health exam 2

the social construction of illness

concepts of illness change over time

• - prescientific: illness as deserved punishment for immoral behavior

• - across time, powerless people are still often blamed for their illness

medical model of illness

views illness as a problem with the body’s normal biological functioning. doctors look for physical evidence to identify a disease and determine what is causing it

• - objective: illness is identified through evidence, such as lab tests, physical exams, and recognizable symptoms

• - focus: finding the biological cause of a disease

• - diagnosis: doctors look for symptoms that match a known medical condition

• ex. a doctor diagnoses diabetes by examining blood sugar levels and other medical evidence

sociological model of illness

looks at how society, culture, politics, and social norms influence how illnesses are defined, diagnosed, and treated

• - social forces: culture and society can influence how a condition is understood or diagnosed

• - moral category: society may judge certain conditions or behaviors are as good or bad, normal or abnormal

• - deviance: a condition may be considered deviant when it differs from society’s expectations

• - political: labeling something an illness can benefit some groups more than others, such as medical professionals, pharmaceutical companies, or people seeking access to treatment

medicine as an institution

medicine is an institution of social control - ensure that people conform

• - medical providers have the power to decide whether someone is truly ill and deserves sympathy or is simply lazy

3 examples of medicine as an institution of social control

medicalization, genetic research, the sick role

medicalization

the process of defining a condition or behavior as a medical problem that requires a medical solution. something that may have once been viewed as a normal behavior, personal problem, or social issue becomes something that doctors diagnose and treat

• - one or more groups must benefit from defining a condition as a medical problem

• - medicalization can expand the definition of an illness to include more behaviors or conditions

consequences of medicalization

helpful impact: promotes social awareness of a problem, can lead to better treatment, can validate individuals’ sense that they are ill

possible harm: increases power of doctors, decreases power of other social authorities, medical treatment deemed only logical solution, depoliticization, used to justify voluntary and involuntary treatment

the shifting engines of medicalization

before 1980s: mainly driven by doctors and their authority, social movements also helped define conditions as illnesses (PTSD, Alzheimer’s)

after the 1980s: increasingly driven by commercial and market interests, biotechnology (new tests and technologies), pharmaceuticals (companies promote medications and treatments), consumers (patients seek specific treatments), managed care (insurance companies influence treatment and coverage

genetic research

the shift toward defining genes as the cause of human disease, behavior, and differences

the sick role

describes society’s expectations or how sick people should behave and how others should treat them

• - being sick excuses you from some responsibilities, but you are expected to try to recover and return to your normal roles

elements of the sick role

1. the sick person has a legitimate reason for not fulfilling his/her typical social role. the more severe the illness, the greater the exemption from social responsibilities. exemptions require legitimation by physician

2. sickness is beyond individual control - individual NOT responsible

3. sick person must see sickness as undesirable and work to get well

4. sick person should seek and follow medical advice

critiques of the sick role

1. 1. not all sick people behave the way Parsons suggest

2. 2. the sick role does not necessarily apply to people with chronic diseases who cannot be restores to normal functioning, no matter how willing they may be to cooperate with the physician

3. 3. the physician-patient relationship is based on office settings and can be different in emergency rooms, hospitals, a patient’s home, and public health campaigns

4. 4. the sick role has middle-class orientation and pattern of behavior that may not apply to people lower on the social scale. some people may deny the sick role because they cannot earn a living if sick

conrad & leiter: from Lydia Pinkham to Queen Levitra

• how advertising influences medicalization and encourages people to view conditions as medical problems that need treatment

• ethical drugs relied on medical professionals, while patent drugs relied on advertising to attract customers

medical model of disability

a deficit within an individuals mind or body, which should be cured if possibly

• individualized disability has potential to be blaming the individual for causing the problems they are experiencing

sociological model of disability

disability results from responses to bodies that fail to meet social expectations or from limitations in the social or physical environment

the social distribution of disability

• 15% of noninstitutionalized adults in the United States have a disability

• rates have increased over time - in the past, death more likely; now disability more likely

• most common among poorer persons, older persons, women, and African Americans

understanding chronic pain

• roughly 40% of Americans have chronic pain

• a symptom, not an illness

• most common underlying reason for disability

consequences of chronic pain

• physically - sleep deprivation, exhaustion

• socially - damage to relationships, increases depression, anxiety, risk of suicide

treatment (for chronic pain) is affected by age, ethnicity, gender, income

• women - significantly more likely than men to encounter doctors who focus on psychiatric causes and prescribe sedatives or psychotherapy rather than pain meds

• troubling - women have to appear neither too sick nor too well and neither too assertive or too passive in order to receive treatment

• minorities - doctors routinely think they are seeking drugs for recreational use

• lower income individuals - pain more often from work which employers downplay

why Americans feel more pain - Kristof

• elderly have most pain

• U.S. - middle ages, especially jobless and less educated

• chronic pain - associated with troubled childhoods, loneliness, job insecurity

• Poor Americans are more than 3x likely to report pain as wealthy Americans

illness behavior

process of defining, interpreting, and responding to symptoms. more likely to seek care if

1. symptoms are frequent, persistent, visible, and severe enough to interfere with daily activities

2. lack alternative explanations for symptoms

3. trust in doctors is high and family and friends encourage seeking medical help

4. no psychological, economic, or practical barriers from accessing health care

living with disability and chronic illness

• women - more likely to seek medical care

• age - elderly more likely to seek care often until they get tired or too many medical visits

• working-class/poor - tend to put off care and accept pain as unavoidable part of hard work. affordability and access also an issue

• racial/ethnic minorities - less likely to seek care

managing treatment regimes (conventional)

conventional health care

• focus on compliance (health belief model)

  • assumes noncompliance due to psychological process internal to the patient (may not understand treatment, lack of resources)

  • assumes compliance is always good (treatment may be disruptive, experimental, ineffective, etc.)

managing treatment regimes (alternative)

alternative therapies

• herbal and dietary supplements, deep breathing, meditation

• compliment rather than replace medicine

• disproportionately college-educated women under 65

• feel modern medicine focuses on treatment not prevention

• placebos

managing stigma with chronic illness

• attempt to avoid stigma by hiding it or deflecting attention

• challenge the basis of the stigma - fighting for rights, body acceptance/positivity

medical model of mental illness

mental illness as an objective reality

sociological model

metal illness as largely a social construction

the epidemiology of mental illness

in all societies, the behavior of some individuals will be considered unacceptable and incomprehensible

social stress and mental illness

chronic stress affects mental illness more than acute stress does

• researchers look at: number of stressful life events, the meaning attributed to a life event, and the resources available to an individual to deal with a life event

race/ethnicity and mental illness

• Blacks have less overall depression and anxiety than Whites

• when depressed, Blacks tend to be more likely than Whites to be chronically or persistently depressed, have more severe symptoms, show higher levels of impairment, and be less likely to seek or receive treatment

• Blacks showing self-esteem, sense of mastery, and family support are able to reduce the effects of stress on symptoms of depression, anxiety, and psychological distress

• Black women that shows their social networks of family and friends help them cope significantly with the stress of their lives

• among Hispanics, extended families seem to help reduce stress

gender and mental illness

• men - higher rates of paranoid schizophrenia, substance abuse, and impulse control disorders

• women - higher rates of mood disorders and anxiety disorders

• women employed outside the home tend to show less psychological distress than stay at home wives but more distress than employed men

social class and mental illness

social class has strongest and most consistent impact on mental illness

• social stress theory: class based stress leads to mental disorder

• social drift theory: mental problems lead to lower social class

sociological model of mental illness

society labels behavior as mental illness when people in power view them as unacceptable or incomprehensible

• cognitive norms: expectations for how people think

• performance norms: expectations for how people behave

• feeling norms: expectations for how people express emotions

the problem of diagnosis

mental illness diagnosis is subjective and influenced by social expectations

• Rosenhan experiment (1973) - 8 healthy researchers faked symptoms (hearing voices) and were admitted to mental hospitals. Staff continued to see them as mentally ill even when they acted normally

• main finding - psychiatric diagnoses can be subjective and influenced by labels

• cultural variations - behaviors considered mentally ill in one culture may be normal in another

the antipsychiatry critique (Goffman)

mental hospitals can harm patients by taking away their independence and identity

• total institutions - places that control nearly every part of a person’s life and separate them from society

• self-fulfilling prophecy - patients begin acting how others expect them to act

• mortification - loss of self-identity due to institutional treatment

• depersonalization - losing independence and feelingless human

deinstitutionalization

shift from long-term hospital stays to treatment in the community, beginning in 1955

• causes: reduced health care and low-income housing funding, increased criminal justice funding, rise of managed care, greater emphasis on individualism, not caused by new medications

• effects: positive - more cost-effective, increased access to science based treatment. negative - too much focus on medication instead of talk therapy, diagnosis becomes a checklist of symptoms

remedicalizing mental illness

shift back toward viewing mental illness as a biological problem rather than a social one

• biological revolution - since the 1980s, focus on brain chemistry, neurological, and genetic causes

• downplays social causes of mental illness

• promoted by doctors, media, and pharmaceutical companies

• most people now view mental illness as biological

becoming a mental patient

people try to avoid being label mentally ill by managing their emotions to fit social expectations

• self-labeling: how individuals view and label their own mental health

• feeling work: trying to make emotions match what society considers appropriate

• labeling by friends, family and the public: families often hesitate to label loved ones as mentally ill

• psychiatric labeling: mental health professionals identify and diagnose the person

US healthcare

the United States is the only more developed nation that does NOT guarantee affordable healthcare to its citizens

• more a combination of public and private health insurers, health care providers, and healthcare settings

History of US health insurance

• before the great depression Americans paid for health care out of pocket

• 1945 - Truman proposed national health insurance for all, but Congress rejected it

• opposition to national health care - labor unions, and AMA

• Blue cross - first major insurance programs, providers paid for each service, for healthier people, everyone pays based on the average risk of the community

• HMOs - designed to make healthcare affordable, doctors receive salaries instead of payment per service, monitor unnecessary care, focus on prevention