THEORY ILLNESS - INTERACTIONIST

Basic Assumptions

• The Interactionist Perspective focuses on how illness is defined and understood through social interactions.

• Illness is not just a biological condition but a socially constructed concept.

• People do not automatically see themselves as ill; they go through a process of defining their illness.

• Rosenberg (1989): "Disease does not exist as a social phenomenon until it is perceived as existing."

Illness as a Social Construct

• Illness is not purely medical; it is shaped by political and social influences.

• Tesh (1988) highlights how different groups define illness based on their interests.

  • Example: Repetitive Strain Injury (RSI)

    • Employers claim it is not a serious condition, and is caused by poor posture.

    • Psychiatrists say it is a psychosomatic condition caused by job dissatisfaction.

    • Labor unions argue it results from work stress and should be recognized as a serious condition.

Illness Behavior

• This is the patterns of behavior that people engage in when they have decided that they are unwell, and what they should do as a result of this.

• Definition (Mechanic, 1968): The way symptoms are perceived, evaluated, and acted upon by an individual who recognizes pain, discomfort and other dysfunction.

• Majority of people who feel unwell do not consult a doctor.

• Freund & McGuire referred to this as the "illness iceberg", which is the large number of illnesses compared to the small amount presented to doctors.

Health Belief Model (Becker et al., 1977)

• Explains the factors influencing medical visits and treatment compliance.

• Three Stages:

1. Stage 1

   • The person recognizes the illness

   • Individuals assess:

     • Their motivation to accept they are ill.

     • The value of reducing the health threat.

     • The benefits of being labelled ill and getting treatment.

2. Stage 2 - Modifying and Enabling Factors

   • they visit a doctor and decided whether or not to take action based on:

     • Age

     • Financial cost of treatment

     • Attitudes of medical professionals towards them

     • Social pressure from family/friends

   • nb. these may also have a bearing on the first stage

3. Stage 3 - Compliant Behavior

   • The likelihood of following medical advice depends on previous stages.

   • Some may fully comply, partially comply, or ignore recommendations.

Criticisms

• Day & Day (1977): Interactionists focus too much on doctor-patient interactions, ignoring wider causes of illness like poverty and environmental issues.

Erving Goffman – Stigma (1968)

• Definition: Stigma is an undesired differentness that leads to discrimination.

• Focuses on social interactions and how stigmatized individuals navigate society.

• Types of Stigma:

  1. Discrediting Stigma – Visible conditions (e.g., disabilities).

     • Individuals use impression management to control perceptions.

     • Covering: Engaging in normal activities to minimize stigma.

  2. Discreditable Stigma – Hidden conditions (e.g., mental illness, epilepsy).

     • Individuals engage in information management to hide their condition.

     • These persons, Goffman suggests, in the process of trying to give the impression that they are ‘normal’ may face considerable problems in managing information, as they will always live in fear of being exposed.

     • Strategies:

       • Passing: Hiding the condition.

       • Withdrawal: Avoiding social interaction whenever possible.

Scambler & Hopkins (1986) – Further Stigma Concepts

• Enacted Stigma: Discrimination based on perceived inferiority.

• Felt Stigma: Fear of discrimination, leading to self-isolation and a feeling of shame.

• Coping Strategies:

  1. Selective Concealment – Telling only close family and friends about their illness, while concealing it from others.

  2. Covering Up – Hiding the condition entirely, however running the risk of being exposed

  3. Medicalizing Behavior – Using medical explanations to gain sympathy.

  4. Condemning the Condemners – Fighting back through political action.

Criticisms

• Charlton (1998): The concept of stigma hides the real problem—poverty is the main cause of illness and disability.