Health and Illness

Health and Illness

  1. Explain how sociological and lay ideas about illness differ from those of biomedicine.
    Health is a broad subject that covers various aspects and hence it is almost impossible to
    define wellness and health without considering illness. Like health, illness is multi-faceted and is
    addressed in various perspectives that include sociological, lay and biomedical concepts.
    According to World Health Organization, health is defined as a state of complete physical,
    mental and social well-being and not just the absence of disease (World Health Organization,
    2013). On the other hand, illness is defined as a condition that affects the normal functioning of
    the body organs. Illness is often used as a synonym for disease but mainly refers to the patient’s
    individual experience on their diseases. It is therefore possible for a person to have a disease
    without necessarily being ill. In addition, illness is not necessarily caused by an infection but to
    sickness behaviour of the body and may include depression and anorexia.
    Sociological Perspectives about Illness
    In the sociological model, the normal functioning of a society largely depends on the
    health and well-being of people living there and their ability to control illness. According to a
    sociologist named Talcott Parsons, the term ‘sick role’ is used to refer to the social behaviour of
    the society towards those who are considered to be ill (Weitz, 2012). Furthermore, Parson added
    that a sick person should not be held responsible for being sick and hence should be excused
    from normal duties. In addition, a sick person should seek help to get out of the ‘sick role’.
    Those people who like their sick role and do not seek any help or treatment to get out of their
    situation, are generally ruled out from the society. This clearly implies that a society plays a vital

HEALTH AND ILLNESS 2
role in determining sickness or illness. Due to research and development in health issues, there
have been major changes in the sociological perspectives of health (Weitz, 2012). For instance,
conditions such as drug addiction that were considered to be a character weakness in the past are
now dealt with through rehabilitation programmes that categorise such additions as illnesses. For
this reasons persons experiencing drug addiction, are allowed to assume the sick role but are
advised to seek treatment.
Lay Perspectives about Illness
The findings of sociological research into lay beliefs on health and illness have been of
significant use to some clinicians. Lay and sociological beliefs on health and illness focus on the
different social groups and how they experience illness in the course of their lives. Such findings
have portrayed to the medical professionals the need to listen to patient’s views instead of just
dismissing them as incorrect knowledge (Bury, 2005). If done consistently, this improves the
relationship between a biomedical officer and a patient.
Lay health beliefs allows ordinary people to develop workable theories based on
individual reasoning to cater for their social and bodily situations. They then use these theories to
relate to their health situations with some drawing their reasoning from previous experiences.
Most of the sociological studies on lay health beliefs have concluded that individuals’
perceptions on health and illness vary according to circumstances (Caplan, McCartney, & Sisti,
2004). These circumstances may limit the broad thinking of the affected individual if the health
condition is not complicated.
According to the social constructs, being healthy is basically described as the absence of
disease or illness. This mentality was mostly held by the elderly especially those in poor health
and hence was less likely to define health in terms of illness. As a result of using this approach,

HEALTH AND ILLNESS 3
social workers who fulfilled their roles while healthy were assumed to have positive moral
characteristics. Social constructionists also perceived health as the ability to overcome disease or
a misfortune. Many lay people would therefore think positively about their health despite being
ill because negative thoughts or mourning may result in bad health.
Moreover, the lay approach on health is that a person’s health is a reflection of his lifestyle
(Blaxter, 2010). In this regard, healthy behaviour such as eating good diet, exercising, and not
taking excess alcohol or avoiding smoking is said to lead to healthy body that is free from
illnesses.
Teleological explanations of illness were also common in the lay people where they
believed that every illness had a meaning, and there was always a purpose of becoming ill. One
of the reasons for being ill could be a sign of external conflict between an individual and the
society or a punishment for a poor lifestyle. In contrast, lay people believe that good health
comes from within the body and requires an individual to avoid unhealthy lifestyles.
Individual perceptions are vital in constructionism where working class people have an
instrumental relationship with their bodies while the middle class treat their body as personal
project (Weitz, 2012). Consequently, the working class value their body as a means to an end
without which they will not be able to go to work and earn their income. With this perception,
the working class are aware that their bodies require constant servicing from medical experts. On
the other hand, the middle class ideology is that personal control is necessary to make a choice
about appropriate lifestyle.
According the sociological approach of Naidoo & Wills (2008) people responded to
illness symptoms in relation to their cultural values and beliefs on illness and heath in general.
This means they interpreted their symptoms on the basis of what was perceived to be ‘normal’.

HEALTH AND ILLNESS 4
Likewise, the decision to seek medical help was also determined by social factors. At times, the
decision to seek medical help did not always materialise as some people used ‘lay referral’
system. This system involved seeking advice from family members and close friends who had
experienced similar conditions in the past. For instance, a young mother with a baby crying
continuously due to health problems may opt not to take such a kid to a health professional.
Instead, she might decide to seek help from her mother who had previous knowledge on how to
deal with babies. People may also opt to administer self medication as many generic drugs are
available over the counter.
Biomedical Perspectives about Illness
The biomedical model of illness and health focuses on biological factors and leaves out
the psychological social and environmental influences of an illness. In this regard, this model is
considered to be the modern way for the medical professionals to diagnose and treat an illness or
a disease. Using this model requires health care professionals to analyse biophysical or genetic
malfunctions from a patient in order to recommend a treatment for an illness. As such, the
biomedical model does not focus of the social history of the patient or the feelings of the patient
but instead focuses on objective laboratory tests to determine the illness. According to the
biomedical model of illness, all illnesses, signs and symptoms are caused by an abnormality
within the body, which is referred to as a disease (Albrecht, Itzpatrick, & Scrimshaw, 2000).
Therefore, all diseases give rise to symptoms although there are other factors that may
influence the effects of a disease. Biomedical model indicates that health is the absence of
disease and that a patient is merely a victim of circumstance with minimum responsibility for the
illness or its cause (Blaxter, 2010). However, it is paramount for a patient to cooperate in

HEALTH AND ILLNESS 5
receiving a treatment. In the biological model, there is a general assumption that disease is
abnormal and that every illness has a specific cause.
The differences between sociological and biomedicine ideas about illness are brought
about by the initial understanding of illness. In biomedicine, health is defined as the absence of
disease while in the social model, health is perceived as a positive state of well-being which is
also associated with the absence of disease or any physical or mental impairment (Blaxter, 2010)
By applying the social construction of medical knowledge, Berger and Luckman (1967) held an
argument that daily knowledge is produced through the creativity by individuals and is directed
towards solving some practical problems. It can therefore be said that ‘facts’ are established
through social interactions and how people interpret knowledge. With this in mind, use of
common sense should be utilised in the understanding of disease.
According to constructivism, all knowledge is socially constructed. As such, individual’s
interpretive process is used to uncover health and disease, and hence gaining an upper hand over
medical science which does not address the issue of health and disease objectively.
In addition, social constructionism holds that social reality is achieved through human
interactions and sharing of ideas (Gabe, Bury, & Elston, 2004). In applied medical sociology, the
meaning is created after the interaction of professionals and lay people. Sociology also sees
disease as being biologically applied in line with social interest. The interpretation of this is that
health is an invention of man.
Social constructionists have varying explanations of health and illness that are
categorized into weak and hard versions. In the weak version, disease is accepted as a biological
state while the hard version objects the notion of a disease being an objective diagnosable state.
The hard version of social constructionism also adds that there is no truth waiting to be revealed

HEALTH AND ILLNESS 6
but truth and meaning comes as a result of interacting with the realities of the world (Blaxter,
2010).
Scholars have often differed on what should be interpreted as an illness. For instance,
Gulf War Syndrome, female hysteria, Chronic Fatigue Syndrome, Obesity, and Attention Deficit
Hyperactive Disorder are some of the conditions that have never been agreed to on whether they
are diseases or conditions (Blaxter, 2010)
Social model differs from biomedical model due to the perception that some diseases
such as arthritis result from social reasoning (Nettleton, 2006). Similarly, categories of diseases
are seen as an effort of medical science to approve some complicated names and codes to
symptoms that are naturally present and have always been part of human anatomy. Furthermore,
(Bury, 2005) expounds that problematisation portrays a deviant status to some symptoms and
behaviours that occur naturally. For instance, he challenges why certain behaviours are labelled
as madness while some behaviours are ignored.
Unlike the biomedical model, social model focuses on the origin of the illness rather than
its cure. On the contrary, the biomedical model tries to treat illnesses through the use of medicine
and science without taking into account the social and emotional factors of how an illness or a
disease occurred (Weitz, 2012). It generally focuses on the root causes of an illness and is
concerned with providing medications or vaccinations to patients.
On the subject of social creations of facts, those supporting this view hold the argument
that scientific facts and notions about disease and body are created through social means. As
disease is categorised in biomedicine, social constructionism argues that classification of
diseases is a product of discursive contexts. In the social construction of illness, historical and
cultural facts are said to influence the medical interpretation of illness (Caplan, McCartney, &

HEALTH AND ILLNESS 7
Sisti, 2004). In biomedicine, language plays a critical role in the way an illness is understood by
the medics while the professionalization of the medical field has led to new disciplines
describing illnesses. Additionally, pharmaceuticals also influential in the labelling of illnesses
although some of them may have existed naturally as explained by the social constructionists.

  1. Discuss the sociological idea that people diagnosed, or at risk of being diagnosed, with a
    socially stigmatised condition, find the stigma more fearful than the condition itself.
    Stigma refers to the conditions that label the bearer as culturally unacceptable in the
    society. Through stigmatisation, the individual affected may also feel inferior while among the
    healthy people. Sometimes, stigmatisation is associated with negative characteristics where an
    individual suffering from a condition that causes stigma is seen to be unfit in the society to an
    extent where other healthy people may start avoiding him (Naidoo & Wills, 2008). Stigma may
    also refer to a negative attribute that discredits a person socially and makes him look like a
    deviant in the society. This can further be explained using Goffman’s dramaturgical theory
    which describes an individual as not being stable or psychologically independent since
    interaction with others constantly changes a person’s identity.
    Moreover, this theory interprets people as mere actors who are always willing to impress
    others during interactions. Before a person interacts with others, he prepares a role or a chance to
    create a positive impression. Stigmatising conditions cause embarrassment to an individual,
    which is a social and a moral problem. Due to the embarrassing nature of the stigmatising
    conditions, the back-stage attributes of an individual are revealed.
    The people who are healthy or perceived to be ‘normal’ in the eyes of others, are often
    the ones who see the people with stigmatised conditions as being inferior or inhuman and hence

HEALTH AND ILLNESS 8
discriminate against them. Among some forms of discriminations that such people are subjected
to include being denied entry into some social places such as parties or family meetings. In
addition, people avoid associating with them for the fear of being infected or just to avoid being
embarrassed when they seen with them (Albrecht, Itzpatrick, & Scrimshaw, 2000). In some
cases, the stigmatised person may end up having additional imperfections imposed on them due
to the original stigma. For instance, an individual suffering from a certain stigmatising condition,
such as being HIV positive, may also be associated with being unhygienic or even smelly. These
additional imperfections are normally due to stereotypes and rarely exist in reality.
According to the hidden distress model, people with stigmata fear situations that would
lead to ‘enacted stigma’ where people can discriminate them openly. Due to this, such people opt
to pursue a policy of non-disclosure where they never let others know they have certain medical
conditions (Bury, 2005). As a result, such people end up with more stress in managing their
disorder because they fear that stigma will have more disruptive effect on their lives other than
the prevailing medical conditions. There are some instances where people with certain conditions
live in disclosure with the fear of being noticed. If this persists for a long time, it may even result
to acute ulcers or depression which would have more negative effects to their bodies than the
conditions leading to stigma. Living in denial eventually makes the disease worse due to the
stigma-related stress. As illness continues, stigma contributes in adding the illness burden.
When an illness is perceived as a deviance, it implies that the condition contradicts the
recognized social norms in the society or norms that are related to specific group. Generally, an
illness may interfere with the social system since the sick are unable to carry out their social role
and hence making them to be labelled as deviants. This social order may however be restored by
a doctor who administers treatment to assist the affected person to exit from the sick role.

HEALTH AND ILLNESS 9
In the medical field, deviance and stigmatisation process is categorized into three levels.
Primary level is the initial violation or the society’s reaction to an illness or a condition. The
secondary deviance involves the deviant’s reactions to the negative society’s reaction to his
condition. This is often accompanied by a feeling of neglect and personal hatred where an
individual sees himself as being unfit and unacceptable in the society to illness or a stigmatised
condition. As the secondary deviance progresses it leads to the tertiary deviance. In this level, the
stigmatised individual reacts to the stigma from others and gets to an advanced level of masters
status (Blaxter, 2010). This label overshadows the other two types of deviance as the stigmatised
person becomes stressed by his condition due to other people’s stigma towards the condition.
Deviance is representation of the labelling theory where it refers to the consequences of what it
has been labelled by the society and not necessarily the act committed by a deviant.
In relation to this explanation, illness can be termed as a form of deviance from societal
norms where it largely explores the primary and secondary types of deviance. But Blaxter (2010)
expounded on labelling by mentioning that mental illness is a product of societal view and a
reaction to a given condition. In other words, mental illness is a result of being labelled as insane
or a deviant in the society.
Admittedly, cultural factors are involved in the stigmatisation process due to stereotypes
and some beliefs associated with some illnesses such diabetes or leprosy. Therefore,
stigmatisation occurs due to power imbalance in the society where people result to labelling and
stereotyping to discriminate against people suffering from certain conditions.
Labelling as a sociological construct has been used to inform the medical practice since
1960s. This was done to include the view that the experience of illness has social and physical
impacts. Rules of deviance can be used to label some people as deviants or outsiders. A deviant

HEALTH AND ILLNESS 10
can therefore be described as an individual who has successfully been labelled. Any behaviour
that is labelled as deviant is considered to be away from the norm and mainly involves
judgements made by individuals who can impose such labels.
Primary deviance consists of many deviant acts that may not be publicly labelled and
therefore has minimal implications to the person being labelled as a primary deviant. Secondary
deviance is however a notch higher since it affects the social roles of the person being labelled as
so. What follows is that a secondary deviant is identified by the public as being a deviant where
the reaction from such a person is judging the society (Naidoo & Wills, 2008). In addition, the
person also changes his behaviour according to the labelling. In relation to illness, the primary
deviance is simple the experience of illness. Additionally, secondary deviance involves diagnosis
process where doctors classify patients based on their level of sickness. It is the public label
stereotypes for the secondary deviance, that causes behaviour change in the people labelled as
secondary deviants.
Most people, including medical professionals, have a perception that some conditions and
disabilities are more stigmatising than others. A good example is the stigma associated with
some diseases such as cancer and HIV/AIDS. Therefore, when one has been labelled through
stigmatisation, the person’s identity is affected negatively. The social stigma that occurs after
labelling may lead to societal discrimination (Caplan, McCartney, & Sisti, 2004). Although an
individual may hide some conditions from the public to avoid discrimination and stigmatisation,
such a person may not be able to hide the condition from him.
Labelling affects an individual negatively and may lead to a prolonged stigmatisation.
Some of the consequences of labelling include isolation and withdrawal from social life,
diminished self esteem, lack of confidence, and restriction of activities and social roles.

HEALTH AND ILLNESS 11
Labelling may also have its consequences beyond an individual. For example, when a child with
disability is being taken care of, the family members’ social life will be affected. In addition, the
family may also experience ‘stigma by association’ due to the direct relationship with the child.
As a result, the family may start experiencing a sense of guilt and shame and may even try to
distance themselves from the disabled child.
When a person is diagnosed with mental illness, there is a possibility of labelling but the
person entrusted with that is the psychiatrist. In such a case, the labelling theory would indicate
that such a person losses his old identity with a new identity being endorsed. This eventually
leads to the mentally ill person internalizing his new social status and hence assumes the ‘master
status’. The person also takes up the role of the psychiatric patient and performs it according to
the expectations of the society or the family members (Caplan, McCartney, & Sisti, 2004). What
follows is the stigmatisation of the patient where he is also excluded from interacting with others.
Generally, stigmatisation affects an individual based on the societal perception on the given
condition and how such an individual reacts to the stigmatisation.
Sociological and lay ideas about illness allow people to reason about their health based
on their social and bodily situations. Their reasoning about illness and health may also be based
on their previous experiences. Social constructs describe being health as the absence of illness. In
addition, social constructionists also define health as the ability to overcome a misfortune or a
disease. The lay people believe that every illness has a meaning and it could be a sign of external
conflict between an individual and the society. Stigma labels the person as culturally
unacceptable or a deviant in the society. Stigmatisation leads to discrimination of an individual
due to illness or any other condition. This occurs after an individual has been labelled as ‘unfit’
in the society or family. The consequences include isolation, low self esteem, and isolation from

HEALTH AND ILLNESS 12
social life. Given these reasons, people find the stigma more fearful and embarrassing than the
condition itself.

HEALTH AND ILLNESS 13

References

Albrecht, G., Itzpatrick, R., & Scrimshaw, S. (2000). The Handbook of Social Studies in Health
and Medicine. Boston: SAGE.
Blaxter, M. (2010). Health. Boston: Polity Press.
Bury, M. (2005). Health and Illness. Boston: Polity Press.
Caplan, A., McCartney, J., & Sisti, D. (2004). Health, Disease and Illness: Concepts in
Medicine. Georgetown: Georgetown University Press.
Naidoo, J., & Wills, J. (2008). Health Studies: An Introduction. New York: Macmillan.
Nettleton, S. (2006). The Sociology of Health & Illness: The Social Construction of Medical
Knowledge. New York: Polity Press.
Weitz, R. (2012). The Sociology of Health, Illness, and Heath Care: A Critical Approach. New
York: Cengage Learning.
World Health Organization. (2013). Who Definition of Health.

SH5002 – Health Illness and Society

What is Chronic Illness?

A chronic illness is an illness of long duration and
generally slow progression (WHO, 2013)

It is also referred to as Long Term Condition
(LTC).

It differs from acute illnesses such as an infection
from which one will recover

Examples of LTCs include:

Heart disease

Cancer

AIDS

Multiple Sclerosis

Diabetes

Rheumatoid Arthritis (WHO, 2013)

Impact of Chronic Illness

Chronic illness leads to a loss of confidence
in the body, and from this follows a loss of
confidence in social interaction or
self-identity.

There is therefore an attempt by the patient
to reconnect their life prior to diagnosis with
the present and future.

Chronic illness can affect everyday life and
lead to an uncertain future

It might result in continuous pain or death

Chronic diseases are the leading cause of
mortality in the world, representing 60% of all
deaths.

Out of the 35 million people who died from
chronic disease in 2005, half were under 70 and
half were women.

Contrary to common perception, 80% of chronic
disease deaths occur in low and middle income
countries (WHO, 2013)

Biographical Interruption

There is a potential for Biographical
Disruption – Disruptive negative experience
in employment, income and sexual
relationships

Bury (1982: 169) explained that experience of
chronic illness …disrupts personal
expectations and plans and the structures of
everyday life, requiring ‘a fundamental
rethinking of the person’s biography and
self-concept’

HIV/AIDS and biographical disruption

Carricaburu & Pierret (2002) studied men living with
HIV and suggest that the term biographical
reinforcement may sometimes be appropriate

Men in their study who acquired HIV as a result of
unsafe sex experienced biographical disruption on
learning they were HIV positive

Men who had lived with haemophilia all their lives and
acquired the infection through a blood transfusion
found that they had to modify their existing and
ongoing biographical work which was associated with
their health status

What are the Challenges for people
with a LTC?

What are the consequences for family
and the individual?

The adjustment of the environment and
re-organisation of lives

Care arrangements?

Self management?

A burden?

The Sociology of Chronic Illness

Two perspectives have dominated the sociology
of illness:

Functional Approach: The extent to which onset
of illness can involve the adoption of an
appropriate social role (the sick role)

Interpretative Approach: Focuses on how the
person who is ill and those around them make
sense of the illness, and how these
interpretations affect action

The Sick Role

What do we know about the sick role?

Must attempt to recover one’s health

How does this concept fit with LTCs?

To be sick in today’s society has become a status
or group identity

The perceived seriousness of the condition
impacts on how someone will react and the extent
to which the rights and privileges of the sick are
granted

Freidson (1970)

Suggests 3 types of legitimacy to access the
sick role

Conditional legitimate: Where it is feasible to
get well, the disease can be treated

Unconditionally legitimate: Incurable illness

Illegitimate: Where the illness is stigmatised by
others

Types of Deviance (Freidson 1970)

Imputed
seriousness

Illegitimate

Conditionally
legitimate

Unconditionally
legitimate

Minor
deviation

Stammer

A cold

Pockmarks

Serious
deviation

Epilepsy

Pneumonia

Cancer

Decision to Seek Medical Help

Zola (1973) identified 5 factors or triggers which
contribute to the decision to seek help

Occurrence of interpersonal crisis e.g. divorce or
losing a job might lead to someone reflecting on
symptoms that have had for some time

The perceived interference of illness with social or
personal life e.g. breathlessness might stop someone
going to the pub with their friend or a painful knee
might stop someone joining a walking club

‘Sanctioning’; another person might legitimize the need
or insist on visiting the GP

Decision to Seek Medical Help (cont)

The perceived interference with
vocational or physical activity e.g.
someone might feel that they can no
longer do their job properly because
of their symptoms

‘Temporalizing of symptomatology’;
e.g. “if my rash has not cleared up by
next Friday, then I will go to the
doctor”

Imputation of Responsibility

Those who acquire sick role status do
not necessarily escape blame

Significant with so-called lifestyle diseases
e.g.

Smokers with lung cancer

Gay men with HIV

Obese person who has a heart attack

Illness Narratives

The experience of illness reflects the
person’s experience of life (Kleinman
1988)

How people make sense of their illness is
within the context of their personal
biography and is influenced by the cultural
values of the society in which they live

Illness Narratives (cont)

Frank (1995) identifies 3 types illness
narratives

Restitution narrative

Quest narrative

Chaos narrative

Restitution Narrative

Typified by the Parsonian sick role

A person is ill

Finds out what is wrong

Seeks help and/or uses medication

Gets better

Fits social expectations

Dominant in popular culture

Is the one we (and the medical profession) are
most comfortable to hear

Quest Narrative

Defined by the ill person’s belief that
something is to be gained through the
experience

Metaphorical journey from which
self-awareness may be gained

E.g. 21 things I would never had known if I
hadn’t had cancer

Chaos Narrative

Antithesis of the restitution narrative

There is no clear beginning or actual or
imagined end

There is no narrative ‘structure’, ‘plot’,
‘metaphysical journey’ or ‘route map’

E.g. being swept along, out of control, taken
as inevitable

Narratives of Medically Unexplained
Symptoms

What is ‘genuine disease’?

Myalgic Encephalomyelitis (ME)

Repetitive Strain Injury (RSI)

People with unexplained symptoms may struggle
to make sense of their illness and want permission
to be ill

Nettleton et al (2004) found that patients with
clinically unexplained neurology symptoms were
confused and uncertain about their illness and fell
into the Chaos Narrative category

Chronic Illness and Disability

Associated with chronic illness are physical
disabilities such as Parkinson’s disease, MS and
stroke

The biomedical model presumes that biological
impairment is the key determinant of disability and
intends to promote rehabilitation to ‘normal’
functioning

The social model maintains that disabilities are a
function of society which fails to take account of
people who have physical impairments

References

Helman, C.G. (2007) Culture, Health
and Illness; Hodder Arnold, 5th Ed

Naidoo J. & Wills J. (2008) Health
Studies; An introduction; Palgrave

Nettleton S (2006) The Sociology of
Health and Illness; 2nd Ed Chapter 4

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