Academic Integrity & Library Quiz

Assessments

• An online quiz makes up 5% of the final grade and is due February 24, 2025.
• Tutorial attendance and participation account for 20% of the grade.
• A small group tutorial presentation/discussion makes up 10% of the grade, and begins the week of January 27, 2025.
• A draft paper is worth 10% and is due February 14, 2025.
• The formal paper makes up 20% of the total grade and is due March 21, 2025
• The final exam is worth 35% of the final grade.

Academic Integrity & Library Quiz

• There are 51 questions in the quiz, but the last 5 questions do not count towards the grade.
• The last 5 questions are only asked for feedback regarding the usefulness of the quiz
• A score received at the end of the quiz will show 'out of 51', but only the first 46 questions answers are counted towards the grade.
• A grade of at least 46 correct answers from the first 46 questions (90.2%) is required to receive credit for completing the quiz.
• After submission, the number and identity of correctly answered questions will be shown, but not the questions answered incorrectly.
• Repeated attempts are necessary until 46 answers are answered correctly.

Important Dates and Information

• Tutorials begin the week of January 20, 2025.
• There are no Thursday lectures, except for make-up sessions, additional support, and research information on Thursday, January 16th.
• Echo360 is used.

Social Constructionism

• The idea that what is known about the world, including health and illness, is not fixed or predetermined.
• Social constructionism says people actively interpret, define, and give meaning to the world, rather than passively receiving an objective reality.

Differing Views on Social Constructionism

• Mild or contextual constructionism posits that objective reality exists but is experienced through meanings given to them.
• Mild or contextual constructionism suggests that multiple realities can therefore exist.
• Radical or strict constructionism suggests that whether reality exists cannot be objectively determined.
• Radical or strict constructionism also suggests that knowledge of anything beyond individual experiences is impossible.
• According to radical or strict constructionism, interpretations and sense of what is objectively real are all that people possess.

Social Constructionism Focus

• Exploring social processes by which individuals create meaning is a common ground.
• An attempt is made to understand if interpretations and meanings are promoted, used, negotiated, or challenged.
• The consequences of learned interpretations and meanings on behaviour analyzed.

Social Constructionism and Health

• The meaning of health and illness is problematized.
• Health is not obvious or self-evident.
• Illnesses are socially constructed and not universal states waiting to be discovered in nature.
• A social constructionist approach doesn't focus on whether someone is healthy or not.
• Social constructionists instead focus on interactions that lead to health-related opinions and social judgements, and how these affect health practices and policies.
• Examining these health processes is the area of focus.
• Questions are asked about what it means to be healthy or ill.
• Belief held that health and illness are subjective/relative states.
• Inquiries arise around the factors that lead to the understanding of health and illness.
• Examinations are conducted as to why these states are defined in the way they are.

Social Construction of Medical Knowledge

• The medical profession became dominant via a targeted, political process, overshadowing other healing traditions.
• Scientific medicine had a monopoly in health services due to the status achieved by doctors, rather than being more effective.
• Medical doctors became the primary holders of medical knowledge.

Key Themes

• Central themes: medicalization, demedicalization, contested illness, and lay constructions.

Medicalization/Demedicalization

• Medicalization refers to the process where conditions and behaviours are defined as medical problems, e.g., illnesses, diseases, syndromes, or disorders.
• Demedicalization is the process by which conditions and behaviours, once understood as medical problems, are reconceptualized.

Medicalization Process

• It is the outcome of someone making a claim about a behavior.
• Alcoholism, hyperactivity in children, delinquency, mental illness, and opiate addiction are examples of successful claims.

Healthism

• Healthism (aka healthicization) is the concept of proactively addressing health concerns by adopting appropriate lifestyle choices.

Diagnostic and Statistical Manual of Mental Disorders (DSM)

• The American Psychiatric Association (APA) publishes the DSM, often referred to as the "bible of psychiatry".
• The DSM lists, classifies, and describes symptoms for all recognized mental disorders.
• It is used to track the medicalization and demedicalization of conditions.
• The manual presented as objective and scientific, which swayed professionals and the public.
• Controversy exists over the dramatic increase of symptoms and conditions in the latest edition.
• Psychiatrists have questioned if the manual goes too far in medicalizing everyday behaviours.

Factors in Medicalization

• Medicalization was initially characterized as medical imperialism, where professionals dominated to expand their power.
• The impetus for medicalization comes from lay groups rather than medical doctors.
• Pharmaceutical companies majorly influence medicalization.

Consequences of Medicalization

• Medical labels are less punitive than criminal labels, but not necessarily less stigmatizing.
• Medical labels leads to sympathetic responses, absolving responsibility, and may exempt individuals from normal duties.
• Medical labels may cause individuals to be seen as victims, and are therefore pitied.
• Medicalization individualizes problems.
• Solutions or treatments are directed toward individuals, sometimes by force.
• Medicalization depoliticizes behaviors.

Demedicalization

• Successful claims-making may lead to "diseases" being redefined as normal.
• Homosexuality is an example of demedicalization.
• Disabilities are termed as "differently abled".
• The mad, asexuality, and neurodiversity movements are recently emerged

Contested Illnesses

• Contested illnesses are conditions where sufferers and advocates struggle to have medically unexplained symptoms recognized in orthodox biomedical terms, despite resistance (Barker, 2010, p. 153).
• Those who suffer from these conditions experience serious distress and significantly compromised quality of life.
• Physicians are reluctant to deal with these conditions as symptoms can be vague, difficult to diagnose, with unknown causes, and are complicated to manage or treat.
• Those diagnosed are excused from social expectations.
• Refusing to acknowledge someone's illness prevents them from obtaining relief.
• Living with an illness requires coping not only with symptoms, but also medical uncertainty, public skepticism, and disparagement.
• Contested illnesses present an opportunity for discussion the reverse side of demedicalization.
• Contested illness literature focuses on efforts to have experiences recognized as illness, while demedicalization literature focuses on efforts to resist disease labels.

Lay Constructions of Health and Illness

• The focus is on how individuals make sense of health and illness in their own lives rather than on "official" recognition.
• Individuals are viewed as active agents involved in making sense of their experiences in daily lives.
• Individual agency can cause clashes of perspectives between doctor and patient.
• Living with chronic illness is examined, where individuals often respond imaginatively, giving suffering meaning.

Culture Defined

• Culture includes refinement or development.
• Culture includes group membership.
• Culture includes learning, sharing, and socializing.
• Culture includes a belief system.

Characteristics of Culture

• Notions of membership in a culture-sharing group are included.
• Elements of Learning, sharing, common beliefs, and values provides a frame of reference among the culture sharing group.
• Culture offers members of the culture sharing group a lens and world view in order to interpret and understand life.
• Culture is passed on through tangible and intangible elements only understood by group members.

Culture, Race, and Ethnicity

• Culture, race, and ethnicity all represent categorical differences among individuals, with transmission from one generation to another.
• Race implies common genetic characteristics.
• Ethnicity broadly refers to the origin of birth for a group of individuals.

Western Views On Health

• Use of prescription medicines to target and treat ailments is emphasized.
• Values, such as patient's right to self-determination and autonomy, are part of the care.
• Belief that care should be provided by professionals.

Indigenous Views on Health

• Understandings of health are inseparable from religion and spirituality.
• Health beliefs are based on supernatural phenomena.
• Care delivered by a "medicine man" or shaman from Indigenous community.

Determinants of Indigenous Peoples’ Health in Canada

• Colonialism a determinant.
• Geographic, economic, historical, narrative, genealogical, and structural determinants.
• Excluded determinants include spirituality, relationship to land, geography, history, language, and knowledge systems.

How Culture impacts Health

• Impacts the relationship between caregiver and patient.
• Can change the way we communicate about our needs and illnesses.
• Impacts our thoughts about who should communicate with providers.
• Shapes assumptions about body and causes of illness.
• Impacts beliefs about whether care is appropriate, or when care is needed.

Modern Medical Culture

• Objectivity and scientific rationalities are commonly valued.
• "True knowledge" means science and medicine intersect.
• There is reliance on biomedical practices.
• Germ theory shifted focus from healing to disease.
• The foundations of bodies were substantiated.
• Modern medicine bases everything on "best evidence" when deciding care.
• Germ theory isolates physical illnesses and patient's psychological state and cultural factors.
• The body is seen as individual parts in a machine.
• Mental and physical health distinct via mind-body dichotomy.

Further Aspects of modern Health Care

• More concerned with causes than relationships.
• Many issues and conditions previously not treated, diagnosed, or discussed as medical conditions medicalized.
• Medical conditions medicalized because of new treatments.
• Biological factors and medical technologies are overestimated, and social relations and culture are underestimated.

Health Sectors

• Health sectors: popular, professional, and folk sectors.

Social Construction of Reality within Health Care

• Health care systems are socially and culturally connected.
• Universal health care is our social reality.
• Universal health care is a value in society.

Popular Health Sector

• The popular sector is the least studied and most poorly understood.
• Participants are lay persons and non professionals/specialists.
• In the popular sector, illness is first defined, and health care activities are initiated which manages 70%-90% of illnesses episodes.
• Illness is first encountered in the family.
• Steps: 1) Perceiving/experiencing symptoms, 2) Labeling/evaluating disease, 3) Sanctioning a sick role, 4) Engaging in specific health care-seeking behavior, 5) Applying treatment from other HC sectors.
• Primarily concerned with health maintenance.
• The “sick role” employed, and the individual does not see alternatives as viable.

Professional Sector of Health Care

• Organized healing professionals use modern scientific medicine.
• Research is limited to biomedicine, and the solutions fit.
• Recent rise of technology, prolific medical subspecialization and establishment of para-professionals.
• Clinical responsibilities are increasingly assumed by nurse practitioners and medical assistants.
• Aspects of professional care, like scientific health concepts, are altered and diffused after they enter the popular health sector.

Folk Health Sector

• Seen as a link between the professional and the popular sector.
• Health care is administered by a practitioner such as a shaman or doctor of Ayurvedic medicine and considers their patients patterns and harmony.
• Also known as complementary and alternative medical care.

The Paradigm

• How folk, popular, professional options incorporated in lives affect human agency related to well being.
• Individuals have different understanding/acceptance of social norms, therefore will have different practices as well.
• Differences create the different choices made about illness.
• How thoughts are formed about illness, how families/practitioners respond are all part of social reality.
• 2 parts to social reality is distinguishing one social cultural word as merely social reality and bridging social reality with psychological/biological/physical reality.
• The bridging reality is symbolic.
• Symbolic reality makes sense of that inner experience.
• Personal identity shaped by social norms.
• Symbolic meanings influence the psychological.
• Less certain how symbolic reality connects the social environment with the psychological process (inner experience).

Fear and Illness across Cultures

• Cultural beliefs about health and illness often imbued with fear.
• Individual's understanding and response to illness dependent on their culture.
• Cultural guidelines/worldviews shape individuals' behavior in situations perceived as “misfortune.”
• People may be afraid to disclose symptoms die to cultural fears which may lead to misdiagnoses.
• Admit to being sick frowned upon by peers or co-workers.
• Stigmatization may occur if a culturally sensitive illness/disease is disclosed.

Alternative Healers

• Religious Healer
• Magician Healer
• Traditional Chinese Healer
• Aboriginal Healer

Effectiveness of Alternative Healers

• Critics say alternative medicine requires blind faith & acceptance of supernatural forces.
• However, healers/medicine do work for some individuals.

Case Study: Art Duerksen

• At 55, Art Duerksen impulsively joined an Ironman triathlon to raise money for charity.
• Just before Christmas, he became sick with slurred speech, left side weakness, blurred vision, and lost balance.
• Duerksen sought medical attention and doctors determined a main artery at the top of his brain stem had become blocked and leaked blood.
• He suffered brain damage and, while in the hospital, had a small stroke which blinded him in his right eye.
• As an optimistic person, his family was scared & saw him lifeless and doctors gave him hope, but prepared him for another possibility.
• Due to medications making him violently ill, travel and work was not feasible.
• Duerksen told himself things could be worse, and his doctor sternly ordered him to relax & ease up when he mentioned still wanting to do the race.
• Then he started feeling slightly better, and one month later climbed onto a treadmill at the hospital and walked for 5 minutes.
• A few weeks later, still not fully healed, he went swimming with a snorkel to avoid moving his head.
• Gradually symptoms faded, with vision returning, clearer speech and increased strength.
• By midsummer he completed a half-Ironman.
• He swam 3.9 kilometers, biked 180 kilometers and ran 26 in 14 hours + 33 min.
• He cannot explain it, only that he asked for God to run along side him and to let him believe in himself to complete the triathlon.

Summary

• It is important to understand the common factors that constitute culture.
• Health beliefs and norms are often transmitted in cultures.
• Although culture may be shared, members are not homogeneous and follow culture.
• Culture is dynamic and changing.
• North American biomedical culture is based on objectivity and scientific rationality.
• Other frameworks of understanding are not as accepted.

3 Important Contemporary Approaches in the Social Sciences

• The Positivist Approach / The Structural Functionalist Approach.
• The Critical Approach / Conflict Theorists.
• The Interpretive Approach / Symbolic Interactionist Perspective, Grounded Theory.

Positivist/Structural Functionalist

• Compte had three stages: Theological, Metaphysical, and Positive / Structural Functionalist Stage.
• Durkhiem needed to look at social facts objectively, observe the patterns, study the patterns of regularity statistically and you are entitled to your opinion, but what are the statistical facts (quantitative methods).
• This approach was dominant from 1950-1960's.
• “this perspective viewed society as consisting of social structures that are interdependent which would ensure social order and stability".

Critical Approach/Conflict Theory

• This views health and illness constructs made due to power struggles between groups.
• One group will exploit to improve their status at the expense of less powerful groups.
• Researchers need to advocate for social justice.

The Interpretive Approach / Symbolic Interactionist Approach

• Symbolic interactionists people socially construct the definition of their health and illness as interpersonal meanings given their lived experiences and interactions with others.