Sociology - Experience of Chronic Illness

Question 1

What is the social underpinning of illness?

Answer 1

Social experience and values underpin the exprience, expression, prevalence and outcomes of illness.
Illness is embedded within our body and experience, impacts how we interact with society.
Difference societies will have different understandings, definitions, action and health care expectations/resources of care around illness.

Question 2

What is the definition of a chronic illness?

Answer 2

Conditions lasting one year or more
Require ongoing medical support or limit activities of daily living or both.

Question 3

How does chronic illness affect a person broadly speaking? (sociology)

Answer 3

Impacts on self
Changes our view on who we are, what we should feel and what we should be able to do.
Need to remake sense of themselves and their world through the new lense of having a chronic illness.

Question 4

What are the ten most common chronic conditions in the UK?

Answer 4

Hypertension
High cholesterol
Arthiritis
Ischemic/Coronary Heart Disease
Diabetes
Chronic Kidney Disease
Heart Failure
Depression
Alzheimers Disease and Dementia
COPD.

Question 5

What is the demand on health care from long term health conditions?

Answer 5

Make up 15m people in England
50% of all GP appointments
64% of all outpatient appointments
70% of all inpatient bed days
Greates increase of demand is expected in those with co-morbidities

Question 6

What are the most common categories of long term health conditions?

Answer 6

Cardiovascular
Musculoskeletal
Depression

Question 7

What is the relationship between socioeconomic status and long term health conditions?

Answer 7

Higher SES has a lower rate of LTC conditions
Rates of LTC are higher for women at all SES
Due to vulnerability leading to vulnerability - less likely to cope and less support available to them.

Question 8

How does the prevalence of multimorbidity change with age and socioeconomic status?

Answer 8

As age increases the rate of multimorbidity also increases
All all ages the rates of multimorbidity are higher in lower SES groups.

Question 9

Why might Chronic illness by more common in lower SES groups?

Answer 9

Access to fewer resources - less likely to cope with small health problems persists becomes worse and becomes chronic.
Disability benefit
Unemployement - lead to poverty - leads to ill-health.

Question 10

Why might long term health conditions leads to more demand on NHS resources than short term illness?

Answer 10

Increased demands
Increased coping demand
Varies in accessibility to treatment - rebook appointments to get what they need
Unmet needs - lifestyle - problem reoccurs
Discrimination - stigma - unable to get help elsewhere.

Question 11

What are the key challenges of living with a long-term health condition?

Answer 11

Chronic - repeatedly in and out of health care - may get gradually worse
Non-curative - impact on quality of life
Uncertainty - diagnostic limbo - patients feel illegitimate in illness, unable to access treatment and self doubting
Requires adaptation to require life as normal
Dealing with stigma and tackling the cultural and social norms which affect how we view ourselves and our experiences.
Cause biographic disruption to a persons life.

Question 12

Why is a diagnosis important for those living with chronic health conditions?

Answer 12

Diagnoses can increase social acceptance of illness and validate the patient experience
Enable access to treatment and support groups
Can impact identity - patients may feel like that can now understand there behaviour consequently incorrect diagnoses can act as a sticky label.
Affects identity and self perception
Affects how others react to them
Underpines the sick role - now has a disease rather than just an illness.

Question 13

What is the diagnostic limbo in chronic health conditions?

Answer 13

Diagnosis can take a long time
Non-legitmate conditions and medically unexplained symptoms may never receive a diagnosis
Some conditions have a complicated and even waiting time to their diagnosis.
Leave patients feeling angry, uncertain or upset.

Question 14

What is meant by a contested condition?

Answer 14

Medically suspect because symptoms not associated with any know physical abnormality. Physicians may not recognise or acknowledge then as distinctly medical.
May debate causes, treatment and existence.
For example; IBS, fibromyalgia, endometriosis.

Question 15

What affects the short term management of a chronic health condition?

Answer 15

Unpredictability of symptoms - may be unable to plan ahead - unsure how they will feel tomorrow
Demands of symptoms - require adjustment
Stigmatising and embarrassing symptoms - may delay help seeking behaviour or encourage social isolation
Treatment can be demanding, complex and stigmatising.

Question 16

Gives some examples of the discontinuities and change that happen to patients when they have a chronic illness.

Answer 16

Change lifestyle
Physical appearance
Social roles and relationships
Social isolation
Family impact
Personal goals and development (reduced career prospects: unemployment or under-employement)
Change self identity.

Question 17

What is meant by biographical disruption caused by chronic illness?

Answer 17

The disruption, destabilising and questioning of identity after the onset of chronic illness.
Plans for future are in doubt
Future is doubtful and pase feel strange and unreachable

Question 18

What is meant by identity?

Answer 18

The distinctive characteristics of a person character or the character of a group, which relates to who they are and what is meaningful to them.

Question 19

How does chronic illness affect identity and self?

Answer 19

Changes view of self and position in society
Low self esteem, crumbling idea of self
Often feel a shift from independent to dependent
Highly influences by stigma around diagnostic labels.

Question 20

What is meant by narrative reconstruction in chronic illness?

Answer 20

Changing routine after a chronic illness diagnosis to make better sense of their life now.
Story of when what and why the illness happened to help them make sense of it and cop with it.
This reconstruction of the illness can include or exclude the diagnosis.

Question 21

When might chronic illness not be considered disruptive?

Answer 21

Viewed as a normal part of ageing a normal crisis.
Normal crisis for certain groups within society.
Is strong familial link may have developed at a young age or have expected diagnosis and prepared well in advance.
Depends on experience, the meaning of chronic illness and expectations of that patient.

Question 22

What is meant by stigmatising illness?

Answer 22

When ceratin conditions have special cultural and social meaning which they acquire through social interaction, in stigma these meaning are very discrediting and cause a negative social reaction.

Question 23

What attributes does Goffman consider stigmatising?

Answer 23

Race
Sexuality
Criminality
Illness
Disability

Question 24

How does stigma change?
How does it reflect society?

Answer 24

Stigma varies across time and place based on the attitudes of the culture
Stigma does not reflect something intrinsic to the stigmatised individual but reflects the values of those who stigmatise them

Question 25

What is meant by discrediting stigma?

Answer 25

Stigma against something that is visible or known
For example - facial disfigurement of the use of a wheelchair

Question 26

What is meant by master status related to stigma?

Answer 26

Any status (position, role, attribute) that overshadows all others of a person in social situations (job, religion etc)
Can be positive, negative or neutral
In chronic illness the illness often becomes the master status - viewed as an illness with a person on the side either than a person with an illness. Is defined by their illness.

Question 27

What is discreditable stigma?

Answer 27

Difference is not immediatly apparent e.g being HIV positive
Can be managed or hidden to avoid stigma
Can become discrediting stigma is people find out
Living under constant threat of exposure can be very stressful, can encourage help delay behaviour.

Question 28

What is enacted stigma?

Answer 28

External or actual stigma - first hand experience of unfair treatment by others

Question 29

What is felt stigma?

Answer 29

Internal or self stigmatization - fear an individual may have they they and their condition may be viewed negatively
Often worse when this condition is hidden.

Question 30

What are the different strategies used to manage stigma?

Answer 30

Passing - attempt to pass as normal (applies to discreditable stigma)
Covering - discrediting stigma may attempt to play down the conditions
Withdraw - avoid contact with people outside their minority group.

Long term direct and indirect effects, inc stress, have long term health consequences

Question 31

Why are certain chronic conditions stigmatised more than others?

Answer 31

1. The cause of the condition is perceived to be the bearers responsibility (obesity, alcoholism)
2. Percieved as contagious (HIV)
3. Percieved as dangerous (schizophrenia)
4. When a condition is really visible and perceived as repellent, ugly or upsetting (Parkinsons disease or epilepsy)

Question 32

What are the practical implications of stigma?

Answer 32

Seek advice and treamtent - less likley, feel ridiculed, mistreated or blamed
May be refused access to treatment or symptoms not acknowledged if no biological cause
Over-use of contested illness diagnosis - symptom mismatch, confuse the patient
Condition underfunded
May have difficulty accessing disability benefits
May not apply to illness behaviour
Management plans may not apply to the patient.