Essay #2 - Sociology of Medicine
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medical_sociology_chapter_6__7.pptxChapter 6
The Experience of Disability, Chronic Pain, and Chronic Illness
Defining Disability
World Health Organization definition:
“any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner . . . considered normal.”
impairments: “disturbances in body structures or processes which are present at birth or result from later injury or disease . . . [and which cause] loss or abnormality of psychological, physiological, or anatomical structure or function”
Defining Disability (cont.)
Medical definition: impairment within the individual mind or body
Sociological definition: restrictions due to social responses to unusual bodies and to the built environment
People With Disabilities as a Minority Group
Minority group – any group considered inferior, subjected to unequal treatment, and having a sense of itself as object of discrimination
Prejudice: unwarranted suspicion, dislike, or disdain due to group membership
Stereotypes: oversimplifications
Discrimination: unequal treatment
Consider: Disabled People as a Minority Group?
Do people with disabilities fit the definition of a minority group? Explain.
Imagine that you work with a group that advocates for disabled people. What are the advantages and disadvantages of using the minority group concept in your work?
The Social Distribution of Disability
Twelve percent of noninstitutionalized adults in the United States
Rates have increased over time
Most common among poorer persons, older persons, African Americans, and Native Americans
Percentage of Americans With Basic Activity Limitations
Source: National Center for Health Statistics (2010b).
Understanding Chronic Pain
A symptom, not an illness
Most common underlying reason for disability (ages 18-65)
Treatment is notoriously difficult
Treatment is affected by age, ethnicity, gender, income
Living With Disability and Chronic Illness
Initial symptoms and diagnosis
Illness behavior: process of defining, interpreting, and responding to symptoms
Predicting Illness Behavior
Biographical Disruption, Fracture, and Flow
Disruption: struggle for new meanings
Fracture: shifts in daily life
Flow: Continuity
Health Belief Model and Medical Compliance
Group Exercise
Use the health belief model to help understand why someone you know does – or does not – comply with medical advice in a given area (e.g., wearing a helmet, taking prescribed drugs).
Use of Alternative Treatments, by Type
Source: Barnes, Bloom, and Nahin (2008).
Use of Alternative Treatments, by Reason
Illness, Disabilities, and Social Relationships
Can strengthen or strain relationships with friends, relatives, and colleagues
Physical challenges
Social challenges
Financial challenges
Managing Stigma
Stigma: social disgrace of having a discrediting attribute
How do individuals manage stigma?
Health Social Movements
Collective efforts to bring about change in health arena
What are their goals?
Why the recent increase in these movements?
The Body and the Self
Illness and disability affect the self-concept
Positive and negative changes
Illness and disability affect men and women differently
Chapter 7
The Sociology of Mental Illness
The Epidemiology of Mental Illness
Unusual behavior found in all societies
31 percent of working-age adults report disagnosable mental illness
Major depression and alcohol problems most common
Social Stress and Mental Illness
Possible cause: Acute stress and life events
More likely cause: Chronic stress
Ethnicity and Mental Illness
Few ethnic differences in rates of major mental illness
However, chronic stress linked to psychological distress among African Americans (little data on others)
Protective effects of Hispanic culture?
Gender and Mental Illness
Men: higher rates of paranoid schizophrenia, substance use, and impulse control disorders.
Women: higher rates of mood disorders (depression) and anxiety disorders.
Effect of sex-role socialization?
Sex, Race, and Class – Risks of Mental Illness
Social Class and Mental Illness
Strong and consistent link
Social stress theory: class-based stress leads to mental disorder
Social drift theory: mental problems leads to lower social class (weaker support)
Discussion: Stress and Disparities in Mental Illness
How does social stress help explain class, gender, and race differences in mental illness?
Models of Mental Illness
The Problem of Diagnosis
Diagnosis is subjective and susceptible to social expectations
Rosenhan’s Experiments
Cultural Variations
The Politics of Diagnosis
The Diagnostic and Statistical Manual of Mental Disorders (DSM)
Why has the DSM changed over time?
Who benefits from these changes?
What are the problems with reliability and validity?
Discussion: Models of Illness
Critique the medical model of mental illness, using evidence from the textbook.
A History of Treatment
Before the Scientific Era
Normalizing mental illness as eccentricity
Religious authorities either punish (sins) or treat
Capitalism and almshouses
The Rise and Decline of Moral Treatment
Moral treatment through kindness and sensitivity
The Great Confinement
Early Treatment
Device invented by Benjamin Rush to treat mental illness
A History of Treatment (con’t)
Freud and Psychoanalysis
Emphasized emotional roots of mental illness
Supported male supremacy
High costs of psychoanalysis lead to cheaper physical interventions
The Antipsychiatry Critique (Goffman)
Mental hospitals as total institutions: large institutions, regimented lives, segregation from outside world
Self-fulfilling prophecy: patients become what others expect of them
Mortification: self-image is damaged and replaced by a personality adapted to institutional life
Role of patient becomes a master status
Depersonalization
Deinstitutionalization
Causes of deinstitutionalization
Changes in health care financing
Rise of individualism
Not due to new medications
Effects of deinstitutionalization
Positive and negative
Remedicalizing Mental Illness
“Biological revolution”
Based on correlations between brain abnormalities and serious mental illness
Applied to minor mental disorders as well
Consider: The Rise of Managed Care
How has managed care helped mentally ill persons?
How has it hurt them?
Becoming a Mental Patient
Self-labeling
Aligning actions and snowballing
Feeling work
Labeling by family, friends, and the public
Accommodation
Labeling by the psychiatric establishment
Assumption of illness
The Post-Patient Experience
Benefits of treatment
Hazards of stigma
