Aim and Scope:
Health and illness are,
surely, simply biological descriptions of the state of our bodies. When we’re
ill, we’re ill. A more refined version of this common‐sense view
underlies the long‐standing biomedical model of disease, which is based
on the following assumptions:
·
Disease is an
organic condition: non‐organic factors associated with the human mind are
considered unimportant or are ignored altogether in the search for biological
causes of pathological symptoms.
·
Disease is a
temporary organic state that can be eradicated – cured – by medical
intervention. Disease is experienced by a sick individual, who then becomes the
object of treatment.
·
Disease is
treated after the symptoms appear – the application of medicine is a reactive
healing process.
·
Disease is
treated in a medical environment – a surgery or a hospital – away from the site
where the symptoms first appeared.
This model has
dominated medical practice because it has been seen to work. It is based on a
technically powerful science that has made a massive contribution to key areas
of health (for example, vaccination). The anatomical and neurophysiologic
structures of the body have been mapped out, and the genetic mapping of the
body is being undertaken through the Human Genome Project. The search for the
fundamental – that is, genetic – basis of human pathology is on, whether the
target is cancer, AIDS or Alzheimer’s disease. This ever closer and more sophisticated
inspection of the body –or as Foucault (1977a) would say, the medical gaze –
has brought considerable power and prestige to the medical profession. It has
also established a large and profitable market for major pharmaceutical
companies. The biomedical model also underlies the official definition of
health and disease adopted by state and international authorities. National
governments and international agencies such as the World Health Organisation
(WHO) proclaim their long‐term health goal to be the eradication of disease.
Sometimes they have been successful, as in the global elimination of smallpox.
The rational application of medical science is therefore a hallmark of
modernity, inasmuch as it has depended on the development over the past two
centuries of a powerful, experimentally based medical analysis of the structure
and function of the body and the agents that attack or weaken it. During the
course of this, scientific medicine has effectively displaced folk or lay medicine.
Modernity is about expertise, not tradition; about critical inspection, not
folk beliefs; about control through scientific and technical regulation of the
body, not customs and mistaken notions of healing.
Yet the power and
status of the medical profession and the health industry in general should not
deflect us from asking about the social basis of health and illness. In fact,
the position of medical professionals is itself a result of the socially
institutionalized power to define the experience of being ‘ill’ and decide what
treatment is required. More reflective doctors will acknowledge that their
definitions of health and illness are not always shared by their patients and
therefore have to be promoted through education, socialization and expensive
advertising. Symptoms that, according to the biomedical model, should force us
to go to the doctor or take a pill are not necessarily seen as signs of illness
by people themselves. Among a household of smokers, for example, the morning
‘smoker’s cough’ is unlikely to be seen as abnormal or a sign of ill‐health: indeed,
it is often calmed by a good pull on the first cigarette of the day. Among many
Westerners, a suntan suggests health and good looks rather than leading to
wrinkled skin or skin cancer. Among the Madi of Uganda, illness is often
associated with failure to deal properly with interpersonal relations, so that
social or moral – rather than biomedical – repair is needed (Allen, 1992).
Thus an alternative or
complementary remedy for ill‐health often takes a holistic approach to
understanding the cause of illness and its remedy.
Sociologists,
anthropologists and historians have described the social basis of health and
illness in a wide range of studies, including ethnographies of specific
communities. They have explored issues of health care, performance of ‘the sick role’, the construction of
mental illness as a disease, the wider creation of medical belief systems and
the relationship between these and the exercise of power and social control.
The sociology of health and illness is concerned with the
social origins of and influences on disease, rather than
with exploring its organic manifestation in individual bodies. The sociology
ofmedicine is concerned with exploring the social, historical and cultural
reasons for the rise to dominance of medicine – especially the biomedical model
– in the definition and treatment of illness. These fields are closely related,
since the way in which professional (or orthodox) medicine defines and manages
illness reflects wider social dynamics that shape the perception and experience
of disease.
The relationship
between individuals and the society or structure in which they live is specific
and distinct. A helpful example of the way on which structure (society)
influences the actions and experiences of individuals is provided by Giddens.
He uses the analogy of language to illustrate the relationship that individual
have with the wider social structure. None of us has invented the language that
we use but without it the social activity would be impossible because it is our
shared meanings that sustain society. However, as Giddens (1994) also points
out, each of us is capable of using that language in a creative, distinct and
individual way, and yet no one person creates language. In the same way human
behavior is not determined in a mechanical way by the structure we call
society. The relationship and interplay between society and individual is
explained in terms of Structure and agency. The latter is a concept used to
refer to a cluster of ideas about the potential for individuals to determine
their lives, to change their environment and ultimately influence the wider
structure. The concept of agency therefore, allows us to appreciate the way in
which we are shaped by society and in turn shape society.
If the subject‐matter of
sociology is human society and behavior is explained primarily in terms of
‘structure’, than this logically denotes specific factors in the explanatory
framework of the discipline. Sociological explanations of what determines our
state of health will necessarily differ from, for example, biological
explanations. Clearly disease is a biological and physical entity experienced
through the medium of the body. The cause of the disease, while biological, can
also be considered in terms of social and structural factors. The immediate
cause of disease may be infection but the factors that lead to this may be many
and varied. This we may call as the social determinates of health. The social
determinants of health are the conditions in which people are born, grow, live,
work and age. These circumstances are shaped by the distribution of money,
power and resources at global, national and local levels. The social
determinants of health are mostly responsible for health inequities ‐ the unfair and
avoidable differences in health status seen within and between countries. Some
of these social and environmental factors such as age, social class, ethnicity,
race and gender fall within the scope of health sociology.
Class refers to a
complex stratification of society based on access to and control of power,
status and economic resources. It is a complex and dynamic power relationship
between people. Class societies are also distinct from other societies that are
also stratified. For example in feudal society distinction between people was
rigid, immobile and seen to be religiously ordained. The reason why someone was
a lord or a peasant was because God willed it that way and there was no way to
change it. But in contemporary societies one can be more socially mobile
between classes. This is because, in many ways one achieves one’s own class
position and it is not fixed by his birth.
There is a great deal
of difference between people’s life expectancy depending on the class to which
they belong. If someone is from manual or working class background, generally
speaking, likely die younger, age faster and encounter more long‐term limiting
illnesses than someone from a non‐ manual or middle‐ class, background. This lamentable state of affairs
has been apparent in much of the research looking at class and health for some
time now. Going back to the mid‐1800s,
Marx’scollaborator Engels wrote about the poor health of the working class in
Manchester. He claimed that the levels of disease, illness and death were a
form of ‘social murder’ committed by bourgeoisie. More recently, landmark
reports such as the Black Report published in 1980 and the Acheson Report
published in 1998 both strongly indicated that which class you are in affects
your health. However there are two perspectives such as Psycho-social perspective and Neo-material
perspectivethat attempt to explain the existence of class and health
inequalities. Both ofthe approaches are provided by Lynch et al. (2000).
Psycho‐social
perspective refers to explanation of class and health inequality that emphasize
the negative emotional experiences of living in an unequal society,
particularly feeling of stress and powerlessness. Wilkinson’s (1996) work in
the 1980s and 1990s demonstrated that in influent societies it is relative, not
average, income that affects health. Wilkinson argues that the greater the
inequality in a given society, the less social cohesion it has and therefore,
the more insecurity and isolation experienced by the most disadvantaged groups
in that society. This insecurity and isolation result in greater levels of
chronic stress. In turn, this chronic stress moves down biological pathways
(particularly the nervous system) in the human body causing all sorts of harm.
Neo‐material
perspectives refer to explanations of class and health inequality that emphasis
unequal distribution of resources such as housing, income and access to
education.
Thus, there are consistent
and persistent differences in class and health in contemporary society. Such
differences are part of the array of inequalities to do with wealth, income and
other recourses. Perhaps it is in health that the social division of class is
most evidently visible, with the bodies people affected and changed by their
location in society. As discussed earlier the bodies of working‐class people are
more likely to age quicker, be more susceptible to illness and be much more
likely to encounter limiting long‐term conditions than those located higher in
society.
Race refers to
biological differences between people based on skin colour and other physical
features, though the actual differences between them genetically are extremely
small. Ethnicity refers to the cultural heritage and identity of a group of
people where a common cultural heritage is socially learned and constructed.
Race is supposed to be based on biological or genetic traits where ethnicity is
purely social phenomena. Racism refers to the supposed racial superiority of
one group over another.
There has been much
research on ethnicity and health over the years. What much of the research
indicates is that there is a burden of ill‐health among ethnic minority groups in the UK. Many
people from ethnic minority groups report poor health and long‐term limiting
illness. This is even more notable as ethnic minority groups tend to have a
younger age profile than the white majority population. Researchers in the past
often favored explanations that drew attention to either genetic or cultural
reasons for ill health. The implication was that there was something wrong with
the biology of ethnic groups, which predisposed them to certain types of ill‐health or that
the culture of the ethnic group was to blame. An indicative example of this
older approach can be noted in research on ‘South Asians’ and coronary heart
disease (CHD) (Nazroo1998). Work by Gupta et.al. (1995) inferred that it was
something to do with either the genetic make‐up of ‘South Asians’ that predisposed them to CHD,
something in cultural practices such as cooking with ghee, nor exercising or
not making the best use of medical services. In the past few years, however the
work of other researchers, such as Ahmad (2000), Nazroo (2006) and Smaje(1996),
have put forward a more challenging and sophisticated explanation of the
complex way in which ethnicity , society and health interact. As Higginbottom
(2006:585) usefully summarizes, variations in ethnicity and health and ill‐health, ‘arise
from the coalescence of complex factors such as migration, cultural adaptation,
racism, reception by host community, socio‐economic influences, and prevailing societal
ideologies’. Reviewing a range of research and reports, Chahal(2004) concluded
that medical and health care services can be problematic for Black and ethnic
minority people, with negative experiences of medical and health services being
a common problem. This is particularly evident with mental health services.
Black people are over represented in mental illness statistics, more likely to
be placed in secure wards and to receive different if not poorer –treatment and
care than Whites. Thus, class and socio‐economic differences affect the health of ethnic
minority groups. Even within the same ethnic minority group there are
differences in health, with those from the non‐manual occupation class having better health than
those in manual occupation classes. Moreover psycho‐social effects
of racism can have a strong impact on the health of ethnic minority groups.
Gender refers to
social, cultural and psychological differences between men and women. It is the
socially constructed differences in roles and responsibilities assigned to men
and women in a given culture or location and the social structure that supports
them. Gender roles and expectations are learnt. They can change over time and
they vary within and between cultures.
The study of gender and
health has recently undergone a period of change and transition. How being a
woman or a man affects one’s health are currently being developed and developed
in a new and interesting way. However we cannot ignore the traditional
perspective of discussing gender and health which could be easily summarized
as’ men die and women suffer’, means when it comes to health differences
between men and women, men experience higher levels of early mortality, while
women live longer but experience higher levels of morbidity during their lives.
The reasons for these differences were often explained by reference to paid and
domestic work roles as well as the wider and often stereotypical, social roles,
which men and women held.
Though traditional
perspectives on gender and health produced a great deal of vital and
interesting research, recently certain sociologist, such as Kandracket al. (1991), Annandale and Hunt (2000)
and Macintyre et al. (1999), have
focused on a new understanding of health and gender. Much of this contemporary
thinking of relation between health and gender has been prompted by two
influences.
·
Firstly, the
society is becoming more complex regarding gender relations. Many of the old
assumption about gender‐ for instance the man as breadwinner, going out to
earn the family wage and the woman staying at home tending to domestic chores‐ simply no
longer fit today’s society. There have been many other transformations, shifts
and movements in how women and men relate to the home, to work and to each
other. In the midst of all this change women’s and men’s health is affected in
new ways.
·
Secondly, there
is growing questioning of the theories used to conceptualize gender. So
adequate understanding of how issues relating to gender affect both sexes is
needed. So emphasis is now lies on understanding the lived experiences of both
women and men and acknowledging that differences exist within each sex.
Annandale and Hunt
(2000) have recently pointed out that research in the study of gender and
health is at a crossroads with ‘traditional’ approaches giving way to ‘new’
approaches. The traditional approaches as mentioned earlier view that men and
women are located in very distinct and different social roles (man in full‐time paid work
and women in the home). Theses social roles required them to act in certain
ways, which were, generally speaking, good for men but bad for women. The new
approach hold that social roles may be ‘masculine’ or ‘feminine’ in orientation
(such as running a business or looking after children) but a man may carry out
a feminine role (looking after children), while a woman may occupy a masculine
role as ( running a business). The new approaches also focus on how men and
women experience those roles and how those experiences affect their health
(Annandale and Hunt 2000). The more ‘feminine’ a role, the lower status it
tends to have and this can lead to poor health. Performing feminine roles also
carries much more pressure than performing male roles.
Annandale and Hunt
(2000: 27‐9) usefully summarize the differences between
‘traditional’ and ‘new’ approaches to gender and health:
·
‘Traditional’
forms of research had the tacit assumption that what was good for men was bad
for women when it comes to health. ‘New’ research follows a more nuanced and
subtle approach, and understands that similar circumstances may have similar or
different consequences for the health of men and women.
·
‘New’ approaches
are aware of the differences within men and within women. In traditional
research men in particular, were treated as an undifferentiated group, where
all men had similar health experiences.
·
In traditional
research positivist, quantitative, statistical methods were predominant. In new
research the role of qualitative method is highlighted in trying to obtain an
understanding of how the experiences of men and women shape their health.
One long‐held view is
that women have higher morbidity rate than men. There have been a number of
reasons behind this, for example:
·
Women do
experience more ill‐health than men because of the demands of their
social roles.
·
Women are more
disposed to seek help than men.
·
Women are more
in‐tune
with their bodies.
·
Surgeries are
not male friendly and put men off seeking help.
·
It is easier for
women to adopt the seek role.
·
Women’s more
attachment to their relation result different kind of mental diseases including
stress.
Another long‐standing
perception, when looking gender and health, is that women have some form of
biological advantage in terms of life expectancy. In the UK, for instance a
woman born in 2004 can expect to live until she is 81.1 years old, while a male
born in the same year can expect to reach the age of 76.7 years (ONS 2006).
Such statistics strongly suggest that women do enjoy some form of biological
advantage over men. However the sizable life expectancy advantage that women
experience in the UK is very much a western phenomenon. Figure depicts how
overall women do have longer lives than men in most countries but this is
extremely variable. On one hand, in some countries, such as Malawi, the life
expectancy for both men and women is very low, while in Algeria there is a
negligible difference in life expectancy for women and men. The reasons for this
are multiple and diverse. For example it depends on levels of health care a
country can offer, where child birth is safer, the levels of poverty and
endemic illness, such as in Malawi, which faces widespread poverty and has many
people infected with HIV/AIDS.
Mental health as an
important aspect of heath system comes directly under the scope of health
sociology where it has an important role to play in trying to understand the
full intricacies of mental illness, especially when it comes to the way in
which society influences and frames both how we see mental health and illness
and how society creates situations that can negatively impact on individual’s
mental health.
There are complexities
and uncertainties that surrounded the whole processes of diagnosis and
identifying mental illness. Unlike physical illness, there is often no clear‐cut objective
sign that someone is experiencing a mental illness. McPherson and Armstrong
(2006:50) this concern well, when they say:
What
is pneumonia or appendicitis or cancer can be agreed internationally with
reference to the presence or absence of certain clearly defined physical
characteristics. In psychiatry, however, there is no such external biological
referent to act as an anchor for diagnosis. Essentially, psychiatry classifies
on the basis of a patient’s patterns of symptoms which might vary according to
how they are elicited and interpreted.
Because then it cannot
always clearly identified what mental illness is, this makes the search for a
cause all the harder. Broadly speaking, explanations for mental illness fall
into one of two camps: biological explanations and social explanations. These
look in very different directions and see quite different reasons for the existence
of mental illness.
·
Biological
explanations focus on faulty genes or imbalance in the chemistry of the brain.
There is, for instance an association between low levels of serotonin and
depression. This way of thinking, of looking for biological cause, in
increasingly reinforced by the proliferation of pharmaceutical interventions
such as SSRIs (selective serotonin reuptake inhibitors) for treating depression
which suggest that if an illness can be treated by chemicals, than it must have
a biological, organic basis.
Social explanations
fall into two general categories: Social
causation and Socialconstructionist.
·
Social causation perspective refers to how the various inequalities in society
(mainly to do with ethnicity, gender and class) produce toxic levels of stress
for some people. As a result of this stress, people may be ‘tripped’ into
mental illness, whether it is a woman expected to bring up children on her own
and keep down a job; or the experience someone from an ethnic minority group
has of being racially abused by a neighbor; or the constant soul destroying
grind of poverty and not being able to lead the life of that others enjoy.
·
Social constructionist explains mental illness is something that does not
exist as a ‘fact’ or something that is ‘real’ and has absolutely no organic
basis. This sociological view is influenced by the work of Foucault, who has
argued that there is no single incontestable truth that can be discovered and
agreed on by everyone. Rather, society is constructed by the idea and
conceptualizations of both individual people and also, more importantly,
certain powerful groups. Some groups, such as psychiatrists, are able to
construct a discourse that privileges a certain view point of others, which
allow them to effectively rule out and rule in ways of conceptualizing, for
example what constitutes mental illness. Constructing such discourses allows
such groups to become dominant in society and allows them to regulate and
control the activities of others.
Thus, both biological
explanations and social explanations explain about mental illness. But these
two are not sufficient to address the complexity of mental health and illness.
Rather there is a complex interweaving of both society and biology, where both
have to be understood as often working together in complex and dynamic ways. As
captured by Rose (2005) in his discussion of causes of mental illness and how
biology and society interact. He points out that just because a change in the
chemistry of the brain takes place does not mean that the chemical change
caused the illness. To illustrate this point he gives a beautiful example: if
someone has a headache, he takes an aspirin. If we
were then to check the
chemicals in the person’s brain in order to discover the chemical basis of a
headache, we would find aspirin. Thus, according to the biological explanation,
we would claim that aspirin causes headache, because people who do not have
headaches do not have the chemical aspirin present in their brains. Now,
obviously, this not to be the case. So, Rose concluded that chemical changes do
occur, but that could equally be the result of other (in this case social)
factors.
Pilgrim and Rogers
(1994) acknowledges and develops the social and cultural factors responsible
for mental health in their studies. According to them the misery and sufferings
of the world is related to the complexities of human life: that humans are
simultaneously organic biological and social beings. This critical realist
perspective fully acknowledges the strong and influential role of culture, but
does not say that it is all down to society. It also accepts the importance of
medical information and research, but crucially, questions how diagnoses are
framed by the social influences on the medical professions. Finally, a critical
realist perspective accepts that biological processes are at work but, like
Rose (2005) attempts to place those processes in a wider context where social
factors may be the cause of biological changes.
Stigma
refers to an attitude that
‘discredits’ or prevents someone’s full acceptance in aparticular situation.
Social stigmas increase the stress of those with mental illness and exacerbate
feeling of social exclusion and social distance.
Goffman is one of the
best known sociologists to have studied and theorized how certain groups of
people attract stigma. His humanistic and sympathetic work focuses on why
certain attributes of an individual or group deny them full acceptance in given
situations and lead them either to be excluded or to be left with a feeling of
not ‘fitting in’. He classifies stigma into three broad groups:
·
Physical stigma
‐
mainly to do with aspects visible ‘on the surface’ of people, for example
facial scarring, a physical impairment or an amputation.
·
Personal/character stigma ‐ mainly to do with aspects ‘below the surface’, for
example drug use, sexuality or mental health.
·
Social stigma
‐ belonging to a particular group or ethnic
minority. (Goffman, 1968)
The ‘counting the cost’
survey by Baker and Macpherson (2000) for MIND highlighted the extent of
stigmatizing images and the effects they had on people with mental illness. For
many respondents to the survey the social stigma was harder to deal with than
the symptoms of their particular condition.
There are a number of
explanations for why people from Black and other ethnic backgrounds appear to
have higher rates of mental illness and a different, often coercive,
relationship with services. These explanations include:
·
racist and
prejudiced attitude on the part of service providers and agencies of the state,
such as the police;
·
lack of cultural
sensitivity
·
more frequent
exposure to stressors in the form of, for example, unemployment; adjusting to a
new society if recently arrived;
·
racism
generally.
However, Pilgrim and
Rogers (1993) pointed out another related concept regarding the relationship of
ethnicity and health. They draw on Foucault’s concept of seeing madness as a
part of the ‘other’, that is the groups of people who are regarded as being
outside the norm of society and as constituting a threat to the order of
society.
Every review of
literature concerning sociology and mental health reaches the same conclusion
when discussing gender – that women always display higher rates of certain
mental illness than man (Foster 1995; Bebbington (1996).
In substantial review
of literature relating to women and depression Bebbington (1996) and Nazoo et
al. (1998) demonstrated the following points:
·
Women did report
more depressive episodes – whether distant, mild or exaggerated episodes.
Whereas there is little evidence for men masking their depression by turning to
alcohol or substance abuse.
·
The chance of
depression is higher in case of woman because of her role identity. For
example: a woman feels a particularly close attachment to and sense of responsibility
for children and because of her role identity, then the chance of depression is
much greater if there is child related problem,
such as difficulties at school or drug misuse.
One of the best known
pieces of sociological research on women and mental health was carried out by
Brown and Harris (1978). Key component of the model are:
Current vulnerability factors – these factors relate to events that have happened in
a woman’s past and indicates whether or not she may be more susceptible to
depression. There are four vulnerable factors:
·
losing a mother
before the age of 11;
·
presence at home
of three or more children under the age of 15years;
·
absence of any
confiding relationship, particularly with the husband;
·
lack of full or
part‐time
job.
Provoking agents –
there are various events that could occur in a woman’s life, which could then
trigger a depressive episode. The events mainly relate to loss and
disappointment, e.g. death, losing a job or discovering a partner’s unfaithfulness.
Symptom –
formation factors‐ women over 50 years of age and women with low self‐esteem were at
greatest risk of developing depression.
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2024 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.