Social Stress & Health PDF

# Chapter 7: Social Stress & Health 1. Impact of stress on health is substantial. 2. Exposure to it is unequally distributed in a population. 3. Members of racial minority groups are burdened by additional stress from discrimination. 4. Stress can continue over life course → cause of differences in...

# Chapter 7: Social Stress & Health 1. Impact of stress on health is substantial. 2. Exposure to it is unequally distributed in a population. 3. Members of racial minority groups are burdened by additional stress from discrimination. 4. Stress can continue over life course → cause of differences in health between advantaged & disadvantaged groups. 5. Impact of stress = reduced when people have ↑ levels of personal mastery (being in control of situations), self esteem, + social support. ### Stress * **Heightened mind-body reaction to stimuli inducing fear or anxiety in the individual.** * **Starts with a threatening or burdening situation** * **Ex) Unpleasant working conditions, financial strain, job loss, divorce, migration, imprisonment, death of spouse, discrimination.** ### Cooley, Thomas, & Goffman * **Reflect symbolic interactionist perspective of human behavior** * **Symbolic Interaction Theory** → individual seen as creative, thinking organism who is able to choose their behavior instead of reacting more/less mechanically to influence of social events. ### Cooley: "Looking-Glass Self" * **Our self concepts are the result of social interaction where we see ourselves reflecting in other people**. * **3 Concepts** 1. We see ourselves in our imagination about how we are viewed by the other person **(Causes Stress!)** 2. We see in our imagination other's judgement of us. 3. Result of what we see in our imagination → self feeling (satisfaction, pride, humiliation) ### Thomas: "Definition of Situation" * **If the definition of a situation is stable → behavior = orderly**. * **If the definition is disrupted → behavior = disrupted, disorganization/uncertainty** * **Same crisis will not produce the same effect uniformly in all people.** * **Comparisons to past crisis → revise judgement/action**. * **Ability of a person to cope with crisis situations = related to socialization experiences that taught them how to handle new situations.** ### Goffman: Dramaturgical or "Life as Theatre" * **People need information about others for social interaction to be possible.** 1. Appearance 2. Past experience with similar person 3. Social setting 4. Information through person's words/actions * **Impression Management.** * **Face** → positive social value that individuals claim for themselves, by the line that others assume they have taken during an encounter. * **Image of self projected to others.** * **Most important personal possession - center of security/pleasure.** * **"Wrong Face"** → information about the person's social worth cannot be integrated into their line of behavior. * **"Out of Face"** → participation in encounter without expected line of behavior. * **"Face Work"** → actions match the face they are projecting. * **2 Views of Self** 1. Self as an image of an individual formed from the flow of events in an encounter 2. Self as a kind of player in a ritual game who copes judgementally with the situation. * **Self is a sacred object.** * Role specific behavior isn't just about doing the role, but about giving the appearance that we are fulfilling it (showing through outfits, etc.). * Stress arises when there is failure in this. * **Key Variable in stress: Perception of an individual.** # Chapter 8: Health Behavior & Lifestyles * **2 Categories: Health Behavior & Illness Behavior.** * **Health Behavior** → activity undertaken by individuals for the purpose of maintaining/enhancing health, preventing health problems or achieving positive body image. ### Health Lifestyles * **Collective patterns of health-related behavior based on choices from options available to people according to their life chances.** * **Includes contact with medical professionals but is largely determined by class position.** * **Ex. Daily food choices, exercise, relaxation, etc. ** * **Most chronic diseases currently arise from health lifestyles (heart disease, blood pressure).** ### Weber: Health Lifestyle Perspective * **Status & Power are important factors.** * **Amount of esteem a person is accorded by others.** * Basis = occupation, income, level of education. * **Status Group** (Social Class) → people who share similar material circumstances, prestige, education, political influence. **Similar Lifestyles.** * **Lifestyles based on what they consume.** ### 3 Terms: * **Lebenssstil (Lifestyle), Lebensführung (Life Conduct), Lebenschancen (Life Chances).** * **Lifestyles can spread across society beyond where they originated.** * **Ex.** Lifestyles emphasizing exercise, sports, healthy diet, avoidance of unhealthy practices: smoking → origin upper middle class. * **Spread across Western Society.** * **Most people try to do something to protect their health** * **Poor most disadvantaged to positive Lifestyles. Also, more smokers.** ### Bourdieu: Book "Distinction" * **Habitus** → a hook of class-related, set of durable dispositions to act in particular ways, shaped lifestyles. (Same class = similar habitus). * "Distance from necessity" → The more distant a person is from having to economize needs, the more freedom to develop tastes with more privileged class. (Ex. Lower class like cheap, bulky meals). ### Cockerham: 4 Categories of social structural variables that shape Lifestyles. 1. **Class Circumstances** → **Most decisive, Upper + Upper Middle > Lower (Healthier).** 2. **Age, gender, race/ethnicity** → Intergenerational (passed on from parents). 3. **Collectivities** (Blacks = ↑ Obesity, Families, Religion, etc.) → As people age, take better care of health, but exercise declines with age. 4. **Living Conditions** → *Men in Britain: Associated with class position (overall)*. *Women have healthier Lifestyles than men (better over life course).** * **Primary Socialization:** Imposition of society's norms and values. * **Secondary Socialization:** (Adult) training, learned from experiences. * **Agency:** Process by which people critically evaluate and choose a course of action. * People act as "agents" of their own behavior. * **Class is the dominant variable in health lifestyles.** ## Chapter 9: Illness, Behavior, & Sick Role * **Before**: Illness = autonomous force, "being" → evil spirit. * **Now**: Illness = state or condition of suffering as a result of disease/sickness. 1. Cause 2. Characteristic train of symptoms 3. Method of treatment * **Medical View of Illness:** Deviance from biological norm of health, + feelings of well-being. * **Traditional identifying criteria for disease** → 1) Patient's experience of subjective feeling of sickness. 2) Finding through an exam/lab tests, etc. 3) Symptoms. * **Symptoms are not always obvious, so feeling states ≠ not medically significant.** * **Laypersons:** Conceive health as absence of illness symptoms, deviance. ### Deviant Behavior * **Deviant behavior involves making a social judgement about what is social right & proper behavior according to norms, rewarded by acceptance and approval = Deviance.** * **Typically offend someone.** ### Sickness as Deviance * **Undesirable for both the sick and society.** * **Early theories** → deviant behavior = genetics, * **Sickness causes self-worth to decrease**. ### Self-Care * **Most common response to symptoms of illness** * **Taking preventive measures, self treatment, managing diagnosis of chronic conditions.** ### Social Networks * **Close cultural/ethnic relationships tend to get insight from within the "Lay-Referral System"** * **More likely to seek medical care if consistent with cultural beliefs.** * **Less likely if culture is skeptical/distrusting.** * **Parental influence is most important.** ## Chapter 10: Doctor-Patient Interaction ### Age + Gender * **Use of health services greater for females than males, greatest = Elderly.** * **More females in household = more doctor visits.** * **Female**: ↑ during childhood + child-bearing years, ↓ after 35. * **Male**: Same, ↓ until 45 then ↑. * **Babies too.** ### Race * **Low income blacks, same pattern.** * **Now visit more after 1970.** * **Blacks = More physician contact than Hispanics** * **Hispanics = Lowest contact** * **Mexicans (could not afford insurance)** * **Less Hispanic doctors too** ### Obamacare (ACA) * **Increased # of insured.** * **People with preexisting conditions cannot be denied coverage.** ### Before 1968 * **Lower income = visit less, etc.** ### In 1968 * **Middle = less, either lowest = highest visit or highest income.** ### By 1970 * **Poor used it most.** * Even Now! * **Poor visit phys most now.** * **But least preventive care.** * **"Public" care → poor less likely to have 1 personal physician → random (usually).** ### 2 Tiered Healthcare Delivery System * **Private vs. Public** * **Rich → more discriminating of their use of doctors, make own decisions.** * **Poor → less likely to question authority/ judgement of doctors.** * **Parsons: Sick Role (Function of medicine as form of social control)** * **Social system viewed in a functionalist perspective: balanced with problems, but still healthy.** * **Sickness = dysfunctional.** * **Sick person = deviant because they cannot help it.** ### 4 Categories: 1. **Sick person is exempt from "normal" social roles.** 2. **Sick person is not responsible for his/her condition.** 3. **Sick person should try to get well.** 4. **Sick person should seek technically competent help + cooperate with doctor.** ### Patient-Physician Role: Mutuality * **Physician has leverage on patient:** 1. **Professional prestige as healer.** 2. **Situational authority.** 3. **"Sit. dependency".** * **Sometimes a physician must act on "hunch" rather than science.** ### Criticisms to the Sick Role: 1. **Not all act this way (Cannot return to normal state).** 2. **Does not apply to chronic diseases.** 3. **Patient-physician relationship differs in settings (office, ER, home, etc).** 4. **Middle class orientation, may not apply to lower.** ### Medicalization * **Non-medical problems treated as such.** * **Ex.) Obesity, mental disorders, ADHD.** * **Biotech companies leading.** ### Doctor-Patient Interaction * **Seriously ill, treated on emergency basis: Doctor in charge (almost entirely).** * **Acute, infectious illness (flu) → Physician makes decisions (guidance cooperation)**. * **Management of chronic illnesses (mutual participation).** * **Nowadays most are like this.** * **Non-emergency situations → patients don't often act passivley (Lower class tend to).** * **Now: Patient-centered care.** ### Communication Problems * **Cause dissatisfaction.** * **But if done properly, 1. reduces uncertainty, 2) provide basis for action, 3) strengthen doctor-patient relationship.** ### Poorly Educated * **Most likely questions ignored.** * **Upper/upper middle → receive more personalized service from physicians.** ### Waitzkin * **Doctors don't usually withhold information, but communicate more info if the doctor from upper middle. Lower doctors = less common..** * **Similar doctor-patient = best common.** ### Male Doctors * **Female Patients** * Lack of sensitivity. * Misdiagnose heart attacks as stomach/anxiety problems. * **Estrogen protects women from heart attacks until menopause.** ### Female Doctor * **More attentive to patients' comments.** * **Both paid more attention to male age-related disease.** ### Women Physicians * **Perceived as less of an authority figure by male patients.** * **Today, women are entering male-dominated specialties.** ### Interaction * **With doctors can be difficult and cause misunderstandings for patients with different cultural perspectives.** * **Patient Compliance = important (Spencer)** * **No longer the term → Adherence.** ### Belief * **"Doctor always knows best" no longer virtually accepted.** ### Intruded by 3rd Party payers * **Insurance Companies.** * **Shift in state's role of protecting the medical profession to protecting corporate interests to reduce costs.** ### Other Factors: 1. **Proliferation of commercial products (patients can use/buy themselves).** 2. **Rise of chronic disease.** ### New Medical Technology * **Internet Medicine:** Apps, fitness trackers, YouTube. * **Provides electronic support groups too (ESGs).** * **Telemedicine (new):** Doctor in clinic/office, patient at home (Zoom) → COVID. * **Gene Therapy:** Treat/cure disease by giving patients healthy genes to replace defective ones. "Designer" or "Precision" drugs to match DNA. * **Genes used for research faced ethical / privacy challenges.** * **Cloning:** * **Theraputic:** Cloning of human organs for transplantation in sick people. * **Reproductive:** Cloning of people themselves. * **Widely criticized for being immoral, illegal in some countries (USA).**