Medical Sociology Lecture 5 PDF
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This document is a lecture transcript covering social determinants of health, health lifestyles, and mental health within a medical sociology framework.
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So, hello dear listeners, we are here with the fifth lecture on medical sociology, and today we\'re going to discuss social determinants of health, health lifestyles, mental health, and postmodernism. All of these are interesting and important topics. So let\'s start with social determinants of heal...
So, hello dear listeners, we are here with the fifth lecture on medical sociology, and today we\'re going to discuss social determinants of health, health lifestyles, mental health, and postmodernism. All of these are interesting and important topics. So let\'s start with social determinants of health and Yes, those are, you can see here a table, you have here economic stability, neighborhood and physical environment, education, food, community and social context, healthcare system. This is one way how to express this, but we could also say that social determinants of health could be listed as this, income, education, environment. workplace hazards, social cohesion, political and economic stability. So you can place economic stability at the bottom or at the top of the list. Well, generally speaking, where you place it matters less than the fact that you include it in this understanding. And if there needs to be one fundamental idea from the course in medical sociology, then this is this, that health does depend on these social determinants, that health does not appear there in vacuum. Health is not something that people just make decisions about, right or wrong, but it is something that is produced by society, that is created by social interaction and social circumstances. We\'re going to discuss that later when we come to health lifestyles theory. But first, let\'s go through just general. understanding of what is every one of these social determinants. So the first one is perhaps the most important, because, I mean, again, apart from revolution, we\'re looking at stable social development. And if that is the case, then the most important thing is direct correlation between health and income. In other words, socioeconomic inequalities transfer into health inequalities in quite a direct way. Thus, there is division in high and low socioeconomic strata, which creates health inequalities and it persists across all societies. The people in the lower socioeconomic groups have the poorest health and the shortest lifespans, regardless of how advanced the society is. So this is a universal law, an axiom, if you will. Now, the relationship between socioeconomic status and health is multifactorial. There would be a direct relationship, where you would have material wealth and benefits that would provide good health. That, of course, includes education and ability to afford medical expenses. healthy foods and places for exercise, also safe homes and neighborhoods, transportation, which also means not just transportation around but access to the health care, and the other luxuries of modern comforted living. And then there\'s indirect relationship, the psychosocial stress associated with material resources or lack of them. That could be chronic financial strain, the persistent struggle to meet daily challenges with an inadequate resources, which then triggers biological cascades, such as inflammatory or immune dysregulating, that potentiates, that is, that become potential causes for chronic disease. So, direct and indirect relationship. Then, financial strain, or the difficulties with the money, is what erodes self-control. This is the individual resource. Thus, persons experiencing financial stress are more likely to engage into smoking, alcohol consumption, poor diet, reduced exercise. It\'s not that they\'re depressed or something. It\'s not that lack of money immediately creates some sort of mental problems. No, it just gives people reason. to care less. I mean, they always would say, I have so many problems in life. Why would I? I mean, if I\... If I add to those problems also the need to take care of my health, then it\'s too much. No, health is the one that goes lower to the list. And because of that, of the slower prioritization of the health, health then gets spent and deteriorates. People of low income must overcome more urges and make more difficult decisions more often. And that increased regulation depletes the mental function and exhausts self-control. And this is said by White and colleagues from his article, Improving Health Through Action and Economic Stability. So weird as it seems is that indirect improvement into welfare would give direct results to quality of life and subsequently to the level of health of population. Next factor. education. Again, quite straightforwardly, health, literacy, and ability to make informed choices. But not just that, education shifts lives. It is a key to reducing socioeconomic and political inequalities because it is strongly associated with life expectancy, morbidity, and health behaviors. That is, educational attainment plays an important role in health by shaping opportunities, employment, and income. And that\'s what we\'re not just this understanding of what is healthy and not, but also that educated people have more opportunities in life, chances for better employment and income. Then the housing conditions, poor housing, including overcrowding, lack of heating, exposure to damp or mold, is linked to a range of negative health outcomes, including respiratory diseases and mental health issues. So housing is not just a physical shelter. It also represents the sense of security, stability, and privacy. And if you don\'t have security, stability, and privacy, if your housing brings\... House would be the place where people come back after a difficult day and gather their strength and rest to get out in the world and do it again next morning. So if that does not give them relief and relaxation, then\... health deteriorates even faster, not to mention the dampness or mold or any other of those anti-sanitary conditions that might be a problem. Employment. Of course, we can see how the multiple ways of how employment interacts with health. It could be hazardous occupations where just there is a higher risk of accidents and fatalities, or It could be unemployment, which does not have a direct impact on health, but it has psychological effects such as anxiety, insecurity, lowered self-esteem and depression, as well as financial problems, especially the debt. And that, again, leads to the previously mentioned mental strain that comes from money problems. So employment could be hazardous, but unemployment could be hazardous too. Next. social cohesion, the existence of mutual trust and respect in community and in wider society. So, of course, more social cohesion helps to protect people and their health, and societies with high levels of socioeconomic inequality tend to have less social cohesion. Therefore, there\'s more crime and there\'s higher death rates. Again, social cohesion is this trust, respect, and general helpfulness of people. towards each other. So, you know, then there\'s this collectivistic individualistic factor that we\'re also going to discuss later. Now, conflict or political economy theory argues that poor health of working class is a direct consequence of capitalist exploitation. However, the past hundred years have shown that level of health in capitalistic countries has generally improved. And William Cockerham has then come to this important conclusion that although capitalism is inherently a system of inequality, and in Marxist days, remember Marx and Engels talking about the poor conditions of the working class, in the early days capitalism was directly responsible for worsening of the health. With the advance of industrial society and with the changes that took place over 100 years of capitalism, the paradox is that it has clearly been compatible with major improvements in overall standards of living in hell. Pay attention, please, that the early Marxist critique has its truth and pathos, rightfully so. But the later Marxist critique has to deal with the fact that capitalism hasn\'t been all but destructive, that there are benefits from the capitalist development. So today, in most advanced countries, Traditional health indicators such as life expectancy and infant mortality have never been better. Bear that in mind, please. Whenever you write about Marxist critique of society in the examination, don\'t forget to mention that there is this paradox of positive impact on health, despite the fact that it is inherently indeed a system of inequality. unequal distribution of resources and benefits. In order to look at examples and how it works out, we should look at what is called a post-Soviet story that is declined in life expectancy. Because again, we need to test this idea of the Marxism, which says that capitalist society is destructive. So let\'s see how socialist society deals with it. the health idea. And here we start with a paradox. Please pay close attention. The Soviet Union was the first industrialized country to record the rise of infant mortality and decline in life expectancy in 1970s. This is research by Davis and Feshbach. And Cockerham\'s theory, that\'s why we study him, and that\'s why he\'s one of the\... main sociologist we\'re going to talk about today, is that he looks at this question of why did overall life expectancy for Soviet men fell in the time? Of course you can see here different Soviet propaganda that paints the picture of happy doctors, healthy society, etc, etc. Well, propaganda creates that fascinating world and so on and so on, but The ridiculous part about propaganda is that both Soviet and Nazi propaganda looks pretty much the same. But that\'s a different story. That\'s from political philosophy. However, there\'s the work. There\'s the work of William Cockerham. It is published both in 1997, but also later in 2002. I took the later edition. So what Cockerham says is this. One of the most significant developments in the world health in the late 20th century is the decline in life expectancy in the former Soviet Union and Eastern Europe. Why? Because in the rest of the world, life expectancy was rising. So, Cockerham says, it was a health disaster for the individuals and societies involved, but it also represents an intriguing puzzle for the sociologists. So what did happen in the former USSR and Eastern Europe so that men started to die that rapidly? The situation is without precedent in modern history. Nowhere else has health generally worsened, instead of improved, among the industrialized nations. Now, and this makes you think, maybe instead of GDP, we should take\... life expectancy as the general indicator of the wealth of society. That is, when we compare how long do people live in different societies, we can then make perhaps a more accurate conclusion about what kind of quality of life they enjoy. To date, Coggerham writes, it is not fully understood why such a pattern emerged in this region in the late 20th century. Nor has an extensive literature developed about this phenomenon in Western medical sociology. And of course, if one states something like this, then the rest of the book is the way of how he deals with it. And that\'s what we\'re going to do right now. We\'re going to follow through Cockerham\'s hypothetical explanations of why did the life expectancy drop so dramatically for the man. Now, he starts with claiming the obvious reasons. Say. There would be individual risk factors like alcohol abuse, smoking and poor nutrition that would be the main reasons for drop in life expectancy. But then we have to ask. Why did Soviet people drink, smoke, and eat so destructively that their life expectancy dropped? And hypothesis is this, that these risk factors have their origins in these social conditions and behavioral patterns, that is, health lifestyles prevalent in society at large. Now, following the World War II, the Soviet Union had become a military superpower. Soviet Union was producing guns, tanks, rockets, and military aircraft in large quantities. In fact, this military production complex of the Soviet Union was working also for the expert. It supplied a great deal of the third world countries, and you know, this is how the Kalashnikov machine gun actually ended up on some of the flags of the African countries. It was that popular, but it could not support the needs of civil law. civilian population, much beyond the state subsidies for food and housing. What I mean by this is that in Soviet Union, you had ridiculously low rent costs, like really nothing. So people basically lived for free, and the cost of electricity was also basically nothing. And a lot of people didn\'t pay it anyways. You know, they just cheated. They circum-wired the, what you call, the machines registering the\... electricity and so on and so on. So in Soviet Union what you get is equal but very poor living. The standards of living were really not that high and the highest they ever got was 1970s and the beginning of the 80s when you had the Brezhnev\'s social renaissance after the 1960s. But then that was it. In 1980s, already towards the end of it, the situation became desperate. And I actually witnessed this. I was about 12 to 13 years old when this happened also in Latvia. So I saw the empty shops. I saw this with my own eyes. And the lines to buy the food and the food carts, we even got to that stage when the\... when we had certain food cards for alcohol, for sugar, for cigarettes, and I don\'t know what else for, but that was it. And yet the propaganda still said, we are a nuclear superpower, we might have some temporary problems with the food, but still we can bomb the world out of its existence. This is just to show you what is the current fascist-Russian propaganda based upon. that we are ready to tolerate all the hardships just because it gives us pride to become this military superpower and to use that fear to instill respect into other countries. So we are ready to tolerate all kinds of hardships, but to enjoy this reputation on the international scale. Well, let\'s see where that takes them. Now, did things get better? with the demise of USSR. No, they didn\'t. The number of deaths of men only increased in 1991. USSR collapsed and the whole generation of Soviet people found themselves in a dire existential situation. They were raised and trained to live in a state-regulated totalitarian regime where the party would tell you what to do, where to go, etc., etc. But all of that was supported by absolutely reliable, stable income. And even though the life was not good, the life was stable. It was poor. It was difficult to get sometimes to the basic commodities. So the system of corruption was widespread, and so on and so on. Again, you know, I lived through that. I remember those things. That part of sociology I have done in my own experience. And here we come to the actual data Cockerham operates. Please take a look at it. We can see that in 1979 through 80, we have one indication of life expectancy. But then in 1991, 92, 93, we have the other. And\... And instead of rising, which is the natural thing that happens all around the world back in the day, and also even today, it\'s dropping. That\'s where the pathos of the whole research is based. Why did it drop? And you can also see that living in Armenia, Azerbaijan and Georgia, the southern part, Caucasian parts of the region, you would still generally have longer life expectancy. So probably they\'re just having better lives. Actually, I believe that is true that in Soviet Union those people did have, because of their attitude towards food and life in general, they did enjoy better living. So Cockerham offers three possible explanations for the shocking trend in life expectancy. One would be Soviet health policy, and that would be then the analysis of the communist failure. And here, you know, we meet our friend Slavoj Zizek again, and even he has to admit that to build a socialist society turned out to be a complete failure, complete disaster. But probably that is why he still\... So\... associates himself with communism, because I guess what he thinks is that this attempt was wrong because it was not true socialism, not true communism. So in his theory, I guess he believes that there is still a possibility to arrive to that kind of society. And maybe there is. And maybe that society is called Sweden these days, Sweden or Norway. I guess they\'re the closest to the actual socialism. But don\'t tell that to Zizek, he might get upset. Yeah, here you can see the book called The Collapse of the Soviet Union. Once again, I remember those meetings. I remember the military on the streets in Riga. It happened a little bit differently. This is the Moscow. You can see the wide streets of the Moscow. They have several lines, like three or four lines going one or the other direction. And there you can see the people facing the army. That was the famous August of 1991. Okay, then there\'s social stress theory, and that picture would be then the indication of social stress. And then there\'s health lifestyles theory. And let\'s compare what all those three theories or three explanations can do for the data. Let\'s start with health policy. Now, what we know about Soviet system is that healthcare delivery was guided by Marxist-Leninist programs for reshaping capitalism into socialism. And the goal of Marxism-Leninism was the establishment of classless society. And that would put end to capitalist oppression and exploitation. That would put end to private property, apart from personal items like clothing. Soviet Union didn\'t\... Everything was state-owned. You didn\'t have any private property. Later on, they kind of went the way that, okay, you can have something like cars and houses and stuff, summer houses, small property. But\... property in general, and that\'s why the first years of capitalism went through the process of privatization. So now property became private after that, but before that, no. Then worker alienation, people should work for personal fulfillment, and Soviet utopias are all about this fulfillment through work. And then economic scarcity, the socialist utopia was that there would be abundance, and there will be no need for money in Soviet future. And one of the I think, greatest writers of Soviet science fiction, brothers Strugatsky, they constructed this image of the world of the noon, Mirpolnya, where that Soviet communist utopia would come true. And that\'s top quality science fiction. I suggest anybody to read this. Some of it is translated into English and so on. Yeah, but let\'s move on. This is\... Fantasy, what is in reality? In reality, Soviet government established a nationwide healthcare delivery systems that was based in local polyclinics, which were the initial point of entry for primary care and a source of referrals for higher-level services. Now, services in some rural areas were provided by physician\'s assistants, health chairs, instead of actual doctors. But what needs to be said\... that healthcare system was available to people. And even though it was of lower quality in comparison to the West, it had well-trained physicians in modern facilities in the large city centers. But most hospitals would be poorly equipped and have inadequate supplies. And that is supported by extensive research you can see here. quotes and everything and of course i\'m borrowing this from cockerham himself because he has gathered all this data all the description of the soviet health system. Now, medical professionalism was expected as part of ideological commitment. The Soviet government, and this is ridiculous to think of it these days, provided low wages, which would be about \$24 a month, less than what a bus driver in Soviet system would make, and low social status, the equivalent of a high school teacher or any other member of what is called intelligentsia class generally. Why would then they have not such a high social status? Because guess who is the highest social caste, at least in an ideological sense, in communism? The working class. So if you\'re not the working class, you shouldn\'t be that respectable. They would put on posters these workers with hammers and spades and whatnot, driving the tractors and whatnot. And they would make a heroic image of the worker. But the image of the doctor or a high school teacher was, yeah, those are not real workers. They don\'t have real jobs. They just blah, blah, blah, etc. They\'re not the real heroes of the working class. The average salary for healthcare providers was just about 71% of the national average. This is by Mezenzo and Rimachevska, the research. They did in 1992. So, disrespected, underpaid, and under-equipped are the Soviet doctors. And that turns out that Soviet class equality was a hoax. Separate closed systems for healthcare existed for the elite groups, for the party top officials, for the KGB, and the top managers of the big industrial complexes. And they had much higher quality. And of course, the world doesn\'t tolerate inequality. So to receive better care, patients typically provided gifts or bribes to the health personnel. And that is how we inherited. And I\'m happy to report that up to this date, this has largely vanished from Latvian health care system. About 20 years ago, we still had the problem with these so-called unofficial payments, because people just couldn\'t believe that they would get a good healthcare unless they do give a bribe or some sort of gift to a doctor. And eventually that, in Soviet times, evolved into second economy within the overall health system. So the free Soviet healthcare was not really for free. I mean, it was for free for those who are higher up in a social hierarchy, but then\... Again, as I say, this is not about class equality. Soviet Union was not an example of classless society. It was an example of the same classes of people. They\'re just named differently. So Soviet healthcare system succeeded in addressing epidemics and contagious diseases. That is back in 1920s and 30s, the period between the two world wars. But it functioned poorly when confronted with chronic illnesses and their causes in the late 20th century. And the paternalism of Soviet states promoted false security and careless behavior on behalf of citizens. That if the state takes care of everything, then, well, to hell with it, I\'ll do what I want. Maybe the system will work and help me when the trouble comes. Maybe it won\'t. It doesn\'t matter. So Cockerham concludes. The Soviet-style health policy did not cause the increase in mortality, but rather it was unable to address the surge of circulatory problems and traumatic episodes. So this is what it means in this slide, that it functions poorly when it is confronted with chronic illnesses and their causes in the late 20th century. It was functioning fairly good to battle the epidemics and contagious diseases before. We had non-voluntary vaccination. and every baby was vaccinated against the basic problems. And every Soviet person, therefore, carries a visible scar on their shoulders. I carry that one too, which is left from this early vaccination with everything. So there were big scars. Size of one cent coin. The social stress and the health lifestyle explanation seem to be more promising lines of inquiry. And therefore, let\'s go to them. Now, let\'s talk about social stress. According to social stress explanation, the critical factor in health is a person\'s location in a social hierarchy. So if you\'re higher up, if your socioeconomic status provides you with resources, then you have less exposure to negative events. more social and psychological resources in coping with such events, even if they occur, and also prosperity and success, a major source of self-esteem and empowerment, which then reflects positively on an individual\'s physical and mental health. But if you have lower socioeconomic status, the less you are able to transfer stress, and the greater is the harm to the individual\'s health. This is the social stress explanation. Now, because of the downfall of communism, which led to fundamental economic, political, and social changes, the societies of Russia and Eastern Europe experienced considerable social stress. Okay, so we can say that the social stress factor is there. But it is not evident that this macro-level stress is the primary cause of increased mortality. Because, for example, in Czech Republic, which underwent basically the same changes. And in Czech Republic, maybe you don\'t know, maybe you don\'t, as in many European countries, you have what is called a beer culture. So when we talk about health habits, we could say that Czech Republic is among one of the biggest beer consumers in the world. I think the recent statistic also confirms this idea. So Czechs are drinking population, they\'re not\... you know, we can\'t say that they\'re healthies. They\'re obsessed with health. No, they aren\'t. So there would be a possibility for Czech people also to undergo the very same devastating drop in life expectancy, but it didn\'t happen. So it may be that stress has more indirect effect and influences life expectancy by promoting unhealthy lifestyles. Unhealthy lifestyles. So\... Social stress is a factor, but social stress is not the factor, is what Coggenham says. Now, let\'s go to health lifestyles. Here\'s the graph from his article, 2005, basically discussing the same thing. And here you can see, that\'s marked in yellow, how life choices, agency, and how life chances, the structure, create the habitus. Here we should remember Bourdieu. We\'re going to talk about him as well in the class. You have that. material on health lifestyles, which gives you a basic explanation of Bourdieu\'s theories. And then it leads to practices. So you have dispositions to act that result in actual practices. And out of those practices, in summary, you get health lifestyles. That\'s the analytical way of how to actually arrive to the point. What is health lifestyle? It is the choices and chances enacted out in practices, and then those practices come together in They form certain clusters of behavior. Okay, life chances include the effects of age, gender, race, ethnicity, socioeconomic status, and whatnot. So this is where we come back to the social determinants of health. Life chances are those social determinants of health. While life choices form an overall pattern of health practices and constitute a lifestyle, that is, life choices are reactions to the life chances that\... in form of choices that the people make. Now, structural constraints which follow from the chances, follow from the external circumstance, may be the dominant factor in the operationalization of health lifestyles. These constraints leave people with little or no choice in exposing themselves to unhealthy conditions and practices. And when I say little or no choice, I mean That of course, with the tremendous willpower, you would go against the whole social norm of, you know, you would try to eat healthy, you would try to avoid ecologically polluted areas, because Soviet economy was not thinking about the environment, not at all. They were polluting everything. We had, in the end of 80s, we had social protests. against one paper factory dumping its waste waters into the rivers and thus poisoning those rivers where you would have dead fish floating upside down, and so on and so on. So you would have ecological catastrophes, you know, with huge factories with smoke and everything coming out of the chimneys and so on. So all that industrial mites was creating quite a lot of pollution. So Soviet ecology was problematic, but so was the diet, and so was the social environment, where smoking and having heavy drinking was a default. Cigarettes were cheap and available, and they smelled horribly, but people, you know, smoked that crap anyways. because smoking was, you know, smoking is addictive. So relationship between a lifestyle involving heavy alcohol use and the raise of male mortality nevertheless appears especially significant. And it is similar to that of World War II. Why am I saying this? When you go back to this slide, when we have this data, numbers here, the numbers in\... 1991, 92, 93, which are direct result of the end of 80s, are similar to the life expectancy during the Second World War. So we could say that social situation at the end of 90s, beginning of 90s, sorry, end of 80s, was as bad as in 1940s. Think about that. The magnitude of alcohol use in 1988\... as the tax revenues show, that the revenue from vodka sales accounted for 35% of the Soviet budget. So this is industrial-scale drinking. And that kind of drinking is a response to something. And in the picture, you can see the lines and the people frantically fighting for a couple of bottles of vodka that would be, of course, you would have quota. They wouldn\'t sell you more than two bottles of vodka per person. And you would have lines, and there in the lower picture you see, that\'s not vodka, that\'s where you buy beer, perhaps. And of course, the drunk people buying that, and so on. So population was drinking heavily. And another curious but important factor from that is that sometimes when you couldn\'t get your hands on the proper alcohol, especially during 1984 and 1987 garbage ships and the alcohol campaign. And he seriously, he saw the devastating effects of drinking, and he decided, okay, we\'re going to limit the alcohol production and the alcohol sales. So what did people do? Did they quit drinking? No. They started to drink everything that had even the slightest hint of alcohol in it. And that would include wood polish, and this is here you can see What it says in Russian is Политурно-спиртовая щелочная. It means that This is a wood polish based on spirit and you would somehow filter it and then drink it and this is the brake fluid in these bottles and The filtering method of the brake fluid was Putting it on a rail that is in freezing temperatures, they would bring out a metal rail and then they would slowly pour this drink and stuff that\'s not liquid, that\'s not spirit, which doesn\'t freeze in low temperatures, would drop off into some other things and the bad stuff would just freeze to the metal object. And that was the filtering process. And then they drank it. It\'s unbelievable. In many situations, drinking stuff like that would cause motor dysfunction and temporary or permanent blindness. But that didn\'t stop them. Perhaps the safest out of it all was the perfumery. And here you can see the cheap perfumes that are still sold in shops. And the picture here with the perfume mysteriously called Classic. depiction of Colosseum on it. This is what you can find in Riga\'s parks, that people who live on the streets or who are addicts and alcoholics and so on, they buy this because it has, I was checking, it was something like 60% of spirit in it and the rest of it is some kind of water or something like that. But drinking perfume\... comes from the Soviet idea that you need to get drunk no matter what, because that\'s the only way how to tolerate the Soviet reality. Now, both totalitarian restrictions, which were often absurd and pompous, and post-totalitarian chaos, these both factors did instill a sense of powerlessness and hopelessness in people. In Soviet times, heavy drinking could even be presented as dissident revolt, as the writings of Benedict Yerofeyev indicate. His famous Writer dissident, famous for what? He wrote, as he calls it himself, a poem, which is called Moskva Petushki, that is, the journey from Moscow to a remote train station Petushki. And that\'s a metaphysical alcoholic journey. The main protagonist, Benny, uh\... that is himself, wakes up in the staircase of the unknown building, and he has a suitcase on his knees, and he wakes up from alcoholic passing out, and he\'s trying to remember what was he drinking yesterday, and where is he going today, and the first thing he does is he waits until the shops get open, and of course he buys some wine and vodka, and then he gets on a train, and the whole book is this journey from the railway station Moscow to railway station Petushki, where he is supposed to meet his supposed wife, fiance, God knows what. And all the way, he\'s drinking heavily with everybody on the train, and everybody on the train is drinking. And this is like this alcoholic absurdist bacchanalia that takes place with a lot of cultural references, jokes, and metaphysical ideas. And in the end, of course\... It\'s not clear whether he arrives in Petushki ever, or is he taken by the devil, or is he taken by the angels. Because at the end of his journey, he\'s in a state of complete mental and physical destruction. But all of that seems to be authentic reaction towards the absurdities of Soviet life. The only thing you can do to tolerate the sort of\... failure of the state to provide any kind of decent living, any kind of real life and real meaning, is to drink yourself to death. Which is what the author successfully did. He died from alcohol-related complications in 1990. And there\'s a documentary, Journey from Moscow to Petushkin. I mean, you can find it all on YouTube. I\'m just digressing here a little bit. But this kind of ethos that drinking to death is somehow a noble reaction, a noble protest, and you can even get some sort of alcoholic epiphany out of it. That was part of this understanding of how to survive Soviet regime. And later, when the regime collapsed, it became some kind of inner immigration, that you sort of hide yourself in drinking, or as the cynical joke would be, if you get yourself drunk on the Saturday. then you have a holiday, because what it means, a holiday, you just pass out unconsciously and nobody can bother you with any kind of housework, any kind of having to go to a summer house to do some work or something like that. No, you have the true holiday when you are passed out from drunk, from being completely drunk. So, Cockerham concludes that the primary social determinant of the decline in longevity in middle-aged, working-class Soviet males is their health lifestyle. It provides the behavioral parameters of heavy drinking, smoking, indiscriminate diets. Indiscriminate means that they would eat whatever, whenever, and if there\'s nothing to eat, no problem. Drinking solves it. And no exercise. Despite the Soviet propaganda, a Soviet person would not look at sports as something that one is supposed to know. And this unhealthy lifestyle, and here\'s the important one, has survived the transition from communism to post-communism without any major modifications. So that\'s why in 1991, 92, 93, you would have this Soviet lifestyle of a Soviet male who cannot face the reality, who is drinking himself away, who is afraid to\... take responsibility for their lives. This shock from that, from the collapse of the Soviet system, now is the shock of the chaos of the new emerging capitalism. So this lifestyle kind of helped. This was an escapist lifestyle, obviously. It helped to deal with all that. And now, only now, gradually, it\'s fading away. But, as Cockerham concludes back then, And today doesn\'t mean today, it\'s not 2024, it\'s about year 2000 or even 1997-1998, when the research actually took place. It operates as a deadly force, shortening the lifespan of those who follow its norms. Next big topic today is the sociology of mental health. So here you can see different sources that I used. Again, we have\... Andrew Scull, we have Ann Rogers, David Pellegrin, we have, what\'s his name, Peter Mottrell, something like that, who writes on the mental health and mental disorder and the sociology of it. Now, let\'s start with definitions. Mental health is described by WHO as a state of well-being in which the individual, first, realizes his or her own abilities, Second, can cope with the normal stresses of life. Third, can work productively and fruitfully. Fourth, is able to make a contribution to his or her community. Now, this definition is consistent with the varied interpretation across the cultures, so it holds up in a multicultural setting. Now, a mental disorder is a syndrome characterized by and this is definition of mental disease. So it\'s a syndrome characterized by clinically significant disturbance in an individual\'s condition, emotional regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or instability in social, occupational, or other important activities. socially deviant behavior, deviant behavior, yeah, I think we agreed upon that, socially deviant behavior, that is political, religious, or sexual behavior that does not conform to the social norms, and conflicts are primarily between the individual and society, but they would not be constituted as mental disorders. So you can be deviant, You can be in conflict with society, but that does not necessarily mean that you are mentally ill, unless the defiance or conflict results from a dysfunction in the individual as it is described above. So what this definition of DSM-5 does, it tells us that basically mental disorders are disturbances that reflect dysfunction. but this dysfunction doesn\'t mean that you cannot be different, individual, or weird within the boundaries of certain psychiatrically accepted idea. I hope you get this, because this is crucial. This is the reason why mental disease is difficult to define, and that difficulty actually creates endless discussions about what is and what isn\'t normal. Mental health, of course, from a sociological point of view, has a cultural context. You have collectivist cultures emphasizing group harmony, interdependence and self-criticism, and social obligations. And, for instance, Mexican culture has strong emphasis on extended families, and that protects from mental illness by offering social support and thus reducing chronic stress. So you can see here that the culture you come from, And if you have a good social capital, if you have social cohesion, strong ties to the relatives and et cetera, that reduces stress. That helps you to maintain mental health. While individualist cultures, which prioritize personal autonomy, self-reliance, uniqueness, and individual achievement, they are more susceptible to mental illness because, first of all, mental health issues are more likely to be conceptualized as personal problems or failures. And also\... The increased sense of isolation and shame and more significant stigma also makes the mental issues worse. So it makes sense to say that being integrated into society and into your family is one of the resources against mental illness. Horowitz one of the famous sociologists and cultural historians that explores madness. says that all societies from simple to complex include individuals who behave in ways considered unacceptable and incomprehensible to others and hence they are considered crazy or mad. Second, symptoms of mental disorder are fairly common. So there you can meet them in every society but they\'re also fairly commonly spread so approximately about 31 percent of working adults experience a diagnosable mental illness while 20% experiencing a moderate or severe disorder. This is coming from Weitz, The Sociology of Health, edited in 2019. She has several editions of those. So different social groups consider different behaviors comprehensible and acceptable. Mental illness depends on which group you come from. So, for instance, the friends of a drug-using teenager, for instance, might consider drug use a reasonable way to reduce stress or have fun. Their views, however, have little impact on public definitions of drug use. Similarly, members of one church might consider a woman who talks to Jesus a saint, while members of another church would consider her mentally ill. And, uh, again, this is one of the Great questions we could ask from a sociological point of view. To what extent religion is a sign of mental health and religious life and religious attitude, and to what extent it isn\'t? And you have two radically opposing opinions. You have Carl Gustav Jung, who says that a person\'s spirituality is a solution of their mental health issues. So unless you understand the spiritual function of the psyche, that psyche needs to have this. opening to transcendent experience, and that doesn\'t mean always religion in form of God or anything. It also holds up for the ideals like justice, democracy, and love. So if one person has those values in one\'s lives, then the one person has a chance at mental health. If you don\'t, then of course you have problems with anxiety and depression and everything. And then the other side, the biomedicine that says all kinds of religion is just a superstition in enlightenment manner. We\'re going to talk about enlightenment today too. But this is a narrow-minded reductionist idea, I think so, that to reduce all the mental processes to just processes, biochemical processes in the brain, I think it\'s much more complex than that. But then you would see the reasons to making irrational experience, to labeling that as unhealthy. So you have two very opposed opinions. Some say spirituality is the way to health, and other people say, well, spirituality is generally a misunderstanding and should be considered on par with schizophrenia, because talking to God, what does it mean? You\'re talking to a voice in your head. And here\'s why we need to compare the medical and sociological model of mental illness. So this is what I just described to you, but here\'s the table. So medical model talks about mental illness as definition defined by objectively measurable conditions. It\'s coming from individual psychology or biology. Mental illness will worsen if left untreated, and many people may improve or disappear if treated promptly by a medical authority. I mean, the illness will disappear, not the people. And medical treatment of mental illness can never harm the patients. Well, sociological model begs to differ. Mental illness is defined through subjective social judgments, hence the labeling theory. We\'re going to talk about that today later as well. Mental illness reflects a particular social setting as well as individual behavior or biology. Persons labeled mentally ill may experience improvement regardless of the treatment, or treatment may not help, and medical treatment for mental illness can sometimes harm the patients. A famous experiment. by psychologist David Rosenhan in 1973 was made to test the validity of mental health diagnosis. And there\'s a book about Rosenhan\'s experiment called The Great Pretender by Susan Callahan. Read it if you care. And what did happen? Rosenhan, with his seven assistants, went to 12 mental hospitals and complained of hearing voices. But otherwise\... to normally. The hospitals diagnosed all or eight of these pseudo-patients as mentally ill and admitted them for treatment. After they were admitted, they all behaved normally. leading to 30% of other patients to identify them as frauds. So the other patients saw that these guys are fake. But the staff, however, never noticed anything unusual about these pseudo-patients. When the results were published, psychiatric professionals refused to accept them. These were too shameful, too much exposure to what goes on. In response, Rosenhan launched a second stage of experiment. He agreed to send pseudopatients to another hospital and challenged the staff at the hospital to identify these pseudopatients. And of course, it was a matter of honor for the industry. So during the three months of the experiment, the staff identified 42% of the new patients and pseudopatients. The only problem was that Rosenhan really did not send anybody. to any hospital. If you want to understand what happened, then to your information, sociologists can use deceptive techniques if it is justified by the scientific, educational, or practical value of the research. So this was a deceptive technique used. First they pretend to be patients, then they say nobody when they expect to be sent. And this just proves the\... the point of how subjective the whole thing is. So, the key findings are following. The confirmation bias. Once the pseudo-patients were labeled mentally ill, all their behaviors became, even the mundane ones, were interpreted as symptoms. Dehumanization. Patients were often depersonalized and treated with suspicion, emphasizing how labels can distort interactions. And third, difficulty of escaping labels. Despite being perfectly sane, After the diagnosis, they found it difficult to convince the hospital staff that they were not mentally ill, demonstrating the stickiness of psychiatric labels. So, it would make sense to compare Rosenhan\'s experiment to the labeling theory, which we will do. Rosenhan\'s experiments demonstrate the subjective nature of psychiatric diagnosis and its susceptibility to social expectations, and one of the theories, which is symbolic interactionism, a labeling theory, did propose exactly this approach, that psychiatric diagnosis is to be made on the observation. So Rosenhan\'s experiment offers critical insights into limitations and potential dangers of this theory. So let\'s recap what labeling theory actually says. So labeling theory says that mental illness is largely a social construct. That arises when society labels someone as mentally ill. And this labeling theory includes also crime, deviance, and other things apart from mental illness, so it\'s not just a psychiatric thing. So Schiff argues that crime, deviance, and mental illness is primarily the result of society\'s reaction to deviant behavior. And once a person is labeled as mentally ill, they internalize this label. leading to self-fulfilling prophecies and reinforcing the deviant behavior. That is depicted by, here you can see Robert De Niro in the role of Max Cady, a fictional character who decides to say that if you call me bad, if you criminalize me, I will show how bad I can actually be, and then he takes revenge and so on. And this is from film Cape Fear, 1991. So\... So once a person is labeled mentally ill, they internalize this label, they accept it, they say, okay, I\'m going to be the criminal, I\'m going to be the crazy person you call me to be, and I\'m going to sort of go to full extent in that, I\'m going to see how far I can take this role. So the label itself then becomes more important than the individual\'s behavior, and it shapes how the person is perceived and treated by society. Okay, if you get this, then let\'s see what criticisms show us. First of all, Schaaf\'s theory overemphasizes the idea that label itself causes deviant behavior. Rosenhan\'s experiment suggests that labels do not always lead to the internalization of the label, and the reality of mental illness cannot be reduced to labeling alone. The pseudo-patients actually never became mentally ill despite their labels, highlighting that labeling does not automatically lead to deviance or mental illness. So mental illness, labeled or not, exists but labels itself. cannot really cause deviant behavior at all times. Maybe sometimes, but not at all times. Second criticism, the misdiagnosis. Rosenhan and associates were not mentally ill, we know that. But the labeling theory, which proposes that mental illness is largely socially constructed and the actual existence of disorder is not as influential as the label applied by society, does not recognize this. We need to distinguish between true mental illness and misapplications of labels, such as being weird. And here you can have a picture, for instance, of David Bowie in his Ziggy Stardust period, the same year of 1973, where strange, abnormal, and weird is what he was looking for. He would be then classified by Schaaf and his colleagues as someone who belongs to a psychiatric institution, because he wears weird clothing, he has red hair, and he\... It has this androgynous look. It\'s not clear whether he\'s a man, he\'s a woman, he\'s what. So this suggests that misdiagnosis is a major issue, but it does not necessarily invalidate the existence of mental illness. So within the context of a mental hospital, staff members were quite reasonably, as you would expect that, they would assume that patients are ill and interpret everything that patients do accordingly to that. And when one board\... pseudo-patient began taking notes, a worker officially recorded his note-taking as a symptom of illness, that is, graphomania. Then, when in the second stage of the experiment, staff members expected to find cytopatients, they interpreted similar behaviors as signs of mental health. That is, they would take what previously was a symptom and normalize it. So you see, just a matter of perspective. So what does it say? It says that institutional context matters. Rosenhan\'s experiment emphasizes the institutional power structures that shape how labels are applied and maintained. Labeling theory, on the other hand, says that society at large is the source of labeling, but no, institutions like hospitals and the psychiatric profession have a significant role in perpetuating labels. Labels stuck not because the patients internalized them, but because the psychiatric staff relies heavily on these labels to guide their interactions with the patients. This criticism of institutional context can be supported by Goffman\'s work on mental hospitals and experiences of mental patients. Goffman pointed out that mental hospitals, much like military prisons and monasteries, are total institutions in which many individuals lead highly regimented lives, segregated. segregated from the outside world. So you can see here how the label transfers. That these institutions strongly endorsed identification with the label. That individual\'s sense of self was damaged and replaced by inpatient personality adapted to institutional life. So they would make this psychological transition from the person with problems that lives outside into an inpatient that carries this label. Okay, and criticism number four. Labeling theory does not always account for individuals who resist the label and do not internalize it. So not only they do exist, and Rosenhan\'s experiment proves it because he and his partners didn\'t accept this. They didn\'t internalize the diagnosis of schizophrenia. Rather, they continued to act normally despite the label. So Rosenhan\'s findings prove that the self-fulfilling prophecies may not always occur. and individuals can remain detached from labels imposed on them. Next topic. Postmodernism. Heterogeneity, multiplicity, and difference. Deconstruction and social construction of reality. Intertextuality and narrative truth. Dismantling the fixed identity. Knowledge equals power. You have Sigmund Bormann. postmodernity and discontents, you have postmodern social theory, you have an anthology of readings from modernism to postmodernism. So let\'s start discussing what is postmodernism. And we have to go back to Enlightenment, which is the period in which contemporary biomedicine was developed and became dominant, and the previously discussed theories such as structural functionalism, conflict theory, political economy, and social interactionism, all these three theoretical frameworks are associated with the Enlightenment movement. Not that they were created by Enlightenment movement, no, but because they carry the Enlightenment\'s focus. They work in the theoretical setting that was built at the age of Enlightenment. And what is Enlightenment? It emphasized the systematic application of reason as the means of understanding the world. It took place in two levels. You had the development of science and rational scientific method, and you had a spread of mass education, the concept of rational and free self-determining individual, which would then later become the modern citizen, which is the staple of democratic society. So the Age of Enlightenment is\... about the reason illuminating the progress of society and the progress of the individual. And the transformation from pre-industrial society, the rise of industrial capitalism, and the transition from the pre-modern to modern era is what takes place here. The big social transition. And Anthony Giddens, in his interview book with Christopher Pearson, talks about the Enlightenment worldview. or in German it would be Weltanschauung der Aufklärung. And you have a book by Hans Wolff that is discussing Weltanschauung of Kleon in German context. So the task of sociological theory was to interpret and understand this modern society and industrial civilization, understand this transition. This is also historically the progress of sociological theory. This is why I\'m talking about Stuckheim. and all the classics of sociology. So modernity is much more dynamic than any previous type of social order. Transformation of society into capitalism, modern economic order expanded by constant technological innovation. Transformation of natural world into urban civilization, fostering the human confidence and mastery over the natural forces. That\'s where we have this superioristic attitude towards ecology. birth of a nation-state as a more progressive form of government, and mass democracy as a new form of political institution, and mass warfare as a new form of military power. So military technology became much more machine-like under the influence of modernity. This is the direct application of rationality, by the way. And you have machine gun as the example of this. and large-scale changes with army discipline and armies that now start to look more like machines themselves. And one of the changes is the change of uniform. It used to be a form of display. In the upper picture you see the uniforms of 18th century, no sorry 19th century, mixed it up. 19th century soldiers, and you see bright colors, you see that the colors are distinguishing them from one another. There\'s bright red, bright white, even bright blue, and so on and so on. In the 20th century, the Second World War, the lower picture shows soldiers. You have predominantly natural colors, not bright at all, blending with the environment, and uniforms become a way of hiding, a way of camouflaging. Postmodernity is a critical response to modernity\'s grand failures. Progressive science is used to the development of mass warfare and to carry out genocide. So the casualties of Second World War, which seemed to be estimated to be 75 million in total, out of which I think about 40 million were civilians, would not be possible without scientific approach to weapons production and warfare. You would have science of death in Auschwitz gas chambers. So science would be directly used to carry out genocide. And you would have atomic bombing of Japan, which was characterized by none other but J. Robert Oppenheimer, as the culmination of three centuries of physics is a weapon of mass destruction. So this is where enlightenment, with this emphasis of rationality and rational progress, is seen as a failure. So post-modernity is a reaction to that failure. Modernity trusted big truths and common values that were assumed universally relevant, and post-modernism is questioning these ideologies as the regime of truth. And here you have the book by Jean-François Lyotard. the postmodern condition, les conditions postmodern, report and knowledge, and they are deconstructing these universally recognized truths. that serve particular interest groups. Postmodernity intensifies reflexivity and uncertainty due to the absence of fixed certainties. Instead of certainties, they\'re only interpretations. So there\'s no truth, there\'s regimes of truth, which have to be deconstructed, have to be shown as social constructions, not the actual truth, and that destroys the certainty. And this idea was soon embraced by sociologists, and everything that could be interpreted as text or narrative became the main focus. The war, religion, economic relations, sexuality, indeed all human behavior just has multiple meanings that may or may not be understood by actors who are engaging in them. Language does not just describe reality, it creates. the reality by describing it. This is of crucial importance to understand the postmodernism, that postmodernism focuses on text and narrative not because they are so hooked on literature, but because they consider everything a story, that the reality does not consist of real objects and stuff like that, but it consists of our stories that we composed about relationship to those objects. So believed in imaginings, the narrative construction of reality. This is the textbook edited by Rivera and Sarbin. Postmodernists, when they apply sociology to the science itself, they reveal the social construction of science. And this idea was, yes, indeed embraced by the Sociology, sorry, the previous slide gets repeated here. So I was thinking about transferring this idea, how to get a sense of this idea that science is a text that we write about the world, and the world then gets translated into text, and the text may have more than one meaning, more than one interpretation, so scientific data can be interpreted. Modernity and post-modernity\... questions, questions everything, and little is taken at the face value. There\'s no right, correct answer, only a partial description. So, narrative, a subjective account of reality, instead of facts. And now you can remember illness narratives as another example of those subjective narratives. And consequently, because there\'s many narratives, then the idea of truth multiplies. And here you see the book that is discussing Derrida\'s idea on deconstruction. Deconstruction is methods, the critical analysis of meaning, revealing the particular ways of seeing and knowing or controlling the reality and alternatives to it. So postmodern sociology means undoing or destruction of past understandings of health and healthcare, focusing on competing truths, interpretations, or ways of seeing. And here we have an important hero in the form of French thinker Michel Foucault and his idea of power and biopower. Deconstruction is necessary, this method of deconstruction is necessary, power embodied in expertise and knowledge in the field of health. So, doctors are experts and they exercise power through their expertise, through their knowledge. And Foucault says, power is everywhere, diffused and embodied in discourse, knowledge and regimes of truth. And he formulates the idea of biopower, that the technologies and techniques which govern human social and biological processes are the ways. of controlling human behavior and production and reproduction of life itself. Hence, we talk so much about demographics, about birth and death. This is the direct way of how biopower expresses itself. So naturally, postmodernism becomes a liberal practice of daring critique of governments. And part of that postmodern appeal was that it was a very convenient tool of ideological critique and political protest. So that\'s why in 1960s, when counterculture was reigning, people fell in love with postmodernism. They thought, yes, this is the sociological and philosophical attitude towards the old traditional society, old cultural context. We can question everything and doubt everything. And Michel Foucault, in his book, The Birth of Biopolitics, talks about the rise of biopolitical technologies of governments that have extended. political control and power to over all the major processes of life itself and medicine has become surveillance and discipline field of surveillance of discipline through the ideology of health. So he sees that medicine is sort of ideologically engaged, not just scientific reference of facts, but ideology too. And that ideology is a particular understanding of health that is proposed by its proponents. Through the body and its behavior, state apparatuses such as medicine, the educational system, psychiatry, and the law define the limits of behavior and record activities, punishing those bodies which violate the established boundaries, and thus rendering the bodies productive and politically and economically useful. So, the books, Medicalization of Birth and Death, The Medicalized America, and Alan Francis\'book, normal, an insider\'s revolt against out-of-control psychiatric diagnosis, DSM, big pharma, and medicalization of ordinary life. This would be the protest against the system. Now, what is health? It is a simulacrum. What is simulated? A copy, this is definition of simulacrum, a copy of reality which had lost its original presence. A floating signifier with manifold. changing meaning subject to continued anxious measurement and scanning to illustrate you all these ambiguous sentences here you have this idea of natural beauty and the irony of that is that natural makeup tutorial this is for the men by the way the irony is that natural look is a fake idea result of skillful production skillful application of makeup is the natural beauty so Think about the irony of that. And postmodernism plays around these ideas that how self-ironic, how self-contradictory are the things that we do. Similarly, it is more important to have a healthy look than being healthy, and hence you have healthism, a certain new trend in Western culture, which concern dieting, excessive exercising, and evangelizing health. You know, they walk around as walking advertisements of healthy living. And then\... health religions like yoga and so forth. And health is then defined as a result of personal responsibility and becomes symbolic of a person\'s morality. This is where the whole shaming of the inappropriate diets and so on comes from. It comes from the idea that your body reflects your ability to have self-control, the ability of virtuous behavior. The body is somehow your visiting card. And postmodernism has thus played a major role in the establishment of post-truth. This is what Lee McIntyre writes. If the postmodernists had been content merely to interpret literary texts or even symbols behind a cultural behavior, things might have been fine. But they weren\'t. Postmodernists came after the natural science. They started to dig into it. drug that too. And what started as a bold critique of authority of experts, the dynamics of power and ideology within the science and medicine ended with conclusion. Science does not have a monopoly of the truth. Now when you do this, you achieve politicization of truth. Because the aim of every propaganda is not to convince the public, but to control what\'s true. What\'s true is what I say is true. But if nothing is true, then everything is a spectacle and a show and a joke. How nothing is true, because I can, by my saying something is or isn\'t true, I can play with that truth. So that\'s how truth becomes a plaything in the hands of politicians. Should politicians be a showman? Should politics become a show? Seems like that. Guy Debord, in his 1967 book, which is called the Society of Spectacles, says that all that once was directly lived has become a mere representation. The passive identification with the spectacle supplants the genuine activity. The history of social life, says Gabor, Gabor, sorry, the history of social life can be understood as the decline from genuine interaction into appearances. And he says that in 1967, no social media inside as of yet. There is television, cinema, though, and press, the printed press and the colorful journals. In his film Joker, Todd Phillips takes the question to its conclusion. In this scene where the Joker shoots the host of the late-night TV show, which, of course, I put in contrast with the real-life politician in the same spot as the Joker occupies, in another real-life late-night show, this is subtle artistic critique on the modern society because people who were watching that show were wondering. At which point, this show is staged, and only when Joker pulled the gun, they realized something might be going off. And when he actually killed the host, as depicted in the movie, I hope I\'m not spoiling, that is when reality enters the television. But that televised reality seems as unreal as everything else you can see on the television. So this\... constant postmodern question of where is the truth, what is spectacle, what is truth, where the facts are, where are the interpretations. The final idea is this. Because of the questioning of truth that takes place in postmodernisms, we have arrived into the society of post-truth. And Timothy Snyder one of the modern-day historians, one of the famous historians operating this time, and he has a wonderful series of lectures on the history of Ukraine on YouTube, freely available. Watch that, if you care, of course. He writes the following, Fascists loved slogans that resonated like new religion and prefer creative myths to history and journalism. This is exactly what the post-truth politics is all about. Slogans and\... make whatever great again. So they used new media, which at the time was radio, to create a drumbeat of propaganda that aroused feelings before people had time to actually ascertain facts. And now as then, many people confused faith in a hugely flawed leader with the truth about the world we all share. So this shifting attitude towards truth, this idea that science does not deliver facts, that science is nothing but another interpretation of reality, and there\'s this narrative, that narrative, and whatever. This post-truth is the prerequisite of fascism, because then truth becomes a matter of political conviction. And what\'s the direct result of destabilizing truth is that you need a politician who will then defend define what truth will be. This is what Hitler did. This is what Stalin did. This is what Putin does right now. That\'s why they all heavily rely on propaganda, not because they need to convince that black is white and white is black. No, they force their own interpretation of reality, not based on facts, but based on their political agenda, upon the people. And because people believe television more than they believe their own eyes, They subscribe to totalitarian ideas. Those ideas, unfortunately, cost lives of the people. That\'s why post-truth is pre-fascism. Thank you for attending the lecture today.