SOC 224 Exam 2

• Medical model

• Illness is an objective label

• Illness is non-moral

• Illness is an apolitical label

• Each illness results from a unique biological cause

• Sociological model

• Illness = subjective category, moral category, political label

• Illness results from a combination of social and biological causes

Institution

• An enduring social structure that meets basic humans needs

• Mezzo level

• Medicine is an ______

  • Referring to world and culture of doctors, and economic and social underpinnings of that world

• institution

Medicine as an institution examples

• medicalization

• genetic research

• sick role

• Medicalization

  • Process of _______ a condition as a medical problem requiring a medical solution

  • Process of broadening the definition of an illness (ex: ADHD)

  • 4 groups involved

    • ______

    • ______ groups (advocate for medical solutions)

    • Pharmaceutical industry (to sell more drugs)

    • Manage care organizations

• identifying, Doctors, Consumer

• Genetic research

  • _______: The shift toward defining genes as the cause of human disease, behavior, and differences

  • Benefits

    • People feel empowered by knowing they have an increase risk for a disease

  • Harm

    • Could increase psychological stress

• Geneticization

• The sick role

  • How society should view the ___

  • How the sick should behave

  • Embedded in _______ approach

  • 4 key aspects

    • Excused from ___

    • Beyond individuals control

    • Work to get well

    • Follow ______ advice

  • Some sociologists say the sick model assumes all illness is ____

    • Many people suffer from chronic illnesses

  • Confuses the experience of being a patient with being ill

  • Ignores class

  • Ignores age

  • Ignore gender and race

• sick, functionalist, role, medical, acute

Consequences of medicalization

• Helpful impact?

  • Provides ______ of those who are suffering

  • Medicine to cure illnesses

  • Provides relief

• Possible harm?

  • Gives doctors more _____

  • View variations as problems and becomes medicalized

  • Drugs can be abused

  • _______

  • Prejudice

  • Justify responses to behaviors that are not problematic

  • _______ _____

    • Combination of illness that they believe constitute an illness but doctors do not believe

    • Ex: fibromyalgia

• awareness, power, Misdiagnosis, Contested illnesses

Defining Disability

• ______ ______ = a deficit within an individual's mind or body, which should be cured if possible

• _______ model = disability results from responses to bodies that fail to meet social expectations or from limitations in the built environment

• Medical model, Sociological

People w/disabilities as minoritized group

• _____ _____ = any group considered inferior, subjected to unequal treatment, and having a collective identity

  • Prejudice = unwarranted suspicion, dislike, or disdain due to group membership

  • Stereotypes = oversimplifications

    • Not likely to change

    • Made with little knowledge

    • Typically perpetuated by the media

  • Discrimination = unequal treatment

• _____ ____ _____ ______ (ADA)

  • Outlaws discrimination against people with disabilities

  • Requires accessibility and employment for people with disabilities

• Minoritized group, American with Disabilities Act

The social distribution of disability

• 15% noninstitutionalized adults in the US

• Rates have increased over time

• Most _____ among poorer persons, older persons, women, and African Americans

common

Understanding chronic pain

• A ______, not an illness

• Most common underlying reason for disability (ages 18-65)

• Treatment is notoriously difficult

  • Few American doctors are trained in pain management

• ______ is affected by patient's age, ethnicity, gender, income

 

• Physicians are more likely to associate women's pain to ______ problems than men

• Men's pain are treated more urgently

• Doctors may assume pain from colored people is to get recreational drugs

• symptom, Treatment, psychiatric

Managing Treatment Regimes

• _____ ______ ____

  • Focus on compliance

  • Health Belief Model is frequently used to study compliance

• _______ ______

  • Herbal and dietary supplements, deep breathing, medication

  • Compliment rather than replace mainstream medicine

  • Users are disproportionately college-educated women younger than 69

  • Users feel that modern medicine focuses too much on treatment, not enough on prevention

• Conventional Health Care, Alternative Therapies

Health Social Movements

• Collective efforts to bring change in the healthcare scene

• Fit for:

  • ____ ___ ___

  • New illnesses being recognized

• What are their goals?

• Why the recent increase in these movements?

• Disabilities challenge a sense of self

  • Often lead to ____ _____

  • Due to health movements can lead to positive self

• Quality of care, negative self

_____ ______

• When a company sells a product and promises a portion of the proceeds go to a cause or charity

• Almost 80% people would switch to a cause

• "Think before you pink"

• Pink ribbon use is unregulated

Cause Marketing

19th century

• ______ principles controlled new order

• biological forces combine with personal susceptibility

• As a result, these new theories blamed illness on ______ behavior rather than on immoral behavior

• scientific, unhealthy

miasma

air corrupted by foul odors and fumes

early 19th-century doctors asserted that cholera could attack only individuals who had weakened their bodies through _____ living

improper

Conversely, doctors (and their wealthy patrons) assumed that wealthy persons would become ill only through ______, ____, or by “innocently” inhaling particularly noxious air. This theory of illness allowed the upper classes to adopt the new scientific explanations for illness while retaining older moralistic assumptions about ill people and avoid-ing any responsibility to aid the poor or the ill.

• people now believed that immorality left one susceptible to illness

gluttony, greed

an ill person is one whose actions, abilities, or appearance don’t meet ____ _____—that is, the expectations within a given culture regarding proper behavior or appearance

social norms

llness, then, like virginity or laziness, is a _____ _____: a social condition that we believe indicates the goodness or badness, worthiness or unworthiness, of a person

moral status

From a sociological standpoint, illness is not only a moral status (such as crime or sin) but also a form of _______

deviance

deviance

refers to behaviors or conditions that socially powerful persons within a given culture per-ceive, whether accurately or inaccurately, to be immoral or to violate social norms

We can tell whether behavior violates norms (and therefore whether it’s deviant) by seeing if it results in ______ ______ _____. This term refers to any pun-ishment from ridicule to execution.

negative social sanctions

sociologists point out that any time a condition or behavior is labeled an illness, some groups will benefit more than others, and some groups will have more ____ than others to enforce the definitions that benefit them.

power

magic bullets

a term used by Paul Ehrlich, discoverer of the first effective treatment for syphilis, to refer to drugs that almost miraculously prevent or cure illness by attacking one specific etiological factor

illness is a ______ construct

social

Biomedicine

refers to the ways in the which medicine, science, and technology often now work together as one social institution—an institution that can increase or reduce the power of medicine as an institution

Medicine is an institution of

social control

Social control

refers to the formal and informal methods used by a social group to ensure that individuals conform to social norms and to protect the existing balance of power among groups

doctors act as _____ _____ _____: individuals or groups (such as parents and religious leaders) that enforce social norms

social control agents

MCOs

are health insurance providers that restrain costs (and ideally improve quality of care) by monitor-ing closely the health services given to patient

In other words, medicalization allowed these governments to _______ the situation: to define it as a medical rather than political problem

depoliticize

The potentially ill

are individuals identified as having an above-average risk of illness, whether because of age, stress level, tobacco use, family history, med-ical test results, or other factors

geneticization is a form of

medicalization

Genes affect health in two ways: by causing _____ genetic diseases and by ______ individuals’ predisposition to develop disease

“true”, increasing

In these cases, disease occurs when genes combine with en-vironmental factors in a process known as an _____ ______

epigenetic effect

Medicine can also work as an institu-tion of social control by pressuring individuals to _____ sickness, a process first recognized by Talcott Parsons

abandon

His emphasis on social stability reflected his belief in the broad social perspective known as _________. Underlying functionalism is an image of society as a smoothly working, integrated whole, much like the biological concept of the human body as a homeostatic environment. In this model, social order is maintained because individuals learn to ______ society’s norms and because society’s needs and individuals’ needs match closely, making rebellion unnecessary

functionalism, accept

Within this model, deviance—including illness—is usually considered _______ because it threatens to undermine social stability

dysfunctional

According to Parsons, the ____ ____ as it currently exists in Western society has four parts.

• First, the sick person is considered to have a legitimate reason for not fulfilling his or her normal social role. For this reason, we allow people to take time off from work when sick rather than firing them for malingering.

• Second, sickness is considered beyond individual _____, something for which the individual is not held responsible. This is why, according to Parsons, we bring chicken soup to people who have colds rather than jailing them for stupidly exposing themselves to germs.

• Third, the sick person must recognize that sickness is _______ and work to get well. So, for example, we sympathize with people who strive to recover from illness and question the motives of those who seem to revel in the attention illness brings them.

• Finally, the sick person should seek and follow _____ advice. Typically, we expect sick people to follow their doctors’ recommendations regarding drugs and surgery, and we question the wisdom of those who don’t.

sick role, control, undesirable, medical

those who hold a ______ ______ argue that society is held together largely by power and coercion as dominant groups impose their will on others.

conflict perspective

The assumption that individuals will attempt to get well fails to recognize that much illness is _____ and by definition is not likely to improve.

chronic

Medicalization can reduce stigma, increase social awareness, and encourage medical research. It can also cause unintended negative consequences, such as increasing the power of doctors at the expense of other social groups, _______ dissent, and justifying medical—and only medical—treatment

depoliticizing

Genetic research and testing have increased the potential for medicine to act as a form of ____ _____, especially because of geneticization: the shift toward assuming that genes cause human disease, behavior, and differences. _____ _____ brings both benefits and problems to individuals and society

social control, Genetic testing

Critics of the sick role model challenge each of the four parts of that model. They note that the model best fits acute rather than chronic illness, and they suggest that the model confuses the experience of being a ____ with the much broader experience of illness.

patient

disability refers to restrictions or lack of ability to perform activities resulting largely or solely from either

(1) social re-sponses to bodies that fail to meet social expectations or

(2) assumptions about the body reflected in the social or physical environment

Individualizing disability therefore exemplifies the broader process of ______ ___ ______, through which individuals (such as people with disabilities) are blamed for causing the problems they experience

blaming the victim

Ironically, because medical training especially values quick, technological cures, doctors may be especially likely to develop ______ _______ toward people who live with long-standing disabilities

negative attitudes

Still, disabled persons are much more likely than others to

live in poverty, to lack employment, and to face barriers to receiving quality health care

chronic pains affects ___% of americans

40

Chronic pain is most common among

women, those who are poor, minorities, and the elderly.

illness behavior

Social scientists refer to this process of defining, interpreting, and otherwise responding to symptoms

Illness behavior is significantly affected by

gender, ethnicity, age, and social clas

_____ _____ ____ _____ and Medical Compliance”). The model suggests that individuals will be most likely to comply if they (1) believe they are susceptible to a health problem that could have serious consequences, (2) believe compliance will help, and (3) perceive no significant barriers to compliance

The Health Belief Model

First, the health belief model assumes that _______ with medical recommendations stems primarily from psychological processes internal to the patient.

noncompliance

Users of alternative therapies are disproportionately likely to be

female, younger than 65, and college educated

placebos

drugs known to have no effects

Most basically—and despite the pre-dictions of the sick role model—living with illness or disability means living with ______

stigma

Stigma

refers to the social disgrace of having a deeply discrediting attribute, whether a criminal record, a gay lifestyle, or a socially unacceptable illness

Becoming a chronically ill or disabled person begins with recognizing that something about the body is troubling, a process that may ______ ______

develop slowly

Obtaining an accurate diagnosis is often difficult. According to the illness behavior model, individuals are most likely to seek medical care and diagnosis if

(a) their symptoms are frequent, persistent, visible, and severe enough to interfere with daily activities;

(b) they lack alternative explanations for their symptoms;

(c) their families and friends generally trust doctors and support seeking medical care for health problems; and

(d) no psychological, economic, or practical barriers keep them from accessing health care

during the course of one year, approximately __% of workingage adults experience a diagnosable mental illness, with _% experiencing a moderate or severe disorder.

31, 20

The most common illnesses are _____ ______ and problems with _____ use, which were reported by 17% and 13%, respectively. These estimates, however, are probably high because they are based on reports of symptoms taken out of context

major depression, alcohol

So why do some social groups experience more mental illness than others?

For many sociologists, the answer lies in their different levels of social stress

In the past, sociologists interested in the link between mental illness and stress largely focused on the acute stresses of life events such as divorce, losing a job, or a death in the family.

Researchers looked not only at the sheer number of life events individuals experienced but also at the ______ _____ _____ have for people and the resources individuals have for dealing with those life events

meaning life events

chronic stress affects affects _____ ____ more than acute stress

mental health

african americans are less likely than whites to develop

anxiety and mood disorders

African Americans are more likely—especially if they are poor—to report _______ distress, which overlaps with but is not the same as diagnosable mental illness

psychological

______ _______ are less likely than white Americans to develop anxiety disorders, mood disorders, or substance abuse problems

Hispanic Americans

Most mental illnesses are equally common among men and women. However, men have ______ rates of schizophrenia, substance abuse, and impulse control disorders (such as compulsive gambling or chronic violence), whereas women have higher rates of _____ disorders and of mood disorders (such as depression)

higher, anxiety

Consistently, men display higher rates of disorders linked to _______. As a result, some researchers hypothesize that these forms of mental illness occur when men become “over-socialized” to their gender roles

violence

many sociologists hypothesize that depression results when traditional female roles—or others’ expectations about the roles women should and should not play—cause ______ stress by reducing women’s control over their lives and exposing them to discrimination and prejudice. This lack of control is multiplied by broader gendered inequality such as the lack of quality _____ _____ or equal pay for working women

chronic, child care

______ women and ______ mothers—the two groups that typically have the least control over their lives.

nonworking, married

Of all the demographic variables researchers have investigated, _____ _____ shows the strongest and most consistent impact on mental illness

social class

Most research, however, suggests that _____ _____ better explains the link between social class and mental illness

social stress

The history of Salvarsan and syphilis provided ideological support for a med-ical model of mental illness. This medical model consists of four assumptions about the nature of mental illness:

1 .Objectively measurable conditions define mental illness, in the same way that the presence of a specific bacterium defines syphilis.

2 .Mental illness stems largely or solely from something within individual psychology or biology, even if doctors (such as those who studied syphilis before 1905) don’t yet know its sources.

3 .Mental illness, like syphilis, will worsen if left untreated but may diminish or disappear if treated promptly by a medical authority.

4 .Treating mental illness, like treating syphilis, rarely harms patients, so it is safer to treat someone who might really be healthy than refrain from treating someone who might really be ill

ccording to sociologist Allan Horwitz (1982), behavior becomes labeled mental illness when persons in posi-tions of power consider that behavior both _______ and inherently _________

unacceptable, incomprehensible

According to Peggy Thoits (1985), behavior leads to the label of mental illness when it violates

cognitive norms, performance norms, or feeling norms

Feeling norms

refer to socially defined expectations regarding the “range, intensity, and duration of feelings that are appropriate to given situations” and regarding how people should express those feelings

The definition of mental illness, then, reflects not only socially accepted ideas regarding behavior but also the _____ _____ of those who hold opposing ideas

relative power

Many, especially those working in health care settings and in epidemiology, use a ____ ___ ______ approach and use essentially medical definitions of mental illness in their research and writing.

sociology in medicine

Over the years, psychiatrists have worked to reduce problems with diagnosis by refining the definitions of illnesses in the Diagnostic and Statistical Manual of Men-tal Disorders (___), first published by the APA in _____

DSM, 1952

To encourage support for the DSM-IIIand avoid open political battles among psychiatrists, its authors decided to stress _______ and avoid discussing either ______ or _______

symptomatology, causation, treatment

In addition, to increase the odds that clinicians would use the DSM-III, the authors described the various diagnoses based not on available research but on the consensus among practicing _______

psychiatrists

Reliability

refers to the likelihood that different people who use the same measure will reach the same conclusions—in this case, that differ-ent clinicians, seeing the same patient, would reach the same diagnosis

Validity

refers to the likelihood that a given measure accurately reflects what those who use the measure believe it reflects—in this case, that persons identified by the DSM-IIIas having a certain illness actually have that illness

First, premodern societies could offer acceptable, ____-___ roles to those whose thought patterns and behaviors differed from the norm.

Second, because work roles rarely required individuals to function in highly structured and regimented ways, many troubled individuals could perform at marginally acceptable levels.

Third, in premodern societies, work occurred within the context of the family, whether at home or in fields or forests. As a result, families could watch over those whose emotional or cognitive problems interfered with their abilities to care for themselves

• mental illness was normalized

low-level

Until the modern scientific age, people typically viewed disturbing behavior as a ______ for sin or for violating a taboo, as a sign that the afflicted individual was a witch, or as a result of evildoing by devils, spirits, or witches.

Therefore, the public assigned treatment to religious authorities—whether shamans, witch doctors, or priests—who relied on prayer, exorcism, spells, and treatments such as bloodletting or trepanning (drilling a hole in the skull to let “bad spirits” out)

punishment

As a capitalist economy began to develop, both religious control and informal ____ _____began to decline

social control

By the end of the 18th century, however, only a few hospitals devoted to treating people with mental illnesses existed along with a few private _________ run by doctors for profit. Instead, most of those we would now label mentally ill were housed with poor people, people with disabilities, and criminals in the newly opened network of public almshouses, or poorhouses

“madhouses”

By the late 18th century, however, attitudes toward persons with mental illness began to moderate. In place of punishment and warehousing, reformers proposed _____ ______: teaching individuals to live in society by showing them kindness, giving them opportunities to work and play, and in general treating mental illness more as a moral rather than medical issue

moral treatment

by _____, doctors largely had gained control over the field of mental illness both in the United States and Europe

1840

By the 1870s, moral treatment had been abandoned. Yet the number of mental hospitals continued to grow exponentially (Rothman, 1971). Historians refer to this change, and similar but earlier developments in Europe, as the ____ ______

Great Confinement

The Great Confinement drew energy from the well-meaning efforts of reformers to close down the brutal almshouses and provide ______ specifically designed to care for people with mental illnesses instead of warehousing them with criminals, persons with disabilities, and poor people

facilities

For those who accepted Freud’s theory, the only way to cure mental illness was to help patients resolve their developmental crises. To do so, Freud and his followers relied on _________, a time-consuming and expensive form of psychotherapy geared to patients without major mental illnesses. In psychoanalysis, patients recounted their dreams and told a (usually silent) therapist whatever came to mind for the purpose of recovering hidden early memories and understanding their unconscious motivations

psychoanalysis

By the middle of the ____ century, mental hospitals had become a huge and largely unsuccessful system

20th

At their peak in 1955, public mental hospitals held ______ patients, who stayed an average of eight years. Most were involuntarily confined and involuntarily treated, often with lobotomies as well as drugs that kept them highly sedated

558,000

Beginning in the _______, however, many people challenged this system as the civil rights, antiwar, and feminist movements all promoted both individual rights and questioning authority. These ideas contributed to a growing critique of mental health treatment by sociologists, psychologists, and even some psychiatrists such as R. D. Laing

1960s

Goffman’s work fell within the tradition of ______ ______ ______. According to this theory, individual identity develops through an ongoing process in which individuals see _______ through the eyes of others and learn through social interactions to adopt the values of their community and to measure themselves against those values

symbolic interactionism theory, themselves