1. Sociology of Health and Illness Week 1. Conceptualising and Defining Health and Illness.

2. Overview of Lecture. conceptual foundations of course. conceptual foundations of course. problems associated with conceptualising and defining health and illness; problems associated with conceptualising and defining health and illness; medical, sociological, bio-social, psychosocial and cross-cultural perspectives. medical, sociological, bio-social, psychosocial and cross-cultural perspectives. Are illness and health social constructions or a biological categories? Are illness and health social constructions or a biological categories? The experience of 'being sick. The experience of 'being sick. Parsons model of the 'sick role' Parsons model of the 'sick role' Sickness as a form of deviance. Sickness as a form of deviance.

3. Problems of definition Defining terms always problematic for social scientists Defining terms always problematic for social scientists a number of definitions of healthy and unhealthy or normal and pathological states, a number of definitions of healthy and unhealthy or normal and pathological states, definitions vary between academic, professional and popular or lay accounts definitions vary between academic, professional and popular or lay accounts also vary widely within and between disciplines. also vary widely within and between disciplines. biological explanations differ from social constructionist accounts biological explanations differ from social constructionist accounts little agreement on the root causes and material conditions of illness. little agreement on the root causes and material conditions of illness. best way to approach questions on health and illness is to use a multi perspectival approach. best way to approach questions on health and illness is to use a multi perspectival approach.

4. Time, space, place and context AlI concepts professional, academic and lay concepts are also culturally and historically specific. AlI concepts professional, academic and lay concepts are also culturally and historically specific. They vary from culture to culture and across time. They vary from culture to culture and across time. Western Culture and obesity - a sign of ill- health thus socially undesirable Western Culture and obesity - a sign of ill- health thus socially undesirable In non-Western cultures -a sign of affluence thus socially desirable In non-Western cultures -a sign of affluence thus socially desirable

5. Time, space, place and context 2 Epilepsy in the Middle Ages viewed as a violent possession by malevolent or even divine forces. Epilepsy in the Middle Ages viewed as a violent possession by malevolent or even divine forces. Empedocles (ancient Greece) a blocking of veins in the head due to an excess of Phlegm. Empedocles (ancient Greece) a blocking of veins in the head due to an excess of Phlegm. Early part of the 20th century epilepsy linked with insanity. Early part of the 20th century epilepsy linked with insanity. Today we know that epilepsy caused by abnormal neurological activity that occurs as a result of damage or injury to the brain Today we know that epilepsy caused by abnormal neurological activity that occurs as a result of damage or injury to the brain However what we know is subject to reinterpretation. However what we know is subject to reinterpretation.

6. Time, space, place and context 3 at any time new technological advances, new medical discoveries, new ways of looking at the structure and functioning of the body or brain could replace the current orthodoxy and epilepsy could come to be seen in a completely different light. at any time new technological advances, new medical discoveries, new ways of looking at the structure and functioning of the body or brain could replace the current orthodoxy and epilepsy could come to be seen in a completely different light.

7. Social constructionism emphasizes the ways in which social institutions and social norms, attitudes, values, behaviour and beleifs- socially produced rather than naturally given or determined emphasizes the ways in which social institutions and social norms, attitudes, values, behaviour and beleifs- socially produced rather than naturally given or determined Strong social constructionist approaches question the natural or biological basis for almost all social phenomena. Strong social constructionist approaches question the natural or biological basis for almost all social phenomena. Sexuality and gender differences, illness, health and physical strength are all social states/ behaviours/ mores/ codes etc are products of culture not biology. Sexuality and gender differences, illness, health and physical strength are all social states/ behaviours/ mores/ codes etc are products of culture not biology. We are socialised into certain patterns of behaviour We are socialised into certain patterns of behaviour

8. Social constructionism 2 social processes create systems of ideas and practices about x, y or z that vary across time and space. social processes create systems of ideas and practices about x, y or z that vary across time and space. social constructionist perspectives particularly problematic when we begin to discuss sexuality, consciousness, the body, disease and human emotions or when issues of Ontology are raised. social constructionist perspectives particularly problematic when we begin to discuss sexuality, consciousness, the body, disease and human emotions or when issues of Ontology are raised. Social reality often appears to be determined by bodies, disease or the natural world (all biological/material things) Social reality often appears to be determined by bodies, disease or the natural world (all biological/material things)

9. Disease as a social response Mc Laughlin disease a mode of social response rather than an organic disruption. Mc Laughlin disease a mode of social response rather than an organic disruption. no illness or sickness out there that is an objective social reality no illness or sickness out there that is an objective social reality only subjective experiences of illness, only subjective experiences of illness, subjective experiences determined by the social, cultural, historical and geographical contexts which we inhabit.. subjective experiences determined by the social, cultural, historical and geographical contexts which we inhabit..

10. Biological Perspectives Social constructionism often contrasted with Biological reductionism. Social constructionism often contrasted with Biological reductionism. nature nurture debate. nature nurture debate. Biologism, Biological determinism and biological reductionism- attempts to explain social phenomena in terms of the material structure/ functioning of the human body. Biologism, Biological determinism and biological reductionism- attempts to explain social phenomena in terms of the material structure/ functioning of the human body. Eg Social behaviour is the result of hereditary or innate influences (Nature) and not learning or environment (Nurture). Eg Social behaviour is the result of hereditary or innate influences (Nature) and not learning or environment (Nurture). Biologism widely discredited in sociology. Biologism widely discredited in sociology. Political reasons for this. Seen as conservative. Political reasons for this. Seen as conservative.

11. An interdisciplinary turn? Many disciplines converge in the field of health illness and medicine. Many disciplines converge in the field of health illness and medicine. Many perspectives also. Many perspectives also. Each discipline/ perspective has something to offer. Each discipline/ perspective has something to offer.

12. Recap. Social constructionists -illness, health, disease are all relative concepts Social constructionists -illness, health, disease are all relative concepts not universal but particular, not universal but particular, Social concepts - learned and shared. Social concepts - learned and shared. Concepts often tell us more about the societies out of which they came than about the thing they are actually describing. Concepts often tell us more about the societies out of which they came than about the thing they are actually describing. Social constructionists largely concerned with explaining and describing the differing experiences of illness by reference to culture. Social constructionists largely concerned with explaining and describing the differing experiences of illness by reference to culture. Biological perspectives often emphasise the natural state, the biological certainty, the innateness and the inevitability of things. Biological perspectives often emphasise the natural state, the biological certainty, the innateness and the inevitability of things. explain illness by reference to biology. explain illness by reference to biology.

13. Problems Secular/Scientific concepts often at odds with local religious or ethical systems Secular/Scientific concepts often at odds with local religious or ethical systems Example HIV awareness programmes in Texas Example HIV awareness programmes in Texas In some African states condoms seen as undermining masculinity, anal sex in many places a way of avoiding pregnancy or cleansing oneself of AIDS virus. In some African states condoms seen as undermining masculinity, anal sex in many places a way of avoiding pregnancy or cleansing oneself of AIDS virus.

14. Important definitions for sociology of Health and Illness Morbidity- amounts of certain types of illness, heart disease, cancer etc -Subjective? Morbidity- amounts of certain types of illness, heart disease, cancer etc -Subjective? Mortality – death. Relative health of social groups assessed by comparing infant mortality rates- Objective? Mortality – death. Relative health of social groups assessed by comparing infant mortality rates- Objective? Disease- can be used in two main 1). any pathological (unhealthy) condition, bodily or mental whether caused through accident or injury 2). it can be used to refer to a specific medically diagnosed condition with distinctive, recognised symptoms.- Subjective or objective? Disease- can be used in two main 1). any pathological (unhealthy) condition, bodily or mental whether caused through accident or injury 2). it can be used to refer to a specific medically diagnosed condition with distinctive, recognised symptoms.- Subjective or objective?

15. Definitions 2 Illnesss or feeling ill is arguably the subjective experience of disease or ill health. Illnesss or feeling ill is arguably the subjective experience of disease or ill health. Sickness- Is a social state or a social role. Sickness- Is a social state or a social role. Health- Bentham: a state of being which is free from discomfort or, more positively, produces comfort Health- Bentham: a state of being which is free from discomfort or, more positively, produces comfort World Health Organisation: Health a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity World Health Organisation: Health a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity

16. Health as a particularistic concept. Baxters study revealed a negative concept of health, as not ill Baxters study revealed a negative concept of health, as not ill To this can be added a concept of health despite disease To this can be added a concept of health despite disease Health as a reserve as in someone is healthy because when he is ill he recovers very quickly Health as a reserve as in someone is healthy because when he is ill he recovers very quickly

17. Baxter (1995) -2 Health as virtuous behaviour Health as virtuous behaviour Health as physical fitness Health as physical fitness Health as energy, vitality. Health as energy, vitality. Health as a Social Relationship. Health as a Social Relationship. Health as Function. Health as Function. Health as psycho-social wellbeing Health as psycho-social wellbeing Concepts of health differ over the life course and between sexes. Concepts of health differ over the life course and between sexes.

18. Conclusion. All definitions contested. All definitions contested. Different views depending on discipline and perspective. Different views depending on discipline and perspective. Variability has important implications for social policy. Variability has important implications for social policy. Health, illness and disease not as unproblematic categories as one might think. Health, illness and disease not as unproblematic categories as one might think. Need to think about subjective and objective aspects of definitions. Need to think about subjective and objective aspects of definitions. Time, space, place, context produce different definitions. Time, space, place, context produce different definitions.