Dr Anthony Pryce

S/L Sociology

To explore how morbidity statistics might be socially constructed

understand the six main stages involved in ‘becoming ill’

To introduce Parson’s notion of illness as a social state

to identify and explore the ‘medical model’ and its critiques

Figures are socially constructed, they are not ‘natural’ and are not objective facts

They arise out of decisions and social definitions of health and illness

They depend on the collection of data with agreed definitions and they rely on the reporting of incidence by a doctor

1: social processes and vulnerability

2: development of symptoms

3: symptoms interpreted as illness

4: a decision is made to seek health care

5: applying an illness label - the dr/pt interaction

6: morbidity statistics shape our view of disease

Social causes of illness:

poverty and inequalities within capitalist societies (Navarro, 1979).

diet

housing

unsafe recreational areas

pollution

stress

occupational hazards

genetic and predisposing factors

Physical, e.g. headache, runny nose, pain

Psychological, e.g. anxiety, depression

Social, e.g. social isolation, damaging relationships

Influence of personal experience; personal or observation of others

Influence of media: the construction of illness stories and the scientific basis of ‘truth’

Influence of family:may collude with symptoms

Influence of culture:social meaning of pain

Influence of gender: interpretations of social role

Not everybody visits the doctor!! -

other options include self treatment; complementary therapies;

May result from anxieties; personal beliefs. Or not wishing to confirm worst fears.

Also latest research on cancer survival & inequalities - 11% difference

May feel that going to doctor is ‘sissy’ or beyond social role expectation

What is the social expectation of the sick?

Functionalist perspective - Illness as deviance

The sick role identifies two rights:

	the exemption from normal social roles

	from responsibility for their own state

and two obligations:

to want to get well speedily

to consult expert medical opinion

Apply a high degree of skill and knowledge to illness

Act in the welfare of the patient not self-interest

Be ‘objective’ and emotionally detached and non-judgmental

Be guided by rules of practice and code of conduct

To examine patients physically and enquire into intimate areas of their life

Professional autonomy

Occupies position of authority in relation to the patient.

Does not address culture, gender, sexuality, race or class; chronic illness;

mental illness nor the experience of women and childbearing

He is uncritical of inequalities in role of doctors as gatekeepers and agents of social control -

to diagnose disease is to define its bearer as in need of ‘corrective treatment’ of body or mind (Friedson 1970 cited by Scambler 1997)

The medical model searches for physical explanations of causes(aetiology) and provides the basis for doctors ‘expert’ status.

Medicine classifies illness.

Is going to the doctor like taking your car to the garage?

The doctor-patient relationship has often been characterised as unequal

The medical model (see Senior & Viveash Chapter 2)

Dominant western view is that:

Illness is caused by bacteria, genes, virus or accident not spirits or curse

Illnesses can be identified and classified into different types such

as diseases of the nervous system, circulatory system etc. the classification of disease is seen as

objective ‘science’ eported to doctors but the statistics rely on doctors interpreting and labelling

of symptoms e.g. RSI or ME

Durkheim’s study of suicide demonstrate the problem of using statistics and generating theory

where there may be doubt over interpretation

Illness is a social state (see Talcott Parsons), and the recognition of illness as a legitimate social

role is not a straightforward process but involves a number of stages, each one of which is saturated in

social and cultural meanings and values

How society deals with illness and death is a significant element in the process

Few aspects of health and illness can be considered ‘objective’,

such as the doctor-patient interaction; beliefs and meanings attached to diseases;

or even whether 'hard' evidence such as those represented by statistics.