5: sociological approaches to chronic illness Flashcards
what are illness narratives?
the story-telling and accounting practices that occur in the face of illness
(most sociological researches based on this)
what do illness narratives offer?
offer a way of making sense of the disease to patient, and they perform certain functions
what are the different types of ‘work of chronic illness’?
– Illness work – Everyday life work – Emotional work – Biographical work – Identity work
what is illness work?
work to manage symptoms and cope with physical manifestation
describe the diagnosis period of illness work
May be prolonged period of uncertainty Diagnosis can be: - profoundly shocking - very threatening - a relief
describe managing symptoms in illness work
Central to the coping task is dealing with the physical
manifestations of illness
physical coping before social coping
overall what is the illness work?
patient works to manage symptoms and cope with physical manifestation
pros of The expert patient programme?
- Coping and condition management skills
- Aims to reduce hospital admissions
- Patient centred
cons of The expert patient programme?
- Responsibility for care placed on (very ill) patients
- Real agency and understanding?
- Little evidence of efficiency savings
what is coping (in chronic diseases)?
the cognitive processes involved in dealing with illness
what are strategies (in chronic diseases)?
actions and processes involved in managing the condition and its impact
what is everyday life work?
NORMALISATION:
pt tries to keep pre-illness lifestyle and identity intact (e.g. by disguising or minimising symptoms)
OR
redesignate new life as “normal life”
what is emotional work?
• Work that people do to protect the emotional well-being of others
how would patients doing emotional work appear?
• Maintaining normal activities becomes deliberately
CONSCIOUS
• People find friendships disrupted and may strategically
WITHDRAW or restrict their social terrain
• May involve DOWNPLAYING pain or other symptoms
• Presenting “CHEERY self”
how can emotional work impact on role (e.g. within families)?
• Impact on role (breadwinner, wife, mother etc) may be
devastating
• Dependency: Feeling of uselessness to self and others
• May be especially devastating for young people
what is biographical work?
loss of self, future ideas and image
interaction between body and identity
what is identity work?
• Different conditions carry different connotations
• Affects how people see themselves and how others see
them
how does identity work come about?
Consequence of actual and imagined reaction of others
illness can become the defining aspect of identity
what is stigma?
negatively defined condition, attribute, trait or behaviour conferring “deviant” status
what does Control of the body mean?
we present ourselves in socially valued ways
what is narrative reconstruction?
process by which shattered self is reconstructed in a way that explains the appearance of illness
what does narrative reconstruction create?
stability and a sense of coherence
what is biographical disruption?
the identification of chronic illness as major disruptive experience
e.g. grief for pre-illness life / disruption of future life
what are the different types of stigma?
- Discreditable and Discrediting stigma
* Felt vs. Enacted stigma
what is discreditable stigma?
not visible unless found out
e.g. HIV, mental health
what is discredited stigma?
– Physically visible characteristic or well known stigma
which sets them apart
– e.g. physical disability, known suicide attempt
are there conditions that can be both discreditable and discredited stigma?
YES
e.g. epilepsy
what is enacted stigma?
• The real experience of prejudice, discrimination and disadvantage (as the consequence of a condition)
e.g. not getting promoted
what is felt stigma?
• Fear of enacted stigma, also encompasses a feeling of
shame (associated with having a condition)
– Selective concealment
(not actually discriminated, just fears it)
what is the medical model of disability?
– Disability = deviation from medical norms
– Disadvantages are direct consequence of impairment and disabilities
– Needs medical intervention to cure or help
what is a critique of medical model of disability?
– Lack of recognition of social and psychological factors
– Stereotyping and stigmatising language
what is the social model of disability?
– Problems are product of environment and failure of environment to adjust
– Disability is a form of social oppression
– Political action and social change needed
critique of social model of disability?
– Body is left out
– Overly drawn view of society
– Failure to recognise bodily realities and the extent to
which these are solvable socially
what is impairment?
concerned with abnormalities in the structure or functioning of body
what is disability?
concerned with performance of activities
what is handicap?
concerned with broader social and psychological consequences of living with impairment and disability
what is the International Classification of Impairments, Disabilities or Handicaps (ICIDH)’s consequence of disease?
disease –> impairment –> disability –> handicap
e.g. arthritis –> stiff joints –> difficult to walk –> can’t find job
