SOCIAL POLICY BA
Health and society
Student Number-
328853.
How is illness socially constructed?
It is argued that the term illness is socially constructed. Illness holds a diverse range of connotations and there is no consensus over the meaning. It is important to understand its meanings and its implications on health and disease in order to look at it in its wider context in relation to health policy and service provision and society. It is also important for the difference between professionals and lay people’s views of health to be analysed as they are so contrasting in conceptions.
It is important firstly to look at the varying notions of illness and conceptualise notions of illness i.e. what counts as a recognisable symptom, in order to be able to research it. Peoples self definitions of illness depend on their mental and physical state and the symptoms in which they define as illness.
Medical model of health
At present the British national and most other western countries health service provisional framework is based around the medical model of health, although it is argued that the social model of health i.e. health from a more holistic approach, is being increasingly being adopted. Curtis and Taket (1996), claim that the medical model of health is domineered by a scientific approach in which the body acts like a machine where by if broken needs to be repaired i.e. ill health leading to treatment. They go on to claim that the emphasis lies on the diagnosis of disease leading to ill health and look at the focus of the model on treatment rather then prevention. It is therefore vital to define the difference between disease and illness. Disease can be defined as “a medical conception of pathological abnormality which is indicative by a set of signs and symptoms.” (Field 1976:176). “Illness refers primarily to an individuals experience of ill-health and is indicated by the persons feelings of pain, discomfort and the like” (Field 1976:334).This implies that disease is something that is diagnosed and treated by medical professionals, whereas patients can experience illness which cannot necessarily be diagnosed or treated by medical professionals. According to Curtis and Taket (1996) you can have illness without disease and vice versa, the concept of illness is therefore subjective and the concept of disease objective. It is at this point the difficulties are highlighted when attempting to operationalise illness. The concept can change in definition when looking at cultural variations and their cultural normative. Illness therefore does not necessarily always have links to the medical model of health and often includes a more multi dimensional aspect which is inclusive of psychological and social aspects.
According to Senior and Viveash (1998) the way in which an individual interprets illness has knock on effects on the way in which they behave. This is known as illness behaviour which effects weather or not an individual goes to the doctors. Weather or not an individual visits the doctor effects morbidity rates. It is often assumed that once an individual develops symptoms of illness they go to a doctor but prior too this, the individual has to access their physical, psychological and social state as a health problem. The influence of life experience is influential upon this. If one has been educated to make the link between particular conditions and indicative signs for example through family, friends and the media, this can effect how you interpret symptoms. The concept of illness can be looked at in terms of a tug of war between medical and social effects. Annandale (1998) states that unlike previously illness no longer almost always leads to death which means the individual has a time to make sense of and gain an understanding of their experience, and move on. Once an individual has moved on, illness related stories are compiled by the individual and are shared with their friends and family and knowledge is passed on, which all contribute to the social construction of illness. This affects how you perceive illness and how to deal with it when it arises. The validity of illness figures are questioned as the varying illness behaviours in each individual restrain a lot of illnesses from being reported by the individual. What one person may define as an illness another may not and therefore will not report to the doctor, whereas others may not. Morbidity figures are simply the illnesses that have been defined by the patient and subsequently the doctor. According to Senior and Viveash (1998) illness figures are therefore socially constructed out of a series of social processes which relate to the development of decisions that people make, depending on the illness behaviour and the definition of illness by that person and there doctor. There is often conflict between lay and professional views on what is defined as an illness. It can be argued that the professional’s views of illness are dominated around the medical model of health whereas lay perspectives circle around more holistic views and general life experience. Senior and Viveash (1998) claim that the medical model of health assumes that bacteria causes illness, that illness is often defined as illness when a lay person reports it to a doctor implying that illness can only be defined by a doctor, and that illness can be diagnosed treated and further more cured. The medical model’s positive aspects include the recognition of explanation for illness i.e. can create a link between illness and causes and preventative methods i.e. not smoking to reduce the risk of lung cancer, although this theory is not applicable to all illnesses. Those sociologists that study the social construction of illness claim that the medical model of health and illness although is domineering throughout most of the western cultures is not the only perspective. They look further more at the medical models success and see how it has developed and thrived in theory and its influence on the dominance of people’s perceptions of health and illness.
Senior and Viveash (1998) claim the medical model of health rose to dominance prior to the 16th century when women and the voluntary sector catered for illness. With the introduction of hospitals alternative perspectives of illness i.e. religious and spiritual explanations, were taken over and the medical model sustained dominance. Soon Social policy was enforced to ensure medical training which brought forth the heir archy of medical professionals, which were mainly men. A whole new set of vocabulary was set up to describe illnesses and conditions which are still in existence and usually only understood by professional medics. This in a way gives knowledge hence power to the professionals over those lay people. Senior and Viveash (1998) claim that medical knowledge has influence over the way in which an individual thinks and construes the concept of illness which affects the way in which an individual behaves. They claim that this controlling knowledge can control ones illness behaviour. This theory ignores and denies the fact that some individuals ignore institutions and their ideas surrounding illness.
Illich (1976) is a major critique of the medical model of health. He investigated consumerism throughout the medical services and claimed that the providers of health care have a vested interest in disease. It is claimed that normative life experiences of the past that didn’t require medical treatment have now been labelled under the medical services as being an illness for example depression. Illich (1976) claims this as being the ‘medialisation of experiences’ and further more ‘social Iatrogenesis’, where by the medical services claim to be the sole providers of health and in turn taking away ones ability to cope independently with life experiences. The medical services make money out of provision and this is said to be the explanation as to why the National Health Service is based mainly on curative methods of ill health as a pose to preventative. So the introduction of the medical model of health is therefore of said to condition individuals to worry about ill health that has been purposely socially constructed in an attempt to capitalise profits. It is Social Iatrogenesis that makes us create our own conceptions of illness.
An effective research methodology when investigating the social construction of illness is therefore to focus on lay perspectives of illness in different countries as this can portray the different perspectives of illness across varying cultures. It is also interesting to investigate the variations of concepts of illness within sub-groupings in one society. Normative values alter social constructions and therefore concepts of illness.
The survey concluded that individual’s definitions of health and illness varied immensely. He went on to categorise individual’s definitions in to positive and negative conceptions. He went on to claim that negative concepts look at health as being free from illness and disease and positive definitions focusing more on physical, mental and social wellbeing.
D’Houtard & Field (1984) also researched the positive and negative concepts of health and illness and claim that higher socio economic groups would seem to use more positive definitions then those people from lower socio economic groups. The research subjects were all from a French population and therefore do not represent much cultural variation.
Contemporary issues surrounding the medical model of health often argue that social, economic, and cultural factors are often ignored. Clare (1980) focused on the diagnosis consensus of schizophrenia across a range of countries. The results concluded that there was considerable difference in the diagnosis results. This could be due to a variation in normative social behaviours and the interpretation of the behaviour in the social environment to which it is observed. The effects of the social construction of illness in this case could lead to stigmatizing effects on those diagnosed if the cultural environment is changed. The validity of the results of this research could be criticised in relation to the efficiency of the medical professionals and their job roles which intern could have direct effects on the reliability of their diagnosis. An example of this can be looked at when many people of Afro Caribbean origin came to live in England and a large percentage were diagnosed with schizophrenia. This was partly due to variations in cultural behaviour which over here was misconstrued as a mental illness, although other reasoning behind this was language barriers.
Blaxter (1990) carried out a health and lifestyle survey looking at the working class females in Aberdeen and their perceptions of illness. The results of the survey showed that women of lower socio economic status conceptions of illness were based around not being able to participate in daily tasks including house work, going to work, child care etc. Therefore many of the participants saw external factors out of their control as main effectors of illness. Baxter (1990) went on to conclude that there was link between behavioural choice, lifestyle, individual responsibility and educational attainment when looking at individuals conceptions of illness. As it is more likely for those of higher socio economic status to be better educated due to finance and its implications on better opportunities, the conceptions of illness are perceivably different over the classes.
Curtis and Taket (1996) claim that when researching lay perceptions of health it is vital in order to gain valid results that the difference between public and private accounts are recognised. Public accounts are those that are in a way censored and abide by what the individual perceives as being culturally acceptable. They therefore do not give true representation of what the individually truly believes and therefore not viable on an individual basis but more so a general culturally moral perspective. Private accounts are based more so around the medical model of health. To gain public accounts the researcher must place the individual in a situation around others close to them where by they are not afraid of revealing what they really think. Certain research methodologies such as questionnaires and interviews are often criticised for not being able to gain private accounts. Private accounts are important as they are more individualistic and demonstrate the influence of both internal and external causal environmental factors. The way in which an individual perceives illness in a private account represents the person and their life experience.
Curtis and Taket (1996) argue that it is possible to predict individual’s beliefs in relation to illness by looking at ones class, culture, age, sex.
So although the medical model of illness is seen as domineering there are many critiques. Senior and Viveash (1998) describe what is known as a patient centred model of illness. As previously discussed there is some conflict between lay and professional opinion, the doctor’s opinion holding power over the patient’s. In the case of the illness M.E. often doctors view this as being not an illness however the patient can enlighten the doctor with information surrounding the condition. The social model of illness focuses on wider deeper social structural issues that affect the self for example lifestyle, behaviour, environment, education. Predominant cultural/ socially constructed views of the body can effect whether one perceives themselves to be ill or not.
Health and illness in relation to sociological theorising can be traced as far back as Durkheim’s study of suicide. According to Annandale (1998) one very influential person in the study of the social construction of illness is the postmodernist sociologist Michel Foucault. Previous to his work the recognition of illness as a social construct had been made. Eliot Freidson (1988: 223) argued “while illness as a biophysical state exists independently of human knowledge and evaluation, illness as a social state is created and shaped by human knowledge and evaluation”. When illness became focus of sociological study attention left the solely biological focus and social aspects were investigated. Disease began to be seen as a biological state and illness began to be referred to in relation to its social aspects. Foucault looked at social construction and biological aspects. He viewed diseases as being “fabrications of powerful discourse, rather than discoveries of truths about the body and its interaction with the social world.” (Annandale (1998:35). This theory has much deeper social structural implications which implies that all knowledge is socially constructed therefore takes an anti-foundationalist ontological stance. Netton (1992:136) states that “whilst knowledge is socially created there exists an underlying truth, a real external world which remains more or less disguised or more or less understood”. Foucaults work was very influential in the view of the body throughout medicine. Disease was beginning to be seen less as a mechanical breakdown in need of a repair and separated it from the self and ones internal feelings of the self. According to Annandale (1998) Foucault’s work privileges the social over the medical claims to knowledge. This is given example to in the imbalanced power relationships as previously discussed between doctor and their patient. Annandale (1998) argues that instead of looking at the social model to alleviate this, the medical model should be looked at and the way in which it provides power to both the patient and the doctor causing partnership to form which implies the social aspects of illness and disease. The illness is now looked at in terms of the individual’s relationship with the social world. This looks at the medical model of illness as now being a form of inclusion and normalization as a pose to exclusion. It is therefore vital to understand what is going on around us in the social world in order to understand the concept of illness. It is just as important in this sense for individuals to gain understanding in everyday life as it is for the doctors.
The paper has looked at the way in which the concept of illness is fluid and there is no real consensus over the meaning of illness. Concepts of illness vary over space and time and therefore are influenced by social construction. The ways in which illness has been socially constructed is demonstrated through the variation and effects that different cultures, socioeconomic groups, religion, gender, domineering models of illness etc has on the concept of illness. This has knock on effects on illness behaviour. The paper has looked at the notion of anti-foundationalist ontological stances and the effects of deeper social structural implications on illness. Illness can be therefore looked at in terms of the individual, weather they be a professional or lay person, and their relationships with the social world. In order to look at how illness is socially constructed it is therefore essential to look at the wider social context.
REFERENCE LIST
Annandale, E. (1998) The Sociology of Health Medicine: A critical introduction. Cambridge, Polity press.
Freidson, F. (1998) Profession of Medicine. London, University of Chicago Press.
Field, D. (1976) The social definition of illness. In Tuckett, D. (ed.), An introduction to medical sociology. London,Tavistock.
Curtis, S., & Taket, A. (1996) Health and Societies: Changing Perspectives. London, Arnold.
Clare, A (1980) Psychiatry in dissent: controversial issues in theory and practice, (eds) London, Tavistock.
Rosenham, D. L. (1973) On being Sane in insane places. Science 179, 250-8.
Blaxter, M. (1990) Health and Lifestyles. London, Routledge.
Senior, M. & Viveash, B. (1998) Health and Illness. London, Macmillian Press ltd.
D’Houtard, A. & Field, M. (1984) ‘The image of health: Variations in perceptions of social class in a French population’, Sociology of Health and illness, vol.6.
Illich, I. (1976) Limits to medicine: Medical Nemesis. Harmondsworth, Penguin.
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