5: sociological approaches to chronic illness

Question 1

what are illness narratives?

Answer 1

the story-telling and accounting practices that occur in the face of illness
(most sociological researches based on this)

Question 2

what do illness narratives offer?

Answer 2

offer a way of making sense of the disease to patient, and they perform certain functions

Question 3

what are the different types of ‘work of chronic illness’?

Answer 3

– Illness work
– Everyday life work
– Emotional work
– Biographical work
– Identity work

Question 4

what is illness work?

Answer 4

work to manage symptoms and cope with physical manifestation

Question 5

describe the diagnosis period of illness work

Answer 5

May be prolonged period of uncertainty
Diagnosis can be:
- profoundly shocking
- very threatening
- a relief

Question 6

describe managing symptoms in illness work

Answer 6

Central to the coping task is dealing with the physical
manifestations of illness
physical coping before social coping

Question 7

overall what is the illness work?

Answer 7

patient works to manage symptoms and cope with physical manifestation

Question 8

pros of The expert patient programme?

Answer 8

• Coping and condition management skills
• Aims to reduce hospital admissions
• Patient centred

Question 9

cons of The expert patient programme?

Answer 9

• Responsibility for care placed on (very ill) patients
• Real agency and understanding?
• Little evidence of efficiency savings

Question 10

what is coping (in chronic diseases)?

Answer 10

the cognitive processes involved in dealing with illness

Question 11

what are strategies (in chronic diseases)?

Answer 11

actions and processes involved in managing the condition and its impact

Question 12

what is everyday life work?

Answer 12

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”

Question 13

what is emotional work?

Answer 13

• Work that people do to protect the emotional well-being of others

Question 14

how would patients doing emotional work appear?

Answer 14

• 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”

Question 15

how can emotional work impact on role (e.g. within families)?

Answer 15

• 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

Question 16

what is biographical work?

Answer 16

loss of self, future ideas and image

interaction between body and identity

Question 17

what is identity work?

Answer 17

• Different conditions carry different connotations
• Affects how people see themselves and how others see
them

Question 18

how does identity work come about?

Answer 18

Consequence of actual and imagined reaction of others

illness can become the defining aspect of identity

Question 19

what is stigma?

Answer 19

negatively defined condition, attribute, trait or behaviour conferring “deviant” status

Question 20

what does Control of the body mean?

Answer 20

we present ourselves in socially valued ways

Question 21

what is narrative reconstruction?

Answer 21

process by which shattered self is reconstructed in a way that explains the appearance of illness

Question 22

what does narrative reconstruction create?

Answer 22

stability and a sense of coherence

Question 23

what is biographical disruption?

Answer 23

the identification of chronic illness as major disruptive experience
e.g. grief for pre-illness life / disruption of future life

Question 24

what are the different types of stigma?

Answer 24

• Discreditable and Discrediting stigma

* Felt vs. Enacted stigma

Question 25

what is discreditable stigma?

Answer 25

not visible unless found out

e.g. HIV, mental health

Question 26

what is discredited stigma?

Answer 26

– Physically visible characteristic or well known stigma
which sets them apart
– e.g. physical disability, known suicide attempt

Question 27

are there conditions that can be both discreditable and discredited stigma?

Answer 27

YES

e.g. epilepsy

Question 28

what is enacted stigma?

Answer 28

• The real experience of prejudice, discrimination and disadvantage (as the consequence of a condition)
e.g. not getting promoted

Question 29

what is felt stigma?

Answer 29

• Fear of enacted stigma, also encompasses a feeling of
shame (associated with having a condition)
– Selective concealment
(not actually discriminated, just fears it)

Question 30

what is the medical model of disability?

Answer 30

– Disability = deviation from medical norms
– Disadvantages are direct consequence of impairment and disabilities
– Needs medical intervention to cure or help

Question 31

what is a critique of medical model of disability?

Answer 31

– Lack of recognition of social and psychological factors

– Stereotyping and stigmatising language

Question 32

what is the social model of disability?

Answer 32

– Problems are product of environment and failure of environment to adjust
– Disability is a form of social oppression
– Political action and social change needed

Question 33

critique of social model of disability?

Answer 33

– Body is left out
– Overly drawn view of society
– Failure to recognise bodily realities and the extent to
which these are solvable socially

Question 34

what is impairment?

Answer 34

concerned with abnormalities in the structure or functioning of body

Question 35

what is disability?

Answer 35

concerned with performance of activities

Question 36

what is handicap?

Answer 36

concerned with broader social and psychological consequences of living with impairment and disability

Question 37

what is the International Classification of Impairments, Disabilities or Handicaps (ICIDH)’s consequence of disease?

Answer 37

disease –> impairment –> disability –> handicap

e.g. arthritis –> stiff joints –> difficult to walk –> can’t find job