1. 1 SO2003 Lecture 11: Experiencing Health and Illness 29 October, 2007

2. 2 Lecture Outline Sociologys relationship to medicine Structural-functionalism Parsons view of the doctor-patient relationship The biomedical model Obesity as epidemic? Sociological criticism of biomedicine

3. 3 Sociology and medicine Theoretical impetus US and UK Medicines influence on sociology Inherited medicines value judgements Topics reflected an implicit medical template Older science dominant Research reifies the authority of the profession – e.g., The Student Physician: Studies in the Sociology of Medical Education (Merton 1957)

4. 4 Structural-functionalism Sees society as a harmonious set of interrelated institutions Each serves its own function Parsons The Social System (1951): Harmony maintained via social roles Illness is a form of deviance The sick role ensures social order Specific rights/obligations for the patient Mirrored in the physician role

5. 5 The sick role Criticisms include: Motivatedness Entry into the sick role not straightforward Certain forms of illness are stigmatising Pertains only to acute conditions (Gallagher 1976) Conflict is common (Friedson 1988) But concept is valuable as a challenge to the biomedical model

6. 6 The biomedical model Focuses on the body of the sick person (i.e., a reductionist model) Based in the doctrine of specific aetiology (Dubos 1960) Sees disease as culturally universal Claims scientific neutrality Rising prestige of medical specialists Hospital represents pinnacle of medical practice

7. 7 The sociological critique Causes of illness are often partly social Biomedical model defines them in individualistic terms Patients are deemed responsible for failed treatment Doctrine of specific aetiology rarely provides a complete explanation

8. 8 The sociological critique Disease is far from universal Changes over time: medicalisation Definitions, descriptions, understandings, and interventions become medical Numerous examples: e.g., childbirth Various factors: e.g., emergence of medical specialty, patient demands, politics, trends Current concerns about the obesity epidemic Contradictory evidence is problematic Cultural imagery is relevant

9. 9 Fat Imagery Disgust involves fear and moral judgement (Miller 1998) People may react to corresponding panic via humour Fat drag now fills the cultural role of black face Both race and obesity are social constructs (Campos 2004)

10. 10 The sociological critique Medical practice is less than value-free May aim to be unbiased, but still normative in practice Factors like class influence consulting behaviours (Cartwright and OBrien 1976) Normative judgements also affect treatment (Jeffrey 1979)

11. 11 The sociological critique Medicine conceptualised as a form of social control Foucault (1973; 1977): Power operates through surveillance/self- surveillance and individuation (New) medical knowledge establishes norms against which all can be judged

12. 12 Tomorrow… Some implications for inequalities in health Patterns associated with gender, age and class Variations in peoples understandings of healthiness, and Beliefs about how to become/stay healthy