What does it mean to say that illness is socially constructed? Focus your discussion on the way bodily experience becomes a symbol or metaphor for social conflicts.
ANTH265
Illness and Healing
Due: 8 October by 5pm
Word count: 2,002
What does it mean to say that illness is socially constructed? Focus your discussion on the way bodily experience becomes a symbol or metaphor for social conflicts.
The notion of Illness is a socially constructed concept. This means that individual societies have unique interpretations of what illness is. These constructs are infused by social factors such as socio- economic situations, religion, and gender roles with in societies, ingrained cultural values, and most of all whom, or what group, has the power to apply the label of 'illness' within the society. Bodily experience becomes a symbol or metaphor for social conflicts when we consider the context in which it occurs. For example, in western culture, elderly are often labeled ill or unwell in order to justify committing them to homes in stark contrast to the eastern interpretation of the elderly as wise worldly and intrinsic to family health.
Social construction has been defined as "the way people view themselves and others is not natural but shaped by the society in which they live."1 People see the world not directly but through a set of conceptual lenses. However one might ask what forces are shaping social construction? The clearest illustration of illness as a social construct is through a comparison of eastern medicine and definition of illness versus western medicine and definition of illness. The Ayurvedic medicine is a more than 6,000 year old comprehensive system of medicine based on a holistic approach. This Indian medical system believes there three main Doshas (organizing qualities of intelligence). The first is Vata, which resembles the classical elements ether and air, the second is Pitta which is fire, and thirdly Kapha which is water and earth2. Ayurvedic patients are classified by body types or Prakriti, which are determined by proportions of the three doshas. Illness is considered to be a matter of imbalance in the doshas. Treatment is aimed at restoring harmony or balance to the mind-body system. One Western medicine definition considers illness to be "an impairment of normal physiological function affecting part or all of an organism"3, while the American Heritage dictionary defines illness as "Poor health resulting from disease of body or mind; sickness"4. The unparallel nature of Eastern and Western ideas of nature illustrate that illness is a fundamentally socially constructed concept.
Following this train of thought one must acknowledge the place of overlapping factors such as culture, religion, values, class, gender and powerful influential opinion leaders who have a surprising and sometimes disturbing amount of control over the social construct of illness.
In modern day western societies there is the common belief that our bodies are like machines and doctors are the mechanics, however, within the western culture, before science won out the battle over Christianity it was the religious figures that determined what was 'abnormal' or illness. Mental illness was often explained as God's punishment to sinners or even in the case of Joan of Arc, a sign of communication with god himself. In fact, the Bible's descriptions of prophets and madmen were often identical. In many early civilisations the religious or tribal leaders had the same privilege of ...
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In modern day western societies there is the common belief that our bodies are like machines and doctors are the mechanics, however, within the western culture, before science won out the battle over Christianity it was the religious figures that determined what was 'abnormal' or illness. Mental illness was often explained as God's punishment to sinners or even in the case of Joan of Arc, a sign of communication with god himself. In fact, the Bible's descriptions of prophets and madmen were often identical. In many early civilisations the religious or tribal leaders had the same privilege of determining what was considered an illness.
. In order for an illness to exist, the classification of certain characteristics or behaviours as 'illness' depends on someone interpreting and labelling them as such and having the influence to make the label stick. Groups that are organised and have access to propaganda are more likely to be successful in labelling reality. In pre-Enlightenment times, disease was viewed as the outward sign of a corrupt soul. As the Christian discourse lost credibility and truth and objectivity sought to replace superstition, medicine and modern conceptions of illness emerged.5 Physicians were able to replace religious notions of madness with medical notions of mental illness as they were more organised and influential than their competitors.6 Illness was created, or socially constructed according to an elite group's assumptions of what is 'normal'.
What constitutes as illness has changed over time. Groups in society that had previously not been considered ill had been condemned, and others that had been considered ill had been freed of the label. For example those formally seen as drunks have become sufferers of alcoholism7, and children that had problems concentrating now have ADHD. In the opposite direction, homosexuality has gone from being a mental illness to a lifestyle choice.
It has always been the key opinion leaders within a society have had great influence over what is considered an illness. These opinion leaders often have ulterior motivations behind their attitudes. Religious leaders need to defend Christianity's scripture by proclaiming homosexuality as an illness for instance. Drug company conglomerates support the idea of a high sex drive as healthy to boost sales for Viagra for commercial incentives. Even trends over the decades such as the fitness boom of the late 70's and 80's influence what is considered healthy, unhealthy, well and unwell.
Of course it is not just these opinion leaders or groups who determine the constructs of illness within a society. Various studies have suggested that social class and environment may influence and construct a person's health and illness.
The Black report8 which was published in Britain in the 1980s showed that there was a pattern to the wealth and health experienced by the different social classes, based on occupation the report showed health inequality and suggested that professionals fare better than managers, managers fare better than skilled workers and so on down the line.
The high levels of child mortality rates of the lower classes can be caused by living in poverty, damp housing, inadequate diet and little money within the family.
These issues contribute to stress and depression as the lower classes are caught up in an never ending circle where each problem contributes to another and the lifestyles seem unable to be changed. The lower classes also have the worst facilities of health care. Doctors and specialists who are able to choose the areas they work will more often choose middleclass areas where they will have the advantage of better staff and equipment.
Gender roles of societies are very important in understanding the unique social constructs of illness as often statistical results attribute illnesses to either gender and have even suggested one gender experiences more illness than another.
The apparent gender gap of illnesses is often attributed to differing gender roles. For instance, It is believed that men engage in more dangerous activities than women such as contact sports, getting into fights, having hazardous occupations and rarely consulting their doctors about their health.
Women, on the other hand, are said to not engage in violent activities and tend to consult their doctor more than men, thus statistics reveal that they suffer more ill health, as there are more records of it.
In Western society, Women tend to be more medicalised than men, in childbirth, reproduction and mental health. Women are more likely to be given anti-depressants and treated for depression. Traditionally, it is the woman, who looks after everyone in the family, carry's the added burden of stress of too many responsibilities, and in some cases results in physical and mental disorders. As victims of social and economic circumstances women tend to suffer from what is known as "housewife syndrome"9. The isolation and constant decision-making involved in housework are very stressful as is the responsibilities of looking after young children. In addition there are certain illnesses that women suffer from because of their biology because women live longer they tend to suffer from degenerative disorders.
As we can see, the social construction of illness has a long history. It has not ended though. In fact, it continues to expand, redefining non-medical problems in medical terms and proposing medical solutions. This process is known as medicalisation.
Medicalisation can be seen as "the process of defining an increasing number of life's problems as medical problems".10 This definition suggests that political, structural and a number of cultural problems are not being given political, structural and cultural remedies.
The consequences of this are cultural and clinical iatrogenesis. Cultural iatrogenesis is the dependence of the population on drugs and other treatments due to the focus on cure over prevention. Clinical iatrogenesis follows from cultural iatrogenesis. It is the side effects of drugs and other treatments, medical accidents and other 'doctor-caused illnesses', which often require treatment of their own.11
There have been many areas in life that have been medicalised. Birth is one such area. This practice used to be an event managed by the mother, her family and a midwife. Today, every stage of the pregnancy, including invitro fertilisation is monitored by a physician. The birth itself is increasingly becoming a medical procedure, with increasing numbers of caesareans. Death is another area subject to medicalisation. The process has been applied to both the dying and to those they leave behind. Most people want to die at home. However the reality is that most will die in hospital. In addition, the family and friends are assisted in following a 'healthy' path of mourning.
Another particularly useful example of the socially constructed nature of illness can be gleaned by examining the subject of sexual activity. In pre-medicine times it was monitored in terms of what was a righteous or sinful level of sexual activity. In the nineteenth century, engaging in too much sex was sign of a disease. Today, too little intercourse is problematic. As mentioned earlier, the pharaceutical company selling Viagra has much to gain from the construction of high levels of sexual activity as healthy. The medicalisation and demedicalisation of sexual identity is a useful illustration of the interplay of power between competing groups.
A great example of the changing constructs changing the notion of illness regards homosexuality as we touched on earlier, was previusly considered a diseas, an illnesss. Recently, the definition was reversed after the organization and uprising of homosexuals and their sympathisers. The gay community were not only successful in redefining homosexuality as a lifestyle choice - and, therefore, within the realm of normal - but in defining those who opposed homosexuality as homophobic and, therefore, diseased. The process of medicalisation was used to validate the views of first the heterosexual community and then the homosexual community. This highlights the authority of the medical discourse and the extent to which illness is socially constructed.
The acceptable levels of what is considered normal and abnormal behaviours are very subjective and subtle, illustrating the fluid nature of illness
A case in point is the 'illness' known as addiction.Addicts perform activities that most people also do. However, addicts do them 'to excess'. Alcoholics are addicted to alcohol and are branded ill with the disease of alcohol. But when? There are commonly accepted signs that directly reflect the societies values. When alcohol starts affecting family and relationships in Western socities for instance, In some cultures that is more the norm and thus is not a sign of an illness but quite acceptable and tolerated..
Gambling addicts gamble 'too much' judged by when gamblers can't control their habit. Much like how the general population of the US or Japan for instance can't control their need to consume material goods... but that isn't an illness as it supports the economy. Or is it? Illness is not absaloute in fact what illness is defined as depends on and reflects the society. At this satge in our Western society, science rules.Birth, death, sexual activity, sexual identity, gambling and alcohol and other drug use, as well as criminal behaviour, eating and child development have all been medicalised.
The notion of Illness is socially constructed and is an accurate insight into the society examined. How the society views gender roles, religion, commercial intersts, political power, the socio economic situation and the general culture is clearly revealed through what is considered an illness and the social conflicts that are caused by and in there turn cause, these illnesses.
Senior & Viveash 1998, p27
2 http://www.campusprogram.com/reference/en/wikipedia/a/ay/ayurveda.html
3 WordNet (r) 2.0, (c) 2003 Princeton University
4 The American Heritage(r) Dictionary of the English Language, Fourth Edition
5 Samson, C 1999. Biomedicine and the Body, p.3-4
6 Peter Conrad & Joseph W. Schneider, Deviance and Medicalization: From Badness to Sickness, 1980, p.46
7 http://www.trinity.edu/~mkearl/ger-med.html
8http://www.courseworkbank.co.uk/coursework/health_illness_are_concepts_which_are_socially_constructed_2611/
9 http://www.courseworkbank.co.uk/coursework/health_illness_are_concepts_which_are_socially_constructed_2611/
0 www.bmj.com/talks/toomuch/sld003.htm
1 M, Senior, B, Viveash, Health and Illness, 1998, p.14-15
