Sociological Perspectives on Illness

Introduction

• Illness is experienced within a social context and is socially patterned
• Sociology of health and illness aims to describe the social causes/consequences of illness, disease, disability, and death
• It also seeks to understand how lay people and medical professionals categorize illness and describe related identities/experiences

Six Central Sociological Perspectives

• Structural Functionalism
• Conflict Theory
• Interpretive/Social Constructionist Theory
• Feminist Theory
• Critical Race Theory
• Post-Structuralism

Structural Functionalism

• This is the "normal" science of the discipline, including mainstream public health and epidemiology

Key Figures in Structural Functionalism

• Auguste Comte is the godfather of sociology and aimed to create a better, orderly, and progressive society
• Emile Durkheim developed theoretical and methodological models and defined sociology as the science of social facts
  • Durkheim viewed humans as predictable and controllable through social facts, existing as norms separate from individual actions
• Talcott Parsons explicitly noted that medical practice and institutions fulfill social control functions, which is the concept of medicalization

Concept of a Sick Role

• Each individual has multiple roles in society which are linked to norms
• Roles/norms come from associated institutions, for example work, community, and friendships
• Parsons thought sickness, if unintegrated into social institutions, could cause societal breakdown
• Sickness must be managed and have a temporary status that is contingent on the sick individual fulfilling certain obligations

Four Components of the Sick Role

• Exemption from normal social roles (missing exams), accompanied by medical acknowledgement
• The sick individual is not responsible for their condition and should be sympathized with
• The sick person should try to recover, following doctor's orders to maintain legitimacy
• The sick person must seek competent medical help and cooperate with physicians or face legal consequences
• Parsons viewed illness as deviance and a threat requiring management by medicine for a return to "normality"
• Medical institutions can be seen as agents of social control
• Parsons's sick role formulation was primarily theoretical and has received many criticisms

Exemptions from Normal Social Roles

• Allowed exemption depends on the nature, severity, and longevity of the illness, as well as the person's characteristics and normal social roles
• A minor finger cut versus multiple sclerosis requires different exemption extents, and a university student's sick role is mostly informal until a deadline

Lack of Responsibility for Condition

• This varies by condition and perceived acquisition circumstances
• Diseases reflecting moral/social worth, like AIDS or lung cancer, may lead to blame/social stigma
• Diseases likely to lead to social rejection were considered under personal control and most severe
• Gender, age, and ethnicity did not impact the stigma associated with different diseases

Desire to Get Well

• Expectations to get well often only apply if the sick role is not induced by chronic conditions
• People are expected to adjust to terminal or chronic illnesses rather than seek healing
• Getting diagnosed with a mental illness might occur from trying to heal in chronic situations
• This is related to the concept of "denying reality"

Seeking Competent Help and Cooperating with Physicians

• Allopathic medicine is the dominant medical care system
• Allopathic medicine treats disease by creating an opposing condition in the body
• Alternative healthcare providers (meditation, herbs, music therapy) are competing systems gaining legitimacy
• Anti-vaccine movements and shifts toward midwifery reflect popular skepticism toward conventional medicine

Structural Functionalism and Social Systems

• Structural functionalism studies the social system, composed of institutions (family, economy, polity, education, welfare, justice, military, and medical care systems), which maintain order like organs in the human body
• Social scientists must be objective and value-free, seeking universally true, causal explanations
• Social facts are real, external entities and scientists are objective and collect data from interviews and questionnaires to reflect behaviour probabilities
• Positivism is a research methodology, though not all positivists are structural functionalists

Contemporary Positivists

• These positivists study human health behaviors as both independent/dependent variables
• Diagnosis or income level impacting health behavior are examples
• The social determinants of health perspective examines the impact of social inequities on health outcomes

Assumptions of Structural Functionalism

• Sociology discovers/explains social facts' impact on human behavior/attitudes/feelings
• Social facts are real, external entities that determine human behavior
• Social facts are norms associated with structural locations (gender, race, status, class), roles in social institutions, and social behaviors
• Sociology describes the world in universal causal laws related to social facts
• Human behavior is objectively/quantitatively measurable

Conflict Theory

• Conflict theory provides a radical critique of structural-functional sociology and societal arrangements
• All social arrangements, sociological theories, and methods have political/economic bases/consequences

Key Figures in Conflict Theory

• Karl Marx believed human thought/behavior resulted from socio-economic relations and can be altered for human betterment through social/economic revolution
• Class struggle relates to the means of production (land/factory), where one class owns production means, and another sells labor for goods/services/cash
• The goal is to end conflict occur in a communist state with citizen ownership of production

Conflict Theory Distinctions

• Sociologists discover and document injustice, attempting to change it
• All knowledge is rooted in social, material, and historical contexts
• Sociological research methods acknowledge social, economic, and historical circumstances
• Marx's analysis influences theorists, the primary study subject is social classes as an important means to effect change

Interpretive/Social Constructionist Theory

• This is symbolic interactionist theory focused on how subjective definitions of social reality are constructed and experienced
• When collecting data, the theorist experiences intersubjectivity/reflexivity, due to subjective data slanting and research-created meanings
• The methodological stance involves empathetic understanding

Data Collection

• Data is collected by observing social action through participation or unstructured interviews
• The level of analysis focuses on individual interaction with others, the mind/self, and meaning
• This is a microanalysis compared to macro analyses which include structural-functional and conflict theories

Key Figures in Interpretive/Social Constructionist Theory

• Max Weber defined social action as actions with subjective meaning
• In causal explanation, sociologists interpret the meaning of a situation from the subject's viewpoint

Feminist and Critical Anti-Racist Theories

• A major theme is the critique of medicalization of women's lives, highlighting the dominance of the medical care system/practitioners
• They tackle constructions of knowledge/power over women, especially in reproductive issues

Theoretical Explanations of Women's Health

• Theorists explain that women's (poor) health results from social-structural inequities that include class, racialization, labor force participation, and familial/domestic roles
• Differentiating factors include racial group positions in the social structure
• Males and whites tend to dominate all institutions, and sociology consistently reflects male/white domination

Post-Structuralism

• Michel Foucault shifts the focus from power held by a few to power flowing through social interactions, knowledge systems, and everyday behaviors
• Biopower explains how social control/power occur in bodies in modern democratic/capitalist states
• The government controls the population by categorizing, counting, and developing policies to manage bodies via public health, science, and medicine
• What is considered as disease, illness, wellness, and good functioning are continually recreated through everyday conversation, mass media, and interaction with the medical care system

Explores sociological perspectives on health, illness, disease, disability, and death within a social context. Covers structural functionalism, conflict theory, social constructionism, feminist theory, critical race theory, and post-structuralism. Key figures like Auguste Comte and Emile Durkheim are examined.