the social construction of health
Dr Anthony Pryce
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aims
to explore what sociology has to do with learning to be a health care professional
to work toward understanding the concept of the social construction of the human world
to identify ways in which the sociological imagination may help us see beyond the taken-for-granted assumptions of ‘reality’ and everyday life
what’s reality? - the traditional view
Edith Cavell: alumni of The London Hospital
Worked in Belgium in World War 1
Executed by the Germans and became an icon of feminine humility and stoicism, a symbol of nursing as a vocation, a national martyr of triumph even in death..or a victim of her own class and gender?
Film made in 1939 - starring Anna Neagle
an old film about a nurse!
what has this to do with sociology...or even nursing?
how are our ideas formed, shaped, influenced as individuals and culturally?
films are documents through which we can interrogate the past in order to better understand the present
What does this film say about:-
Nurses and nursing?
Women, gender and Power?
How histories are socially constructed?
how myths are made...how stories become interwoven into the beliefs of an increasingly global society
what was true in 1915 will have already changed in 1939, and the story will be transformed to use as propaganda
how individual stories may represent the ‘moment’ in history e.g.the life and death of Diana
so what!
what is ‘real’ in now was not necessarily real in 1915 or 1939 or 2000......cultures and meanings attached to social and biological phenomena change over time and place
what is real for a child living on the streets of Sao Paulo or Bombay or Johannesburg is not necessarily real for a child in Rome, Manhattan or Whitechapel
‘reality’ is thereby socially constructed and also fragile e.g. postmodernism, cyberspace
Social Constructionism:
	 - does not imply that disease is imaginary but rather that medicine is a form of social practice, which observes, codifies and understands these sufferings. Concepts of disease thus have no necessary, transhistorical, universal shape, and reflect a particular way of viewing the world.
(Morgan, Calnan & Manning, 1985:29)
what makes it ‘constructed’?
Examples: where you are will determine your experience of reality:
class
religion
gender
sexualities
race
ethnicity
education
sociology is concerned with two main issues within the social world:
social structure
&
social action
so....?
how does looking at old films, or soap operas help make sense of sociology and it’s relevance to nursing... even if they are about medicine, nursing or disease?
Structures
are concerned with those elements in any culture that act as social frameworks and reference points
we need to understand what is meant by class and social stratification because it can have profound implications for the way we experience health and illness and other life opportunities and expectations
social structures (like class, religion, gender or law) didn’t suddenly appear fully formed as we know them now, they developed over time, through discourses and continue to move on, formed by economic, political, moral, environmental, social and technological changes.
such changes profoundly effect expectations health and the practices of health care delivery
Examples:
complementary and alternative therapies now compete with heroic ‘scientific’ medicine
genetic engineering will have profound moral, social and political consequences
the invention of, and responses to new diseases such as AIDS or ME, BSE or old social responses such as labelling and stigma e.g.TB
how society controls accepts new treatments e.g. Viagra or reproductive technologies
human organisations are based on structures and different forms of power and knowledge
religion
law
medicine
Government
Education
Legal systems
Social systems
Health
Language
Technologies
Economics
Work
Environments
these profoundly influence:
the family
rites of passage into social groups and socialisation
notions of history and nationality
the environment
the sense of self....of being an individual who is born into a (sub)culture
social action is concerned with meaning(s):
each person has own cocktail of experience emotional and social histories
identitie(s)
sexualities and gender
belief systems and their own way of telling their stories
these meanings vary from one (sub)culture to another
ok...so why important in nursing?
nursing is primarily concerned with social action within social structures such as class, governments, professional groups
it concerns the meanings that are attached to health and illness - these vary from culture to culture, person to person, generation to generation, man to woman, heterosexual to gay, black to white, the affluent to the deprived, the urban to the rural
It also concerns Power in: -
social inequalities (Marx)
professional - lay relationships
about the meanings of illness - why is madness so bad? what is stigma and the consequences of disability? (Goffman)
the experience of illness
the forms of professional practice and knowledge such as medicine and nursing (Foucault)
also: -
social expectations and roles (Parsons)
bureaucracies and the organisation of healthcare delivery (Weber)
health and society in a global culture (Ritzner)
cultural variations in health and health care (Hillier)
Sociology is about:
developing and/or applying theory that helps you to stand outside your own prejudices and perspectives in order to explain and understand what may be happening in the ‘real’ world - given that reality is increasingly seen as fragile, shifting and co-existing with other ‘realities’
in nursing:
it helps you understand and explain why life chances and health expectations vary, and why the embodied person you are nursing might have a different points of view and experiences of health and meanings of why they might be sick or dying
sociology uses many forms of research to gain these theories:
statistics - Census, mortality and morbidity
interviews
history
observation
surveys
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media
visual images
literature
Next time...
We shall explore the social process of becoming ill - what makes us ill, and what is illness anyway?