KPE404 Exam Notes - 3 (PDF)

WEEK 1 What is sociology? Study of the relationship between the individual and society ; how we create society at the same time as we are created by it Health problems as social issues: We tend to view illness as an individual problem e.g. poor lifestyle, bad luck, genetics) but health & illness are also social experiences. Sociological imagination: a term from Mills to describe the sociological approach to analyzing issues. We see the world through a sociological imagination when we make a link to personal troubles The sociological imagination can be viewed as consisting of 4 interrelated parts (Willis, 2004): 1. Historical factors: how the past influences the present. 2. Cultural factors: how our culture impacts our lives. 3. Structural factors: how particular forms of social organization shape our lives. 4. Critical factors: how we can improve on what exists. This four-part sociological imagination template is an effective way to understand how to think and analyze in a sociological way. Figure 1.2 represents the sociological imagination template as a diagram that is easy to remember. Anytime you want to sociologically analyze a topic, simply picture this diagram in your mind. Sociological analysis involves applying these four aspects to the issues or problems under investigation. For example, a sociological analysis of why manual labourers have a shorter life expectancy would examine how and why the work done by manual labourers affects their health, by investigating for example 1. Historical factors: such as how practices in the past influence present work structures and ethics so as to make manual workplaces dangerous. Structure and Agency: “Sociology is the study of the relationship between the individual and society; it examines how ‘we create society at the same time as we are created by it’ (Giddens, 1986, p. 11)” (p. 10). The Biomedical Model of Health Fallacy of specific etiology Objectification and medical scientism Reductionism and biological determinism Victim blaming The Social Model of Health Society Production & Distribution of Disease Social Construction of Health and Illness Social Organization of Healthcare The Biomedical & Social Models of Health Differences Focus: Biomedical-individual focus (clinical services, health education, immunization) Social Model-societal focus (living & working conditions affecting health (public health structure, legislation, social services, community action, equity, access) Goals: Biomedical-cure disease, disability, and reduce risk factors Social Model-prevent illness and reduce health inequalities to aim for equal health outcomes (find the root of causes of illness). Physical Cultural Studies “...we have to identify and analyze how dominant power structures become expressed in, and through, socially and historically contingent embodied experiences, meanings, and subjectivities. Such is the preoccupation of physical cultural studies…” (pp. 53-54) “Physical Cultural Studies (PCS) advances the critical and theoretical analysis of physical culture, in all its myriad forms. These include sport, exercise, health, dance, and movement related practices, which PCS research locates and analyzes within the broader social, political, economic, and technological contexts in which they are situated. More specifically, PCS is dedicated to the contextually based understanding of the corporeal practices, discourses, and subjectivities through which active bodies become organized, represented, and experienced in relation to the operations of social power. PCS thus identifies the role played by physical culture in reproducing, and sometimes challenging, particular class, ethnic, gender, ability, generational, national, racial, and/or sexual norms and differences.” (p. 54) “PCS advances an equally fluid theoretical vocabulary, utilizing concepts and theories from a variety of disciplines (including cultural studies, economics, history, media studies, philosophy, sociology, and urban studies) in engaging and interpreting the particular aspect of physical culture under scrutiny.” (p. 55) Dominant power structures manifest in embodied meanings Embodied meanings and experiences are situated within context(s) ○ Social, political, economic, technological, historical, etc. A focus on social power How bodies become organized, represented and experienced The relationship between physical culture and social norms Our concern: What does all of this mean for the experience of illness and disease? Why is this understanding important to kinesiology and its practice? Physical Cultural Studies & The Discipline of Kinesiology (Over) emphasis on the biomedical approach Body as genetic, physiological, biological entity only Other approaches become marginalized in kinesiology ○ e.g., sociology of sport Lack of critical perspectives on sport, physical activity, and the body within Physical Cultural Studies & The Body The social construction of bodies ○ Shaped through power, politics, class and many other intersectional identities The body as a site of power and of conflict Hargreaves & Vertinsky (2007) book good source of various case studies of these processes “in action” Our interest: How do these processes shape the experience of illness and disease? And again, what does this mean for kinesiology? PCS & This Course The “bad” body The illness experience The suffering / recovery experience The suffering / dying experience The social organization of sport The social organization of rehab Practical applications ○ Critical perspectives on media ○ Implications for practice READING: Kinesiology's Inconvenient Truth and the Physical Cultural Studies Imperative Author: Andrews 2008 Introduction Kinesiology faces an epistemological hierarchy favoring positivist, quantitative, and predictive knowledge. Political, economic, and cultural forces contribute to this hierarchy, leading to fragmentation in the field. Physical Cultural Studies (PCS) is proposed as a corrective approach integrating various methodologies. The Epistemic Crisis of Kinesiology The field's development since the 1960s has led to a rigid scientific hierarchy. Sub Disciplinarity has hindered kinesiology’s potential for comprehensive understanding. The dominance of positivist methods limits the inclusion of qualitative and interpretive approaches. (Re)Turning to Physical Culture The term "sport" is seen as limiting; the focus should expand to "physical culture." Physical culture encompasses a broader range of activities beyond just sport. The shift to PCS reflects a return to the department's original focus on holistic physical culture. A Synthetic Physical Cultural Studies PCS combines insights from sociology, cultural studies, and the history of physical activity. It emphasizes the critical analysis of physical culture within social power dynamics. PCS aims to address issues of physical cultural injustice and equity through diverse methodologies. Conclusion A call for an integrated kinesiology that values multiple ways of knowing. Recognition of the need for interdisciplinary approaches to enhance understanding of human movement. Silk et al., 2017 The Body in Popular Culture Increasing interest in the body within academia and popular culture. This focus has been reflected in the launch of Body and Society in 1995, which aims to explore the significance of the body across various domains, including consumer culture and everyday life. The Role of Body and Society Since its inception, Body and Society has examined diverse aspects of physical culture, drawing on foundational thinkers such as Jean-Marie Brohm, Pierre Bourdieu, and Maurice Merleau-Ponty. It addresses topics like art, technology, medicine, gender, sexuality, and sport, utilizing a range of theoretical frameworks to analyze the socio-political and ecological contexts of bodily practices. Techniques of the Body The work of Marcel Mauss highlights the cultural importance of "techniques of the body," which refers to how societies teach individuals to use their bodies through education and imitation. These techniques are linked to broader social processes and cultural values, shaping how people engage with their physicality. Historicizing Physical Culture Understanding the body as a contested site in social sciences is crucial for historicizing Physical Culture Studies (PCS). The "somatic turn" in kinesiology seeks to challenge traditional scientific views of embodiment, advocating for a more nuanced understanding of physical culture that transcends departmental confines. The Evolution of Body Cultures The histories of physical culture primarily focus on Europe and North America during the nineteenth and twentieth centuries. They illustrate how various actors, including dancers and physical educators, contributed to the development of diverse "body cultures." These cultures collectively shaped a modern conception of the body, suitable for work, play, and self-expression, reflecting the complexities of modernity and artistic movements. Global Circulation of Physical Culture By the early twentieth century, knowledge and practices related to physical culture were circulating globally, influenced by colonial struggles and technological advancements. For instance, yoga began to emerge as a global brand while adapting to local contexts, illustrating the interconnection between different cultures. The Interplay of Physical Culture and Politics Physical Culture Studies (PCS) and kinesiology reflect the "anatomo-politics" of modern nation-states, emphasizing the governance of bodies. However, the history of physical culture must extend beyond Western contexts to include non-Western influences and histories, acknowledging the political dimensions of body culture. Challenges within Kinesiology PCS has often emerged from internal struggles within kinesiology departments, where a focus on natural sciences has overshadowed sociocultural perspectives. The increasing emphasis on sports medicine and technology has led to concerns about the marginalization of sociological inquiries into the body, identity, and social inequalities. Cultural Studies Influence Cultural studies have significantly influenced both the sociology of sport and PCS, promoting a critical examination of how bodily practices intersect with power dynamics. This eclectic field has encouraged a contextually based understanding of active bodies, challenging traditional disciplinary boundaries. The Need for Broader Perspectives Despite the positive impact of cultural studies, PCS may benefit from adopting a more expansive ontological approach to studying physicality. This approach should not merely unify existing disciplines but instead explore new trajectories within the somatic turn. Contemporary Shifts in Understanding The twenty-first century continues to witness evolving perspectives on corporeality. The shift from questioning "what the body is" to "what a body can do" reflects a broader engagement with life and affect in the social sciences and humanities. Journals like Body and Society have played a role in these changing dynamics, signifying a renewed interest in the complexities of the body beyond anthropocentric views. WEEK 2 Approaches to Sociology of Health Functionalism Symbolic interactionism Materialism (Conflict theory) Feminism Anti-racism / Post-colonialism Postmodernism Functionalist Approaches Structural functionalism ○ All social institutions, structures, etc., have a “function” for society ○ “Organic” model of society ○ “Consensus” model of society Critiques? It doesn’t account for all the ways society DOESN'T work Functionalism: The “Sick Role” Concept of Talcott Parsons “Rights and responsibilities” of being sick Rights ○ Exempt from your usual roles and activities. Requires medical legitimization ○ Not considered responsible for their illness Responsibilities ○ Get medical help ○ Follow medical advice ○ Recover & resume Small group discussions (see Padlet) We have certain responsibilities, but as a sick person our right is that we don’t need to do our regular roles, since we are exempt from that, unable to go to class, or go to work, etc. BUT you need to legitimize why you can’t go, with doctors notes for ex. Number 1: if you’re sick you have to get help. 2. Once you get help you need to listen and follow the health precautions to improve 3. Most important you need to recover and resume your regular functioning for society Critiques of the sick role: some people are unable to get the desired help or the medical system is not in easy access, some people are unable to attend their roles again e.g. don’t get better, chronic conditions, doesn’t account for socioeconomic status, should health really be only that person's responsibility? are they in a position where they CAN get better, is there a way they can receive healthcare, if not then it’s not fair for it to be fully that one's person responsibility to find it. Interactionist & Constructionist Approaches to Health How do individuals interact? How do they create meaning through interaction? “Definition of the situation” ○ The Thomas dictum: What people define as ‘real’ becomes real in its consequences (WI Thomas) Interactionist & Constructionist Approaches to Health Erving Goﬀman ○ Total institutions ○ Stigma ○ Labelling theory There are structures that exist to change the way people operate or label people in ways that make others act towards them in certain ways. If we’re labelling people it can become the way society understands them and stigmatizes them, Structure that changes ways people operate: mental illness —> psychiatric wards Labelling theory ○ Green (2009) as cited in Constantinou (2022) 1. Label characteristics 2. Stereotype 3. Construct the ‘other’ 4. Understand the ‘other’ as inferior 5. Label = discrimination 6. Labels = constructions to control others (powerless) “Biographical disruptions” (Bury, 1982) ○ Adjusting ‘self’ around illness ○ Identity changes ○ Life plans are disrupted ○ Impact on social relationships ○ Development of coping mechanisms ○ Significance of context ○ Changing narratives Also work by Anselm Strauss & Kathy Charmaz Interactionism and health care ○ “Cloak of competence” (Haas & Shaﬃr): Impression management to display ‘competence’ and ‘skill’ ○ Having Epilepsy (Schneider & Conrad): Centrality of uncertainty, Controlling symptoms, Changing relationships Social Construction of Reality ○ Berger & Luckmann ○ Diseases as “political accomplishments” Medicine as social control ○ “Medicalization” of disease as a means to exert control Materialist (Conflict) Approaches Macro-level, focus on conflict: Who controls production? Marxist analyses: Capitalist class vs. proletariat Political Economy of Health Political economy… ○ State/governance ○ Economy ○ Civil society Issues considered… ○ How is wealth produced? ○ How is wealth distributed? ○ Who has power in society? Why is it that way? ○ Who controls resources? The state or the markets? With respect to health…○ Production & distribution of resources are determinants of the health of populations Key issues ○ Income distribution ○ Employment conditions ○ Availability of social and health services Political Economy of Health / Marxism “Illness-generating social conditions” (Germov & Hornosty, 2016, p. 33) Medical-industrial complex: Commodification of healthcare Feminist Approaches to Health Patriarchy ○ Male-dominated nature of society Concern with gender inequalities Women not adequately represented in other forms of social theory Medicalization of women and women’s bodies ○ Hospitalization during childbirth Discovery of “menopause” Women in healthcare system ○ Sub-ordination ○ Midwifery Nurse associated with female and physician or doctor associated with male Anti-Racism / Post-Colonial Approaches Impact of race on health/health care Structural determinants of racism Post-colonialism ○ Race & “the other” ○ Giving “the other” a voice Intersectionality theory Focus on “racialized” experiences of ○ Care recipients ○ Care providers Experiences of groups and health systems ○ Canadian First Nations peoples ○ Loss of health human resources in developing nations Postmodern Approaches to Health Postmodernism / post-structuralism ○ No objective “truth” to be known ○ Subjective knowledges Foucault – “government of the body” ○ Governmentality: Medicine as governing the body ○ Techniques of the self ○ “New” public health (lifestyle risks) Sociology of the Body (in Sport) A turn towards recognition of ‘the body’ within sociology ○ Not just ‘individuals,’ but bodies that reproduce social processes Moving beyond the ‘naturalistic’ (biological) view to explain bodies in sport The importance of a constructionist perspective ○ “Flesh-and-blood bodies take on particular meanings” (p. 7) ***Media representations of bodies Sport as a site for constructing bodies Bodies, identities and sport ○ Gender performativity ○ Power relations and the ‘other’ body ○ The social constructions of gender: Both ‘femininity’ and ‘masculinity’ ○ ‘Other’ identities – racial, classed, disabled…bodies Consumer culture ○ Construction of the ‘healthy’ body ○ “Healthism” – body problems are individual responsibilities ○ ***Constructions of the body within policy Medicalization “Medicalization” (Conrad & Schneider) ○ Behaviours come to be defined as “illness” or “disease” ○ Behaviour first defined as deviant ○ Prospecting: announcement of “finding” ○ Claims-making: medical/non-medical interests promote new medical designation ○ Legitimacy: official designation ○ Institutionalization: official medical classification; treatment organizations Stigma Goﬀman’s well-known concept Stigma as interaction ○ Stigma = an ‘attribute that is deeply discrediting’ and that works to reduce a person ‘from a whole and usual person to a tainted, discounted one’ BUT – stigma is not inherent in the individual itself. Stigma needs to be socially produced “What we define as ‘normal’ and as stigmatising is dependent on dominant socio-cultural understandings; these definitions vary over time, in diﬀerent places, and even situationally” Various ‘configurations’ of stigma discussed in later parts of the chapter Illness Narratives Narratives are socially-situated (and therefore to some extent, socially constructed) ○ Within power structures and ideologies Drawing on the work of Arthur Frank (1997) ○ Comic plot – good / bad / happy ending ↙ ○ Recovery (restitution) – sick / intervention / cured ○ Quest – sick / intervention / cured + new & improved ○ Chaos – sick / helplessness & confusion / no resolution “Homework” 1. What are the key themes across the readings? 2. Why are these readings/themes relevant to our purposes in the course? READINGS (Shapiro, 2011) Summary of "Illness Narratives: Reliability, Authenticity, and the Empathic Witness" The Value of Patient Narratives Johanna Shapiro highlights the importance of patient voices in medicine, emphasizing that illness narratives are complex representations influenced by personal motives and societal narratives. While recognizing the potential pitfalls in interpreting these stories, she advocates for an attitude of narrative humility among physicians and scholars. Skepticism Towards Patient Stories In the post-Flexnerian era, physicians have often viewed patient narratives with skepticism due to their perceived subjectivity. This skepticism has led to a reliance on objective clinical data, sidelining the nuanced insights offered by patient experiences. Despite movements promoting patient-centered care, patients' stories can still be dismissed as untrustworthy. The Complexity of Reliability and Authenticity Shapiro discusses how literary scholars question the reliability of personal narratives, identifying biases and motivations that can distort the truth. The concept of the "unreliable narrator" complicates the interpretation of patient stories, raising concerns about authenticity and the potential for misrepresentation. Meta-Narratives and Their Influence The author explores how dominant cultural narratives shape patient experiences. Recovery and quest narratives, which imply positive outcomes, can overshadow voices expressing suffering or dissatisfaction. This emphasis on conformity may hinder the emergence of more authentic, diverse stories. Third-Party Representations Shapiro argues that third-party accounts, such as those offered by physicians or family members, are not inherently more reliable than first-person narratives. These representations are also influenced by biases and subjective motivations, potentially complicating the authenticity of the narrative. The Allure of Transgressive Narratives While there is a growing appreciation for transgressive narratives that challenge norms, Shapiro warns against valuing them as inherently more authentic than conventional stories. Both types of narratives can hold truth and meaning, and each should be evaluated on its own terms. Embracing Narrative Humility Shapiro calls for a balanced approach to interpreting illness narratives, advocating for an understanding that appreciates both the patient’s agency and the external influences shaping their stories. Acknowledging the complexities of storytelling can foster a more compassionate engagement with patients’ experiences. Conclusion Ultimately, Shapiro posits that every narrative contains elements of both authenticity and inauthenticity. A commitment to narrative humility allows clinicians and scholars to appreciate the significance of the patient’s story, respecting its meaning while remaining critically aware of its limitations. (Hannem, 2022) The Dual Nature of Stigma Stacey Hannem argues that stigma functions on both symbolic (micro) and structural (macro) levels. This duality reinforces the marginalization of certain racial, religious, and ethnic groups, who are often deemed undesirable by dominant societal norms. Structural stigma legitimizes control over these groups, perpetuating their exclusion from various social and economic avenues. Symbolic and Structural Feedback Loop In a neoliberal context, symbolic devaluation of marginalized identities creates a feedback loop, where those labeled as "risky" face increased surveillance and intervention. This language of risk serves to mask deeper moral judgments, allowing for widespread control of entire groups based on perceived danger rather than individual circumstances. Consequently, individuals belonging to statistically "risky" categories are subjected to interventions despite not posing any actual threat. Stigma as a Tool of Power Drawing on Tyler's framework, Hannem highlights how stigma operates as a mechanism of power intertwined with the histories of capitalism, colonialism, and patriarchy. Stigma is viewed as a form of symbolic violence that maintains social and economic inequalities. By perpetuating divisions among marginalized groups, stigma politics facilitates the acceptance of policies that further entrench systemic oppression. Implications for Collective Action The political divisions fostered by stigma hinder collective resistance against oppressive structures. Tyler’s insights extend Goffman's original concept, illustrating how stigma is not merely a social response but a strategic tool of governance that reinforces inequality. This shift in perspective underscores the importance of understanding stigma in the context of power dynamics. Goffman's Legacy and Future Research While Goffman’s foundational work on stigma remains significant, Hannem calls for a broader analysis that addresses the structural implications of stigma. Future research should continue to explore how power influences stigma and its role in sustaining societal inequalities. Understanding stigma as a relational construct within social contexts is essential for confronting and challenging the mechanisms of oppression. WEEK 3 Social Constructions of Aging Life shifts/passages influence social identity and role ○ Retirement / Widowhood / Biographical disruption Biomedical = biological/physiological decline ○ Anti-aging / ‘war on age’ (Vincent, 2007, cited in Phoenix, 2017) Socio-cultural = constructions of aging ○ Cultural views about aging ○ Challenging stereotypes: Telling “counterstories”, Bodies as “sites of resistance” (Phoenix, 2017, p.184) “Successful” or “healthy” aging “Ageism” / Age discrimination Two concepts: 1. Negative social constructions about older people 2. Societies designed for young people Can be both individual and structural in nature Ageism & Fitness Industry Ageism can be explicit or implicit Perceptions ○ Practitioners ➡ older adults ○ Older adults themselves Types of ageism ○ Self-imposed ○ Other-directed Ageism & Fitness Industry 4 Themes of ageism in the review 1) Perceptions: Encountering ageism 2) Motivations: Ageism ⬇ motivation & engagement 3) Opportunities: Fewer opportunities to participate 4) Positionality: Sense of belonging Implications for practice Bias: Mindful of own assumptions, stereotypes and biases. Positive perspectives: Promote exercise/fitness at all ages, Dispel self-imposed ageist beliefs ○ Tailored advice: Reflect ability, rather than age Supportive environments: Change the narrative, Create age-friendly environments Education & training: Address ageism in education Ageism in Policy Critical discourse analysis: Investigating how policy wording reflects and reproduces broader social norms and assumptions. Highlighting “hidden power relations and ideologies embedded in discourse” (p. 35) Analysis of local government physical activity policies re: perspectives on age, aging and physical activity Assumptions about older adults embedded within the policies: Vulnerable, Disabled, Incapable, Caregiving burdens Assumptions of economic dependency: Need for support, Contributes to the “vulnerability” discourse “Of course, older adults’ bodies change as they age, but it should not be assumed older adults are not capable of being active or a comparison made with younger individuals regarding physical abilities” (p. 39) “Older age should not, in and of itself, be used as an indicator of vulnerability” (p. 40) BODY SIZE Weight Stigma & Physical Activity Stigma in gyms: Direct (Comments from staﬀ, users), Indirect (Internalized feelings), Structural (Physical spaces, Constructed stigma) Impacts: Distress, Mental health, Disengagement, Self-exclusion Fitness culture: Constructions of the ideal body Implications for practice: Question assumptions (Reproducing stigma), Focus on outcomes, rather than weight, Non-judgemental approaches Media Frames Framing: What story gets told? How does ‘obesity’ become constructed in (through) the media? Medical frames: Biomedical / risk, Individual-blaming, Healthism Acceptance frames: Diversity of body size, Fat ≠ risk How are the frames shaped? “Expertise” & questioning expertise, Economic & symbolic power (Medical-industrial complex vs. grassroots), Media interests (what sells? what gets scrutinized? healthism), Class/race (Anorexia vs. obesity), Geographic/political (US vs. French representations) READINGS Do you find it normal to be so fat?” Weight stigma in obese gym users Argüelles, Pérez-Samaniego, & López-Cañada (2022) Abstract Weight stigma involves discrimination against overweight and obese individuals. Gyms can hinder obese users' exercise experiences due to stigma. The study explores how obese gym users experience weight stigma through interviews. Three forms of discrimination identified: direct, indirect, and structural. Recommendations for preventing weight stigma in gym settings are provided. Introduction Weight stigma has been extensively studied since the 1960s, affecting many in Western societies. Higher rates of stigma are observed in individuals with higher BMIs. Weight stigma negatively impacts the wellbeing and social status of affected individuals. The study draws on stigma theories and critiques the Weight-Centered Health Paradigm (WCHP). Fitness culture often perpetuates weight stigma, impacting obese individuals' experiences. Methods Participants Six obese gym users (BMI ≥ 30) were selected based on specific criteria. Participants varied in gym attendance frequency and past sports experience. Data collected through semi-structured interviews lasting 75-105 minutes. Data collection and analysis Interviews focused on various themes related to gym experiences. Thematic analysis was performed to identify recurrent themes and categorize experiences of stigma. Ethics and quality Ethical approval was obtained, emphasizing the use of neutral language. Care was taken to avoid stigmatizing language and to respect participants' narratives. Results and discussion Direct discrimination Participants experienced explicit negative attitudes and comments about their weight. Sources of discrimination included gym staff, trainers, and other gym users. Negative comments resulted in feelings of humiliation, distrust, and self-devaluation. Indirect discrimination Indirect discrimination manifested as internalized negative stereotypes. Participants reported fear of being judged or stared at in gym environments. Feelings of self-stigma were prevalent, affecting their gym experiences. Structural discrimination Structural discrimination refers to institutional practices that disadvantage obese individuals. This includes physical environments that do not accommodate diverse body sizes. The fitness culture perpetuates weight stigma, reinforcing negative stereotypes. Conclusion The study highlights the need to understand and address weight stigma in gym settings. Recommendations for exercise professionals to foster inclusive and respectful environments are provided. Ageism in the fitness and health industry: A review of the literature Jin & Harvey 2021 Overview The review investigates age-related stereotypes affecting older adults’ physical activity engagement. Focus on the perception, manifestation, and influence of ageism in fitness and health contexts. Introduction The global population of older adults is increasing; significant growth expected by 2060. Regular physical activity is crucial for improving fitness and mental health in older adults. Despite benefits, older adults are the least active demographic. Barriers to Physical Activity Internal Barriers: Physical ailments, motivation, personal beliefs. External Barriers: Environmental factors, physician advice. Age-related stereotypes limit older adults' engagement in physical activity. Manifestation of Ageism Ageism is prevalent in healthcare, fitness, and media, often subtle and systemic. Ageism negatively impacts health and well-being, leading to reduced opportunities and dignity. Definition of Ageism Distinct aspects: prejudicial attitudes, discriminatory practices, institutional policies. Focus on stereotypes and biases based on chronological age. Research Findings Ageism in the fitness and health industry is exacerbated by idealizing youth. Stereotypes hinder older adults' participation in physical activities. Fitness professionals may unconsciously perpetuate ageist beliefs. Research Questions 1 How do people construe ageism in fitness and health? 2 How does ageism manifest in this industry? 3 How does ageism affect older adults’ learning and engagement in physical activity? Methods Systematic literature review following PRISMA guidelines. Data collected from multiple databases, yielding 22 empirical studies. Overview of Research Studies conducted mainly in North America and Europe. Majority used qualitative methods; some employed quantitative approaches. Theoretical Frameworks Studies utilized frameworks such as social psychological, socio-cultural, and clinical perspectives to analyze ageism's impact. Key Findings from Studies Age bias exists in health recommendations. Age discrimination affects self-perception and health outcomes. Stereotypes influence older adults’ physical participation and perceptions of capabilities. Conclusion Ageism significantly influences older adults’ engagement in physical activities. Recommendations for further research to address ageism in the fitness industry. Representations of fatness by experts and the media and how this shapes attitudes. Mason & Boero (Eds.). (2021). Abstract Explores the framing of fatness by experts and media. Highlights the dominance of medical and individual blame frames in discussions of fatness. Suggests future research avenues on framing effects. Key Findings Framing Contests: Anti-obesity researchers frame fatness as a public health crisis, while fat acceptance activists argue for recognition of fatness as body diversity. Media Reporting: Media emphasizes individual responsibility for obesity, with skepticism toward studies that contradict the dominant medical framing. Research Implications: Exposure to anti-obesity media reports increases anti-fat prejudice. Literature Discusses the development of the framing concept by Erving Goffman. Frames are used to mobilize support and influence public understanding of fatness. Methods Combines ethnography, interviews, and textual analysis to study fat stigma and media representation. Utilizes controlled experiments to assess the impact of exposure to different media frames on attitudes. Formal Interviews Conducted interviews with various stakeholders in the fat discourse. Analyzed media samples from major publications to study framing differences. News Media Coding Systematic coding of articles to quantify the presence of different themes related to fatness and health. Experiments Series of controlled experiments to explore how media framing influences attitudes toward obesity and health policy. Conclusion Calls for a balanced discourse that considers both health implications and the diversity of body sizes. Emphasizes the need for more inclusive representations of fatness in media and research. WEEK 4 Social Construction of Gender Dorothy Smith (1990): -“relations of ruling” -Bodies are important (how we think, act, dress) -Bodies must be understood within their social contexts (Location, time, space, relationships) External factors Internal (agency) Bodies-“Material constructs, usually talked about as physically separate from the environment but understood here as shaped by the environment” (Armstrong, 2016, p. 97) Gender: “a multidimensional social construct that is culturally based and historically specific, and thus constantly changing” (Armstrong, 2016, p. 98) Male-masculine / female-feminine are not fixed and not dichotomous “We cannot understand bodies outside their environments” (Armstrong, 2016, p. 99) Gender vs. Sex -Biological sex = physical characteristics -Gender is socially constructed roles and behaviors (patterned early in life, implications throughout the life course – health disparities between men and women, biological explanations but also social explanations) CASE STUDIES: WOMEN, ISLAM AND SPORT Personal vs. Social Identity Muslim women's experiences of their bodies shaped by personal beliefs and societal expectations An external and internal negotiation of identity Influences: Interpretations of Islam, political arrangements, patriarchal control Bodies in context: How do culture and religion shape one's perception of the body? Islam, Veiling, and Female Identity Veiling – a symbol of modesty and identity for Muslim women Contrasting views: Islamic fundamentalists (Western sportswear as immodest), Western perspectives (Emphasize freedom and gender equality Eg., Olympic participation and the struggle with sports attire) Diverse Perspectives Among Muslim Women Islamic Feminism: Advocates for women's rights within an Islamic framework. Views hijab as a choice or act of empowerment Secular Feminism: Calls for separation of religion and state. Advocates for gender equality and freedom of expression How do these perspectives differ in their approach to sports? Challenges and Progress Barriers: Restrictions on mixed-gender events. Limitations on appropriate sports attire Opportunities: Establishment of women-only sporting events (e.g., Women's Islamic Games) Global vs. Local Tensions Global influence: Western sports culture promotes freedom, individualism, and visibility Local context: Islamic traditions emphasize modesty, religious values, and gender segregation Negotiation: How Muslim women blend Islamic principles with modern sports practices Media and Politics Media representation: Limited visibility of female Muslim athletes in the media Political struggles: Impact of fundamentalist opposition and governmental policies Key Points Muslim women's participation in sports is a complex negotiation: Culture, religion, politics There is no single narrative: Experiences vary based on personal beliefs, societal norms, political climates Bodies in context CASE STUDIES: LBTQ+ IN SPORT 2SLGBTQI Participation in Sport Sport as gendered and sexualized space: Traditionally linked to hegemonic masculinity. Homophobia, transphobia, and hyper-masculine environments marginalize 2SLGBTQI athletes. Gender segregation in sports excludes non-binary and transgender individuals Impact on mental health: Negative experiences: trauma in locker rooms, exclusion from teams, homophobia in sports settings. Psychological harm due to rigid gender roles 2SLGBTQI Sports Communities: Positive Safe Spaces: 2SLGBTQI sports clubs as spaces for community and personal growth -Ben & Ju-Jitsu Experience (Overcome psychological barriers related to sexuality by joining an 2SLGBTQI ju-jitsu club) Community Building: 2SLGBTQI sports teams provide social support and a sense of belonging, Anna & lesbian softball team (positive self-identity and community connection) Challenges Negative effects on well-being: “J” – elite athlete who felt he needed to remain “in the closet”, related to alcohol abuse issues Rigid gender norms in sport: Dan – trans man who choose lacrosse over tennis due to gender presentation; choice of outfits (skirts vs. shorts) Gender conformity through coaching: Graham – coaching advice in tennis to “man up”, “be like men” CASE STUDIES: SPORT, MEDIA, AND SEXUALITIES Sexuality & Social Norms in the Media Social construction of sexuality: Sexual behaviors seen as 'normal' vs. 'deviant'. Heteronormativity = heterosexual, monogamous relationships as default 'Good' vs. 'Bad' sexuality -'Good' sex: heterosexual, reproductive, monogamous -'Bad' sex (homosexual, casual, non-reproductive) Surveillance of sexuality: Sexual identities are monitored and policed by media and society The Body as a Site of Social Control Foucault's theory of power: Bodies are controlled through societal norms (gender, health, sexuality) Policing of bodies: Deviant bodies are disciplined (those that do not conform to gender/sexual norms) Normal vs. Deviant Bodies: -'Normal' = healthy, conforming to gender expectations -'Deviant' = unhealthy, challenging gender/sexual norms “Shock and Silence” Magic Johnson's (a heterosexual basketball player) disclosure of AIDS-diagnosis -“Even straight people can get it” = SHOCKING! – a counter to AIDS as strictly a“gay disease” - Focus on sexual identity rather than sexual behaviour (“Gays” are necessarily at risk; “straights” are not) Greg Louganis (a gay Olympic diver) disclosure of HIV-positive diagnosis -No shock, no questioning -HIV/AIDS as a “necessary risk” of the “gay lifestyle” – constructed as an inevitability -Further reinforces heterosexual monogamy as 'normal' -“Aggressive women” at fault for Magic Johnson; personal blame for Louganis Individual Responsibility & Ideology Magic Johnson – a “family man” who “made mistakes” Greg Louganis – immoral, deviant and stigmatized -Gay framed as immoral, dangerous, HIV/AIDS as inevitable conclusion -Gay bodies are “assumed to be doomed necessarily” (p. 12) Magic Johnson: Presidential appointment, National spokesman, Public educator Greg Louganis: Florida senator tries to ban Louganis from speaking at local university because of his “moral decadence”, an embarrassment to the university community Power and Surveillance of Bodies Role of the media: Media acts as a surveillance mechanism that reinforces social norms by monitoring deviant bodies. Focus on reinforcing heteronormativity, gender norms and hegemonic masculinity Reinforcing Heteronormativity Body as a moral signifier: Athletes like Greg Louganis judged based on their health status and sexual identity. Bodies become sites where social judgments on morality and deviance are imposed Intersectionality Intersectionality and power: Gender and sexuality intersect with race, class, and other identities Example of intersectionality: Black male athletes like Magic Johnson face compounded scrutiny due to both race and sexuality The Social Construction of 'Bad' Bodies Gender and sexuality shape societal perceptions of 'bad' bodies These perceptions are enforced by institutions like sports, media, and healthcare Bodies that challenge norms are disciplined, while 'normal' bodies are upheld Bodies as constructed within contexts GUEST SPEAKER Inequality in physical activity: An intersectional and life course approach Chloe Sher Outline 1) Physical activity and why do we care 2) Why some people are more active than others? The debate 3) An intersectional and life course approach 4) Three studies Gender Race Case study 5) Policy implications What is physical activity? “any bodily movement produced by skeletal muscles that require energy expenditure” (WHO) Why exercise? Health Inactivity causes a 20 to 30% increased risks of death (Haileamlak, 2019) An indicator for population health Overlooked benefits Citizenship skills, network Social cohesion, democracy In a diverse society Sport plays a particularly important role Facilitates social integration among immigrants (make friends) Facilitates intergroup interaction, enhances cultural understanding The Canadian government has identified sport participation as an effective instrument to promote social cohesion and to foster community identities, and citizenship. Inequality in physical activity is widespread In Canada, CCHS data shows that the gender gap in exercise has widened in the last two decades. 2001: 4% point difference 2020: 6.1% point difference Why some people are more active than others? Habitual A habit that people develop over time and perform regularly under stable circumstances Structural Out of one’s control Habitual model Gender gap in physical activity Women are less motivated to engage in physical activity because they perceive sports as “tiresome”, “masculine” and “not cool”. Structural model Racial minorities, immigrants Neighborhood effects Precarious jobs, underemployment → Limited time, limited financial resources and limited access to sports participation My research aims to transcend the debate Not competing theory! It’s the interplay of these two major factors that shapes activity pattern. My goal is to determine when, where, and how structural and habitual factors come to play. It’s important to consider life course Life stage = new social roles, situations... Shapes level and inequality Weekly sport participation for girls and boys at ages 6-8 is around 55% Then it increases from ages 8-12 At 13 it decrease and keeps decreasing until adulthood At all ages boys participation is higher Intersectionality during COVID Women had lower physical activity per week People of color had lower PA per week Uneducated had lower PA per week An intersectional and life course approach Bringing them together: Life course perspective Intersectionality perspective Consider the intersectionality in physical activity across the lifespan. Helps determine when, where, and how habitual and structural factors shape gender, racial, and all forms of inequality in physical activity. Three studies to demonstrate this approach 1) How gender gap in physical activity changes across racial groups over the lifespan. Findings: When examined separately, both gender gap and racial gap persist over the lifecourse. Overall decline in physical activity levels as people get older. Racialized women are most disadvantaged across the lifespan. Not all men are more active than women. Habitual factors seem to be more important at young age and later in life. Structural factors are most active during working age. 2) How racial gap in physical activity change across immigrant groups over the lifespan. Same data, Immigrant status, Canadian born (0); not Canadian born (1) Findings: Racial gap same as in study 1 Gap between immigrant and nonimmigrant groups persist across the lifespan. Racialized immigrants are the most disadvantaged. Racialized nonimmigrants are most active. More active than Whites. Habitual factors seems to be more important at younger age and older age. Structural factors are most active during working age. 3) Intersectionality highlights the need to focus on specific groups. To unpack the lived experience of Chinese people in Toronto. Semi-structured interview Participants: n= 15, Identified as Chinese, Live in Toronto, Age 18 or above How may a participant's physical activity level change over time? What may help explain the change? Findings: Gender and immigrant status interact to affect how women cope with this life stage after having a baby (Like Amy). Immigrant: limited social support, no family members around. Conclusion: Both habitual and structural factors are key to physical activity patterns. But their relatively importance changes across racial groups over the lifespan. Structural factors are more active during working age whereas habitual factors are more salient at younger age and later in life. An intersectional life course approach can be used to study all forms of inequality. Policy implications Policy solutions need to address structural factors in shaping inequality in physical activity, especially among racialized disadvantaged groups. Working age is a crucial period where people of disadvantaged backgrounds are the least active. More needs to be done to address structural barriers to physical activity. Physical activity is considered the best buy for public health. Hence inequities to physical activity must be addressed. Takeaway Think about what role does physical activity play in your life and others? Be aware of inequity issues in physical activity. Who are often missing in sport/physical activity spaces? Adopt a sociological imagination to think about social forces/structural factors that are affecting physical activity participation and other forms of social inequalities. What can we do about it? Physical culture, power, and the body CH. 4 Sport, exercise, and the female Muslim body Negotiating Islam, politics, and male power Jennifer Hargreaves Intro Focuses on Muslim women’s intimate, emotional, and physical experiences with their bodies in sport and physical recreation, primarily in the Middle East. Shaped by varying interpretations of Islam, political environments, and patriarchal influences. Influenced by both local Islamic norms and global tensions, especially Western ideals of femininity and sport. Western sportswomen, seen as symbols of freedom, contrast with conservative Islamic views emphasizing modesty, leading to anxiety about public sports participation. Muslim women's engagement with sport is diverse: some see the hijab as empowering, others view it as male control. Politicization of Muslim women’s bodies, especially through veiling, highlights cultural and religious struggles. Veiling, symbolizing Islamic modesty, often conflicts with Western physicality in sport. Muslim feminists have not fully addressed the intersection of the female body, sport, and health. Sport can challenge male authority and subvert power dynamics over women's bodies. Muslim Feminisms, Complexities, and Sport Across the Muslim world, individual women and groups of women have challenged gender inequalities and patriarchal discrimination. These women are often collectively characterized as Muslim feminists. However, their approaches differ, shaped by historical, political, and cultural contexts. Muslim feminists are split into Islamic feminists, who work within an Islamic framework to argue for gender equity based on Shariah law, and secular feminists, who advocate for the separation of religion and state, linking women's rights to broader concerns like human rights and democracy. A major point of contention is the interpretation of the Qur'an. Islamic feminists argue that gender equality can be found within the text, while secular feminists criticize religious conservatives for using the Qur'an to justify discrimination. The term Islamic feminism is controversial, as it is opposed by both right-wing conservative Islamists, who hold anti-feminist views, and secular feminists, who see Islam and feminism as mutually exclusive. Muslim sport feminists, a subset of Islamic feminists, navigate between tradition (such as enforced veiling and female-only sports) and modernity (sexualized sportswear and mixed sports), using the Qur'an to advocate for gender equity in sport. Secular feminists, on the other hand, often criticize sex-segregation and enforced veiling as human rights issues and argue that true democratization and gender equality can only be achieved outside a religious framework. While Muslim sport feminists have had some success, such as the establishment of the Islamic Countries' Women’s Games in 1993, they continue to face challenges from conservative religious ideologies that limit their participation in international competitions and mixed-gender sports. Muslim Female Olympians: In 1984, Nawal El Moutawakel from Morocco became the first Muslim woman to win an Olympic gold medal, followed by Hassiba Boulmerka from Algeria in 1992. Muslim female participation in the Olympics is extremely limited, with many athletes receiving wild cards but often being knocked out in the first rounds. Islamic ideologues criticize the IOC for not providing Islamic-rules competitions, while Western critics accuse Muslim leaders of violating human rights by restricting women's participation. Muslim sportswomen face a deadlock: they lack high-level training opportunities in their own countries and are banned from international events unless they wear Islamic clothing. Muslim women Olympians often participate in sports that accommodate traditional dress codes, such as canoeing, archery, and equestrian events. Sprinters and swimmers from Muslim nations at the 2004 Athens Olympics performed significantly slower than their non-Muslim counterparts, but their participation was still seen as a triumph. Muslim nations send very few women to the Olympics. For example, at the 1996 Games, countries like Saudi Arabia, Kuwait, Iran, and Pakistan sent predominantly male teams, with few or no women. Negotiating the Local and Global: Grasping the Possible Muslim women's participation in sports is shaped by religious and cultural restrictions within Islamic societies. Policy gaps exist where countries may acknowledge the benefits of sports for women, but opportunities remain limited compared to men. In countries like Saudi Arabia and Iran, strict cultural norms heavily restrict women’s access to public spaces and sports. Elite Muslim women, often from wealthier backgrounds, navigate restrictions by participating in sports privately or abroad. Experiences vary based on location and class, with poorer women facing more severe restrictions. Growing resistance as Muslim women assert agency through sports, using it as a tool for empowerment. Conclusion Modernization in Muslim societies has improved women’s education and political participation, but control over women’s bodies persists. Muslim women's bodies are highly politicized, reflecting male dominance and power dynamics in many communities. Women resist these barriers, pushing for greater autonomy and change, especially in the sports domain. Tensions exist between traditional cultural norms and Western expectations, creating a complex balancing act for Muslim women. Muslim women’s experiences in sport are diverse, shaped by intersections of gender, class, and religion. Out on the pitch: sport and mental health in LGBT people Callwood & Smith 2019 Sport is often promoted as beneficial for mental and physical health, but this view lacks cultural context and overlooks the negative experiences faced by LGBT individuals in sports. LGBT individuals often encounter hostile environments in sports, with homophobia, rigid gender norms, and traumatic memories from school sports. Positive experiences in sport can offer more than just physical benefits, helping LGBT individuals confront psychological challenges and build confidence. Oral histories reveal both the harmful and beneficial impacts of sports on LGBT mental health, offering nuanced insights often missed by standard health studies. Ben’s experience with LGBT Jujitsu helped him overcome personal barriers, while Anna’s involvement in a lesbian softball team fostered a strong sense of community and personal growth. However, for others like J., sports led to isolation and harm due to the pressures of concealing sexuality. Gender expectations in sports can also be harmful, as seen in the experiences of trans man Dan and tennis player Graham, where rigid norms negatively impacted their self-esteem and mental health. Overall, while sport can empower some LGBT individuals, it also carries significant risks due to cultural pressures and gender conformity, necessitating a more nuanced understanding of its impact on wellbeing. WEEK 5 Constructing (Dis)Ability The ideas of “normal” and “disabled” The body as a social construction where our understandings of “our body” are mediated through our contexts. “Ideal” bodies are likewise contextually-specific and are central to our self-identities What is a “normal” body? A productive body and a social construction as well What is a “disabled” body? Something other than a “normal” body “Disability” as a form of social oppression: Exclusionary practices “Disability” as an individual issue, not a social one “Disabled” is a social construction that relies upon a social construction of “normal” The Biomedical Model of Disability Disability as an individual issue like an individual pathology Disability is a “personal tragedy”, where the bodies are “abnormal” Disability to be “solved” by the medical profession:“Gatekeeping” for accommodation Focus on fixing the body…and not the society The Social Model of Disability Disability is a social pathology, not an individual one Impairment → disability due to social conditions and contexts eg, deaf community in Martha’s Vineyard, 1940s Two approaches: 1. Environmental approach 2. Rights-outcome approach The Social Model of Disability: Environmental Approach Disability is constructed through environments Environments are not responsive to diﬀerent mobility/access needs Systematic exclusion. Not because of impairment, but because of lack of accommodation Policies to address barriers The Social Model of Disability: Rights-Outcome Approach Recognizing inherent rights of all individuals Access isn’t “something nice to have” but a human right. Systemic barriers must be eliminated Distinctions between equality and equity Equality = everyone is treated the same Equity = fairness through recognizing diﬀerence (A need to address inequalities) Chronic Illness The illness experience is socially constructed as well Chronic illnesses impact on one's sense of self. May lead to “diminished self” –loss of your social identity Issues of “contested” diseases. Lack of medical legitimization Returning to the “sick role” Injury (disability) as “deviance”: No longer able to fulfill your social role as expected and expected to consult expertise & get better Is “getting better” a reasonable expectation? Do we all have equal opportunity to “get better”? Returning to “biographical disruption” Changes in sense of self and social relations in the face of injury/disability Three levels of disruption 1. Taken-for-granted assumptions about life 2. Social identities become threatened 3. (Re)activating social networks Sense of the “diminished self” Returning to “illness narratives” Stories that can help make sense of an injury/disability experience Give meaning to experiences, also a vehicle through which experiences can be shared Narration can help foster “normalization” of the condition: regaining control and accepting new limitations Injury - Recovery Pathway “Culture of Risk” in Sport Pain and injury as normalized part of sport Cultural messages about sport: pain and injury as normal, being “tough”, playing through injury Messages mediated through media Implications for Practice Acknowledging the culture of risk Education about long-term risks of playing through pain and injury Advocating for safer sport practices: Athlete-centred policies Supporting psychological and social pressures on athletes Ethical approaches PRACTICE 1: Have you experienced or witnessed the “culture of risk” in sport? Provide an example and justify the category (role constraints, socialization, etc.) One example of the “culture of risk” in sport is the pressure athletes feel to play through injuries. Athletes often fear being replaced, stigmatized, or letting their team down, which can lead them to prioritize short-term performance over long-term health. This situation exemplifies structural role constraints, as athletes may feel obligated to endure pain to maintain their position on the team. 2: Choose a sport or physical activity. Identify the risks involved in the sport, including but beyond physical injury Football involves numerous risks, including physical Injury (contact nature of the sport leads to injuries such as concussions, broken bones etc), Mental Health (the pressure to perform and the threat of injury can result in anxiety and depression among players), Financial Risk (injuries can lead to significant medical expenses and lost wages due to time off work), Social Risk (injured athletes may face stigmatization or exclusion from their teams and social groups) The media often normalizes pain and injury in sports, which reinforces the culture of risk. For example, coverage may highlight a player's choice to return after a concussion, overlooking the external pressures from coaches and teammates that influenced this decision. Additionally, athlete-centered care in rehabilitation emphasizes understanding an athlete's unique needs and the social factors affecting their recovery. Injury - Recovery Pathway Narratives of Injury Implications for Practice Understanding the Athlete’s Narrative: Role of narrative in shaping experience -Identify & work within narratives Holistic Support -Explore alternative narratives -Balanced perspective of long-term goals and health outcomes Tailored Rehabilitation Strategies -Rehab that acknowledges narratives of injury -Developing resilience without perpetuating narratives that injury is normal Fostering a Multi-Dimensional Identity -Identities beyond sport / athlete -Finding meaning / growth in the injury experience Education for Coaches and Practitioners -Recognize and resist injury narratives -Strategies and policies for long-term health of athletes Recovery Implications for Practice Incorporate social support ○ Engage networks (friends, families, coaches, etc) into the rehabilitation process ○ Importance of a strong therapeutic relationship (Shared decision-making) Integrate contextual factors ○ Rehab tailored to specific contexts ○ Challenging norms that support playing while injured ○ Considering long-term health Personalized rehabilitation plans ○ Plans that account for contextual factors ○ Patient-centred care ○ Return to sport based on readiness as primary factor QUESTION How does social and/or contextual factors influence the recovery experience? Social: Strong social support from friends, family, and coaches enhances emotional resilience and coping strategies during rehabilitation, helping athletes navigate the challenges they face. The "culture of risk" in sports often pressures athletes to prioritize performance over health, which can prolong recovery and lead to adverse outcomes. Contextual: access to resources and cultural norms can significantly influence the recovery experience. For example, an athlete with limited access to quality healthcare, rehab facilities may face more challenges during recovery. The demands of a particular sport (e.g. football) can influence the recovery experience, as well as an individual's expectations about the process. The difference: 1. Social factors focus on the influence of interpersonal relationships and societal structures on an individual's recovery. This can include: ○The level of social support ○Societal pressures and expectations, such as the "culture of risk" in sport ○The impact of social stigma and discrimination, related to factors like gender, race, or disability, which may influence how individuals seek help and engage in the recovery process. 2. Contextual factors relate to the specific environment and circumstances surrounding an individual's recovery. Examples of contextual factors include: ○Access to resources, including quality healthcare, rehabilitation facilities, and financial assistance. ○Cultural norms and beliefs, which may influence perceptions of pain, illness, and appropriate responses to health challenges. ○The specific demands of a sport or activity, which may affect recovery timelines and the types of challenges individuals face. ○Environmental factors, such as geographical location, climate, and safety of the surrounding environment. 3 stages of injury/recovery? Culture of risk, injury, and recovery Consider the implications for practice at each stage of the injury/recovery experience: (Culture of risk, injury and recovery) Culture of Risk Socialization: Normalizing pain and injury Institutional Rationalization: Normalizing injury for success Cultural Values: Promoting toughness and commitment Structural Role Constraints: Pressure to play despite injury Structural Inducements: Pursuit of fame and recognition Injury Injury Narratives: Understanding personal injury stories Contextual Factors: Access to resources and sport demands Psychological Impact: Addressing fear and identity changes Recovery Tailored Rehabilitation Strategies: Individualized recovery plans Challenging Unhelpful Narratives: Replacing negative stories Fostering Multi-Dimensional Identity: Exploring identity beyond sport Return to Sport Readiness: Focusing on readiness over pressure PART 2: EXERCISE AS MEDICINE Exercise is Medicine (EiM) Launched in 2007 as a global initiative by the American Medical Association and the American College of Sports Medicine Exercise as a form of disease prevention and treatment EIM suggests that exercise can act like medicine ○ Similar benefits to medications for conditions like hypertension, depression, and anxiety EiM Assumptions: Critiques Pervasive inactivity: Individual issue that demands attention ○ Reductionist: Ignores intersectionality, SDoH which impact PA levels ○ Victim-blaming: Alignment with allopathic medicine. Individuals are held responsible for adhering to treatment ○ Contexts of inactivity e.g. structural barriers not accounted for Exercise is ‘good for all’ ○ May exclude those living with disabilities ○ Perpetuates constructions of the “normal” body ○ Again ignores contexts of physical activity The “credibility” of medicine ○ Exercise retains credibility of medicine ○ Allows for further social control (re: scope of doctors’ control) EiM Challenges “Adhrence” to treatment ○ Pursuit of health, but do individuals necessarily see exercise as the answer? ○ Medical treatments do not always have high adherence Exercise is not completely benign ○ Exclusion of diﬀerent bodies ○ Risks of injury ○ Intrinsic value of activity may be overlooked Costs of aligning with medicine ○ Particularly for kinesiologists ○ Professional autonomy ○ Perpetuating limited understandings of exercise Overall: the importance of problematizing the concept ○ Understand when and how the idea is important or applicable ○ Continue to explore the implications of the concept WEEK 6 (Dis)Abled, Disrupted & Recovering Bodies Synthesized Implications Athlete-Centred Care ○ Acknowledging and addressing injury narratives ○ Tailored rehab ○ Addressing contextual factors influencing injury and rehab The “Culture of Risk” ○ Raising awareness ○ Long-term risks ○ Advocacy on policy and practice Empowerment ○ For coaches, practitioners ○ Multi-dimensional identities ○ Importance of social support networks PART 1:Medicalized Bodies: Medical Dominance Medicine as “Science” A relatively recent development A focus on biomedicine (allopathic), the “scientific approach” (p. 262) Assumptions of biomedicine ○ Determinants of health = biological ○ Body as machine ○ Healthcare = curing ○ Medicine = science ○ Doctor is the authority Medicine as Dominant Physicians as most powerful group in healthcare ○ Autonomy over own work ○ Control over other’s work ○ Influence on policy ○ Influence on hospital/care organization Public status Medicalization of broader areas of life Medical dominance per Freidson (1970) ○ Doctors as ‘gatekeepers’ of illness ○ Authority over other professions ○ Gatekeepers to treatment via referrals ○ Doctors set professional standards ○ Doctors control curriculum and credentialing of future doctors Navarro (1988) – medical dominance as serving the interests of the dominant classes ○ Gender, race, class, etc. – who is in control? Challenges to Medical Dominance Welfare state ○ Medicare – curbed some autonomy about economics of medicine ○ Bureaucratic organization restricted direct control over workplaces Professionalization outside of medicine ○ Self-governing bodies ○ Independent practices Internal conflicts ○ Focus/significance of GP vs specialist ○ Growing recognition of SDoH “Demystification” of medicine ○ Scepticism about “science” ○ Limits to self-regulation ○ Iatrogenesis (Iatrogenesis refers to any adverse consequence of medical care, such as an injury or illness, that was not intended to occur) Public Health / Health Promotion Individualism ○ Canada a “leader” in health promotion ○ However, focus still tends to be on individuals ○ Education to change behaviour Materialist/Structuralist ○ Individual choices are not the problem ○ Social inequalities are the problem Perpetuated by governments and corporate interests ○ Political economic forces shape access to resources to be healthy Medical Dominance: Regulated Bodies “Types” of Bodies Individual ○ Self-control of the body Social ○ Social meanings ascribed to the body Politic ○ Social control ○ Regulated bodies Regulated Bodies Bodies regulated by social institutions ○ Law, education, religion, medicine Goﬀman – “total institutions” Foucault – “disciplinary power” ○ Hierarchical observation – giving up parts of your body for inspection by doctors ○ Normalizing judgement – examinations and assessments compared to what is “normal” ○ Examination – bodies examined and fixed (the treatment) Medicine as Social Control Work of Zola (1972) Hegemonic position of doctors Medicalization of more behaviours Levels of medicalization ○ Beyond biology as its focus (lifestyle, habit) ○ Increasingly legitimate control (via technology) ○ More access to “private” areas (inside of body) ○ Increased corrective actions (e.g., EiM) Previous discussions re: Conrad & Schneider work on medicalization Medicalization of obesity Historical context ○ Renaissance: Obesity linked to wealth and status ○ Modern Era: Obesity linked to health risks and moral judgment Body Mass Index (BMI) ○ Developed to measure and classify weight in relation to height ○ Categorizes (labels) individuals as underweight, normal weight, overweight, or obese Social implications ○ Labels such as “overweight” and “obese” carry moral judgments, implying personal responsibility for body size ○ Brown (2015): The term “obese” stems from Latin, meaning “having eaten until fat,” suggesting individual fault “In sum, medical practice is an individualized treatment mode, a mode which defines the client as deficient and which reconstructs the individual’s understanding of the problem for which help is being sought. That reconstruction individualizes and compartmentalizes the problem, transforming it into its most immediate property: the biological and physical manifestations of the individual, diseased, human body. The answer to the problem is then logically held to be found in the same professionalized and individualized treatment, not in the reordering of the social, political, and environmental circumstances in which the individual exists.” (Crawford, 1980, as cited in Safai, 2017, p. 195) Medicalization in Sport -“Within the privilege of performance at all costs, we see pain, injury and even death constructed as individual troubles or failings and not the consequence of the particular depoliticized, individualized and medicalized ways in which we produce athletic bodies.” (Safai, 2017, p. 195) -“It is also important to acknowledge that, despite the growth in the critical study of health, medicine and the active body over the past few decades, we have not yet fully explored or advocated for more humane sport and fitness. In other words, there has been a relative absence of active, political engagement in the dismantling of health-compromising social practices and institutions by scholars who, in at least their writings, are ‘[committed] to progressive social change’ Part 2: Exercise as Medicine Exercise is Medicine (EiM) Launched in 2007 as a global initiative by the American Medical Association and the American College of Sports Medicine Exercise as a form of disease prevention and treatment EIM suggests that exercise can act like medicine ○ Similar benefits to medications for conditions like hypertension, depression, and anxiety EiM Assumptions: Critiques Pervasive inactivity ○ Individual issue that demands attention ○ Reductionist: Ignores intersectionality, SDoH which impact PA levels ○ Victim-blaming: Alignment with allopathic medicine. Individuals are held responsible for adhering to treatment ○ Contexts of inactivity: structural barriers not accounted for Exercise is ‘good for all’ ○ May exclude those living with disabilities ○ Perpetuates constructions of the “normal” body ○ Again ignores contexts of physical activity The “credibility” of medicine ○ Exercise retains credibility of medicine ○ Allows for further social control (re: scope of doctors’ control) EiM Challenges “Adherence” to treatment ○ Pursuit of health, but do individuals necessarily see exercise as the answer? ○ Medical treatments do not always have high adherence Exercise is not completely benign ○ Exclusion of diﬀerent bodies ○ Risks of injury ○ Intrinsic value of activity may be overlooked Costs of aligning with medicine ○ Particularly for kinesiologists ○ Professional autonomy ○ Perpetuating limited understandings of exercise Overall: the importance of problematizing the concept ○ Understand when and how the idea is important or applicable ○ Continue to explore the implications of the concept Exercise is medicine: critical considerations in the qualitative research landscape Cairney & McGannon & Atkinson (2018). Introduction Exercise is Medicine® (EIM) was launched in 2007 by the American Medical Association and the American College of Sports Medicine. EIM promotes exercise as a method for disease prevention and management of chronic conditions. The article critiques underlying assumptions of EIM, emphasizing its socio-cultural and political implications. Assumptions of EIM Inactivity as a Problem: ◦ EIM assumes inactivity is a widespread issue needing intervention. ◦ This perspective overlooks sociological factors influencing physical activity. Exercise is Good for Everyone: ◦ EIM posits that exercise benefits all individuals, promoting universal participation. ◦ This view can exclude individuals with disabilities or varying abilities. Exercise Linked to Medicine Enhances Credibility: ◦ Advocates argue that medical endorsement of exercise increases its legitimacy. ◦ This connection may diminish the role of other professionals in promoting exercise. Challenges to Assumptions Behavior Change: ◦ The assumption that medical framing of exercise will lead to behavior change is simplistic. ◦ High non-adherence rates to prescribed medications suggest similar issues may arise with exercise prescriptions. Social Construction of Exercise: ◦ Exercise is not a neutral activity; its meanings are shaped by social and cultural contexts. ◦ Risks associated with exercise can be overlooked in EIM discourse. Institutional Hierarchies: ◦ Medical institutions dominate health narratives, potentially marginalizing non-medical practitioners. ◦ This dominance may limit the broader understanding of exercise's role in health. Week 7 SOCIAL ORGANIZATION OF REHAB MEDICINE The Biopsychosocial (BPS) Model in Rehab Introduced by George Engel in 1977 Response to the limitations of the biomedical model Three Key Components 1. Biological 2. Psychological 3.Social influences Holistic view of pain management Limitations of the Biomedical Model Emphasis is on anatomical causes of pain Heavily reliant on diagnostic imaging e.g., X-rays, MRIs Missing? Psychological and social factors Imaging findings often do not correlate with pain severity Misinterpretation of the BPS Model in Practice Studies often claim to use the BPS model but focus on biological outcomes Psychosocial factors are often underrepresented or neglected Result → conflation of the BPS model with the biomedical model Psychological and Cognitive-Behavioral Focus Focus on changing thoughts, beliefs, and behaviors. Emphasis on cognitive-behavioral approaches like CBT Social Aspects in LBP Management Work-related factors e.g., job satisfaction, stress Family relationships and social support networks Socioeconomic status influences recovery and access to care Critical Review Findings: Four Discourses Conflation with the biomedical model Focus on cognition, behavior, and rapport Brief mentions of social factors Neglect of cultural, ethical, or power dynamics Cultural and Power Dynamics in LBP Care Cultural beliefs and practices influence pain management Power imbalances between clinicians and patients affect treatment Need for shared decision-making and patient empowerment Implications for Physiotherapy Practice Further training needed to address psychosocial and cultural aspects Time constraints limit biopsychosocial assessments Physiotherapists often over-rely on biomedical and CBT approaches WEIGHT STIGMA IN PHYSIO Weight Stigma in Rehab Weight stigma ○ Negative social judgment or discrimination faced by individuals based on body weight or size Impact of stigma ○ Physical health outcomes (e.g., avoidance of healthcare, reduced physical activity) ○ Mental health outcomes (e.g., stress, anxiety, depression), Barriers to care. Physiotherapists may be unaware of their role in perpetuating stigma Weight stigma may be inadvertently reinforced in clinical settings Key Theoretical Foundations Goffman's Stigma ○ Stigma as a social process, an embodied experience Foucault’s theory of power and normality ○ Healthcare institutions define 'normal' and 'abnormal' bodies, contributing to stigma Post-structuralism ○ Weight stigma is socially and politically constructed, influenced by cultural norms The Rehab Context: Why Weight Stigma Matters Focus on the body ○ Weight becomes visible when patients are weighed, observed, or touched Vulnerability ○ Patients feel judged in clinical settings when their body size is a focus Clinician ○ Research shows clinicians can stigmatizing attitudes toward larger patients Challenges in Reducing Weight Stigma Complexity ○ Stigma is socially, politically, and culturally embedded Weight stigma reduction interventions ○ limited success with short-term, passive interventions Challenges with passive interventions ○ One-off lectures or web-based training fail to create long-term attitude changes Developing a Theory-Driven Approach Fostering reflexivity in physiotherapists ○ Encourage self-awareness and challenge assumptions about weight Active, multi-level strategies ○ Incorporating Goffman’s and Foucault’s insights into stigma reduction The role of professional reflection ○ Encourage critical thinking about the role of physiotherapists in perpetuating stigma Intervention: Methods and Findings Study design: Action research with eight physiotherapists over three months Key findings: Participants reported increased awareness of stigma and changes in patient care Challenges: Shifting away from a 'neutral expert' role can feel uncomfortable for physiotherapists Implications for Kinesiologists Relevance of weight stigma ○ Kinesiologists also focus on body movement and fitness, making weight a frequent point of interaction Practical implications ○ Incorporate reflexivity into practice, use inclusive language, and be mindful of body diversity Impact on patient outcomes ○ Reducing stigma can improve trust, treatment adherence, and overall well-being CRITICAL DISABILITY STUDIES Overview of Critical Disability Studies (CDS) Challenges societal assumptions about disability Emphasizes social and environmental factors over individual pathology Seeks to deconstruct ableist norms Disability as a social construct Intersectionality in understanding disability Ableism and its role in constructing 'normal' bodies Rehabilitation Sciences (RS) Overview Biomedical approach to disability as a problem to be 'fixed' Emphasizes physical therapy, occupational therapy, and interventions Goal: Normalize function and reintegrate individuals into society Often overlooks the lived experiences of disabled people May perpetuate ableist ideals by focusing on 'normalization' Bridging CDS and RS: A New Approach Tensions Between CDS and RS CDS critiques RS for its focus on normalization RS critiques CDS for being too theoretical and detached from practical solutions Use tension between fields to develop new models of rehabilitation Focus on inclusive practices WHO’s International Classification of Functioning, Disability, and Health (ICF) Attempts to synthesize medical and social models of disability Defines disability as interaction between health conditions and contextual factors Critique ○ Reinforces normal/abnormal binaries through statistical norms Positions impairment as biologically defective, perpetuating ableism A Post-Structural Critique of the ICF Post-Structural View ○ Bodies and impairments are socially constructed through discourse ○ Biological 'abnormality' is not a pre-given fact, but a product of social narratives Calls for re-thinking how bodies are classified and understood in rehabilitation Ableism in Rehabilitation Rehabilitation often focuses on 'fixing' disabled bodies to fit able-bodied standards Fails to consider potential of diverse bodily experiences Recognize difference as the default human condition Embrace the inherent diversity in human bodies and abilities Re-Thinking Rehabilitation Practice Move away from 'normalizing' disabled bodies Promote practices that are inclusive and empowering for all bodies Encourage critical reflection on assumptions underlying rehabilitation Development of transdisciplinary rehabilitation practices Ongoing dialogue between CDS scholars and RS practitioners CASE STUDY Jordan, a competitive swimmer for nearly a decade, has been diagnosed with a rotator cuff tear during training. This injury significantly limits their ability to swim without pain and restricts their range of motion. The physiotherapist has prescribed a biomedical rehabilitation plan that includes: Rest: A period of rest to avoid further strain on the shoulder. Physical Therapy: Gradual introduction of exercises aimed at strengthening the shoulder muscles. Pain Management: Use of ice and anti-inflammatory medication to reduce pain and swelling. Return Timeline: Aiming for Jordan to return to swimming in approximately 6-8 weeks, contingent on satisfactory progress. While the initial treatment plan focuses primarily on physical recovery, a BPS or Critical Disability Studies perspective would expand the plan to include psychological support, social engagement, empowerment, and a redefinition of recovery to better align with Jordan's identity and aspirations Holistic and Inclusive Approach Moving Beyond the Biomedical Model ○ Traditional focus on biological aspects often overlooks psychological and social factors ○ Chronic conditions (e.g., pain, disability) require a biopsychosocial (BPS) approach, considering the whole person, not just physical symptoms. Recognizing Psychosocial Influences ○ Social support, mental health, and life circumstances Stigma ○ May hinder recovery and reduce access to care Cultural Competency ○ Cultural and social factors shape patients’ experiences of illness and recovery ○ Kinesiologists need to be sensitive to these factors and avoid imposing universal standards of care Challenging Assumptions about Disability From 'Fixing' to Empowering: Rehabilitation traditionally focuses on ‘normalizing’ bodies, which can reinforce stigma around disability. Focus on empowering patients and valuing diverse bodily experiences Critical Reflection on Ableism ○ Kinesiologists should challenge societal assumptions about disability as ‘deviance’ from a norm ○ Reflection on ableist assumptions helps develop practices that are more inclusive of all abilities Collaborative and Inclusive Care ○ Engage patients in their treatment plans, respecting their autonomy and individual goals ○ Work across disciplines (e.g., with sociologists, disability studies scholars) to incorporate diverse perspectives in rehabilitation Creating Equitable Environments Patient-Centered Care ○ Recognize and respect the lived experiences of all patients, particularly those who have experienced stigma ○ Tailor interventions to individual needs, rather than imposing ‘one-size-fits-all’ solutions Ensure that care environments are accessible, inclusive, and supportive for all patients Professional Development ○ Continuous learning about the impact of stigma on health and patient outcomes ○ Review/update practices to foster an environment of acceptance, inclusion, and respect for diversity (Mescouto et al., 2022) Physiotherapists navigate the tension between biomedical dominance and multidimensional care when treating patients with low back pain (LBP). Despite guidelines advocating for a biopsychosocial approach, physiotherapy often remains focused on biological aspects due to ingrained training and institutional norms. The study, which involved ethnographic observations and discussions with physiotherapists, highlights how power dynamics influence practice. It identifies areas of resistance where physiotherapists can incorporate human aspects of care, such as emotional and psychosocial factors, through reflective practices and patient collaboration. The findings: Biomedical Dominance: the biomedical model remains dominant in physiotherapy, with practitioners often prioritizing biological factors over human aspects of care. This focus is reinforced by training, institutional expectations, and the fee-for-service payment model, which positions patients as consumers seeking biological solutions. Resistance and Reflection:despite this dominance, the study identifies moments of resistance where physiotherapists can challenge biomedical norms. By reflecting on their practices and engaging in open dialogues with patients, physiotherapists can begin to address overlooked psychosocial elements of care. Power Dynamics: The analysis highlights the subtle ways power dynamics operate within physiotherapy settings. It suggests that both physiotherapists and patients may voluntarily conform to biomedical expectations, but there are opportunities for redefining these interactions through collaborative practices. NO WEEK 8 BECAUSE OF MIDTERM WEEK 9 MENTAL HEALTH Correlates of Mental Health (Illness) Intersectional nature of mental health ○ Class, gender, age, migration status Socially situated nature of mental health ○ And relationship to SDoH Culturally-mediated understandings of mental health ○ Acknowledgement, diagnosis, treatment Significance of culturally competent approaches Mental Health: Canadian Elite Athletes Prevalence if symptoms of single mental disorder or comorbid disorder among 186 elite canadian athletes: 17.2% only depressive symptoms, 41.4% one or more disorders ECOLOGICAL MODEL OF EARLY INTERVENTION Ecological systems approach Promoting mental health & wellbeing ○ Importance of a culture shift “Win at all costs” → “psychologically safe and mentally healthy environments” for all ○ Improve narrative – physical and mental health as inseparable ○ Environments that promote mental wellbeing & protective factors: culture of “psychological safety” Promoting mental health & wellbeing ○ Social support within and outside of sport ○ Physical and mental health safety in sporting environments: no abuse, racism, discrimination, etc. ○ Respect for diversity and diﬀerence within sport Promoting mental health literacy & protective factors ○ Sport-specific mental health training ○ Institutional-based, person-centred mental health strategies ○ Opportunities for self-management skills, with professional support ○ Development of strong, non-athlete identities ○ Support during transitions Example of Mental Health Promotion in Physical Activity/Sport. Then, justify the level of intervention according to the ecological systems approach. Creating Inclusive Gym Environments: the establishment of inclusive and supportive gym environments that cater to individuals of all body sizes. Combat weight stigma, which can affect mental health and discourage participation in PA. Individual Level Issue: Individuals with obesity may experience weight stigma, leading to distress, mental health issues, and disengagement from physical activity. Intervention: Programs aimed at building self-esteem, resilience, and challenging internalized negative stereotypes can empower individuals to engage in physical activity without fear of judgment. Interpersonal Level Issue: Discrimination from gym staff, trainers, and peers can exacerbate weight stigma. Intervention: Educating staff and gym members about weight stigma and promoting positive interactions can help create a more supportive atmosphere. Workshops and training sessions can foster empathy and understanding. Organizational Level Issue: Gyms may unintentionally perpetuate discrimination through their physical environments and fitness culture. Intervention: Modifying equipment to accommodate larger bodies and changing marketing strategies to focus on body positivity and inclusivity can help reshape the organizational culture and environment. Community Level Issue: Societal norms around weight and body image can create barriers to participation in physical activity. Intervention: Public awareness campaigns that promote body diversity and challenge weight stigma can shift community attitudes. Collaborating with local organizations to create inclusive fitness spaces can further enhance community support. Policy Level Issue: Weight stigma may also be present in healthcare and other institutional settings. Intervention: Developing guidelines for healthcare professionals to communicate about weight in a non-stigmatizing manner, along with implementing anti-discrimination policies, can protect individuals from weight-based discrimination. MENTAL HEALTH, PA, AND SPORT Barriers/Facilitators to Athlete Mental Health Help-Seeking Barriers to help-seeking: 1. Stigma (Athlete identity, Sport environment) 2. Mental health awareness and literacy (Believing that help isn’t needed, Lack of knowledge about services) 3. Mental health services (Attitudes, access) 4. Personal barriers Facilitators of help-seeking 1. Awareness and literacy 2. Sport culture 3. Normalizing help-seeing 4. Nature of mental health services SPORT ENVIRONMENT AND MENTAL HEALTH Review the narrative findings of the Poucher et al. (2023) required reading for this week. How might we understand these findings in the context of PCS theories and/or concepts? Poucher et al. (2023) findings highlight how environmental factors, such as resource availability and social support, significantly influence athletes’ mental health. This aligns with the Psychological Continuum Model (PCM), which emphasizes the dynamic nature of psychological states and the impact of contextual factors. Trust in relationships with coaches affects help-seeking behavior, while performance pressures can detract from well-being. Overall, the study underscores the need for a supportive environment that prioritizes both mental health and performance. Sport Environment & Mental Health Narratives of elite Canadian athletes Elite sport environment has both protective and risk factors for mental health Key factors ○ Provision/access to services ○ Performance outcomes, mental “toughness” (funding & performance outcomes, Stigma) ○ Social support ○ Lack of clear communication ○ Language/attitudes (used by those in positions of power, body-related comments) ○ Sport as “play” (and not a career) READING (Poucher et al, 2023) The article explores how elite sport training environments in Canada affect the mental health of Olympic and Paralympic athletes. It emphasizes the importance of considering broader contextual factors rather than focusing solely on personal issues. Purpose The study aims to understand the relationship between athletes' perceptions of their training environments and their mental health experiences. Methods Thirty-two athletes participated in semi-structured interviews, which were analyzed using thematic analysis. The study focused on both team and individual sports. Key Findings -Environmental Influences Athletes identified various environmental features that supported or detracted from their mental health, including resource availability, social support, and performance pressure. -Stigma and Help-Seeking Concerns about stigma influenced athletes' willingness to seek help, indicating that mental health is often not viewed as a priority within sport organizations. -Trust and Relationships Trust in coaches and support staff significantly impacted athletes' mental health and their likelihood of seeking assistance. -Performance vs. Well-Being A focus on performance outcomes can negatively affect mental health, highlighting the need for a balanced approach that promotes both performance and well-being. Discussion The findings stress the importance of creating supportive training environments. Recommendations include enhancing athlete autonomy and educating coaches on mental health. (Cosh et al., 2024) "Athlete Mental Health Help-Seeking: A Systematic Review and Meta-Analysis" Introduction Athletes face various mental health challenges due to stressors in their sports environments. Understanding help-seeking behaviors is crucial for enhancing mental health support for athletes. Objectives The review aimed to: Examine rates of formal help-seeking behavior among athletes. Identify barriers to seeking help. Explore facilitators that encourage help-seeking. Barriers to Help-Seeking Stigma: A significant barrier, with athletes fearing perceptions of weakness and concerns about confidentiality. Low Mental Health Literacy: Athletes often lack understanding of mental health issues, leading to denial of symptoms. Cultural Factors: Issues related to athlete identity and the competitive nature of sports hinder help-seeking. Facilitators to Help-Seeking Role Models: Promoting positive experiences through athlete role models can encourage help-seeking. Supportive Environments: Creating team cultures that prioritize mental health can facilitate access to help. Implications Sport organizations should implement strategies to reduce stigma and promote mental health awareness. Training for sport staff as mental health navigators is vital to identify at-risk athletes and facilitate referrals. (Constantinou, 2023) Mental Illness and Social Class Contradictory Findings Early studies (Clausen & Kohn, 1959; Weinberg, Gerard, & Houston, 1953-1960) found no link between social background and mental illness. Later studies (Srole et al., 1962; Langner & Michael, 1963) associated psychotic symptoms with lower-class individuals and neurotic symptoms with middle-class individuals. Emerging Hypotheses 1. Drift Hypothesis: Mental illness causes individuals to move down the social hierarchy or live in disadvantaged areas. 2. Opportunity and Stress Hypothesis: Stress from social circumstances leads to mental disorders. Empirical Support Hudson (2005): Strong correlation between mental illness and socioeconomic status, supporting the social causation theory. 2016 UK report and Reiss et al. (2019): Lower income correlates with higher rates of mental illness. Gender and Mental Illness Higher Vulnerability Among Women Women report mental illnesses more often, possibly due to societal pressures from demanding roles (mother, wife, employee). Negative factors include: ○ Vulnerability Factors: Early loss of a mother, unemployment, multiple children. ○ Provoking Agents: Life stressors like divorce, health issues. ○ Psychological Factors: Low self-esteem, past abuse. Gender Differences in Coping Women tend to ruminate and experience chronic strain, while men engage in antisocial behaviors or substance abuse (Afifi, 2007). Depression in women linked to societal roles and interpretation of life events (Piccinelli & Wilkinson, 2000). Cross-Cultural Insights European Social Survey (Van de Velde et al., 2010): Depression higher among women, especially in transitioning societies where women face multiple roles. Protective factors: Higher education, better socioeconomic status, and family support. Age and Mental Illness Youth Vulnerability Meta-analysis (Solmi et al., 2021): ○ 30% experienced their first mental disorder before 14. ○ 48.5% and 62.5% by ages 18 and 25, respectively. Reasons include: ○ Rapid brain changes during adolescence (Blackmore, 2019). ○ Social media, cyberbullying, and reduced face-to-face interactions (Twenge et al., 2019). Impact of COVID-19 Increased depressive and anxiety symptoms among youth due to isolation and fear (Racine et al., 2020). Older Adults and Depression Studies (e.g., Roberts et al., 1997): Depression rates rise with age, particularly in those over 60 and 80. Contributing factors: Widowhood, past trauma, physical health issues (Arrango et al., 2021). WEEK 10 DEATH AND DYING Death & dying: Dying, death, and aging as socially constructed processes ○ Historical, social, cultural contexts ○ “social death” (p. 242) – social isolation resulting from marginalization “Medicalization” of death: medicine as extending lives. Hospitals as battles for life and death Death of older adults as “acceptable,” death of younger people as more tragic Death as “ambiguous”: living with terminal diseases or making preparations for death A “good death” – from religion to medicine Alternatives = palliative care & euthanasia Palliative Care: Comfort (respect and quality of life), Control pain, provide counselling and support, at home hospital or hospice, diﬃculties with homecare – cost, access Euthanasia / MAiD aka Medical Assistance in Dying ○ “Gentle death” / voluntary death ○ Individual control over own death ○ Religious/moral aspects vs medicalization & medical dominance Death as a social process Causes of death in canada From 1-41 accidents are the leading cause of death, then from 45 and older, cancer is the leading cause Suicide peaks at 15 Suﬀering What is suffering? Suffering is not synonymous with pain. Defined as a state of severe distress threatening personal integrity. Subjective experience, Can occur without physical pain e.g., depression Can suffering be assessed by another? Challenges: Suffering is subjective and context-dependent. Objective assessment limited to observable signs, which may not reflect the internal experience Professional Implications: Reliance on empathy and interpretive engagement and limitations of proxy assessments in clinical decision-making What is the moral significance of suffering? Cultural and ethical dimensions: seen as inherently 'bad'. Modern medicine’s goal: alleviate suffering, sometimes over preserving life Clinical implications: Role in decisions on life-sustaining treatments. Ethical considerations in rehabilitation and end-of-life care Relevance for kinesiologists: Understanding emotional dimensions in clinical and rehabilitation settings. Empathic Attunement in Practice: Empathic attunement as an interpretive, fallible process Acknowledges both patient and clinician emotions Importance for kinesiologists: Understanding the emotional impact of physical conditions. Facilitating meaningful patient engagement in rehabilitation Hacker’s analysis of emotions ○ Suffering is an emotion ○ Includes both perturbations (short-term) and attitudes (long-term) Implications for Clinical Practice Reframing s

KPE404 Exam Notes - 3 (PDF)

Document Details

Tags

Related

Summary

Full Transcript

Upgrade to continue