Sociology of Health: Chronic Illness and Stigma

Disease vs. Illness

• Disease is defined by medical criteria, such as biophysical abnormalities.
• Illness refers to the subjective experience of disease, emphasizing the individual's perception of physical symptoms.

Chronic Illness Studies

• Two main directions in chronic illness studies: epidemiological studies focusing on populations and disease, and analyses of illness experience focusing on individual experiences.
• Focus on illness experience: analyzing how individuals with chronic conditions define and manage their illnesses, considering practical, social, and identity-related implications.

Shift in Chronic Illness Research

• Focus less on physical symptoms, more on meanings individuals assign to them.
• Emphasize consequences for daily living and long-term physical incapacity.

Development of Research

• Emphasizes implications for self, identity, and social relations.

Limitations in Micro-Social Context

• Overlooks broader contexts shaping chronic illness.

Parsons' Sick Role Theory

• Found inadequate for understanding chronic illness experiences.
• Emphasized temporary exemption from responsibilities.

Ethnographic Challenges

• Highlighted patients' negotiations with physicians.
• Emphasized prolonged nature of chronic illness and active role of patients.

Underinvestigated Dimensions

• Corporeal facticity and emotions in chronic illness.

Importance of Emotions

• Intrinsically linked to bodily experiences and influence physical and social disruption.

Role of Shame and Stigma

• Mark individuals as different and less valuable.
• Managed through information control and collective efforts.

Influence of Social Contexts and Institutions

• Shaping and being shaped by sociohistorical approaches to medicine.
• Reflect changes in medical formulations and societal responses.

Erving Goffman's Stigma

• Developed fundamental concepts regarding how socially defined "difference" influences the status, roles, rewards, and penalties associated with mental illness.
• Focused on the aftermath of occupying a negatively valued status, elaborating on the types, dynamics, and effects of devaluation associated with social circumstances.

Stigma

• Social stigma is the extreme disapproval of an individual based on social characteristics that are perceived to distinguish them from other members of a society.
• Stigma is about social control.
• A corollary to this is that stigma is necessarily a social phenomenon.

Goffman's Typologies

• Types of stigma:
  • Stigma associated with mental illness.
  • Stigma associated with physical deformation.
  • Stigma attached to identification with a particular race, ethnicity, religion, ideology, etc.
• Typologies in Asylums (1961) and Stigma (1963):
  • Established for those labelled in capable and harmless (e.g., nursing homes, orphanages, poor houses).
  • Established for those labelled incapables and an unintentional threat (e.g., TB sanitaria, mental hospitals).
  • Established to protect the community from 'intentional' dangers and threats (e.g., jails, P.O.W. camps, concentration camps).
  • Established to pursue an instrumental task (e.g., Army barracks, boarding schools, work camps).
  • Established as retreats and training stations (e.g., monasteries, convents).

Coping with Stigma

• Types of stigma:
  • Abominations of the body (e.g., physical deformities).
  • Blemishes of individual character (e.g., mental illness, alcoholism, obesity, criminality, homosexuality).
  • Tribal stigma (e.g., race, religion, national identities).
• Coping strategies:
  • Acceptance with isolation.
  • Acceptance with actions.
  • Passing.
  • Correction.
  • Compensation.
  • Hostile bravado.
  • Victimhood.
  • Blessing in disguise.

Stigma and Chronic Illness

• Every illness stigmatizes us to a greater or lesser extent.
• Strategies for managing stigma include denial, disclosure decisions, and concealment, each with its own emotional and social implications.
• Disease and stigma trajectories for HIV and AIDS highlight critical points in the illness where social stigma may be experienced differently.

Mental Illness and Stigma

• Stigma surrounding mental illness arises from societal attitudes and perceptions, including a belief that mentally ill individuals are embarrassing and potentially dangerous.
• Surveys show that many people prefer limited contact with those displaying psychiatric symptoms, indicating prejudicial attitudes towards mental illness.
• Public perceptions of mental illness are influenced by both personal contacts and media representations.
• Media coverage often associates mental illness with violence, shaping public perceptions and contributing to stigma.