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SO2003 Lecture 11:Experiencing Health and Illness

29 October, 2007

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Lecture Outline

Sociology’s relationship to medicine

Structural-functionalism Parsons’ view of the doctor-patient

relationship

The ‘biomedical model’ Obesity as epidemic?

Sociological criticism of biomedicine

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Sociology and medicine

Theoretical impetus US and UK

Medicine’s influence on sociology Inherited medicine’s value judgements Topics reflected an implicit medical template ‘Older’ science dominant Research reifies the authority of the

profession – e.g., The Student Physician: Studies in the Sociology of Medical Education (Merton 1957)

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Structural-functionalism

Sees society as a harmonious set of interrelated institutions Each serves its own function

Parsons’ The Social System (1951): Harmony maintained via social roles Illness is a form of deviance The ‘sick role’ ensures social order

Specific rights/obligations for the patientMirrored in the ‘physician role’

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The ‘sick role’

Criticisms include: ‘Motivatedness’ Entry into the sick role not straightforward Certain forms of illness are stigmatising Pertains only to acute conditions

(Gallagher 1976) Conflict is common (Friedson 1988)

But concept is valuable as a challenge to the biomedical model

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The biomedical model

Focuses on the body of the sick person (i.e., a reductionist model)

Based in the ‘doctrine of specific aetiology’ (Dubos 1960)

Sees disease as culturally universal Claims scientific neutrality Rising prestige of medical specialists Hospital represents pinnacle of medical

practice

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The sociological critique

Causes of illness are often partly social Biomedical model defines them in

individualistic terms Patients are deemed responsible for

‘failed’ treatment

Doctrine of specific aetiology rarely provides a complete explanation

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The sociological critique

‘Disease’ is far from universal Changes over time: medicalisation

Definitions, descriptions, understandings, and interventions become medical

Numerous examples: e.g., childbirthVarious factors: e.g., emergence of medical

specialty, patient demands, politics, trends Current concerns about the ‘obesity

epidemic’Contradictory evidence is problematicCultural imagery is relevant

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Fat Imagery

Disgust involves fear and moral judgement (Miller 1998)

People may react to corresponding panic via humour

‘Fat drag’ now fills the cultural role of ‘black face’

Both ‘race’ and ‘obesity’ are social constructs (Campos 2004)

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The sociological critique

Medical practice is less than value-free May aim to be unbiased, but still normative

in practice Factors like class influence consulting

behaviours (Cartwright and O’Brien 1976) Normative judgements also affect treatment

(Jeffrey 1979)

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The sociological critique

Medicine conceptualised as a form of social control

Foucault (1973; 1977): Power operates through surveillance/self-

surveillance and individuation (New) medical knowledge establishes norms

against which all can be judged

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Tomorrow…

Some implications for inequalities in health Patterns associated with gender, age and

class

Variations in people’s understandings of ‘healthiness’, and Beliefs about how to become/stay

healthy