Health as a social Construct: is every illness a disease

Question 1

define differential diagnosis?

Answer 1

is a process where a doctor differentiates between two or more conditions that could be behind a person’s symptoms.

Question 2

what are Marinker’s three levels of Health and Illness?

Answer 2

disease – a physical pathological process - deviation from biological norm
viewed ‘objectively’; measured and tested
Medical system in the foreground
Individual experience in the background
This view can cause damage to the patient
(e.g. by unnecessary intervention or by
ignoring their need for understanding)

illness – a personal experience of feeling unhealthy (subjective) (sometimes exist when no disease can be found)

sickness – having a disease
Social position of the ‘sick person’
Different social status of sickness in relation
to other existing hierarchies (gender/ age/
hospital vs. community care)
Negotiation of individual’s duties and need for
support
Involving the state/ worker’s rights
Medical system as gatekeeper (‘fit note’)

Question 3

what is the WHO Definition of Health?

Answer 3

“A state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”

Question 4

what is the WHO Definition of Mental Health?

Answer 4

Mental health is defined as a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

Question 5

what is the germ theory of health and disease?

Answer 5

Germ theory
debunked spontaneous generation theory
Germ theory lead to biomedical model of disease
Germ theory led to great improvements in
medicine (hygiene, antibiotics…)
Also led to a wider search for the specific
origin of illness (e.g. bacterium, virus, toxic
chemical, hormonal imbalance)

Potential consequence:
Target all research and interventions at this
causal agent
Focus on individual body, not environment

Question 6

what is the Biomedical model of disease?

Answer 6

• Each disease has a single specific cause
• Focuses on the physical biological factors (biochemistry, pathology, physiology) and excludes psychological, environmental and social influences.
• Target all research & interventions at this causal agent i.e. germ, radiation, toxic chemical, gene (i.e. using human genome project)
• considered to be the predominant model of diagnosis in western medicine

Question 7

what is the biomedical model of illness?

Answer 7

How should illness be treated ?
Vaccination, surgery, chemotherapy

Who is responsible for treatment?
Medical profession

What is the relationship between illness and health?
Health and illness are qualitatively different. No continuum between the two,

Question 8

what are the multi-causal models of illness?

Answer 8

Examples for possible causes:
– Body (e.g. genes, immune system)
– Microbes (bacteria, viruses)
– Behaviour (food choices, smoking)
– Physical environment (pollution, walkability)
– Social environment (e.g. lack of support)
– Wider society (inequality, crowded housing)
What are the ‘causes of the causes’? (Marmot 2018)

Question 9

what is a social construct?

Answer 9

an idea that has been created and accepted by the people in a society

Question 10

what is health as a social construct?

Answer 10

• Sociologists claim health and illness are social constructions because the concepts mean different things to different people.
• Therefore, health and illness cannot be objective scientific facts.
• Not everyone experiences symptoms in the same way
• Different societies have different methods of diagnosis and treatment
• Constructs are under moral, social and religious influence (e.g. homosexuality, suicide)
• Illness is not randomly distributed

Question 11

how is medicine and science a social process?

Answer 11

Disease categories are not created independently from social or moral forces.
This does not mean medicine is ‘unscientific’ BUT that medicine and science are social processes.

Question 12

how can health be a relative (societies)?

Answer 12

Different societies can differ widely in their beliefs about the causes and solutions to illness.
They can also differ in terms of the levels of discomfort and pain that are considered as normal.

Question 13

what are the 2 critiques of biomedicine?

Answer 13

Medicalisation (Conrad)
Iatrogenesis (Illich)

Question 14

what is medicalisation?

Answer 14

The process by which non-medical problems become defined and treated as medical problems e.g. homosexuality, obesity, stress, infertility, alcoholism.

Question 15

what are the different levels that medicalisation can occur on?

Answer 15

Interactional - Dr–patient interaction when a social problem is defined as a medical one & medical treatment occurs
Conceptual - medical vocab used to define a problem, signs and symptoms become medicalised e.g. ADHD, Dyslexia etc.
Institutional – when organisations adopt a medical approach to treating a problem e.g. alcoholism, mental health, pregnancy and child birth (reduce people to their medical conditions)

Question 16

explain the shifting engine of medicalisation?

Answer 16

Conrad: used to be doctors responsible.. now its the pts
past drivers: professional dominance, institutions/pressure groups e.g. pharmaceutical industry
present drivers: Consumerism, the ‘care’ industry, media
E.g. medicalisation of ageing to promote anti-aging products

Question 17

define iatrogenesis

Answer 17

the harm caused by iatrogenic effects (effects of treatment) of intervention e.g. side effects of drugs, secondary infections in hospitals or negative clinical consequences of surgery

Question 18

what are the 5 different iatrogenic effects?

Answer 18

clinical/medical incompetence – medical errors, mis prescribing medication, misdiagnosis, surgical error,

cascade iatrogenesis – serial development of multiple medical conditions as a result of initial medical treatment e.g. someone going to hospital to have a benign lump removed and then they develop a hospital infection for which they are treated for but then have side effects from antibiotics (cascade occurring)

social iatrogenesis: medicalisation

cultural iatrogenesis: ability to cope with illness or death is eroded by handing over to professionals

Structural iatrogenesis: loss of autonomy and ability of self-care leading to a dependency of healthcare services to function. E.g. sectioned under mental health act.

Question 19

what is the impact of Iatrogenesis?

Answer 19

Antibiotics was once a wonder drug saving millions of lives to now resulting in antibiotic resistance (and complications resulting from it)

Question 20

how has medicalisation of Madness (Mental illness) changed over time?

Answer 20

Historically individuals were labelled as mad, bad or sad
People’s behaviour came under a Moral, religious or clinical gaze
Medicalisation of peoples emotional life e.g. when does grief become clinical depression
Psychiatry came under scrutiny for being agents of social control with powers to incarcerate people such as sectioning people under the mental health act including people who refuse to take their medication.

Question 21

what is the Consequences of Labelling Study Rosenhan (1973)?

Answer 21

On being sane in insane places:
Consequence of labelling was highlighted in a study (would not be replicated today as considered unethical). The study was an attempt to identify the consequences of physiatry labelling. So pseudo patients (researchers pretending to be patients) manged to get them admitted to a psychiatry hospital where the pseudo patients sanity went undetected. Spent an average of 19 days on the ward before being released. When released they were diagnosed as Schizophrenic and not as being sane as they had already admitted themselves out. Pseudo patients took notes – found there was a complete loss of autonomy. Study highlights consequences of labelling.

Question 22

who wrote The Birth of the Clinic?
what is it about?

Answer 22

Foucault -French Philosopher wrote The Birth of the Clinic
He said the medical gaze should not just focus on the body as the location of disease but between the psycho-social space between bodies and communities
He placed an emphasis on lifestyle factors (what we eat and drink and how much we exercise) as being risk factors which are linked to diseases such as smoking
Disease not only caused by germs but also the lifestyle of people leads to things such as heart attacks etc.
Shift from hospital medicine to new forms of surveillance medicine (public health & primary care) (promotion and education of good health e.g. good diets etc)

Question 23

what is the feminist critique of medicalisation of childbirth?

Answer 23

Women are pathologized if they drink or smoke during pregnancy or are unable to breast feed
Health visitors surveillance on children 🡪 performing regular check-ups at home was seen as intrusive
Child birth changed from being in community to hospital
Obstetrics - largely male dominated