1、Chapter 3 : Principal Theories of Social Medicine Huazhong University of Science and TechnologyTongji Medical CollegeFaculty of Social MedicineContentsprefaceDefining Health and MedicineSociological Perspectives on Health and MedicineSocial Capital and HealthPart 1 PrefaceSection 1.1 A Story of Soci
2、al MedicineSeventeen-year-old Jim Davis (a pseudonym) was checked into the rehab center two days age by this parents. Today, he is curled into a fetal position on the bed in his room, his body convulsing. Periodically, he gets up screaming and tears the sheets off his bed or throws a chair against t
3、he wall. Jim is going through withdrawal, but from what? Is he addicted to heroin, perhaps, or cocaine, alcohol, or even nicotine? No, Jims psychologist explains that Jim is an Internet addict.A high school senior and, until recently, honors student, Jim spends more than six hours a day on-line. He
4、quit long-distance running and withdrew from other extracurricular activities to have more time for the Internet. Then he began skipping classes and calling in sick to his part-time employer. His parents insisted that he cut down his time on-line, but Jim couldnt seem to do it. When they removed Jim
5、s computer from his room, he at first become depressed, but then he went into a rage, threatening to kill himself if his parents did not return his computer. Thiss when the decided to seek professional help, which eventually led to Jims admission to a rehabilitation center that usually treats drug a
6、nd alcohol abusers.Clinicians report that they are seeing an increasing number of people with Internet addiction, a compulsive disorder similar to uncontrollable gambling, binge eating, and drug and alcohol abuse.But sociologists see these report as the latest example of medicalization, the process
7、of defining a behavior or condition as an illness in need of medical treatment.Sociologists believe that illness is not simply a biological or physiological condition. Rather, illness is socially constructed. What gets defined as illness has as much to do with a societys culture as with objective sy
8、mptoms.Section 1.2 Relations of Concept and TheoryThe structure of a theory: concept, variable, proposition, hypothesis.ConceptAbstract of phenomena Relations of concept and theory: concept is a section of theory; a theory is made up of a group of logic-related concepts.VariableConcept with multi-di
9、mension.PropositionA statement about the characteristic of a concept or the relations of a group of concepts. Categories of proposition: axiom, law, hypothesis.HypothesisA tentative statement about the relationship of related-variable.Part 2 Defining Health and MedicineSection 2.1 What is health?Som
10、e people define health as simply the absence of illness, but this vague definition raises more questions than this answers.For example, when should we consider a person is ill when that person is unable to perform normal social roles?On the one hand, an individuals assessment can be problematic beca
11、use research shows that while most people consider their very good or excellent, only a small percentage is completely free of physical ailments at any given time (U.S. Department of health and human services,1996).On the other hand, if we define health solely in terms of the absence of disability o
12、r incapacitation, we overlook the thousands of people who are ill but who continue to carry out their daily activities for a variety of reasons, such as economic necessary.As these examples illustrate, health is multidimensional. In addition to a physiological dimension, health also has psychologica
13、l and social dimensions.Consequently, we have adopted the World Health Organizations definition of health as a state of physical, mental, and social well-being. This definition makes the point that we cannot consider a person healthy if she or he is emotionally distressed or living in a hazardous en
14、vironment, even if the person is free of physical illness.Section 2.2 Health and SocietyStandards of health vary cross-culturally.Standards of health vary over timeStandards of health reflect the dominant values and norms of a societyHealth is affected by a societys level of economic development.Sta
15、ndards of health vary cross-culturallyWhat is considered healthy or wholesome in one society may be regarded as unhealthy or harmful in another.For instance, physical conditions that would be diagnosed as serious skin diseases by U.S. physicians are not considered even symptoms of illness by the Kub
16、a of Sumatra.Definitions of health and illness may also be manipulated for political reasons.For example, in Japan, where the national government owns the countrys largest cigarettes manufacturing company, any medical reports that warn of the health hazards of smoking must also include claims about
17、cigarettes benefits, such as how smoking cigarettes contributes to creativity.Standards of health vary over timeLittle more than a century ago, physicians believed that hysteria was caused by the uterus breaking free and moving through the body. Thus, by definition, all hysterics were women, and the
18、 “cure” was removal of the uterus (hysterectomy).Hysteria, which is today called histrionic personality, is still a medically recognized disorder, but it is not thought to have a physical cause, nor is it only diagnosed in women; 25 to 50 percent of individuals with histrionic personality are men.St
19、andards of health reflect the dominant values and norms of a societyConsider that in the United States, where individualism is highly prized, some people develop a phobia of being embarrassed, whereas in Japan, where group welfare is valued over the individual, some people develop a fear that they m
20、ight embarrass others.Health standards may also be used to enforce norms.In many West African countries, for example, young women are expected to be virgins when they marry. To guarantee marriage ability, parents usually have their daughters “circumcised” (their external genitals are removed and the
21、 vagina is sewn closed except for a small opening to allow the passage of menstrual blood), even though the procedure often results in complications, including shock, hemorrhage, and tetanus.In this countries, the circumcision serves as a means of social control to ensure young womens conformity to
22、their societys sexuality norms.Health is affected by a societys level of economic development.Economically undeveloped societies have high rates of illness and health, especially from preventable infectious diseases.As a society develops, death from infectious diseases declines dramatically, so that
23、 industrialized societies enjoy the highest standards of health.This does not mean that industrialized societies are illness-free, however.Infectious diseases may be under control, but industrialization generates other health problems.Only in industrialized societies, for example, do workers contrac
24、t life-threatening illnesses because of occupational exposure to cotton fibers, coal dust, asbestos, mercury, and numerous chemicals. Section 2.3 What is medicine?Medicine is the social institution established to identify and treat illness and promote health.Goals of medicine: prevention of disease,
25、 relief of suffering, care of the ill and avoidance of premature death. Section 2.4 Medicine and SocietyJust as health reflects the culture and structure of a society, so does medicine.We usually think of medicine after the factthat is once we have gotten sick, we rely on medicine to make us better.
26、 This kind of medicine, curative medicine, focuses on treating people who are already ill. In contrast, preventive medicine seeks to establish conditions that keep illness from occurring.In the United States, preventive medicine has been getting more attention in recent years. We are all family with
27、 the current campaigns to quit smoking and “eat heart healthy”. But for the most part, medicine in United States has traditionally emphasized cure than prevention, an emphasis that follows logically from our societys values of individualism and free enterprise. The individual is supposed to determin
28、e his or her own health needs, find a source of health care, and pay for that care privately. Part 3 Sociological Perspectives on Health and MedicineThe Structural Functionalist PerspectiveEvaluating the Structural Functionalist Perspective The Symbolic Interactionist PerspectiveEvaluating the Symbo
29、lic Interactionist PerspectiveSection 3.1 The structural functionalist perspectiveThe structural functionalist perspective on health and medicine was formulated largely by Talcott Parsons (1951).According to Parsons, a healthy population is essential to society. Health people can perform the social
30、roles necessary to keep society functioning optimally. Illness, then, is dysfunctional because it prevents people from performing their social roles, at least temporarily.Thus, the social institution of medicine plays a vital role in the overall functioning of medicine by making members healthy.Of c
31、ourse, everyone gets sick sometimes and when they do, Parsons argued, they follow a socially prescribed role. Physicians also have specific role expectations.Section 3.1.1 The Sick RoleParsons identified four characteristics of the sick role, the behaviors defined by a society as appropriate for peo
32、ple who are sick.First, sick people are excused from their usual responsibilities, such as attending class or working.However, while saying youre sick might initially evoke sympathy, you wont be excused from your obligations for long unless your illness is verified by a recognized expert, such as th
33、e school health service or your physician.Second, sick individuals are considered “worthy” of others sympathy only if they did nothing to precipitate their illness.Consider, for example, the recent lawsuits brought against the tobacco industry by smokers with serious illnesses. Juries have been relu
34、ctant to award damages because the plaintiffs knew smoking was harmful to their health, but kept doing it anyway.Third, the sick person must display a sincere desire to be well. Someone who claims to be ill to avoid work, get out of a sociology exam, or be pampered by others is not considered legiti
35、mately sick by society.Finally, the sick person must do everything possible to get well.If the sick person makes no attempt to get medical help or ignores “doctors orders,” he or she relinquishes legitimate claim to the sick role.The help-seeking element of the sick role reads us to consider the rol
36、e of help provider, the physician.Section 3.1.2 The Physicians RoleAccording to Parsons, the physicians role has two components.One is to evaluate peoples claims of illness, assessing whether they are really sick and, if so, determining the cause of their ailment.The second component of the physicia
37、nss role is to cure the sick so they can carry out their normal social roles.Section 3.1.3 The relationship between the physicians role and the sick rolethe physicians role and the sick role are interdependent.First, patients must supply their medical history and symptoms in order for the physician
38、to fulfill the first component of his or her role. Then, to fulfill the second components, the physician depends on the patient to follow instructions.Despite this interdependence, the specialized knowledge of the physician makes the physician-patient relationship unequal.The level of inequality var
39、ies cross-culturally, but the physician always has the uppers hand in the relationship.Parsons did not view patient-physician inequality negatively, though. The physician simply knows what is necessary for a person to get better, so the patient should defer to him or her.Section 3.2 Evaluating the S
40、tructural Functionalist PerspectiveParsonss analysis of the sick role shows how social norms impinge on both health and illness.Parsons also correctly depicts the physician as the gatekeeper to the sick role. But parsonss ideas have also been criticized. Some, for example, say that Parsonss concept
41、of the sick role implies that a person as only temporarily ill and can be restored to normal functioning relatively quickly.This is true if the person is suffering from an acute illness, which , though often serious, is curable.But chronic illnessprolonged illness that may be controlled, but not cur
42、edis permanently incapacitating and prevents a person from ever resuming normal social roles.Parsons is also criticized for putting too much emphasis on individual responsibility while downplaying the social structural factors that can affect health.For instance, Parsonss claim that people who contr
43、ibute to their own affliction have no legitimate claim to the sick role overlooks the fact that social structural factors also shape peoples behavioral choices.Advertising, for example, promotes a great deal of unhealthy behavior, including smoking and alcohol consumptionFinally, Parsons has been cr
44、iticized for ignoring the negative consequences of social inequality for health and medicine.Sick people may wish to get well, for example, but their access to medical care may be limited by their financial status.Section 3.3 The symbolic interactionist perspectiveSymbolic interactionists are primar
45、ily concerned with the meanings people give to their social interactions, so they focus on how health and medicine are socially constructed.Quite apart from objective symptoms, health and illness are socially defined by the members of a society.In Lithuania, for example, there are about as many rear
46、-end car collisions as in Norway and the United States, but Lithuania never report the lingering neck pain, called whiplash, commonly reported by Norwegian and American accident victims.Lithuanians dont have stronger neck muscles and their cars arent safer, so why dont they get whiplash?Researchers
47、believe the answer lies in how the situations are socially defined.In Lithuania, people are not accustomed to suing one another for any reason, let alone accident liability.Lithuanians do not have personal injury insurance; if they are injured in an accident, the governments public health insurance
48、program pays the medical bills.When a rear-end collision occurs, they define it as a major inconvenience, not because they will miss work because of neck pain, but because it is so difficult to get spare car pats in Lithuania.In contrast, in Norway, which has the highest number of whiplash cases in
49、the world, there is much to be gained from defining a rear-end collision as an injury-producing event because insurance companies generously compensate individuals for chronic disability caused as injury suits are commonplace, rear-end collisions are defined as injuries heal on their own within a fe
50、w days or weeks and require little or no treatment.This is not to say that accident victims in Lithuania never experience neck pain, or that people on Norway and the United States only pretend to be in pain.Rather, according to symbolic interactionists, the social expectations that individuals attac
