Social Construction of Illness PDF

10/3/2023 What do you mean illness is “socially constructed”? SOC 162 10/3/2023 1 2 1 10/3/2023 Definition: What is Social Constructionism? • Social constructionism is a conceptual framework that emphasizes the cultural and historical aspects of phenomena generally considered to be natural....

10/3/2023 What do you mean illness is “socially constructed”? SOC 162 10/3/2023 1 2 1 10/3/2023 Definition: What is Social Constructionism? • Social constructionism is a conceptual framework that emphasizes the cultural and historical aspects of phenomena generally considered to be natural. • It emphasizes that meanings of phenomena do not necessarily inhere in the phenomena themselves but develop through interaction in a social context. • A social constructionist approach to illness: highlights the conceptual distinction between disease (biological condition) and illness (social meaning of the condition). • The biomedical model assumes that diseases are universal and invariant to time or place. • The social constructionist framework sees meanings and experiences of illness as shaped by cultural and social contexts. [Adapted from Conrad and Barker 2010, p. 67] • E.g., Obesity, BMI, health risks; Meanings of “fatness” across contexts? 3 Theoretical Origins of Social Constructionism • Symbolic Interactionism: Individuals participate in the construction of their own social worlds, via ongoing social interactions. [Erving Goffman] • Conflict Theory: These social interactions are shaped by power relations. • Power/knowledge nexus: Discourses and knowledge systems about what is normal carry a form of power. [Michel Foucault] • Medical discourse can influence people’s behaviors and their illness experiences; can shape what society considers legitimate medical interventions. 4 2 10/3/2023 Applying a Social Constructionist Perspective: Is (homo-)sexuality a medical issue? • In many countries, homosexuality was medicalized and de-medicalized throughout modern history. • Was “none of my business;” • Was considered a moral failing or a spiritual sin; • Was medicalized as an illness; [“From bad to sick”] • De-medicalized, largely in response to gay rights movement. [“Different;” not bad or sick] 5 A Case Study • Being gay in China. • Focusing on what the doctors said about gay shock therapy, explain: • Which part of this medical discourse is based on biology? • Which part of this medical discourse is based on culture? • Do gay people face similar and/or different challenges in China, compared their counterpart in the US? 6 3 10/3/2023 • How do gay people cope with being considered “abnormal?” • When the “scripts” of their life stories deviated from “standard” story lines, one woman chose to enter a “convenience marriage,” her partner opposed it. • Why? 7 Three Key Points about the Social Construction of Illness • “Cultural meanings of ‘illness’ are shaped by social contexts.” • “Illness experiences are subjective stories.” • “Medical knowledge and assumptions are shaped by social, not just scientific, factors.” 8 4 10/3/2023 ML1 “Cultural meanings of illness are shaped by social contexts.” • Some illnesses are stigmatized or contested. Partly shaped by social contexts. • E.g., Fibromyalgia often considered “unfounded” complaints in today’s context of high-tech biomedicine. • In less advanced societies, it might have been recognized as a legitimate illness for which we don’t yet have an explanation. • It affects patients’ access to care, the responses of others, and the very identity of the sufferer. 9 Policy Implications • A “good” health policy can mean different things in different contexts. • E.g., Policies concerning prenatal genetic screening and selection. • Designed to help pregnant women decide about their pregnancies. • The disability rights movement opposes it. They sees a different cultural message behind these policies: “It’s better to not be born at all than disabled.” 10 5 Slide 9 ML1 Ming-Cheng Lo, 1/7/2017 10/3/2023 “Illness experiences are subjective stories.” • A serious illness is often experienced as a “biographical disruption.” • E.g., cancer, Alzheimer’s disease, etc. • The patient uses available cultural resources to adapt to these unexpected “plot developments” of her life story. 11 Policy Implications • Illness narratives are a means of bringing the person back to medicine: • What is it like to be living with this condition? From the patient’s perspective. • Being “listened to” in itself is therapeutic for many. • Patients don’t just want to get better; most want to find meanings in their conditions. • E.g., many oncologists focus on the newest experimental treatment, but sometimes what is needed is to focus on finding peace and closure. 12 6 10/3/2023 • “Medical knowledge and assumptions are shaped by social, not just scientific, factors.” • Biomedical science has its own culture. • It is a “culture of no culture.” • The biomedical model focuses on objectivity; and accepts only certain methods for achieving this objectivity, e.g., double-blind experiments, randomized trials, etc. • These assumptions characterize a specific knowledge system. It’s very useful, but it is not the only legitimate ways of accumulating knowledge. • Many doctors believe that this specific knowledge system is the truth and that other medical knowledge systems are just “cultures.” 13 • “Randomized, double-blind, placebo controlled” clinical trials are considered the “gold standard” for establishing the safety and efficacy of a new vaccine. • During COVID, some scientists advocated for “immuno-bridging” • Comparing the safety and efficacy of a new vaccine to an approved vaccine. • Resistance and conflicts. • Gradually accepted. • A fight about what counts as legitimate ways to build scientific knowledge. 14 7 10/3/2023 As the opioid crisis grows, some states open Medicaid to alternative medicine… 15 • Vermont’s Medicaid study finds that: among about 150 pain patients, acupuncture improved patients’ rating of pain, fatigue, depression, and other measures — though the study didn’t include a control group, and so may have reflected a placebo effect. 16 8 10/3/2023 Critics and Supporters • Medical community: Evidence is • Acupuncture practitioners: unclear enough, so we shouldn’t be spending taxpayers’ money on pseudoscience. • What counts as “evidence” for this Acupuncture is not going to solve the opioid crisis, but it’s one tool for pain control. • What counts as “evidence” for this group? group? 17 Policy Implications • Biomedical solutions are extremely valuable. • But we should critically reflect upon biomedicine’s own cultural assumptions. • E.g., presence of symptoms= disease; • Treatment = biomedical procedures or pills; • “Patient experiences are less reliable than double-blind experiments.” • There exist other “ways of knowing” or knowledge systems, which are sometimes worth considering. 18 9 10/3/2023 Building Good Bridges? (1) • CAM gains credibility by explaining its mechanisms in biomedical terms and using double-blind experiments. 19 20 10 10/3/2023 Building Good Bridges? (2) • Can the biomedical model also incorporate different notions of care? When, why, and how? • E.g., psychedelic therapy is being examined through double-blind, randomized clinical trials. • Still being debated: should psychedelic counselors have first-hand experience, because traditional healers serve as mentors for the patients? 21 Your opinions? • “I don’t need to have experienced domestic violence to provide counseling to victims of domestic violence. Psychedelic therapy is no different.” • “Psychedelics can alter the patient’s mental state drastically. Traditional psychotherapy training may not equip the therapist to properly guide the patient. Indigenous healers almost always have firsthand experiences, and we should heed this tradition.” • https://synergeticpress.com/blog/con sciousness-and-psychedelics/shouldpsychedelic-therapists-havepsychedelic-experience/ 22 11 10/3/2023 Taking Stock…. • “Cultural meanings of an illness are shaped by social contexts.” • “Illness experiences are subjective stories.” • “Medical knowledge and assumptions are shaped by social, not just scientific, factors.” • Can you think of an important illness experience of your own, or of someone close to you? How would any of these three theoretical points help you better interpret this experience? 23 12