Chronic Illness Flashcards
How is the sociological approach to chronic illness distinct?
Focuses on how chronic illness impacts on social interaction and role performance
Concerned with experiences and meanings of chronic illness - a ‘negotiated’ reality
Interested in how people manage and negotiate chronic illness in everyday life
What are illness narratives?
“Illness narratives refer to the story-telling and accounting practices that occur in the face of illness”
Much of sociological research on chronic illness is based on people’s narratives of their illness
These narratives offer a way of making sense, and they perform certain functions
Give some details about getting a diagnosis in terms of a chronic illness
May be a prolonged period of uncertainty Ambivalent status of some diagnoses (e.g. chronic fatigue syndrome...) Process can be very unpleasant Diagnosis can be: - Profoundly shocking - Very threatening - A relief
Describe what is meant by illness work in relation to chronic illness
Managing the symptoms
Central to the coping task is dealing with the physical manifestations of illness
This has to be done before coping with social relationships
Interaction between the body and identity
Body changes leads to self conception changes
Describe what is meant by everyday life work in relation to chronic illness
Coping and strategic management
Coping - the cognitive process involved in dealing with illness
Strategy - actions and processes involved in managing the condition and its impact
Decisions about the mobilisation of resources and how to balance demands on others and remain independent
Normalisation
- You can try and keep to your pre-illness lifestyle and identity intact (e.g. by disguising or minimising symptoms)
- Or redesignate your new life as “normal life” - this may involve people signalling changes in identity rather than preserving the old ones
Describe what is meant by emotional work in relation to chronic illness
Work that people do to protect the emotional well-being of others
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
Impact on role:
- Impact on role may be devastating (breadwinner,
wife, mother etc…)
- Dependency - feeling useless to self and others
- May be especially devastating for young people
Describe what is meant by biographical work in relation to chronic illness
Loss of self
Former self-image crumbles away without simultaneous development of equally valued new ones
- Constant struggle to lead valued lives and maintain
positive definitions of self
- Argued that focus on physical discomfort minimised
broader significance of suffering for people with
chronic illness
Interaction between body and identity
Biographical disruption
Chronic illness as a major disruptive experience
Threatens sense of taken-for-granted world
New consciousness of the body and fragility of life, grief for a former life
Biographical shift from a perceived normal trajectory to an abnormal one (Change in plans for future)
Describe what is meant by identity work in relation to chronic illness
Different conditions carry different connotations
Affects how people see themselves and how others see them
Consequence of actual and imagined reaction of others
Illness becomes the defining aspect of identity
‘Loss of self’ gives rise to 4 dilemmas:
- Scrutinise reactions of others for signs of
discreditation
- Foster dependence on others (but this strains
relationships)
- Relationships harder to maintain as illness progresses
but increasing needs require more intimate contact
- Inability to ‘do’ leads to a loss of social life
Stigma
Control of the body means we present ourselves in socially valued ways
Stigma is a negatively defined condition, attribute, trait or behaviour conferring “deviant” status
What is Discreditable and Discrediting stigma?
Discreditable
- Nothing seen, but if found out…
- e.g. mental illness / HIV +ve
Discredited
- Physically visible characteristics or well known stigma which sets them apart
- e.g. physical disability, known suicide attempt
Some conditions can be both, e.g. epilepsy
What is felt stigma and enacted stigma?
Enacted stigma
The real experience of prejudice, discrimination and disadvantage (as the consequence of a condition)
Felt stigma
Fear of enacted stigma, also encompasses a feeling of shame (associated with having a condition
- Selective concealment
What is meant by narrative reconstruction?
Process by which the shattered self is reconstructed in ways that explain the appearance of illness
Desire to create sense of coherence, stability and order in the aftermath of biographical disruption
What is meant by the work of chronic illness?
The extra work a person has to do to get on with their life after having a chronic illness
It is work because it requires time and effort
It may take years to do all of the work and many starts at it
Illness Work (symptom management) Everyday life work (managing daily living) Emotional work (managing one's own emotions and those of others) Biographical and narrative work (reconstruction of biography) Identity work (work to maintain an acceptable identity)
Briefly talk about self management in chronic illness
There is an increasing push for more self management
Optimum self-management is difficult to achieve
- Poor rates of adherence to treatment
- Reduced quality of life
- Poor psychological wellbeing
Brief interventions to improve self-management
- Delivered online/in-person/via telephone
- Vary in quality/effectiveness
What is the medical model of disability?
Disability as deviation from medical norms
Disadvantages are direct consequence of impairment and disabilities
Needs medical intervention to cure or help
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
What are disabling environments?
Disability is a function of society which fails to take account of people with impairments
‘Special needs’ only special in a particular context
- e.g. dyslexia no disadvantage except when society
places emphasis on literary skills
What are the critiques of the medical model of disability?
Lack of recognition of social and psychological factors
Stereotyping and stigmatizing language
What are the critiques of the 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 the ICIDH? And what are the problems with it?
International Classification of Impairments, Disabilities or Handicaps
Attempted to classify consequences of disease
Offered three concepts:
- Impairment: concerned with abnormalities ion the
structure or functioning of body
- Disability: concerned with performance of activities
- Handicap: concerned with broader social and
psychological consequences of living with impairment
and disability
Problems with ICIDH:
Problematic use of term ‘handicap’
Implies problems are intrinsic or inevitable
Embodied many features of the medical model, not many of the social model?
What is ICF?
International Classification of Functions
It is WHO’s framework for measuring health and disability at both individual and population levels
Endorsed for the sue as the international standard to describe and measure the level of health and disability
Attempts to integrate medical and social models, and recognise significance of wider environment
Key components are:
- Body structures and functions: and impairments of/to
- Activities: undertaken by individual, and
difficulties/limitations experienced in doing them
- Participation: or involvement in life situations, which
may become restricted
All components, and relationships between them, affected by personal and environmental contextual factors
