Chapter 1

1. Chapter 1 Ways of Thinking Sociologically about Health, Illness, and Medicine

2. the definition and issues of interest in the Sociology of Health, Illness, and Medicine • four different approaches (theories) to doing sociology in general, and doing the sociology of health, illness, and medicine specifically: structural–functional, conflict, symbolic interactionist, and feminist/critical race theory • how each approach involves a fundamentally different paradigm, or way of seeing, involving the important issues in sociology as well as some distinct methodological strategies. In this lecture you will learn…

3. Overview of Sociology of Health: Definitions • The sociology of health and illness seeks to describe and explain: • social causes and consequences of illness, disease, disability, and death • how people and professionals construct illness • how illness affects and is affected by social interaction • how medical systems are organized, structured, and financed • the occupational roles of health-care providers such as doctors and nurses. • See Table 1.1 for topics in the sociology of health

4. Central Sociological Perspectives • Sociologists study the social world from a variety of perspectives. • See Table 1.2 (The Four Central Sociological Perspectives) • Depending on their perspective, sociologists focus on some aspects of social life and ignore others. • Sociologists also ask different questions and use different methods to answer them. • All of these different sociological perspectives are used to explore the sociology of health.

5. Structural Functionalism: Introduction • Émile Durkheim provided the theoretical and methodological model for structural functionalism. • For Durkheim, sociology is a science of social facts. • Social facts are social forces external to individuals, yet capable of constraining and directing human behaviour. • Constrained by the external world, human beings are predictable and controllable through the power of norms that exist in their own right.

6. Structural Functionalism: Introduction con’t • Structural functionalism assumes that the proper level of study for the sociologist is the society or the system. • Institutions—the family; the economy; the polity; and the educational, welfare, military, and medical care systems—function to maintain order in the social system. All these institutions operate interdependently to keep the society functioning.

7. Structural Functionalism: Five Assumptions • Structural functionalism aims to discover and explain the impact of social facts on human behaviour. • Social facts are to be treated as real and external to human actions. • Social facts can be seen in various aspects of the social structure—the norms that guide behaviour, social institutions such as the family or the economy, and social behaviours such as those in relationships.

8. Sociology is a science that seeks to describe the world in a series of universal causal laws. • Structural functionalism believes that human behaviour is objectively and quantitatively measurable through methods such as experiments and survey research. Structural Functionalism: Five Assumptions, cont’d

9. Structural Functionalism: Sick Role • One of the most influential contributions structural functionalism has had to the sociology of health is through Parsons’ work on the ‘sick role’ • Parsons describes the processes that maintain societal institutions—his notion of the sick role must be looked at in this context. • Sickness could lead to societal breakdown if the sick are unable to fulfill their necessary social roles, such as parenting, maintaining a home, and working in the paid labour force. Therefore…

10. Sickness must be managed and accorded a special, temporary role, contingent on the fulfillment of certain obligations by the individual who claims the sick.

11. Structural Functionalism: Sick Role, cont’d • There are four components to the sick role (these components must be fulfilled if the equilibrium of society is to be maintained). A sick person: • is exempt from ‘normal’ social roles • is not responsible for his or her condition • should try to get well • should seek technically competent help and co-operate with the physician.

12. Structural Functionalism: Sick Role, cont’d • Parsons’ formulation of the sick role was primarily theoretical • Empirical analysis has led to a number of criticisms • A sick person: • is not necessarily exempt from ‘normal’ social roles • the extent to which a person is allowed exemption depends on the nature, severity, and longevity of the sickness

13. Structural Functionalism: Sick Role, cont’d • may be held responsible for her or his condition • A person with lung cancer may be held responsible if he/she has smoked. • should want to get well; there are illnesses, however, from which people cannot or are not expected to recover. In these cases, trying to get well is not a logical course of action

14. Structural Functionalism: Sick Role, cont’d • may not seek technically competent help and co-operate with the physician. • The dominant medical care system—i.e., allopathic medicine, or ‘Western’ scientific medicine—is the type of treatment most likely to be defined as ‘competent’ and claims a monopoly on the right to provide treatment and thus to legitimate sickness. • There exist, however, competing medical systems with varying and growing degrees of legitimacy. These are called complementary and alternative medicines (CAMs).

15. Structural Functionalism: Sick Role, cont’d • Despite these criticisms, the concept of the sick role is important in medical sociology. • Parsons was the first to explicitly argue that there are ways in which medical practice, medical ideology, and medical institutions serve to fulfill social control functions in a society. • Therefore, Parsons provided an analysis of sickness from a distinctly sociological point of view.

16. Conflict Theory: Introduction • Conflict theory, based on the writings of Karl Marx, focuses on class-based power relations and dynamics. • Like structural functionalism, conflict theory focuses on the social system; however, it involves the documentation and analysis of social injustices resulting from such factors as class, race, and gender.

17. Conflict Theory: Three Assumptions • The purpose of sociology is the documentation and analysis of injustice resulting from such factors as class, race, gender, and power. • Knowledge is never objective but always dependent on its social, material, and historical context. • Understanding conflicting social and economic forces is essential for an understanding of all the other conditions of social life.

18. Symbolic Interactionism: Introduction • Symbolic interactionism, based on the writings of Max Weber, is the study of how social reality is constructed and experienced by individuals in society (social actors). • It suggests that since all social reality is subjectively defined and experienced, it can be studied only through the subjective processes of social researchers or through empathetic understanding (verstehen).

19. Symbolic Interactionism: Introduction, cont’d • Symbolic interactionists: • ask questions like: What is the meaning of illness? Does a cancer diagnosis have the same impact on an 80-year-old man or woman that it does on a 17-year-old? • collect data through observing social action while working closely with subjects (participant observation) or through long, unstructured interviews • study individual interactions with others or the self, rather than with social systems as do structural functionalists and conflict theorists.

20. Feminist and Critical Race Theory: Introduction • Gender and race are at the centre of this theoretical approach. • Feminist and critical race theory and research assume: • men and women of different racial groups occupy different places in the social structure • men and white people tend to dominate in all institutions in society • sociology, including the sociology of health, has historically reflected male and white dominance with respect to subject matter and styles of theorizing and research.

21. Feminist and Critical Race Theory: Introduction, cont’d • Feminist and anti-racist researchers theorize about the social world so that gender and race (along with other cross-cutting inequities such as class and sexual orientation) are always central focuses.