and risk; and inter-personally in relation to characteristics
of trustworthiness such as competence. Trust can be conceived as generalised, e.g. through
the level of trust based exchanges between members of a community; or particular, as in
personal relationships. Moreover, there are important definitional problems concerning the
relationship between trust, confidence, faith and familiarity (Seligman 1997).
Conceptually there
are tensions but also interesting theoretical possibilities between late [high] modern and
post-modern conceptions of society. Both identify the fragmentation of traditional forms
of authority and expertise, and acknowledge the increasing complexity this produces
through the availability of multiple sources of information and different lifestyle
choices. This uncertainty gives rise to an increasing reliance on trust in the agency of
others (Seligman 1997). Late [high] modern conceptions of trust tend to point to the
failure of rational choice theories to account for human behaviour as evidence for the
existence of a range of social norms that promote altruistic behaviours, obligation and
responsibility (Seligman 1997; Dean 2003). Post-structuralists, in particular
governmentality theorists, have discussed risk and uncertainty at length (Osborne 1997,
Petersen 1997), but leave the discussion of [social] ‘trust’ to an observation
that the trust traditionally placed in authority figures has been replaced by audit.
Concerns about social norms could be reframed within a post-structuralist lens by locating
the debate about trust with those relating to ‘ethics’ and ‘technologies of
the self’ (Davidson 1994).
As stated earlier,
trust and responsiveness are assumed to be the issues of central concern with transparency
and targets providing supporting technologies through which trust is promoted and
maintained. The discussion will now turn to explore the relationship between trust and
targets, transparency and responsiveness. For the purpose of this section Luhmann’s
(1979) definition of trust as ‘managing expectations and reducing complexity’ is
assumed.
In considering the
performance of public services the National Consumer Council (2004) [NCC] (Wisniewski
2004) identify transparency and responsiveness as core values for public services, arguing
that a balance of consumerist ‘choice’ and participatory ‘voice’ is
essential to the quality and performance of public services. Responsiveness becomes a
blend of choice and voice at both individual and organisational levels, with the
proposition that consumers will participate in the setting of organisational targets and
contracts, while individual consumers will be able to modify services to meet individual
needs. In the context of disabled people the functioning of the Direct Payments Act (1997)
(Powell, 2005) provides a key example of responsiveness. Targets and official ratings e.g.
star ratings become the external measures of performance on which people are assumed to be
able to make judgements, with transparency the key to trust in this process (Shaw 2001,
Stewart and Wisniewski 2004, McIvor et al.
2002).
The NCC position is
underpinned by a model of human behaviour that assumes individuals will balance their own
needs with an element of social responsibility, which also reflects a good deal of New
Labour’s discourse around encouraging older people into paid work.. In parallel
public service organisations behave reflexively to anticipate concerns and changing
patterns of need. This benign model is somewhat undermined by evidence that suggests that
individuals do not always make rational choices (Taylor-Gooby 1999) and that for some
people, particularly vulnerable and dependent groups, choice can be anxiety provoking a
position further compounded by the fact that such groups tend to be disproportionately
exposed to risks (Taylor-Gooby 2000). At the same time theoretical debate has exposed the
complexity of the relationship between public services, fragmented across the statutory
and third sectors (, Rose 1999), and a range of public service consumers whose motivation
is somewhere between altruistic and totally self-seeking (Le Grand 2000, 2003 Dean 2003).
Complexity in the relationship between health
services and consumers is further exposed when the focus shifts from the structural and
organisational level to the individual level of personal lives and relationships. A link
between trust and coping strategies has been identified by Taylor-Gooby (2000) in the
context of financial decision making. Coping is also the central concern of
Sheppard’s discussion of the responsiveness of child care agencies and social workers
(Sheppard with Gröhn 2004). Drawing on a range of psycho-social models of coping he
concludes that responsiveness is evaluated on the basis of the ability of
services/professionals to deliver practical support, quickly and efficiently. At the same
time it is noted that an important feature of the level of stress is the importance of
people’s self-evaluation of their success in coping.
The
suggestion in ‘From Care to Citizenship’
(Powell, 2005) that a new status had been achieved could be
taken to be somewhat premature if the evidence from the fieldwork is taken at face value.
Regardless of which conceptualization of citizenship we might take, people with learning
disability have some way to go before it can be claimed that citizenship has been
achieved. A level of functional integration in the community is evident but they still
experience large scale exclusions, especially in relation to work. At the same time people
with learning disability remain largely dependent upon the organisations that provide them
with support for their access to and participation in the community.
However,
if we take the sentiment expressed in ‘From
Care to Citizenship’ to be an
expression of the discourses circulating through social policy and link this with the
analysis of governmentality, a somewhat different picture is produced. The deployment of
discourses of citizenship enable the population to be managed. The management of people
with learning disability has shifted from large institutions, either hospitals or
daycentres, to management through the community. The
discourse of normalization which underpinned the move from
institutions has been transformed into a discourse of citizenship with people with
learning disabilities now managed within specialized spaces in the community which remain
supervised by professionals (Rose 1999).
The
role of professionals is to encourage people to move along a continuum towards
self-management while they anticipate and manage the risks involved (1999). These
discourses of citizenship provide a number of reference points e.g. work, exercising
choices in the community, and obligation to a particular community: but the partial and
fragmented way these discourses penetrate both policy and practice means that a number of
different, often contradictory positions are established.
The differences between the different models of support, residential care and supported
living, are evidence of this uneven process. However, the commissioners of services favour
the ‘supported living’ model therefore new contracts tend to promote this model.
Ethics
of the Self
Despite
the fragmented nature of the outcomes for older people we can consider the different
outcomes in relation to the ethic of the self central to governmentality (Miller 1993,
Davidson 1994). This ethic, deployed through the discourses of citizenship, works to
construct people with learning disabilities as useful while also identifying those who are
greater risk. The latter, experience further segregation and surveillance by professionals
with more coercive technologies. As noted earlier this ethic of the self is composed of
four dimensions: ethical substance, mode of subjection, self forming activity and telos or
end product. It concerns the way bodies are made useful, productive and self-managing.
These dimensions will now be considered in relation to choices and opportunities produced
for people with learning disabilities. The first dimension, the ethical substance, is that part of the self that is
to be worked and subjected to ethical judgement. In this context we can consider the
identity formed and the feelings of responsibility and obligation being produced. The
identities of citizen-tenant, of worker, as consumer in the marker, as member of the
community are suggestive of a new identity for people with learning disability. These
identities are formed in opposition to previous identities of dependence. At the same time
feelings of responsibility are created as individuals become accountable for their choices
and obligation is produced through a ‘felt responsibility’ for a particular
community.
The
mode of subjection, relates to the way in
which the individual recognises themselves in accordance with particular rules and norms,
and puts these into practice. The recognition of oneself as citizen-tenant, worker,
consumer, and member of a community requires the individual to actively engage in these
processes and through this engagement to demonstrate their compliance with the rules and
norms. There are examples of individuals engaging in work and exercising consumer choice .
In relation to community based voluntary work the two themes of work and affiliation to a
particular community, are brought together clearly paralleling communitarian views of
citizenship. Nevertheless, these circumstances remain incomplete and fractured as the
relationship with the community and the formation of obligation is mediated, not by the
individuals themselves, but through the organisations that manage the individual in the
community. In contrast the citizen-tenant achieves a relationship with the community in
their own terms i.e. not mediated by an organisation. In this case the modes of subjection
are more instrumental with expectations over paying rent and other bills promptly, and
maintaining the private space in a responsible way so not to offend other citizens. Work
and an affiliation to a particular community are possible but not engineered.
The
third element is the self forming activity or
ethical work required transform and develop the individual as an ethical subject. This
relates to the particular practices individuals engage in to maintain their identity.
Discussing governmentality, Miller (1993) Rose 1999), while cautioning against any
necessary correspondence, identify a range of techniques where individuals work upon
themselves to modify their behaviours, improve their knowledge and develop skills linked
to their identity and modes of subjection. Many of these activities relate to reflective
and confessional practices. However, in relation to the fieldwork and people with learning
disabilities we might identify practices that sustain individual self-discipline i.e.
attendance at work, appearance, maintenance of personal space, and relationships with
others. In the marginalized spaces that older people occupy these self-forming activities
are mediated, encouraged and supported by professionals. Nevertheless, it is clear that
there is not an option for older people not to comply with this discipline without having
to face the consequences. The final dimension, telos,
relates to the aim governmentality: the production of the useful, productive and ethically
self managing individual; the role of services and professionals is to encourage and
support people towards this goal.
Approaching
interpersonal relationships through the medium of ethical decision-taking is seductive
because it appears to offer comprehensive solutions to both structural and personal
dilemmas at the point of contact between helping professionals and older patients. It is
an approach that chimes well with the claim that the medical model should be objective and
free from prejudice and also preserves the exclusive context of the patient-physician
relationship . Interaction between older people and their
doctors and nurses may thereby be driven by a clear ethical code, a clinical examination
of need, and respect of the autonomy of the patient. It becomes a matter of technical
gate-keeping within the symbolic space of a special, one to one, relationship. Whilst such
an approach directly addresses the inequities that arise from explicit decisions, it is less able to digest issues of institutionalised ageism or imbalances of power between patients and health
professionals.
This
implies that the way in which alliances and power imbalances are played out varies between
service systems. An example of this variation can easily be seen, by comparing health care
systems in the US and the UK. In the United States, with its predominantly commercial
system, it is not uncommon for patients to be reportedly distrustful of their doctors.
This trend has been intensified with the advent of managed care, a system that attempts to
reconcile treatment options with insurance liabilities. Physicians are often seen as being
in alliance with the insurance companies when making clinical judgements as the latter
determine what can be legitimately prescribed. It is not uncommon for patients to go
‘doctor shopping’ within the US system in order to gain alternative opinions or
interpretations of access criteria to clinical procedures. Under the UK system however,
Doctors and most notably General Practitioners are most likely to be seen as in alliance
with the patient in attempts to secure adequate treatment from a limited state system.
However, because patients have to register with one doctor and public services are subject
to ‘queue’ systems, doctor shopping is virtually unknown. Thus, when Powell
(2005) talk about the ethical ‘responsibilities to
third party interests’, speaking from the US context- they are referring to a
potential conflict of ethical demands from the patient and from the insurer. In the UK
context, this is currently more likely to be interpreted as a debate on the duties to
informal carers, mostly relatives, or the implications for wider public health. Further,
in state-controlled quasi-markets, increasing politico-economic control of public health
services and attacks on professional autonomy are more likely to be engineered through
‘quality’ processes such as monitoring and audit,
which are perceived to be a greater threat to professional autonomy than corporate
capital.
Traditional
ethical concern about the relationship between professionals and older people need has
tended to focus on issues such as: what to divulge to patients about their own health
status and in what form; the need for privacy and confidentiality and its limits, plus the
discussion of conflicts of interest. This tends to take
the power/knowledge relationship between professional and user as a given, in such a way
that discussion hinges on how and whether the former should make information available. To
return for a moment to the question of patient autonomy, this is often presented as the
deciding factor, whether an individual patient has the where-with-all and sufficient
information to make a judgment. Whilst a laudable objective in itself it also uncritically
reflects decision-taking within the traditional one-to-one patient-physician relationship
where other factors are supposedly more or less equal.
Foucault
(1977) has argued persuasively that the birth of the medical profession brought with it a
different way of seeing illness and well-being. Most notably, the sick other became an
object to be modified. Under the ‘medical gaze’, people become their bodies,
bodies disaggrogated into a series of dysfunctional parts. This is useful for the
scientific analysis of function and remedy but severely limits any perspective that takes
into account interpersonal and wider social factors.
re-classification
of experience into symptoms which can then be addressed separately from interpersonal and
wider social impacts.
Common-sense
assumptions of health service contexts, the history of institutions and social structure, are not questioned. In reality,
these service systems reflect the different attention and options offered to different
ages and social groups, the use of strategies,
routines and masquerades deployed by professionals and older patients in health settings and the complex relationship between the experience of illness,
of ageing and the emotional labour of being a patient in care.
Frank (1998) argues that the ability to tell
ones own story of illness is by no means straight-forward. If as Foucault (1977 claims, the maintenance of existing power
relations depends not on the use of force, but on the ability to persuade active subjects
to reproduce those relations for themselves, then the telling of narratives will always be
suspect. According to this perspective the scope of ideas such as patient autonomy will
always be limited and problematic because the frameworks that are used to explain and
understand our own illness experience to ourselves are themselves compromised. Frank
(1998) poses the almost unanswerable question of when does self-care turn into a
technology for producing a certain sort of self ? Personal narratives, particularly for
older people in health settings, remain both a means of taking care of oneself and
conformity to a restricted legitimising discourse.
The
professional’s role as a sort of gatekeeping adviser, itself contains profound
interpersonal inequalities in terms of who controls and allows access to scarce medical
and social resources, which simultaneously intereact with the economic, social, and
cultural capital of the practitioner and the
patient both within and beyond the clinic.
This
paper has explored the notion of trust in relation to older people and the assumption that
policy penetrates into the lives of people in partial, fragmented and locally specific
ways. The analysis of the interview material suggested that there was no coherent idea of
citizenship operating through the services. Instead there were fragmented approaches
leading to contradictory positions of inclusion and dependence or independence and
isolation. However, the analysis of trust and governmentality provides a richer picture.
Rather than evaluating the adequacy of particular discourses, governmentality identifies
strategies that work to make individuals productive and self-managing. First, the
marginalised spaces were older people are maintained and subjected to techniques of
surveillance and training are identified. The different discourses of citizenship, while
producing contradictory positions for older people, do nevertheless provide positions to
be had when less than half a century ago no such positions existed. In this sense these
discourses are productive and the role of professionals is to move people along the
continuum towards self management. The analysis of governmentality enables the
identification of a range of techniques that work to make older people useful through a
variety of forms of work and opportunities to exercise consumer choices. Consumer
discourses become devices which transform real relations - 'older people' become
'consumers', 'social workers' become 'managers', 'social service departments' become
'purchasers' all crystallised by the formation of community care policies. In this case,
care services provide schemas for the 'conduct of conduct'
in
highly professionalised services dominated by power/knowledge and characterised by the
discretionary autonomy of social workers. It is within this disciplinary matrix of
knowledge, contracts and autonomy that power operates over older people, ultimatley
reinforcing the fragmentation that health surveillance engenders in the identities of
older people at the centre of the professionals' gaze.
References.
Barnes,
M. and Shardlow, P. (1996). Effective consumers and active citizens: Strategies for
users’ influence on service and beyond. Research,
Policy and Planning, 14(1), 3-38.
Beresford,
P., Croft, S., Evans, C. and Harding, T. (1997). Quality in personal social services: The
developing role of user involvement in the U.K. In Evers, A., Haverinen, R., Leichsenring,
K. and Winstow, G. (eds.) Developing Quality in
Personal Social Services: A European Perspective. Aldershot: Ashgate.
Carabine
J (2001). Unmarried Motherhood 1830 – 1990: A Genealogical Analysis, in M Wetherell,
S Taylor & S J Yates [eds.]. Discourse as Data:
A Guide for Analysis. London: Sage pp 267 – 310.
Coomber R (1997).
'Using the Internet for Survey Research'. Sociological Research Online, vol. 2, no. 2.
<http://www.socresonline.org.uk/socresonline/2/2/2.html>
Dasgupta, P.
(1988). Trust as a commodity, in Gambetta, D. (ed.) Making
and Breaking Co-operative Relations. Oxford: Basil Blackwell.
Davidson, A.
(1994) Ethics as ascetics: Foucault, the history of ethics, and ancient thought. In C,
Gutting [ed.] the Cambridge Companion to Foucault.
Cambridge: Cambridge University Press.
Dean H (2003). The
Third Way and Social Welfare: The Myth of Post-emotionalism. Social Policy and Administration, 37(7): 679 -
708.
Fairclough
N (2001). The Discourse of New Labour, in M Wetherell, S Taylor & S J Yates [eds.]. Discourse as Data: A Guide for Analysis. London:
Sage pp 229 – 266.
Fink J (2004)
Questions of Care, in J Fink [ed.] Care: Personal
Lives and Social Policy. Bristol: Polity Press/Open University pp 1 – 42.
Foucault, M (1977)
Discipline and Punish, Tavistock: London
Frank, A (2005) The
Wounded Storyteller. Chicago University Press
Fukuyama F (1996).
Trust: the social virtues and the creation of
prosperity. Harmondsworth: Penguin.
Giddens A (1990). Consequences of Modernity. Stanford NY: Stanford
University Press.
Giddens A (1991). Modernity and
Self-Identity: Self and Society in the Late Modern Age. Bristol: Polity Press.
Gilbert
T. (1998). Towards a Politics of Trust. Journal of
Advanced Nursing. 27(6): p 1010-1016.
Gomm
R, Hammersley M, and Foster P (2000a). Introduction, in R Gomm, M Hammersley and P Foster
[eds.], Case Study Method. London: Sage pp 1 -
16.
Gomm
R, Hammersley M, and Foster P (2000b). Case study and Generalization, in R Gomm, M
Hammersley and P Foster [eds.], Case Study Method.
London: Sage pp 98 - 116.
Hall
S (2001). The Spectacle of the Other, in M Wetherell, S Taylor & S J Yates [eds.]. Discourse Theory and Practice: A Reader. London:
Sage pp 324 - 344.
Kramer RM and
Tyler T R [eds.] (1996). Trust in Organisations:
Frontiers of theory and research. London: Sage.
Kvale S (1996). Interviews: An introduction to qualitative research
interviewing. London: Sage.
Lane C (1998)
Introduction: Theories and Issues in the Study of Trust, in C Lane & B Bachmann
[eds.]. Trust Within and Between Organisations:
Conceptual issues and empirical applications. Oxford: Oxford University Press pp 1 -
30.
Langan,
M. (1998). The Personal Social Services, in N Ellison & C Pierson [eds.]. Developments in British Social Policy. Basingstoke:
Macmillan.
Le Grand J (2000).
From Knight to Knave? Public Policy and Market Incentives, in P Taylor-Gooby [ed.] Risk, Trust and Welfare. Basingstoke: Macmillan pp
21 – 31.
Le Grand J (2003).
Motivation, Agency and Public Policy: Of Knights and
Knaves, Prawns and Queens, Oxford: Oxford University Press.
Lewis G (2004)
‘Do Not Go Gently …’: Terrains of Citizenship and Landscapes of the
Personal, in G Lewis [ed.] Citizenship: Personal Lives and Social Policy. Bristol: Polity
Press/Open University pp 2 – 35.
Luhmann N (1979). Trust and Power. New York, NY: John Wiley and
Sons
Mason J (1996). Qualitative Researching. London: Sage.
McIvor R, McHugh
M, & Cadden C (2002). Internet technologies:
supporting transparency in the public sector. International
Journal of Public Sector Management, 15(3): pp 170 – 187.
Mehan
H (2001). The construction of an LD student: A Case Study in the Politics of
Representation, in M Wetherell, S Taylor & S J Yates [eds.]. Discourse Theory and Practice: A Reader. London:
Sage pp 345 – 363.
Miller
T. (1993). The Well-Tempered Self: Citizenship,
Culture and the Postmodern Subject. Baltimore: John Hopkins University Press.
National Consumer
Council (2004). Making Public services Personal: A New Compact for Public Services. The
Independent Policy Commission on Public Services report to the National Consumer Council.
London: National Consumer Council www.ncc.org.uk
Office of the
Deputy Prime Minister (2004). Mental Health and
Social Exclusion: Social Exclusion Unit Report. Wetherby: ODPM Publications.
Osborne T (1997).
Of Health and Statecraft. In Petersen A & Bunton R [eds.] Foucault: Health and Medicine. London: Routledge.
Petersen
A. (1997). Risk, governance and the new public health, (Petersen A. & Bunton R. eds.) Foucault: Health and Medicine. London: Routledge,
pp 189 – 206.
Powell, J (2005) Social
Theory and Aging. Rowman and Littlefield: Lanham.
Putnam R D. (1993)
Making Democracy Work: Civic traditions in modern
Italy. Princetown: Princetown University Press.
Rapley M (2003) Quality of Life research: A critical introduction.
London: Sage.
Rose N (1999). Powers of Freedom: Reframing political thought.
Cambridge: Cambridge University Press.
Schofield
J W (2000), Increasing the Generalizability of Qualitative Research, in R Gomm, M
Hammersley and P Foster [eds.], Case Study Method.
London: Sage.
Seligman A B
(1997). The Problem of Trust. Princetown:
Princetown University Press.
Shapiro
S P. (1987). The social control of impersonal trust. American
Journal of Sociology. November. 93(3): pp 623-658.
Shaw S (2001)
External Assessment of Health Care. British Medical
Journal, 322(7290): 851 – 854.
Sheppard M with
Gröhn M (2004). Prevention and Coping in Child and
Family Care: Mothers in Adversity Coping with Child Care. London: Jessica Kingsley.
Silverman D
(2001). Interpreting Qualitative Data: methods for
analysing talk, text and interaction. London: Sage.
Stewart D and
Wisniewski M (2004). Performance Measurement for stakeholders: The case of Scottish Local
Authorities, International Journal of Public Sector
Management, 17(2&3): pp 222 - 233.
Taylor-Gooby P
(1999). Markets and Motives: Trust and Egoism in Welfare Markets. Journal of Social Policy, 28(1): 97 – 114.
Taylor-Gooby P
(2000). Risk and Welfare, in P Taylor-Gooby [ed.] Risk,
Trust and Welfare. Basingstoke: Macmillan pp 1 – 20.
Uslaner E M
(1999). Democracy and Social Capital, in M Warren [ed.]. Democracy and Trust. Cambridge: Cambridge
University Press pp 121 - 150.