Chronic Illness and Social (Dis)ability

Week 21Sociology of Health and Illness

Recap

• Thought about how health and illness are structured by society

• Considered the ‘sick role’, medicalisation, surveillance medicine and ‘lay’ understandings of health

• Considered social inequalities and health

Outline

• Look at chronic illness as biographical disruption

• Consider to what extend disability is socially constructed

• Consider the points of intersection and contestation between these two ideas

The rise of chronic illness

• The 20th saw a move from acute illness to chronic illness

• Existing theories (eg ‘sick role’)

could not easily explain these conditions

• The meaning and experiences of

‘living with’ illness began the focus

of sociological attention

Illness as narrative reconstruction

• Understandings of causes are constructed through the meanings and interpretations that are placed on it

• People make sense of their condition (why me?) in relation to their social circumstances

• This may not coincide with biological explanations

Illness as narrative reconstruction

• Williams (1984) interviewed people with rheumatoid arthritis

• Complex understandings which rejected potential biomedical explanations– Bill Made links to bad workplaces– Gill Gender roles– Betty God’s purpose

• Narratives can become a coping mechanism

• How useful do you think the idea of illness narratives is in explaining:– The social construction of illness?– The why me question of individuals?

Illness as biographical disruption

• Bury (1982) argued that the onset of chronic illness should be seen as a ‘biographical disruption’

• A person’s identity is underthreat as it changes their previously ‘normal life’

• They need to reassess their lives and perhaps adapt/take on a ‘new’ identity

Illness as biographical disruption

• Issues include dealing with the uncertainty of symptoms or life expectancy

• Learning to live with an altered body or status

• Deciding whether or not to

disclose condition/symptoms/issues

Stigma

• Goffman highlighted the ways in which bodies and illnesses come to be stigmatised

• Stigma arises when an deeply discrediting attribute become known

• It realigns an identity from ‘normal’ to ‘discredited’

• What conditions can you think of that are stigmatised?

• How do you think this will impact on biographical disruption

Perspectives on Disability

From the Victorian Period onwards two dominant perspectives on disability

1. disability as a tragedy which has required the assistance of charity

2. disability as illness which has required treatment by professionals

Disability Movement

• In the last 40 years, people with disabilities have challenged these ideas

– Separation of illness and disability– Push for independent living and civil rights– The social model of disability

• Successes include the Disability Discrimination Act and benefits paid directly to people with disabilities

The social model of disability

• This model argues that is not physical or mental impairments

• Societies failure to cope with

their needs– Physically through the

build environment– Mentally through

disabling attitudes

Maintaining Control

• The Independent Living Movement has focused on the aims of control

– Right to employment– Allowances for personal assistance

• Needs need to met without disempowering the person with impairments

• To what extend do you think that the experiences of disability are socially constructed?

Competing theories

• Seeing illness as always biographically disrupting is problematic

– Seen as inevitable part of ageing?– Reinforce some ideas about the self?

• Does it reinforce the idea of bodily impairments as a personal tragedy?

Competing theories

• The social model of disability has been critiqued for overemphasise physical and economic barriers

• It ‘fits’ better with static rather than deteriorating conditions

• It does not easily explain how people adjust to bodily pain or impairment

Summary

• Considered a range of theories which look at the experience and meaning of chronic illness and disability

• Coming to terms with different bodies can cause a re/conceptualisation of the self

• Stigma and social barriers impact of experiences of impairments

Next week

• Look at sociological understandings of mental illness

• Consider relationships between social problems and mental health

• Look at the impact of racism and sexism in diagnosis and treatment