Health and Illness

Health and Illness

 

1. Explain how sociological and lay ideas about illness differ from those of biomedicine.

Health is a broad subject that covers various aspects and hence it is almost impossible to define wellness and health without considering illness. Like health, illness is multi-faceted and is addressed in various perspectives that include sociological, lay and biomedical concepts. According to World Health Organization, health is defined as a state of complete physical, mental and social well-being and not just the absence of disease (World Health Organization, 2013). On the other hand, illness is defined as a condition that affects the normal functioning of the body organs. Illness is often used as a synonym for disease but mainly refers to the patient’s individual experience on their diseases. It is therefore possible for a person to have a disease without necessarily being ill. In addition, illness is not necessarily caused by an infection but to sickness behaviour of the body and may include depression and anorexia.

Sociological Perspectives about Illness
In the sociological model, the normal functioning of a society largely depends on the health and well-being of people living there and their ability to control illness. According to a sociologist named Talcott Parsons, the term ‘sick role’ is used to refer to the social behaviour of the society towards those who are considered to be ill (Weitz, 2012).  Furthermore, Parson added that a sick person should not be held responsible for being sick and hence should be excused from normal duties. In addition, a sick person should seek help to get out of the ‘sick role’. Those people who like their sick role and do not seek any help or treatment to get out of their situation, are generally ruled out from the society. This clearly implies that a society plays a vital role in determining sickness or illness. Due to research and development in health issues, there have been major changes in the sociological perspectives of health (Weitz, 2012). For instance, conditions such as drug addiction that were considered to be a character weakness in the past are now dealt with through rehabilitation programmes that categorise such additions as illnesses. For this reasons persons experiencing drug addiction, are allowed to assume the sick role but are advised to seek treatment.

Lay Perspectives about Illness

The findings of sociological research into lay beliefs on health and illness have been of significant use to some clinicians. Lay and sociological beliefs on health and illness focus on the different social groups and how they experience illness in the course of their lives. Such findings have portrayed to the medical professionals the need to listen to patient’s views instead of just dismissing them as incorrect knowledge (Bury, 2005). If done consistently, this improves the relationship between a biomedical officer and a patient.

Lay health beliefs allows ordinary people to develop workable theories based on individual reasoning to cater for their social and bodily situations. They then use these theories to relate to their health situations with some drawing their reasoning from previous experiences. Most of the sociological studies on lay health beliefs have concluded that individuals’ perceptions on health and illness vary according to circumstances (Caplan, McCartney, & Sisti, 2004). These circumstances may limit the broad thinking of the affected individual if the health condition is not complicated.

According to the social constructs, being healthy is basically described as the absence of disease or illness. This mentality was mostly held by the elderly especially those in poor health and hence was less likely to define health in terms of illness. As a result of using this approach, social workers who fulfilled their roles while healthy were assumed to have positive moral characteristics. Social constructionists also perceived health as the ability to overcome disease or a misfortune. Many lay people would therefore think positively about their health despite being ill because negative thoughts or mourning may result in bad health.

Moreover, the lay approach on health is that a person’s health is a reflection of his lifestyle (Blaxter, 2010). In this regard, healthy behaviour such as eating good diet, exercising, and not taking excess alcohol or avoiding smoking is said to lead to healthy body that is free from illnesses.

Teleological explanations of illness were also common in the lay people where they believed that every illness had a meaning, and there was always a purpose of becoming ill. One of the reasons for being ill could be a sign of external conflict between an individual and the society or a punishment for a poor lifestyle. In contrast, lay people believe that good health comes from within the body and requires an individual to avoid unhealthy lifestyles.

Individual perceptions are vital in constructionism where working class people have an instrumental relationship with their bodies while the middle class treat their body as personal project (Weitz, 2012). Consequently, the working class value their body as a means to an end without which they will not be able to go to work and earn their income. With this perception, the working class are aware that their bodies require constant servicing from medical experts. On the other hand, the middle class ideology is that personal control is necessary to make a choice about appropriate lifestyle.

According the sociological approach of Naidoo & Wills (2008) people responded to illness symptoms in relation to their cultural values and beliefs on illness and heath in general. This means they interpreted their symptoms on the basis of what was perceived to be ‘normal’. Likewise, the decision to seek medical help was also determined by social factors. At times, the decision to seek medical help did not always materialise as some people used ‘lay referral’ system. This system involved seeking advice from family members and close friends who had experienced similar conditions in the past. For instance, a young mother with a baby crying continuously due to health problems may opt not to take such a kid to a health professional. Instead, she might decide to seek help from her mother who had previous knowledge on how to deal with babies. People may also opt to administer self medication as many generic drugs are available over the counter.

Biomedical Perspectives about Illness

The biomedical model of illness and health focuses on biological factors and leaves out the psychological social and environmental influences of an illness. In this regard, this model is considered to be the modern way for the medical professionals to diagnose and treat an illness or a disease. Using this model requires health care professionals to analyse biophysical or genetic malfunctions from a patient in order to recommend a treatment for an illness. As such, the biomedical model does not focus of the social history of the patient or the feelings of the patient but instead focuses on objective laboratory tests to determine the illness. According to the biomedical model of illness, all illnesses, signs and symptoms are caused by an abnormality within the body, which is referred to as a disease (Albrecht, Itzpatrick, & Scrimshaw, 2000).   Therefore, all diseases give rise to symptoms although there are other factors that may influence the effects of a disease. Biomedical model indicates that health is the absence of disease and that a patient is merely a victim of circumstance with minimum responsibility for the illness or its cause (Blaxter, 2010). However, it is paramount for a patient to cooperate in receiving a treatment. In the biological model, there is a general assumption that disease is abnormal and that every illness has a specific cause.

The differences between sociological and biomedicine ideas about illness are brought about by the initial understanding of illness. In biomedicine, health is defined as the absence of disease while in the social model, health is perceived as a positive state of well-being which is also associated with the absence of disease or any physical or mental impairment (Blaxter, 2010)

By applying the social construction of medical knowledge, Berger and Luckman (1967) held an argument that daily knowledge is produced through the creativity by individuals and is directed towards solving some practical problems. It can therefore be said that ‘facts’ are established through social interactions and how people interpret knowledge. With this in mind, use of common sense should be utilised in the understanding of disease.

According to constructivism, all knowledge is socially constructed. As such, individual’s interpretive process is used to uncover health and disease, and hence gaining an upper hand over medical science which does not address the issue of health and disease objectively.

In addition, social constructionism holds that social reality is achieved through human interactions and sharing of ideas (Gabe, Bury, & Elston, 2004). In applied medical sociology, the meaning is created after the interaction of professionals and lay people. Sociology also sees disease as being biologically applied in line with social interest. The interpretation of this is that health is an invention of man.

Social constructionists have varying explanations of health and illness that are categorized into weak and hard versions.  In the weak version, disease is accepted as a biological state while the hard version objects the notion of a disease being an objective diagnosable state. The hard version of social constructionism also adds that there is no truth waiting to be revealed but truth and meaning comes as a result of interacting with the realities of the world (Blaxter, 2010).

Scholars have often differed on what should be interpreted as an illness. For instance, Gulf War Syndrome, female hysteria, Chronic Fatigue Syndrome, Obesity, and Attention Deficit Hyperactive Disorder are some of the conditions that have never been agreed to on whether they are diseases or conditions (Blaxter, 2010)

Social model differs from biomedical model due to the perception that some diseases such as arthritis result from social reasoning (Nettleton, 2006). Similarly, categories of diseases are seen as an effort of medical science to approve some complicated names and codes to symptoms that are naturally present and have always been part of human anatomy. Furthermore, (Bury, 2005) expounds that problematisation portrays a deviant status to some symptoms and behaviours that occur naturally. For instance, he challenges why certain behaviours are labelled as madness while some behaviours are ignored.

Unlike the biomedical model, social model focuses on the origin of the illness rather than its cure. On the contrary, the biomedical model tries to treat illnesses through the use of medicine and science without taking into account the social and emotional factors of how an illness or a disease occurred (Weitz, 2012).  It generally focuses on the root causes of an illness and is concerned with providing medications or vaccinations to patients.

On the subject of social creations of facts, those supporting this view hold the argument that scientific facts and notions about disease and body are created through social means. As disease is categorised in biomedicine, social constructionism argues that classification of diseases is a product of discursive contexts. In the social construction of illness, historical and cultural facts are said to influence the medical interpretation of illness (Caplan, McCartney, & Sisti, 2004). In biomedicine, language plays a critical role in the way an illness is understood by the medics while the professionalization of the medical field has led to new disciplines describing illnesses. Additionally, pharmaceuticals also influential in the labelling of illnesses although some of them may have existed naturally as explained by the social constructionists.

 

2. Discuss the sociological idea that people diagnosed, or at risk of being diagnosed, with a socially stigmatised condition, find the stigma more fearful than the condition itself.

Stigma refers to the conditions that label the bearer as culturally unacceptable in the society. Through stigmatisation, the individual affected may also feel inferior while among the healthy people. Sometimes, stigmatisation is associated with negative characteristics where an individual suffering from a condition that causes stigma is seen to be unfit in the society to an extent where other healthy people may start avoiding him (Naidoo & Wills, 2008). Stigma may also refer to a negative attribute that discredits a person socially and makes him look like a deviant in the society. This can further be explained using Goffman’s dramaturgical theory which describes an individual as not being stable or psychologically independent since interaction with others constantly changes a person’s identity.

Moreover, this theory interprets people as mere actors who are always willing to impress others during interactions. Before a person interacts with others, he prepares a role or a chance to create a positive impression. Stigmatising conditions cause embarrassment to an individual, which is a social and a moral problem. Due to the embarrassing nature of the stigmatising conditions, the back-stage attributes of an individual are revealed.

The people who are healthy or perceived to be ‘normal’ in the eyes of others, are often the ones who see the people with stigmatised conditions as being inferior or inhuman and hence discriminate against them. Among some forms of discriminations that such people are subjected to include being denied entry into some social places such as parties or family meetings. In addition, people avoid associating with them for the fear of being infected or just to avoid being embarrassed when they seen with them (Albrecht, Itzpatrick, & Scrimshaw, 2000). In some cases, the stigmatised person may end up having additional imperfections imposed on them due to the original stigma. For instance, an individual suffering from a certain stigmatising condition, such as being HIV positive, may also be associated with being unhygienic or even smelly. These additional imperfections are normally due to stereotypes and rarely exist in reality.

According to the hidden distress model, people with stigmata fear situations that would lead to ‘enacted stigma’ where people can discriminate them openly. Due to this, such people opt to pursue a policy of non-disclosure where they never let others know they have certain medical conditions (Bury, 2005).  As a result, such people end up with more stress in managing their disorder because they fear that stigma will have more disruptive effect on their lives other than the prevailing medical conditions. There are some instances where people with certain conditions live in disclosure with the fear of being noticed. If this persists for a long time, it may even result to acute ulcers or depression which would have more negative effects to their bodies than the conditions leading to stigma. Living in denial eventually makes the disease worse due to the stigma-related stress. As illness continues, stigma contributes in adding the illness burden.

When an illness is perceived as a deviance, it implies that the condition contradicts the recognized social norms in the society or norms that are related to specific group. Generally, an illness may interfere with the social system since the sick are unable to carry out their social role and hence making them to be labelled as deviants. This social order may however be restored by a doctor who administers treatment to assist the affected person to exit from the sick role.

In the medical field, deviance and stigmatisation process is categorized into three levels. Primary level is the initial violation or the society’s reaction to an illness or a condition. The secondary deviance involves the deviant’s reactions to the negative society’s reaction to his condition. This is often accompanied by a feeling of neglect and personal hatred where an individual sees himself as being unfit and unacceptable in the society to illness or a stigmatised condition. As the secondary deviance progresses it leads to the tertiary deviance. In this level, the stigmatised individual reacts to the stigma from others and gets to an advanced level of masters status (Blaxter, 2010). This label overshadows the other two types of deviance as the stigmatised person becomes stressed by his condition due to other people’s stigma towards the condition. Deviance is representation of the labelling theory where it refers to the consequences of what it has been labelled by the society and not necessarily the act committed by a deviant.

In relation to this explanation, illness can be termed as a form of deviance from societal norms where it largely explores the primary and secondary types of deviance. But Blaxter (2010) expounded on labelling by mentioning that mental illness is a product of societal view and a reaction to a given condition. In other words, mental illness is a result of being labelled as insane or a deviant in the society.

Admittedly, cultural factors are involved in the stigmatisation process due to stereotypes and some beliefs associated with some illnesses such diabetes or leprosy. Therefore, stigmatisation occurs due to power imbalance in the society where people result to labelling and stereotyping to discriminate against people suffering from certain conditions.

Labelling as a sociological construct has been used to inform the medical practice since 1960s. This was done to include the view that the experience of illness has social and physical impacts. Rules of deviance can be used to label some people as deviants or outsiders. A deviant can therefore be described as an individual who has successfully been labelled. Any behaviour that is labelled as deviant is considered to be away from the norm and mainly involves judgements made by individuals who can impose such labels.

Primary deviance consists of many deviant acts that may not be publicly labelled and therefore has minimal implications to the person being labelled as a primary deviant. Secondary deviance is however a notch higher since it affects the social roles of the person being labelled as so. What follows is that a secondary deviant is identified by the public as being a deviant where the reaction from such a person is judging the society (Naidoo & Wills, 2008). In addition, the person also changes his behaviour according to the labelling. In relation to illness, the primary deviance is simple the experience of illness. Additionally, secondary deviance involves diagnosis process where doctors classify patients based on their level of sickness. It is the public label stereotypes for the secondary deviance, that causes behaviour change in the people labelled as secondary deviants.

Most people, including medical professionals, have a perception that some conditions and disabilities are more stigmatising than others. A good example is the stigma associated with some diseases such as cancer and HIV/AIDS. Therefore, when one has been labelled through stigmatisation, the person’s identity is affected negatively. The social stigma that occurs after labelling may lead to societal discrimination (Caplan, McCartney, & Sisti, 2004). Although an individual may hide some conditions from the public to avoid discrimination and stigmatisation, such a person may not be able to hide the condition from him.

Labelling affects an individual negatively and may lead to a prolonged stigmatisation. Some of the consequences of labelling include isolation and withdrawal from social life, diminished self esteem, lack of confidence, and restriction of activities and social roles. Labelling may also have its consequences beyond an individual. For example, when a child with disability is being taken care of, the family members’ social life will be affected. In addition, the family may also experience ‘stigma by association’ due to the direct relationship with the child.  As a result, the family may start experiencing a sense of guilt and shame and may even try to distance themselves from the disabled child.

When a person is diagnosed with mental illness, there is a possibility of labelling but the person entrusted with that is the psychiatrist. In such a case, the labelling theory would indicate that such a person losses his old identity with a new identity being endorsed. This eventually leads to the mentally ill person internalizing his new social status and hence assumes the ‘master status’. The person also takes up the role of the psychiatric patient and performs it according to the expectations of the society or the family members (Caplan, McCartney, & Sisti, 2004). What follows is the stigmatisation of the patient where he is also excluded from interacting with others. Generally, stigmatisation affects an individual based on the societal perception on the given condition and how such an individual reacts to the stigmatisation.

Sociological and lay ideas about illness allow people to reason about their health based on their social and bodily situations. Their reasoning about illness and health may also be based on their previous experiences. Social constructs describe being health as the absence of illness. In addition, social constructionists also define health as the ability to overcome a misfortune or a disease. The lay people believe that every illness has a meaning and it could be a sign of external conflict between an individual and the society. Stigma labels the person as culturally unacceptable or a deviant in the society. Stigmatisation leads to discrimination of an individual due to illness or any other condition.  This occurs after an individual has been labelled as ‘unfit’ in the society or family. The consequences include isolation, low self esteem, and isolation from social life. Given these reasons, people find the stigma more fearful and embarrassing than the condition itself.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Albrecht, G., Itzpatrick, R., & Scrimshaw, S. (2000).  The Handbook of Social Studies in Health   and Medicine. Boston: SAGE.

Blaxter, M. (2010). Health. Boston: Polity Press.

Bury, M. (2005). Health and Illness. Boston: Polity Press.

Caplan, A., McCartney, J., & Sisti, D. (2004). Health, Disease and Illness: Concepts in      Medicine. Georgetown: Georgetown University Press.

Naidoo, J., & Wills, J. (2008). Health Studies: An Introduction. New York: Macmillan.

Nettleton, S. (2006). The Sociology of Health & Illness: The Social Construction of Medical           Knowledge. New York: Polity Press.

Weitz, R. (2012). The Sociology of Health, Illness, and Heath Care: A Critical Approach. New     York: Cengage Learning.

World Health Organization. (2013). Who Definition of Health. Retrieved from            http://www.who.int/about/definition/en/print.html on 22^nd May 2013.

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