Social and biomedical models of health and illness

Question 1

What is the biomedical model?

Answer 1

• Mind and body treated separately
• Body can be repaired
• Knowledge is objective: neutral and distinct from the social context
• The model that we are meant to used and influenced by as physicians

Question 2

What is the social model?

Answer 2

• Medical knowledge is a sociological construct
• mind and body: holistic approach
• shaped by wider-socio economic context

Question 3

Why are the definitions of health important?

Answer 3

• The definition of health we choose has consequences for how we seek to improve health
• Definitions of health that focus on the absence of disease result in medical services to treat disease. Such health services are almost entirely medical services.
• Definitions of health that focus on the wider determinants of disease result in different kinds of interventions.

Question 4

What is the significance of health for society?

Answer 4

The significance of health for society:
“the capacity of the organism, or its propensity, to undertake successful goal orientated courses of behaviour” (Gerhardt 1989 p.6).
Health is “vital, because the capacity of the human individual to achieve is ultimately the most crucial resource” (Gerhardt 1989) (p.6).
This view eventually merged with the perspective taken from physiology that illness constitutes deviance from systems equilibrium

The social nature of the human condition also means that illness has a double impact on both physical bodies and the social functioning of the ill person.

Question 5

What is a social norm?

Answer 5

Social norms are shared standards of acceptable behavior by groups. Social norms can both be informal understandings that govern the behavior of members of a society, as well as be codified into rules and laws.

Question 6

What is deviance?

Answer 6

Non-conforming to social norms. Behaviours acceptable in one culture might be a deviant in another. Illness is technically a deviance as it disrupts the social system by inhibiting peoples performance of their normal social rules.

Question 7

What is the patients role?

Answer 7

On the patient’s part they have a right to reduced role performance, expectations and to receive support so long as they do not malinger (trying to get sympathy) within the sick role

Question 8

What is the definition of impairment?

Answer 8

any loss or abnormality of psychological, physiological or anatomical structure or function

Question 9

What is the definition of a disability?

Answer 9

a restriction or lack (resulting from an impairment) of ability to perform an activity in a manner or within the range considered normal for a human being

Question 10

What is the definition of a handicap?

Answer 10

a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfilment of a role that is normal (depending on age, sex and social and cultural factors) for that individual

Question 11

What is labelling?

Answer 11

• Doctors as a profession are responsible for not only constructing but also for selecting and applying diagnostic labels.
• People’s conditions can come to dominate the perceptions that others have of them and how they treat them.

Question 12

What is stigma?

Answer 12

• Goffman, E. (1961). Stigma: notes on the management of a spoiled identity. New York, Doubleday Anchor).
• ‘Tt is a question of conformance, not compliance’
• Can be enacted or felt (Stigma and deviance can either be enacted or felt (denote internalised shame, fear of being discriminated)
• He talks of being discredited or discreditable
• ‘To display or not to display; to tell or not to tell; to lie or not to lie: and in each case, to whom, how, when and where’.

Question 13

What is the four criteria of good care?

Answer 13

1. Co-participation in care and the patient as decision maker
2. Acceptance of an open agenda
3. Holistic rather than biomedical orientation: ‘persons’ in context’ rather than managing disease
4. Development of counselling skills: awareness of impact of illness and advising on coping strategies

Question 14

What is the medical model?

Answer 14

• Taken for granted way of thinking about sickness and disease is referred to as the medical model
• A particular view of the causation of illness and physical malfunction
• Biochemical process and not related to the individual’s social life
• Increasingly applied to other areas of social life and behaviour which become tangentially linked to a biological understanding
• Not simply a product of biological imperative, but as aspect of wider social expectations and control
• Failure to conform to these expectations may lead to a diagnosis of disease and legally sanctioned treatments to enforce conformity with social roles

Question 15

What are the characteristics of medicalisation?

Answer 15

Explains problems in medical terms. Consider the following examples:
Responding to social problems with heavy drinking: alcoholism
Inappropriate behaviour in the classroom ADHD
Suicide: psychiatric terms

Question 16

What are characteristics?

Answer 16

Labels and treats deviant and non-conformist behaviour
Replaced the church as guardian of social values
Defines the limits of normal behaviour

Question 17

What is a paradox?

Answer 17

• Social relationships are seen as problematic
• Brings them into a realm of surveillance
• But suggests the treatment and solutions are biological
• Ultimately it turns problems of politics and social problems into medical problems

Question 18

What is pediatrics?

Answer 18

children inherently at risk of disease or dysfunctional social relations

Question 19

What is psychiatry?

Answer 19

locates disease in a range of social relations, deviance or behavioral disorders. As most people are at risk of these, we are all potentially diseased or sick

Question 20

What is gerontology?

Answer 20

defines old age as disease. Social risk factors translated into medical problems of poor diet, alcoholism (if male) depression (if female)

Question 21

What is GP?

Answer 21

medical check ups and monitoring: disease located in social networks and between bodies, not just in them and in need monitoring

Question 22

What is the medicalisation thesis?

Answer 22

1.There are more professionals and more bureaucracies and control is being given over to these
2.Professions seek control over different domains of expertise
3.Professions control definitions and establish the criteria by which the work is to be interpreted as good or bad.
4. It is the nature of professions to expand their empire and seek dominance in other aspects of social life
5.The needs covered by each profession are subject to indefinite expansion.
6. Any profession is capable of limitless expansion
7. Professions tend to see problems as properties of an the individual
8. Even conditions that seem to be medical are in fact products of social forces
9.Clients are addicted to the products provided by the professions and demand an ever increasing range from the same professionals

Question 23

What is Iatrogenesis?

Answer 23

Clinical
essentially refers to the unintended side effects of modern medicine.

Social
leads to nothing other than the ‘expropriation of health’

Cultural
health professionals have an even deeper, health denying impact that removes people’s ability to deal with their weakness and vulnerability

Question 24

What are some criticisms of medicalisation?

Answer 24

1. Historical naivety
2. Over simplistic view of medicine
3. Under estimate the degree to which modern medicine has been successful in eradicating disease.
4. The addiction of patients to modern medicine is considerably over stated.