Soc 420 exam 2

Social construction of illness - How have concepts changed over time

Pre med- Illness as deserved punishment for immoral behaviors

1800- illness results from unhealthy behaviors; biological forces + personal susceptibility

• Across time, powerless people are still often blamed for their illnesses

Two different approaches to understanding illness: Medical model

• Dominant conception of illness in the medical world

• An objective label given to anything that deviates from normal biological function

Two different approaches to understanding illness: Sociological model

Used by critical sociologists and others who are interested in how social forces affect health and health care

Medicine as an institution of social control: Medicalization; definition, example, supporters, consequences

Def: process of identifying a condition as a medical problem requiring a medical solution

Example: ADHD

Process: Broadening the definition of an illness

Supporters: Pharmaceuticals, med. professionals, insurance groups

Consequences: Social problems, medical social control

Medicine as an institution of social control: Demedicalization

Social and institutional process of which a previous medical condition is no longer seen as a medical condition

Medicine as an institution of social control: Genetic research/ Geneticization; definition, example, consequences

Def: Process analyzes DNA, chromosomes, or proteins to identify mutations associated with health conditions

Example: Disease risk, commercial DNA testing

Consequences: Genetic discrimination

Medicine as an institution of social control: The sick role; elements, and critiques

4 elements: exemption from responsibility, not responsible for illness, want to get better, seek medical help

Critiques: Not all people behave as Parsons suggests; the sick role doesn’t apply to the chronically ill if they cannot be restored; middle-class orientation

Article- Conrad and Leiter: From Lydia Pinkham and Queen Levitra

Want people to view everyday experiences as conditions and medical problems that can be treated with medicine.

• Past (Lydia Pinkham): Ads promoted products to women for common health concerns, presenting as problems that need to be fixed

• Now (Queen Levitra): Pharmaceuticals advertise perscriptions right to consumers, to ask doctors about specific drugs

Article- Article- Conrad: Shifting engines of medicalization; Impact of Biotechnology (pharmaceuticals)

• New medication/ medical technology advancement

• Create new markets - new conditions and meds to treat them

• Conditions that were once normal may be seen as conditions

Article- Article- Conrad: Shifting engines of medicalization; Big pharma- 1997 modernization act

• FDA changes regulations

• Drug ads on TV

• $2.5 billion spent, steadily rising

• Most advertised: erectile dysfunction medication like viagra

Article-Article- Conrad: Shifting engines of medicalization; Consumers

• Self-diagnose

• Consumer groups- orgs that advocate for people with specific conditions

• Internet info

• Consumer influence: Goes to a doctor and requests a certain diagnosis or medication

Article- Conrad: Shifting engines of medicalization; Managed care/ Health insurance- incentives and constraints

Incentives: Cover certain treatments because they are less expensive than treating future complications

Constraints: Limit coverage, require approval, or refuse to pay for certain treatments

Article- Conrad: Shifting engines of medicalization; History of medicalization and driving forces

Not controlled by doctors anymore but by businesses, tech, consumers, and the healthcare system

Video- Unrest

• Illness doesn’t have to be visible to be serious

• Affects person’s daily life

• Social support

• Awareness creating- interviews of people like her

Disability: Medical Model

A deficit within an individuals mind or body, should be cured if possible

Disability: Sociological model

Disability results from responses to bodies that fail to meet social expectations or from limitations

People with disabilities as a minority group: Prejudice

Unwarranted suspicion, dislike, or disdain due to group membership

People with disabilities as a minority group: Stereotypes

Oversimplification for explanations

People with disabilities as a minority group: Discrimination

• Unequal treatment

• As recent as the 1900’s- laws forbad those with certain disabilities to get married or mandated institutionalization or sterilization

ADA- American people with Disabilities Act

Passed in 1990 that protects people with disabilities from discrimination

• Defined as a physical or mental impairment that limits one or more major life activities

• Examples: Mental health, intellectual disability, motor impairments

Social distribution of disability

• 15% of non-institutionalized adults in the US have a disability

• Rates increased over time

• Most common amongst poor, older, women, and African Americans

Chronic Pain

• 40% of Americans

• Doesn’t heal, worsens over time

• Consequences: physical-poor sleep, exhaustion— Social: Damage to relationships, depression, anxiety

• Women, poor, elderly

Illness Behavior: When are people most likely to seek care

• Frequent, persistant, visible, or severe symptoms

• Lack of explanation

• high trust in doctors

• No barriers

Illness Behavior: Who is most likely to seek care

Women, Wealthy, and the elderly

Managing treatment regimes: When are people more likely to comply with medical advice (health belief model)?

When people believe they’re at risk and benefits outweigh barriers

Managing treatment regimes: Alternative therapies

Herbs, meditation, dietary supplements

People who reject modern medicine

Impact of illness and disability on social relationships and self-concept

• can strengthen or strain relationships with friends, family, and colleagues

• Physical, social, and financial challenges

Stigma: Definition

• Social disgrace of having a discrediting attribute

• Does NOT imply that a condition is bad or immoral, only that it is commonly used in that way

Stigma: How to manage

• Hide or deflect attention

• Fight for rights/acceptance

Health Social Movements: Definition

Collective efforts to bring change in the health arena

Health Social Movements: Goals

• Equal access to health care

• Meeting needs of particular group

• Winning medical acknowledgement- lobbying

Article- Kristof: “Why Americans Feel More Pain”

• pain is related to social and economic conditions

• Poorer, less educated, stress, inequality- more pain

• Pain is not just a medical issue

Article: Case, Deaton, and Stone- Differences in pain by education and birth cohort; implications

• people with less education report more pain (no 4-year degree)

• Younger people report more pain than previous gens.

• pain increases with age

• more pain around the US

Birth Cohort

People born in a certain time period

Medical Model of Mental health

• Objective reality

  • Measurable conditions

  • Stems from individual psychology or biology

  • Medical treatment will never harm patients

Sociological model of mental health

• Social construction

• Subjective social judgements

• Reflects social setting behavior or biology

• May improve regardless of treatment

• Medical treatment can harm patient

Epidemiology of mental illness: Impact of chronic stress on mental health

Chronic effects mental illness more than acute stress

• Look at events and resources to be able to tell

Epidemiology of mental illness: Differences by race, gender, social class

• Depression rates Blacks<Whites, once depressed blacks will be more depressed

• Men: paranoia Women: Mood disorders

• More stress on lower social class

Epidemiology of mental illness: Social stress theory vs. Social drift theory

Class-based stress leads to mental disorders vs. mental problems lead to lower social classes

Violation of cognitive, performance, and feeling norms

Label of mental illness

The problem of diagnosis

Diagnosis is subjective/susceptible to social expectations

The problem of diagnosis: Rosenhan’s experiment

• Researchers went to mental hospitals and presented mental illness- but acted normal once admitted

• Demonstrates the subjective nature of psychiatric diagnosis

The problem of diagnosis: Politics of diagnosis- DSM changes, reliability and validity

• New research, understanding, advocacy, pharma and med professionals pushing diagnosis

• How things change

• Real condition or disorder presented

The problem of diagnosis: Almshouses

Shelter for those who couldn’t care for themselves

The problem of diagnosis: Great confinement

Historical period when poor were institutionalized

The problem of diagnosis: Freud and psychoanalysis

Unconscious thoughts, feelings, memories, and conflicts

Anti-psychiatry critique: Total institutions

Large institutions, regimented lives, segregation from outside world

Anti-psychiatry critique: Self-fulfilling prophecy

Patients become what others expect of them

Anti-psychiatry critique: Mortification

• Self-image is damaged and replaced by a personality adopted to institution life

• Cut off from work/family, patients lose the support that gives them a sense of self

Anti-psychiatry critique: Depersonalization

No longer feeling like a human or being seen that way by others

losing rights

Deinstitutionalization: Causes and effects

Causes

• Decreased funding

• rise of individualism

• Managed care organizations

• NOT NEW MEDS.

Effects

• + cost effective, better standards

• - too much focus on medication

Remedicalization of mental illness and the biological revolution: Antidepressent use in the US

• Women > Men

• 45-64 years old has the most use

Remedicalization of mental illness and the biological revolution: Challenges

• Public believes mental illness is biological

• Pushed by doctors, media, and phamaceuticals

Becoming a mental patient: Self-labeling

Individuals try to avoid being labeled as needing psychotic help by engaging in feeling work

Becoming a mental patient: Feeling work

Actively working to make emotions match social expectations

Becoming a mental patient: Labeling by friends, family, public, psychiatric establishement

Families only reluctantly label their members mentally ill

Article- Johnson: Changes in mental health and treatment- summary

• Examines if Us mental health actually got worse

• Poor mental health did not increase but treatment did

• Cultural attitudes, reduced stigma, and treatment help explain the difference

History of US health insurance from 1930’s to the present: Blue cross/ Blue shield

• First major insurance programs

• Fee for service

• Protect provider incomes

• Coverage rating: Each person charged premium based on average risk of community

History of US health insurance from 1930’s to the present: Health maintenance organizations (HMOs)

• Affordable healthcare

• Salaried doctors, monitored for unnecessary care

• Emphasis on prevention

History of US health insurance from 1930’s to the present: Medicare

• over 65 years old and permanently disabled

• Funded by states and federal government

• “Entitlement”

History of US health insurance from 1930’s to the present: Medicaid

• Poor people

• Funded by states and government

• Framed as charity

• Eligibility, coverage, and payments differ by states

• Many doctors reject because of low rienbursement

History of US health insurance from 1930’s to the present: Commercial insurance

• profit over non-profit

• Avoid or charge more for unhealthy people

• Actuarial risk rating: Individual premium based on risk

History of US health insurance from 1930’s to the present: Managed care revolution

• Price schedules

• Utilization review

• Formularies

• Backlash

History of US health insurance from 1930’s to the present: Managed care revolution— Price schedules

Mcos negotiate prices with doctors and consumers can only use doctors in that network

History of US health insurance from 1930’s to the present: Managed care revolution— Utilization review

Doctors may get bonuses for keeping costs down

May need approval for out of network things

History of US health insurance from 1930’s to the present: Managed care revolution— Formularies

Lists of cost-effective drugs for specific conditions

Need permission to go off the list

History of US health insurance from 1930’s to the present: Managed care revolution— Backlash

More access

• Drive by

• Experimental

• Out of network

Scale by formularies

Health care security act (1993)

• Not passed due to political opposition (insurance industry)

• Opponents raised fears for “big government” in public

State Children’s health insurance program (SCHIP)

• Passed

• Extended coverage for children under 18 years old via medicaid

Affordable care act (ACA/Obamacare)—Individual mandate

Each US citizen and legal resident must obtain health insurance through “health exchanges”

Affordable care act (ACA/Obamacare)

• Individual mandate

• Employer mandate

• Medicaid expansion

• Deductibles/ copayments

Affordable care act (ACA/Obamacare)— Employer mandate

Employers with more than 50 employees offer health insurance to employees

Affordable care act (ACA/Obamacare)— Medicaid expansion

To include all poor and near-poor Americans under 65, but SCOTUS rules states did not have to expand

Affordable care act (ACA/Obamacare)— Deductibles and Copayments

• Limits made, cannot refuse people with pre-conditions

• Those under 26 can be on their parents health insurance

ACA under attack

More difficult to go coverage, ACA placed reduced

Trump administration (bruh)

Article- Wright and Rogers “Health Care”— 6 properties of health care in a market economy

1. Extraordinary value of the service

2. Ethical issues in distribution of health care

3. Information costs

4. The market for health vs. market for treatment

5. Supply crates demand in health care

6. Competition among providers generates overinvestment

Article- Wright and Rogers “Health Care”— 7 ways health care is provided

1. Direct private payment for medical services

2. Employer-provided insurance

3. Government-provided insurance

4. Individually purchased private health insurance

5. Government subsidized, privately purchased insurance

6. Direct government-provided health care

7. Pro bono services provided by doctors and hospitals

Myths of US health care costs

1. Its the malpractice suits

2. It’s our aging population

3. It’s our advanced technology

4. It’s because we receive more and better care than do others

Realities of US health care costs

• Administration costs of fragmented system

• Health care providers largely sets prices

• The for-profit basis of the US health care system

Why is the ACA unlikely to lower costs

• Multitude of insurers so continues administration inefficency

• Limited efforts

• Preserves the for-profit system

Big pharma and rising costs

• Most profitable industry

• FDA decreased

• Manipulation of drug testing and research

  • Antidepressant causing suicidal thoughts in teens but not adults- left out teenager experiment

Uninsured and underinsured Americans

• Less likely to report good health

• Less likely to receive needed health care

• More likely to die from potentially treatable conditions