Social Constructionism and Health

Sociologists in medicine- collaborate closely with medical doctors to solve practical

problems in medicine
Sociologists of medicine- committed to use issues of health, illness and healing as a
window to help us understand larger sociological questions
Disease- the biological condition
Illness- the social meaning of the condition
These distinctive terms are examples of how all aspects of health and illness are wholly
shaped by biological as well as social factors
Medical sociologists are interested in
How we understand the biological abnormalities in our bodies
How we respond to illness
How we interact with medical professionals
How we deliver our health care
The Cultural Meanings of Illness
o Abnormalities in our bodies are often tied to rational and acceptable responses,
however, we never really think of how much of these responses tend to be a result
of the exposure to our specific societies
o For example, Sontag mentioned cancer and how it holds a rather negative
connotation, related to evil
o There are survivor movements, as seen with former breast cancer patients,
however, in spite of the general positivity that roots from this, there are
those who are alienated. Such as individuals who have the illness recur or
those who believe their own experiences were not extreme enough to take
on the title of survivor
o Goffman 1963 Stigma- an attribute that, according to prevailing social norms, is
deeply discrediting, marks a person as tainted, and allows the target to be
denigrated (criticized)
o Frequently stigmatized illnesses:
Epilepsy
Cancer
Mental illness
HIV/AIDS
Sexually transmitted diseases
o Link and Phelan 2001 Stigma- the co-occurrence of its components ( labeling,
stereotyping, separation, status loss, and discrimination) and suggest the power
must be exercised stigmatization to take place
o Stigma can be viewed in high or low levels and different stigmas can be
associated with a specific subject
o Lung cancer generally has high levels of stigma, being linked to smoking,
and is applied to both smokers and non-smokers

o Mental illnesses have a range of stigma level

EXAMPLE: more negative attitudes towards schizophrenia than to
depression due to the violence that espouses schizophrenia
Parents would rather have their child in the same class as a child
with depression, as opposed to a child with ADHD
The opposite happens if the child is able to befriend one of
the two children (depressed or adhd)
o Meaning is often changed with social interactions over time, resulting in
how some illnesses are viewed differently presently
Masturbation was once an illness
Drapetomani: the mental illness the causes black slaves to flee
captivity
Homosexuality was once considered a disorder in the DSM until
1973 when the gay rights movement took place
Still not completed eradicated as the APA developed the
ego-dystonic homosexuality disease, wherein a person
who has homosexual feelings wants to be heterosexual
The Distinction between the Normal and Abnormal
o Often times, social behaviors that are identified as deviant are not inherently
deviant or are wrong in any way, but they just deviate from what are considered
social norms
o These are norms that are forcefully placed upon us with a great sense of
importance to lead a regular life
o Szasz did not think that mental illness was a thing since it lacked characteristics
that characterize illnesses- biological deviation
o They are more so problems faced while living and are simply reactions to
an abnormal world. But the individuals with these issues are not abnormal
themselves
o Scheff 1966 believed that we all expressed deviant behavior at one point or
another
o Being mentally ill is just a social role placed upon individuals, thereby
causing people to act in a self-fulfilling prophesizing manner to uphold the
typical behaviors of the illness
o Link and colleagues still believe that labeling is a direct cause of mental illness
o Stereotypes play a very powerful role, creating restraints that others in
society place upon them and those that they place upon themselves
Since labeling makes it seem that the illness is a part of their
identity, they tend to fear rejection from their own community, in
both personal and professional realms
This applies to those who encounter the mentally ill; they, with the
stereotype in mind, often allow notions to take over before they
can get close enough to those with the issues to know them as the
individual that they are an not simply a walking, breathing version
of the label

o Medicalization plays an important role as they often are simply sources of power
as people with this capability completely disregard religion and law to determine
what is considered ill
o Power tends to shape what is abnormal
In the past, societies tend to medicalize womens problems because
of the fallacious beliefs that women are in more need to be fixed
EXAMPLE APA decided to include premenstrual
syndrome (PMS) as a psychiatric disorder in 1986,
meaning that all women could have a mental illness
Corresponds to the cultural position of people and meaning
of certain roles (such as gender)
o Pharamceutical companies play in this as well
They often market certain medications for people with very mild
conditions, making symptoms indications of certain illnesses
EXAMPLE: GlaxosmithKline marketed a drug that was
meant for severe anxiety, but due to the lack of potential
buyers, they marketed the drug with milder version of the
condition as a cure.
o Whoever experiences any anxiety would technically
have seasonal anxiety disorder or general anxiety
disorder
o Definitions of normal behavior is constructed within social context, shaped by
certain power towers, allowing certain groups to be capable of defining what is
wrong and what is not
o All while, others with the lower power become subject to this coercion
of labeling and definition
How Illness Responses are Embedded in the Community
o Culture plays a huge role in how we react to illness, giving up a proper frame for
how a normal reaction should be
o Culture is located in the realm of expectations, values, ideas and belief systems
(according to anthropologists)
o Network Episode Model (NEM) views that help seeking behavior is a
phenomenon that is assignment meaning within social networks
o The illness career and importance of social networks interplay, shaping the health
care in certain realms
o Individuals encounter multiple pathways when it comes to mental health
treatment
o Choice (choose to enter treatment because they recognize a problem
themselves)
o Coercion (forced into treatment because those around them recognize a
problem)
o Muddling through (refers to individuals who neither actively seek out
treatment nor actively reject it. They somehow end up in treatment)
o The interpretations of symptoms of what should be done is often embedded within
communities

o There have been contradicting views that either social networks help catalyze
mental health treatment or that they hinder the use of the services
o To fully understand the importance of social networks, we must consider the
ideas, beliefs, and values held by individuals who are associated with certain
networks
o EXAMPLE: large social networks in Puerto Rico often delay or halt
seeking mental health services since people in these networks are usually
of lower class and ethnic minorities, they have less positive views on such
services.
o Ethnicity and language capture cultural characteristics
o Language is a carrier of culture itself
o Adherence of Asian cultural values actually decreases use of counseling
o We must consider whole cultural systems of beliefs and attitudes to completely
understand why certain individuals do or do not use services
o Cultural mapping- identifies cultural boundaries by showing how individuals
discriminate between different providers in the medical marketplace
o There is no real correct method of reacting to illness, more so what is common
to our communities
How Medical Knowledge Itself is Impacted by Social Factors
o Freidson (sociologist) saw that the medical profession, though does reflect
biological facts, is also reflective of social aspects.
o Lay impressions of illness are seen in social context wherein people make
assumptions of deviations in relation to themselves or others who are healthy.
o Lay beliefs show how medical knowledge is an amalgamation of experiences in
the community and what is taught from medical education
o There is a fact that heart disease typically does not occur for women until
around the time of menopause and because of this being in the knowledge bank
for physicians, the wrong diagnoses are made early on, thereby continuing the
validity of such occurrences.
o Mid-1980s there was a renovation in the field of medical research, wherein
genders and race were considered, lessening the reliance on assumption for
diagnoses.
Strengths and Weaknesses of Social Constructionism