Download The Social Construction of Health & Illness

The Social Construction
of Health & Illness
G672
Learning Objectives
Discuss

What do we mean when we say something is socially
constructed?
Social Construction
What are these two people doing and
why?
Social Construction

An interactionist view, from the work of Berger &
Luckmann (1966).

They argue that actions can only be interpreted through
the meanings people give them.

The reality of a thing – and what it means – is dependent
on the attitudes, values and norms of
the society in which the thing is and
the context of the situation.
Be Careful Who You
Wink At

So, in the UK, many of us will assume these people are
winking. Depending on the context – and our own
experiences – we might wink at someone because we find
them attractive, because we’re sharing a secret etc...

But winking is socially constructed because in other
societies it can have entirely different meanings and
interpretations. It can be...

A sexual invitation (Latin America)
A signal for someone to leave the room (Nigeria)
A sign of rudeness (China)
A sign of disrespect or boredom (Japan)



In what way do the following demonstrate
the concept of social constructionism?
Health as a Social Construction

Sociologists claim health and illness are social
constructions because the concepts mean different things
to different people.
They demonstrate that this is the case because:
 Not everyone experiences symptoms in the same way
 Different societies have different methods of diagnosis and
treatment
 Illness is not randomly distributed
Therefore, health and illness cannot be objective,
scientific, absolute facts.
Recap

In pairs, review what we have studied on the unit
so far and find examples of how health and illness
are socially constructed.
Health & Illness as Relative

This means that health and illness are relative to
individuals and societies (we discussed examples of this
when we looked at the social model).

One way of showing that health and illness are relative is
when there are different definitions of the concept.
We have already identified some differences with
definitions...Which ones?!
Health as Relative to Individuals
(Lay Definitions)
Blaxter (1990)
‘The Health & Lifestyles Survey’
Selected a random sample of 9003 people; over 70% of whom
agreed to participate.Two home visits took place; the first by a
nurse who conducted a limited medical examination (blood
pressure, weight etc.), the second by a researcher who conducted a
long, structured interview about health-related behaviour (e.g
smoking, diet).
Additionally, each respondent completed a
postal questionnaire in which they
self-assessed their wellbeing.
The findings were that individuals have many
different definitions of health; some positive,
some negative.
In pairs (5 mins)
Comment on Blaxter’s research in terms of:
 Reliability
 Validity
 Representativeness
 Generalisability
 Issues
Definitions of Health (Blaxter; 1990)
Negative
Positive
Health is the absence of
Health is being physically fit e.g.
symptoms of illness e.g. “I don’t “I am fit enough to play sport”.
have a headache”.
Health is not having a disease
or disability e.g. “I have no
medically diagnosed condition
such as a broken leg or
arthritis”.
Health is psychological and
social wellbeing e.g.“I feel
emotionally stable and able to
cope with life.”
Activity (5 mins): Categorise the
following quotes using Blaxter’s table.
“Health is being carefree:You look better, you get on with
other people.” (f,23)
“Health is being able to walk around better, doing more work
in the house when my knees let me.” (f,70)
“When I’m not healthy is when I just want to sit down in
front of a box.” (f, 38)
“Health is having lots of whumph” (f,28)
“Health is when you don’t feel tired or out of breath”
(m,51)
“Health is when you don’t have a cold” (m,19)
“Health is when you don’t have to think about pain” (f,78)
Ext: - Comment on the features of the respondents; any patterns or issues?
Blaxter (1990)

Found social patterns in definitions of health.

Young men more likely to consider health in terms of
strength and fitness.
Young women considered it in terms of energy, vitality
and ability to cope.
Older people (especially the men) considered it in
terms of the ability to do things.


Other Studies...

D’houtard & Field (1984) found respondents from nonmanual backgrounds in France had more positive definitions
of health than those from manual backgrounds.

Pill & Stott (1982) found working-class women in the UK
were likely to associate health with the ability to participate in
normal social roles (e.g. being a “good mother”).

Howlett et al (1992) found that Asians were more likely to
define health as the ability to function, whilst AfricanCarribeans were more likely to define it in terms of energy
and strength.
Health as Relative between
Societies
Health as Relative (Societies)

Different societies can differ widely in their beliefs about
the causes and solutions to illness.

They can also differ in terms of the levels of discomfort
and pain that are considered as normal.
Rashes
A skin rash is considered a potential
medical issue in the UK...
...But in some South American tribes, a
rash disappearing can prevent a couple
from getting married.
Good news: My
rash is gone.
I hate you
now.
In some South African cultures,
menstruation is considered a dangerous
‘disease’, as it is believed contact with a
menstruating woman can ‘pollute’ animals,
crops – and even humans.
Dead? Hmm...must have come
into contact with a
menstruating woman.
What’s up?
My slave
ran away.
The only possible
explanation is that
he was mentally ill.
In the mid-19th Century, an American
physician claimed that black slaves who
escaped their white owners did so because
they suffered from a mental abnormality
called ‘drapetomania’.
In some W. African societies, rolls of
body fat in women are considered signs
of such good health that rich men
frequently send their daughters to
‘fatting houses’ to make them plump.
Health as Relative (Societies)

Different societies – and cultures within a society – also
have different models for understanding health e.g.
Model
Examples of cultural beliefs
Equilibrium
Chinese medicine states the body has energy channels
(yin and yang) that need to be balanced.
Humoural theory suggests that an imbalance in the
humours (blood; phlegm; black/yellow bile) causes
illness.
Religious
Possession by evil spirits causes illness. Exorcism could
therefore be the prescribed treatment; a priest or
shaman would be the protector of health.
Ethical
Illness is a punishment for wrong-doing, or the result of
someone casting a spell on you.
Acupuncture
http://www.youtube.com/watch?v=41vm87qq1KU
Watch the documentary on Acupuncture
(also on Clickview)
How do the ideas expressed about health, illness and the
body differ to (or reaffirm) the biomedical model.
Discuss
How do the ideas expressed about health, illness and the body in
the documentary differ to (or reaffirm) the biomedical model?
Identify 2 ways acupuncture differs from the biomedical
model.
Identify 2 ways acupuncture reaffirms the biomedical model.
Health as Relative (Over Time)
Health as Relative (Over Time)

Within a single society, ideas of health and illness can
change radically over time.

For example, until 1957, homosexuality was classified as
a mental illness – and a man who admitted to being gay
would have to undergo treatment (e.g. aversion therapy).

Helman (1978) studied ‘folk’ beliefs about catching a
cold; these beliefs suggested that having your head or feet
uncovered and generally being ‘careless’ were the reasons
people caught colds.
Research




In small groups, research one of the following ‘vanished’
illnesses:
Sweating sickness
Dancing mania
Ptosis (detached colon)
Neurasthenia
What were the signs, symptoms, causes and solutions of
such illnesses.
The Social Process of
Becoming Ill
Becoming Ill

The symptoms that constitute an illness are also
culturally relative. Different people might interpret the
same symptoms entirely differently.
I feel out of
breath and can’t
walk very well.
I’m 23...I think I
must be ill.
I too feel out of
breath and can’t
walk very well. I’m
94, so that’s
normal.
Becoming Ill means Becoming a Statistic





Illness in our society is measured by morbidity
statistics.
This provides a record of people who are officially ill.
To become officially ill, a medical professional has to
label your symptoms as an illness.
Becoming ill is therefore a complicated social process...
...This also means that morbidity statistics are socially
constructed; they are based on an interpretation of
symptoms and are the outcome of a highly subjective
process.
Discuss

What factors make people more or less vulnerable to
illness?
Stage 1:
The Person is made vulnerable to illness
A person becomes vulnerable to illness by:


Social factors such as diet, poor housing, unsafe
recreational areas, pollution, stress and occupational
hazards.
Genetic factors (particularly when combined with the
above).
Discuss: Are there any other
factors that might make
someone vulnerable to
illness?
Stage 2: Symptoms Develop
Physical Symptoms
Clinical Depression
Food Poisoning
Broken Leg
Headache
Feeling depressed
Feeling isolated
Psychological
Symptoms
Social Symptoms
Hearing voices
Migraine
Unable to eat
Runny nose
Inability to relate to people
Copy and complete: Match the symptoms to their type. Add
one more of your own to each.
Stage 3: Symptoms are Interpreted as
Illness

Just because you have symptoms of something, doesn’t
mean you automatically consider yourself ill.

There are various influences on whether or not a person
interprets symptoms as a sign of illness (and all of these
influences contribute to the view that illness is socially
constructed).
You find a strange lump on a part of your body
where no lumps should be. What factors will
influence whether or not you worry about it?
Stage 3: Symptoms are Interpreted as
Illness (cont...)
Personal Experience
e.g. “a mole on my body is sore. My friend had the same thing
and it turned out to be skin cancer, so I’d better see a doctor”
Mass Media
e.g. It said on the news that only a small proportion of men
suffer from breast cancer, so probably no need for me to get
this lump checked.
(alternatively, mass media campaigns could increase the
number of people seeking advice).
Stage 3: Symptoms are Interpreted as
Illness (cont...)
Family Influence
e.g. I didn’t think these headaches were much to worry about,
but my mum keeps nagging me to go the doctor so I guess I
should...
Cultural Influence
e.g. A study by Zola (1952) concluded that Irish-Americans
tended to dismiss physical symptoms, whereas ItalianAmericans were unable to tolerate much physical pain.
Stage 4: A decision is made to seek
health care
Discuss:
What factors would influence your decision to
visit – or not visit – your doctor?
Under what circumstances might you visit an
alternative practitioner e.g. a herbalist?
Stage 4: A decision is made to seek
health care (cont...)



Some people might disregard their symptoms.
Some might accept they are ill, but try to treat
themselves.
Some might accept they are ill and seek an alternative
form of therapy.
None of the above will make the morbidity
statistics. Only people going to their GP have a
chance of becoming ‘officially ill’.
Discuss

In pairs, identify a minimum of three things a person might
do to look after themselves instead of going to visit a
doctor.
Punamaki & Aschan (1994): How people care for themselves
instead of seeing doctors:
Type of Care
%
Example
Faith
18
Pray; listen to religious music
Nature
9
Get more fresh air
Work/hobbies
43
Work a few less hours; go fishing
Relaxation
30
Retail therapy!
Sports/exercise
63
Walk a bit more
Food/diet
31
Detox
Sauna/hygiene
26
Go to the sauna to keep clean (this survey was
Finnish!)
Avoiding risk
10
I’ll cut down on cigarettes
Lay care
50
I’ll take an aspirin; get a massage
Official health care
10
I’ll go and see a doctor
The study showed that a majority of people do not seek medical advice when
they experience symptoms; instead, they choose to self-care. Therefore, they
don’t make morbidity stats.
Stage 4: A decision is made to seek
health care (cont...)
Other reasons to avoid seeing a doctor:



Availability and cost
Faith in (Western) medicine
Giving symptoms a specified time to improve
Stage 5: Labelling (Doctor-Patient
Interaction)

The doctor (or other official) will decide whether or not
to label the symptoms as an ‘official illness’.
Discuss: How does a doctor decide whether or not a
person is officially ill?
Stage 5: Labelling (Doctor-Patient
Interaction)

Most people would imagine that this is a straightforward
process: If your symptoms match a ‘proper’ illness, the doctor
will declare you ill.

However, some Sociologists believe that patients and doctors
enter a negotiation process, which can lead to a struggle.

Part of the struggle is because the doctor is in the position of
power and there is a social expectation that a patient will
agree with whatever the doctor says.

The labelling of illness is therefore a problematic process.
Bloor (1976)

Studied the experiences of patients in ENT clinics.

He found that doctors and consultants restricted the
ability of the patients to participate in conversations
about their problems, by demanding very specific answers
to closed questions.
Doctor (D): How old is he?
Mother of Patient (M): Nine months
D: He’s had two bad attacks?
M: Yes
D: He’s fevered?
M: Yes
D: And he came into hospital with one of
them?
M: Yes
D: In between times he’s alright?
M: Yes
D: He hasn’t had any ear trouble?
M: No.
Activity (Pairs): Rewrite this dialogue so
that it becomes more open and negotiated
between doctor and patient.
Can patients influence doctors?
Strategies that patients might use:
 Offer their own diagnosis (maybe informed by the
internet, or other experience...)
 Request further information/clarification
 Openly disagree with the doctor
 Threaten with a ‘second opinion’
Discuss: Identify reasons why it might be important to a
person to be labelled ‘officially ill’ by the doctor.
6. Label = Morbidity Statistic

Morbidity statistics shape our understanding of health and
illness...

...But as we’ve seen from this process, relatively few
people who experience symptoms of illness actually make
the statistics...

...Therefore, our understanding of health and illness is
deeply flawed.
The Illness Iceberg
6%
94%
Small Groups

Design a flow chart demonstrating the process of
becoming ill.

Add your own examples, ideas and illustrations.
Activity - Individually

For the following table, decide individually the extent to
which you consider the symptoms to be an illness (1 =
Not ill at all; 5 = definitely ill).
Set of Symptoms
1
2
3
4
5
Pregnancy
1
2
3
4
5
Severe Hangover
1
2
3
4
5
Migraine
1
2
3
4
5
Breast Cancer
1
2
3
4
5
Lack of appetite resulting in serious weight loss
1
2
3
4
5
Broken Leg
1
2
3
4
5
Wrinkles
1
2
3
4
5
Severe memory loss
1
2
3
4
5
Acne
1
2
3
4
5
Shouting at oneself in public
1
2
3
4
5
An 80 year old woman whose eyesight is fading
1
2
3
4
5
A 14 year old boy having difficulty hearing
1
2
3
4
5
An overweight man with high blood pressure
1
2
3
4
5
A man who wants a sex change
1
2
3
4
5
A woman who smoked 80 a day and now has lung cancer
1
2
3
4
5
An alcoholic
1
2
3
4
5
A young man who claims he is Napolean
1
2
3
4
5
A woman who has gone bald
1
2
3
4
5
Discuss

Which factors did the class agree were ‘definitely ill’ and
which were ‘not ill at all’.

What patterns can be identified.
Written Task
Health and Illness are not Biological ‘Facts’ – they
are Socially Constructed.
Write a 1000 word blog/essay evaluating this statement, using
concepts, studies, theories and ideas covered in the unit so far.
Due:This time next week.