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society,cultureandhealthanintroductiontosociologyfornursesKarenWillisandShandellElmerOXFORDUNIVERSITYPRESS·~;::')l:-·-I'tJ!
~'i"TYJ,~~\1;0'AOXFORDIUNIVERSITYPRESS253NormanbyRoad,SouthMelbourne,Victoria3205,AustraliaOxfordUniversityPressisadepartmentoftheUniversityofOxford.
Itfurthl;'[stheUniversity'sobjectiveofexcellenceinresearch.
scholarship.
andeducationbypublishingworldwideiuOxfordNewYorkAucklandCapeTownDaresSalaamHongKongKarachiKualaLumpurMadridMelbourneMexicoCityNairobiNewDelhiShanghaiTaipeiTorontoWithofficesiuArgentinaAustriaBrazilChileCzechRepublicFranceGreeceGuatemalaHungaryItalyJapanPolandPortugalSingaporeSouthKoreaSwitzerlandThailandTurkeyUkraineViemamOXFORDisatrademarkofOxfordUuiversityPressiutheUKandincertainothercountriesCopyrightKareuWillisandShandellElmer2007Firstpublished2007ReproductionandcommunicationforeducationalpurposesTheAustraliauCopYrightAct1968(theAct)allowsamaximumofonechapteror10%ofthepagesofthiswork,whicheveristhegreater,tobereproducedand/orcommunicatedbyanyeducationalinstitutionforitseducationalpurposesprovidedthattheeducationalinstitution(orthebodythatadministersit)hasgiveuaremunerationnoticetoCopyrightAgencyLimited(CAL)undertheAct.
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AllenquiriesshouldbemadetothepUblisherattheaddressaboveNationalLibraryofAustraliaCataloguing-in-PublicationdataWillis,Karen.
Society,cultureandhealth:anintroductiontosociologyfornurses.
Bibliography.
Includesindex.
ISBN9780195559071(pbk.
).
1.
Nnrsing-Socialaspects.
2.
Sociology.
3.
Socialmedicine.
1.
Elmer,Shandell.
II.
Title.
610.
73Coverdesign,textdesignandtypesetbyKerryCooke,eggplantcommunicationsProofreadbyAnneMulvaneyIndexedbyJeanneRuddPrintedinHongKongbySheckWahTongPrintingPressLtdPo"1'I//,.
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A70021368872BGuidedtour1'lIlAcknowledgmentsxPermIssionsx,Chapter1WhatisSociologyandWhyisitRelevanttoNursesWhatissociology3Approachingsociology:thesociologicalimagination3Sociologyandsocialtheory5Ourtheoreticalapproach:socialconstructionandcriticalanalysis11Usingourframeworktopresentasociologicalapproachfornursingstudents12.
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IdeasaboutHealthandIllness17Chapter2ApproachingHealthandIllness19Keyideas:knowledge,discourse,powerandtruth21ThediscoursesofsCienceandscientificmedicine22Biomedicine:adominantdiscourse24Asociologicalperspective27Thesociallyconstructednatureofmedicalknowledge28Thesideeffectsofadominantdiscourse30Asociologicalapproachtohealthandillness34Content,Chapter3Chapter4.
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.
Chapter5Lay,FolkandConsumerIdeasaboutHealthandIllness39Overviewoffolkandlayapproaches41Folkmodels42Exampleone.
traditionalChinesemedicine43Exampletwo:interactionsbetweenWesternandfolkmodelsofhealing43Examplethree:healthinAustralianIndigenouscultures45Laymodelsofhealthanddisease46Knowingabouthealthpatternsscientific,socialandlayepidemiology48Consumersandthechallengetoexpertise51TheMediaandHealth55Themedia57Themediaandmediaownership58Theauthorityofnewsmedia61Constructingmeaning62Theimportanceofvisualsandlanguageuse64Constructingmeaningabouthealthandillness65Portrayalsofhealthandillness68Informationconsumptionandproduction:thecaseoftheInternet70SocialStructureandHealth75HealthandIllnessPatternsinAustralia77Socialpatternsofhealthandillness79Socialstructure79Socialclass82Explanationsforhealthinequalitiesrelatedtosocialcloss83Theimpactofsocialclass.
workandhealth84Gender85Women'shealth88Men'shealth89Theimpactofgender:domesticviolence91ConlenlsEthnicity92Healthimpactsofethnicity93Theimpactofethnicity'mentalhealth,refugeesandthemigrationexperience95Chapter6TheHealthEffectsofMarginalisationandExclusion99Socialexclusionandmarginalisation100Exampleone:Olderpeople102Exampletwo:Ruralityandhealth105Examplethree:Poverty,unemploymentandhomelessness107Examplefour:Sexualityandsocialexclusion771Chapter7TheHealthofAboriginalandTorresStraitIslanderPeoples116AboriginalandTorresStraitIslanderpeoples',systems,societyandculture118Historicalcontext:fromtraditionalthroughtransitionaltocontemporary120Thehealthimpactsofhistory,societyandculture124Addressinghealthissues:differentapproaches,differentsolutions126TowardshealthrightsforAboriginalandTorresStraitIslanderpeoples131CuIturaIprotocol134IIiIIIIExperiencingHealthandIllness137Chapter8TheBody,HealthandLifestyle139ThebodyandsocialIdentity140Health,medicineandthebody141143Approachingthebodyincontemporarysociety150Thebody,publichealthandhealthpracticesChapter9TheIllnessExperience:ChronicIllness155Chronicillness,biomedicineandthesocial158Sociologicalapproachestochronicillness159·eo~ientsChapter10II1IIChapter11Chapter12Chapter13Stigmaandchronicillness163Mentalillness165ContemporaryDebatesaboutHealthandIllness170Technologiesinhealth171Thesocia',constructionoftechnology173Technologyandthediagnosticprocess175Genetictechnologies177Thenewpredictivetechnologies779PharmaceuticaIs183WorkinginHealth189HealthCareSystemsandtheHealthWorkforce191TheorganisationofhealthcareinAustralia192Historicalcontext192SocialandpOliticalcontext194Healthexpenditure198Whoworksinhealth:thehealthworkforce200Professionsandprofessionalisation202Medicaldominance204ComplementaryandAlternativeMedicine210Whatarecomplementaryandalternativemedicines212Legl(',macy213Professionalisationofcomplementaryandalternativemedicines216Whoislikelytousecomplementaryandalternativemedicines218Theconvergenceofcomplementaryandalternativemedicines221Nursesandcomplementaryandalternativemedicines223NursinginContemporaryAustralia227Thenursingworkforce228NurSingasaprofess·,on229EarlynursinginAustralia231'Newnursing'233Nursingandthemedicalprofession235Claimstoprofessionalism:theimportanceofautonomy237Generalpracticenurses237Nursepractitioners239Thenurse-patientrelationship240Chapter14Nurses,SociologyandHealth244References247Index269IntroductionJuliahadalwayswontedtobanurse.
Hermotherandherauntwrebothnurses-theyhadtramedinthedayswhenyoungwomenlivdatnurseshomes',andheyhadlotsoffunandexCIingstoriesatellabouttheirtrammg,heirimeonthewards.
andtheparrntstheyhadlookedafter.
ShiftworkmeantthatJulia'smumwashomeduringthedaytolookafterJuliaandhertwobrotherswhenteywereyoung.
ButthingsaredifferentnowursingISnotaughtatuniverslandJuliaisthefirstinherfamilytostudythreoJuliadaesn'mindtoomuchbuthermumisworriedthatshewon'tgetenoughpracticeonteardswhilesherains.
.
TwoweeksinatheurseJuliaISstarting0worrytoo-shecanunderstandwhyshmuslearnaboutanaamandphYSiology,butshecan'teethepointofsomeothersubjects,Inparticular,sociologyseemstobecompletelythewrongsubjectfornursing.
JuliaJustwantscocarorsickpeope,whyshouldshebehinmgaboutpoemsofhealthandillneS,andissuesthatwon'tchangehowshelooksaftertheporintsinhercoreAsociologicalapproachtohealthcareshiftsthefocusfromsickindiidualstowidersocialissues:hereforeanundersanding0sociologVenableshealthcareworkersto:cnicallvevaluatehedifferingwaysthathesocialworldmayshapetheeperienceofhealhandillnessundertandhebroadersocialorceshaacindividualsconsiderho:halhcarearrangementsimpactontheind'vidual'sexperienceaealhandillness.
Warguethaaociologicalunderstanding0healhandillnessw"resultinamoreInformeapproch0heprocessofhealthcare.
HalhorkoccusnacompleandchagtngnvironmenSuchchangescanbeparIvanbued0patns0disas,wherelong-ermchroniCIIIesssprdomInae,andparIVavariatiointheillnesseperienceotdifferentgroupsinthepopulation.
Technologicalchangesmeanthathospitalisation--'"maynolongerberequiredformanyproceduresand.
ontheotherhand,weareableoexpandthenumberofinterventionsthatarepossibleAdditionally,nursesareworkinginanenvironmentwherethetypeandcostofcarearecontinuallydebatedInhealthcarorganisationsandinthepublicarena.
Thus,Juliawillneedabroadknowledgeofhealth,healthcareandtheorganisationofhealthcareifsheistobeaneffectivenurse.
ObjeIvesAfterreadingthischapter,youshouldbeableto:identifythekeycharacteristicsofasociologicalapproachtohealthissuesunderstandwhyitisimportanttoconsiderasociologicalapproachhaveabasicunderstandingofthedifferingtheoreticalperspectivesinsociologyunderstandsomeofthekeyconceptsthatwewillbedrawingoninoursociologicalapproachthroughoutthisbook.
Whatissociology1Igyitheillyof0ity.
identifypatternsofbhaviour,meaningandbeliefinordercouncoverrhlink'berwenindividualliveandocialforce',thurevealinghowuhphenmenaarethereuJrofialarrangemenatanyonetime.
Importantlyiologyisconcernedwiththeunequalditributionofpowerandeek[0uncvertheeffetsofchionociallife.
ndertandingialidea,ocialstrutureandp\errelationenableeplorationofhowacialLifeinotfiedandunchangingbutwadifferentinthepatarieindifferentcultureand0ialetting.
andwillbedifferentinthefuture.
Williamon(1999:269)laimthatociologyisarfleetivediiplintbathIptointerpreteverydayexperienceanditasirs[0'developnurewharecapableofundertanding,analyingandadaptingrtheialanorganizationalchangewhihiahrnifeatureofourprfinallive"Approachingsociology:thesociologicalimaginatioTheworkof.
Wrightill(1959)pointtothenedtodeelopa'ociologicalimaginationinrdrcoanalyecontemporarycialiue.
MillclaimedthattheociologicalimaginationenablesustomakelinkbetwenwhatmayeernrobeindividualiuandtheironnectioDwithurreneinociety.
Usingthe0iologlcaJimaginationrequirethecpaitytoIkbyndourperonalbeliefsandeperiencesandexaminethewaythatourperonalperpctivemaybhapedbybroader0ialfore.
Thuthciologialimagination'.
.
.
nableustograp.
toryandbiographyandtherelationerweentetwowithinsiety(Mills1959:6).
TheilogicalimaginationprovideuwithawayofthinkingabouthealthandiUneiuebyconsidrinqutionabouttherelatinhipoftheeiuetbroadrcietalorce.
hiiimportantwhenweoniderthatmuchofhealthcarproviionandmanyfthidawefindinthebrderocietyfouattentionDindividualswithprolemratherthanIatinginiviualinasoialcontextthatmayal0contributeoundertandingandolvinhealthareiue.
Pioraltdvelopingaiologialimaginationitheapairytoetheditinctionbetweenpriateroublandpubliciue:whatmayappeartobeprivatetroubleaffectingonlyafewindividualmayinfatbepubliciuethatarefonerntothewiderociry.
WhililludtheampleofunmplymnttoeplainthedifferencehealthirepletewithearnpJesthatcanhelputoraptheeencefa0iologicalimagination.
onsider,forexample,theissueofeatingdisordersinyoungwomen(predominantlyanorexianervosa).
Whenviewedasaprivatetrouble,wefocuourattentiontotheindividual.
Ourprimaryquestionis:whatisitaboutthiyoungwoman'spersonalpsychologicalstatethatcauseshertostarveherselfThesolutionwouldbeindividuallyfocused,astheproblemislocatedintheindividual.
Therefore,solutionsmaybesoughtfromthefieldofnutritionandfrompsychiatry.
However,thestatisticsonearingdisordersindicatethatthiafflictionaffectsalargenumberofindividualsatanyonetimeinWesterncultures,suggestingthatthismaybeapublicissue.
Whenanorexianervosaiseenasapublicissue,thequestionbecomes:whyisitatthisparticulartimei.
nhistoryandinourculturethatyoungwomenarechoosingtostarve.
themselvesWhenweturnourattentionfromtheindividualtothebroadersocialforceweidentifycontributingfactorssuchasgenderandbodyimage,themedia,andindustriesthatpromoteparticularbodyshapesandsizes.
Whilewestillneedtotreatindividualswhorequirecare,oursolurions,evenattheindividuallevelwouldbebetterinformedbecausewearelocatingtheillnessasapublicissue,ratherthanseeingitaspurelyindividualandpsychological.
sociologicalperspectiverequiresusroconsiderthenatureoftherelationshipbetweenindividualsandthebroadersociety.
Inparticular,iologi5tsareinterestedintheextenttowhichindividualsinfluencesocietyandocietyinfluencesindividuals.
OUfsocialstructuredevelopsfromthepatterninsocietythatendureovertime(suchassocialclass,gender,cultureandage)andisanimportantdeterminantoflife-chances.
Socialstructurecanconstrainthebehaviourofindividuals-forexample,peoplefromtheworkingclassareunlikelytobecometheprimeminister,andwomen,onaverage,earnlessthanmen.
Theseexamplescanbeexplainedintermsoftheconstrainingeffectsofialclassandgenderrespectively.
Ontheotherhand,individualsareabletointerpretandgivemeaningtotheirsocialsituationinawaythatchallengeexistingsocialarrangementsorcrearesnewones.
Thisisknownas'agency'.
ItiimportanttotakeaccountoftheconstrainingeffectsofsocialstructureaswellasthevoluntarynatureofagencyinordertoexaminesocialphenomenafuUy.
Encapsulatedwithinsociologyasthe'structure-agency'debate,thisrepresemsakeychallengeinthinkingsociologically.
QuestionforreflectionIdentifytwohealthproblemsthatarefocusedonindividualsandtheirbehaviour.
HowmightweseethemdifferentlyjfweviewedtheseissuesasapublicIssue,ratherthanasaprivatetroubleSociologyandsocialtheoryeanerendourunderstandinoftheociologicalapproachbyconideringrheimprtanthat0iologitpIaenialtheryinunderstandinghealthandillnelues.
tleoryisaetfidathatanhIptadneeknoIege.
Athertialundrstandinnableutplainwhatihappeningnowandpredictwhatmayhappeninthefurur.
Thutheorieinanydiiplineproidealensthroughwhichwunderstandtheiueathand.
Theoriarnortati-theyaredevlopedandrefinedthroughtheacumulationofadditionalknowIdgeoftenthroughreearhtudithatattempttoapplythetheryinarealworldsetting.
Wearuethatatheoretia1knowledgeofiologyiuefu!
inhealthpraitting.
urfouinthibokrathrthanengagingindebateaburthevalueofnetheoryoveranother,itbridgethgapbtwntheoryandprericebyillustratinghealthissuesuingarangeof0ialtheorie.
TIlefIIwingderiptionoftherecenthistoryofilogydmonfratthediveriryfteoriethatavebeenudtundrtanoeialisuepartiularlyatheyrelatetohealthandillnes,theorganisationofhealthandmedicalareandundertandingtheffectofpowerdiffetence.
ThelinksbetweensocieyandhealthThedifferingapproachestohealthandillniucaneeeninornetharliet0iologialreearchandwriting.
In197,FrenhociologitEmileDurkheim(15-1917)ndutatudyofuieid.
hill"itmaybawnedrhatsuicideianintenelyindividualaDurkheimargudthatujidecanbeundrtodbettrbyundertandingitiHy.
Hefoundimportantpredictivefactorsrelatingtohowtrnglyiniviuaareintegratedincotheirwosociety-findingsthatreonatewithcontemporaryiaabutuiid.
Fromtheeidea,abranIof0iologydevelpdtherfuingnhowsocialrderandonnuwereintegraltothemoothfuntiningofciety.
ailedfunctionalimthitheoreticalapproachlookedatthebradtrutureofocietytevidaabout0ialfuntioning.
Atauttheametimeandinformedbchangeinocierybroughtaout}'heIndutrialRevolurinarlarx(l1-3)andrederickEngel(1820-5)velpedadiffrentapproachtoundercandiDiry.
Thyvied0ietyaharaerriedyonflifnotconenu.
Engel(14)chartedthepoorhealthnditionoftheworkingclaethathadmovedintothelargecitiestoworkinfatoriandwhoufferedfromtheffctfooranitationandovercrowding,combinewithunhealthyanduna~orkinndition.
BotharandEngelfuedattentionnthewaythat0ieryifundamentallunequalandonhowthisinequaliryisevidentinpatternsofhealthandillness.
TheworkofMarandsubsequenttheoristSwasfurtherdevelopedinexplorationsofinequalitiesinhealthandillness,andthisremainsanintegralfocusinhealthsociology.
Writer:romthisperspectivearguethatbetterhealthoutcomescanonlybeachievedwhenthematerialconditionsofdisadvantagedgroupsareimproved.
ByexploringtheJinksbetweenprofitandhealthcare,conflicttheoristsarguthatthoseinpowerhavelittleinterestinchangingsocialrelationstoimprovehealthforall.
Whilethefocusformanyofthesetheoristsisoninequalityduetosocialclass,feministwritershavedrawnattentiontogenderinequality.
Theinstitutionofmedicinewasalsoseenasanimportanecontributortoanunequalsociety.
FeministsexposedandcritiquedthewaythatmedicinepIaanimportant'socialcontrol'function,thuscontributingtotheperpetuationofinequalitiesbetweenmenandwomen.
TheworkofMaxWeber(1864-1920)developedtheideasofMarbroadeningourunderstandingofinequality.
Hearguedthatioequahtywasnotjustabouteconomics,butaboutbeliefs,idealsandvalues.
Weberpointedtotheimportanceofunderstanding'lifechances',anintegralcomponentofwhichitatus.
Healsopointedtotheimportanceofgroupmembership(called'party').
ThusWeberarguedthatweneededtounderstandsocialinequalitybyfocusingonclass,statusandparry.
QuestionsforreflectionWhIchgroupsinsocietydoyouthinkaremoresusceptibletoillnessHowcanweusethetheoreticalapproachesoutlinedabovetobegintoexplainthisSociologyinmedicineandsociologyofmedicineThefunctionalistviewmentionedabovewasextendedbytheworkofTalcottParsons(1902-79l,asociologistfromtheUSA.
Functionalistresearchfocusenthewayinwhichclearlydefinedsocialrolesandresponsibilitiescontributedtoastructuredinequaliryinsocietythatalsoservestomaimainconsensus.
Thitartedatheoreticalunderstandingofthewaysinwhichprof,haveparticularrolesandstatus.
neofthemOStimportant(andmostcritiqued)contributionsthatParsonmadeintermsofhealthwasinthedevelopmentoftbe'sickrole'.
Thisvieweessicknessas'deviance',inthatwhenpeoplearesick,theyareunabletoundertaketheirnormalresponsibilities.
Usingthesickroleasanexplanatorytheoryhelpstoexplainthemechantsmsbywhichsocietiesareabletoallowucheviance.
ite.
painteonditioninietthatgmwhenandunderhatcircwnstanesweareegitimateallowedtowithdrawfromnorma!
0iationin.
Theickroletheorypointttheroleandreponibilitjeofbothpatientandprofeiona!
inrdrtminimiethediruptieeffetfiJJneonthemoothfunctioninofsociety.
Ideaaroundthesickrole'hryhvereultedinproliferationofiolgicalworkniueuhahronieilloe,cuparinalhealtiupatintbeaviour(incuclingnonomplian)andprafeioninhealth.
WritrsintheUontinuedtheirfuoniologyinmediinewithparticular.
pirationfprofionandprofesionalrole.
Ren(197)developedourtheorenalundertandingofmedicalandhealthknowledebypiringthneeptof'medicalunertainry'.
thrtherihaeelredtheapparentntradietionbetweenthertainryprmiecientifieowlegeantheuncertainrythatiexperienedmtheday-t-daworkofdOCtorandnures.
otwocawillbetharnewhihriethquscinabuthowecanbetducatehealthcarworkersfortheuncertaimithwillfaewhileattheamrim,ueainrillmdeladnertainryathecornerroneoftheirtraining.
oioogisthaya1fa'nritiIaprahtoaminintheproeebywhichmediineandmedicaknowlghaveomethedominantfrmfhalingiierytoday.
Freample1Iiotriedon(l70)arguedthamedlinc'pitinofpowerinhealtharwetablihedpriortituefientificmedicine.
Inutralia,EvanWilli(199)anali0healthareandhealthcareorganiatin,termd'medicaldominane',aminedthewaymdiinahieveautricyinheathcareandoterupannweremarginaliedaspartofthisproces.
Tbicritia1explorationofthepowerofprfeininhalthwillbethefufPart4ofthibok.
Wbr310ontriutedtilgicaltheorythrughhiwrknprofins.
Hewainteretedinthewaysthatdifferentocupationarabletoinfluenctheworoftherandlaim0cupationalterritryoftheirown.
important!
forurunertandingofthntemprarhealtharerganiationthatJuiawillerkingin,ebr(1964)developedourunder[andinofbur~ucracy.
hilentheonehan,wnedtohaeruleandpredureinlargeoranisatin',Weberal0aruedthatthiapprachuldbmean'irODcage'thutiflingindividualreativiryinIvingproblem.
QuestionsforreflectionThinkaboutyourownencounterswithhealthcareprofessionals.
WharethedefiningfeaturesoftheseencountersDotheyvaryaccordingtothehealthcaresettingTheexperienceofillnessociologicaltheoryhasalsocontributedroourunderstandingofhowmdividualunderstandandexperienceillnessbyexaminingsocialinteractionasittakplacebetweennvoormorepeople.
Incontrasttostructuraltheoriesthattakeamacroperspectivebyviewing'socieryasawhole'andthemfluenceofbroadocialforces,symbolicinteractionismtakesamicroperspectivebyfocusinanentiononrheconstructionofmeaningthroughinteractionwithothers.
Thlapproacharguesthatindividualsinterprettheworldaroundthem,ratherthantheworldbeingfixedand/orprcdetcrmined;rharoursenseofself(orIdcmiry)Lproducedthroughinteractionwithothers;andthat,throughusinglanguageorothersymbols,weattachmeaningrotheacrionsofothers.
Forexample,Becker(1963)arguedthatdevianceisaculturaUyandhisroricaUyspecificcondltionthatdependsoncertainbehavioursbeinglabelledasdeviant-thusadeviantactonlyexistsbecauseitisdefinedassuch.
Inthecaseofhealthandillness,asymbolicinteractionistapproachexamineshowweimeractwithinthehealrhcaresysrem,howwecometodefinecertainconditJonsasillness,andhowthesemeaninghapeourresponsetospecificillnesses.
Symbolicinteracrionismhal>beenimportantininformingideasabourmenralillnessbecausethisapproach'focusentheimportanceofpowerrelationsintheconstructionandmanagementhealthandillness'(BiltoneraI.
,1996:417-18).
TheworkofErvingGoHmanisalsoimportantinundersranJingthperienceofillnessincontemporarysocieties.
HISworkonstigmaIdentifiesthprocessesthroughwhichsomeindividuals,groupsorparticularillnessesmaybetigmarised(Goffman,1963).
ForGoffman,stigmaresultsina'spoiledidentity',isworkisusefullyappliedtoenhanceourunderstandingofrheexperiencefmentalillness,disabilityandsexuallytransmittedinfections.
Similarly,rheconceptof'labelling',whereone'sbehaviourii>set>nintermsofamedicalordeviantlabel,ratherrhanindividualartributes,aboassistsInunderstandlt1gtheexperienceof,andresponseto,healthandillnessissues.
GoHmanalsopointedtothewayinwhichmuchhealthandnursingcareiscomprisedofritualsandperformances.
Importantinunderstandingrheexperienceofbeingnursedishiideaof'frontstage'and'backstage'performance.
Fronrstageperformancesarthosesituationswherepeopleknowrheyareonshowandrhustheymaypresenthemselvesinparticularsociallyacceptableways.
However,muchnursingworkalsocomprises'backsrage'workwherenurseshaveroassistpeoplewithnodi!
.
functionsanditISdifficult,.
fnotimpossible,topresenttheseinasociall}'acceptablemanner.
iologicalworkonchronicIllnesshasalsousedthesymbolicinteractionapproach.
Thisworkhasenabledustodeepenourunderstandingofhowadiagnosisofcbronicillnessaffectsoursenseofselfandthus,thedecisions,valueandattitudethatrnahapeourrepausetosuchanevent.
1nfoeuingattentionohowweinterpreteventwithinabraderialorxtociologihaveuedymbolimteraetionirn(0plainthfftfchrniillnenidentityontructionarguingthat.
.
eontructourenofelf(ouridentity)innjunctionwithlifeevent,acralideaandvalue,andintratinwiththrScChpr9in.
oeicy.
QuestionsforreflectionIdenifycontemporaryhealthand/orriskbehavioursthatmaybedeemeddeviantinoursociety.
HavetheyalwaysbeenviewedasdeviantHowhaveideasaboutthesebehaviourchangedovertimeUnderstandingheath,understandingknowledgenumcrofrcorieoriginatinginrbeciologyofnowledgeekreplainhownwidgontrucrioniimprtantinundertandingontemporaryhealthcareisue'.
Inadditiontotheideasaburrheditributinnde.
prienceofillne,me(heorihaveexminedbowkn"ledgehpurappraherhalthanddine.
TheyrakeatheirtarringpomttheideathatourknowledgeiI:nringenrupontheial,'ulturalandhitri31ondirinthatitatanyonetime.
Theirthrieartereforefauson'howwenowwatweknw.
Takin'theideathatrealityitheproductofodalculturalandpolitialinrerarion,ratherthnexttinindpndntlyofthem,thethericthereforemedICalknowledgeandpractleathereuJtofaiaJrelatinrathrthanexitingindependntlyinanurralobjeriveandvalu-freescientificvacuum.
neatheetheoriei0ialontrurin.
DeeopebyBergeranukrnann(191)thntraltnetfialontrurionisthatourknowledeandInturnourinterpretationofmeaningiarultofour0ialinterarionwitheahotherandournvironment.
ThiwayofiewlIlgtheworldiufulfrcririallyanalyinothurialmeaningandrhe01(11tructurethatwemaymherwierakeforramed.
WhiletakingthetanethatrealityiialyntructedthiapproachaknoledgtharmnillneeandicaeareblOlogiarealitierharde,it.
uptn(200:14)pOintsout,heoeialconteutionapproachemphaizethatuchexperienearealwayinevitaIygivenmaningandtherforeundertdndeperiencedhrouhuluralandialprce'.
frenbyhighlightmgonrentloustuesthesociIcontructionapprahtheIthandiUne'ointoutthathealrhnoedgeanp'erarnotobj'tiveanvalufreutareinfactereulofotalIdeaandvalue.
'oreamplehereareorneareaoflifewheretherearehighlevelsofmedicalintervention,butwherethescientificknowledgeinformingsuchinterventioniscontentious.
Examplesincludeattentiondeficithyperacrividisorder,menopauseandevenhighbloodpressure.
Socialconstructionistsarethereforecriticalofthewayinwhichmuchofconremporarylifehasbeen'medicalised'-chatis,takingareasofourlifethatwerepreviouslynotconsideredassickness,andapplyingamedicallabelandaconsequentinrervention(oftenintheformofpharmaceuticaldrugs).
Anextensionofsocialconstructioncanbeseeninthosetheoriesthatare'post-strucruralisr'.
Posr-structuralisrtheorieshavecontinuedthefocusoncriticallyexamininghealthandmedicalknowledge.
TheworkoftheFrenchthinkerMichelFoucault(1926-84)hasbeenparticularlyimportantinshapingourtheoriesabourhealthknowledge.
Bytakinganhistoricalapproach,hiworkexploresthewaystharhospitals,clinicsanddoctorsemergedasthekeyrovidersofhealthcare.
Hisworkalsoinformscontemporarydebaresinpublichealthabouttheapplicationof'lifestyle'knowledgethatrequiresusconstanrlytofocusLnwardlyonourbodiesinordertomaintainourhealth.
Importantly,itisthroughFoucault'sdevelopmentoftheideaof'discourse'tharweareabletothinkaboutknowledgeandideasinheaJthasbeinginterwovenwithhealthcarepracticeinawaythatprevioustheoristsdidnor.
AdiscourseISaayinwhichweareabletospeak,thinkandactaboutanissue.
Somediscouraredominant-thatIS,theyarethewaywemostoftenapproachanissue.
Forxample,acontemporarydominantdiscourseaboutcardiacdiseaseisthatirrelarestolifestylefacrors.
WhenweconsiderthebroaderpatternsofhealthandiIInesc;,wemayconcludethatheartdiseaseismoreaboutsocialclassthansimplylifesryle,butlifestyleisprivilegedinthewaywecurrentlythinkaboutheartdisease.
onceptssuchasmedicalisationanddiscoursealertus[0furtherconceptuchas'ideology'and'power'thatareimportantinunderstandingcontemporarhealthandhealthcareissues.
Themore'normal'or'natural'approachestohealthproblemsandtheirsolutionsappeartobe,themorelikelyitisrhatthereigeneralaccepranceoftheseapproachesandlessinclinationtocriticallyexamin,rquestionthem.
Asocialconstructionapproachwouldaskquestionssucha'whohasconstructedthisparticularknowledge"'whostandstobenefitfromeeingtheissueinthisway',and'howmightwethinkaboutthisdifferently.
Insummary,therearedifferenttheoriesinsociology,allofwhichcanassistinexplainingaspectsofwhypeopledowhattheydo.
Sometheoriesareconcernedwithhowsocialorderismaintainedinsociety(e.
g.
funcrlonaJlsm).
Othertheorientheextenttowhichaccesstopowermeansthatdifferentgroupsareadvantaged(e.
g.
conflicttheories).
Sometheoriesfocusonparticularaspectsofthesocialstructuretotryandexplorehowone'ssociallocationcanaffectlife(e.
g.
feministtheoriesareconcernedwiththeeffecrofgender).
Allofthesetheoriefocustheirattentiononthebroadersocialfactorsthatmayaffectpeople'sJive~.
thertheoriesiniologyhIpustmakeeneofindiidualaction,meaningandidea(e.
.
ymbIiinterarionim).
ialnrrutinappracheanbeeenaabridgebetweenthebroader'macro-themie'afun0nalimandoniliettheorieandthe'micro-theorie'ofymbolicinteracrionim.
Bplacingknowledgeatthentrfthitherecialapproach,wecane.
:ploreboththeroaderialirnplicarinofaniueawellathexperieneattheindividuallevel.
QuestionforreflectionHowcananunderstandingofthesocialtheoriesoutlinedaboveassistJulia(andherclassmates)inexploringcontemporaryhealthissuesOurtheoreticalapproach:socialconstructionandcriticalanalysisWhilewewillpinrutthecontriburinfrbdifferingtheoreticalperpeetivethroughouttheboktheorieofsialntrutin.
nfrmourapproah.
Wearguetharitisimportantfornurestodevelopacriticala'lareneofthewayinwhichindividualsarehapedbytheirial.
.
rid,whilerrharnetimehapingitthrOllhtheiraction.
riticalialntrutionitapproachidentifiethewayinwhichwecanbridetbedifferencbtwentherirharIareeplanatinincialtructureadtherithatfouontheindividual.
Tofullyundrtandhelinkbetween0°alcructureandindiidualactionwemutalsoeamineandanalyetheimactfideaabuttruthandper.
Wearguthatwecanetanayecontemporaryhalthiubytainga,riricalapproh'.
hidnotmeanthateareusingcriticalinthe'taken-forgrantedenfcriticiineverythingtodwithhealth.
Ratherbingririaliabutakingwhy,refletingonouranocialpoitionandquetioningtheeident'withwhihwearepreeoted.
10tryingroeethinsdiferemlywernaalpnupibilitiefrhane.
eagreewithPeteren(1994:)thatwhnufigariocalperpetivethefuinpwerrelatinbetweengroupandbt\eenindiidualandontheinequalitiesthatarisefrommecerieofpower.
[rdrawartneinrthwerofknowledgetodefineothersandontrolthem,andpellouwhatthismeansforhealth.
ocialonstruetionismrequirthatwtakeacritialperpcriveinorderonsiderthepowerrelationthatopratearundhIrhandilineHwe0rpndtovritininhealthtatumaydpndnthrthdifferentialexperienceisperceivedaunfairorinequitabl.
Healthinuicyrferttheinqualitieinhealththatardemedtobunfairrtmmingfrmmefrmofinjustice'(KawachietaI.
,2002:647).
Thus,'healthequityisaboutenablingpeopletohaveequitableaccesstoservicesonthebasisofneed,italsoisabouttheresources,capacitiesandpowertheyneedtoactuponthecircumstancesoftheirlivesthatdeterminetheirhealth'(Keleher&Murphy,2004:5).
QuestionforreflectionChooseacontemporaryhealthissueWhatarethekeyquestionsyouneedtoaskintakinga'criticalapproach'todevelopingyourunderstandingoftheissueUsingourframeworktopresentasociologicalapproachfornursingstudentsThisbookisinfourparts.
Part1commencesoursociologicalexplorationofhealthandillnessbyexaminingideasabouthealthandillness.
Usingtheoryandvidencetounderstandhealthandillness,wemovebeyondacommonsenseapproachor'taken-for-grantedideas'andquestionwheretheseideascomefromandwhotheybenefit.
Forstudentnurses,thismayrequireashiftinthewaytheyhavepreviouslyviewedillnessissuesandthetypeofhealthcareincontemporaryusrralia.
Westartthisprocessbyexaminingwhatis,infact,arecenthistoricalapproachtohealthcareprovision,thatofbiomedicine.
Thisapproachidominantthatitmaybedifficulttoquestionorconsideralternativeviewpoint~.
Oneimportanteffectofthediscourseofbiomedicineismatwetendtolocateillnessasexistingpurelywithinindividualmotivesandaction.
Sociologistshavecritiquedthewaythatthismayresultinseeingindividualsasresponsiblefortheirownillnesses,orvictimblaming,ratherthanlocatingillnessissuesinthentextofbroadersocialstructures.
'ethenshiftthefocustoexploringotherdiscoursesabouthealththathavealwaysexistedbutthatreceivelessattentionthanbiomedicine.
layandfolkideasabouthealthcanprovidehealthcareworkerswithimportantinformationaboutthepeoplewhoareintheircare.
ThewaythatideasabouthealthandillnessareconveyedthroughthemediaisexaminedinthefinalhapterinPart1.
InPart2,weexaminethesocialpatterningofhealthandillness.
Asociologicalapproachconsidersthewaythataperson'ssocialpositioningma)'affecttheirlife,andinparticular,theirhealth.
Socialstructuresrelatetoourpositionasmemberfaparticulargender,socialclass,ethnicorindigenousgroup.
Recognisinghealthandillnessassociallypatternedrequiresustoquestionthecommon-senseidthatillnithrultfat'orimpl'bdiuk'.
iIgicalanaljfoueattentionon'Lifechanceandthe'iaythatpeople'healthareaffetdtbrughtheirmemberhipfpartiularialrup.
enidrthehalthepnnefarangefppulatingrupb'fuInnrhiueialmarinIiarionandeluin.
nitiedtthiuialpatterninandtofrdmof(thrruture-agn)'dbate)Juliahuldbblrwighupjusthowmuhscialircurntaneecanimpatoniueofaceeqwndqualityinhealthar'.
art3fuseontheexperienceofiUne.
tartquetiningwhairmeantobehealthorillanduintheoeiologyofthebd"e'aminehowntuha'rik'and'liferyl'andidaaOutthe'normIhalthyhapeourundertandingfhealthandillnimportantchanginhelthcarepatternsitheinere-aeinehroniilin.
Theontdiaaiandtratmntfbroniillnearemuhtaleperienamedialphcnmna.
oeiIialprpetiveinorpratebthindiidualandialrpntcbroniiUnee.
uhaprptiveiuefulfrhealthworkertounderrandthelinktwenpcpIe'reptinandtheirdiininthefeofbronieilln.
Furthr.
ureperiencefhealthareilikeltehapdbpreailingtrendsinteehnologialdevelopment.
Weeplorethiue0iatdwithheinraedtehnolgialinterventioninthedefinition,diagnoiandtreannentofiIlnethrugheaerudifgntlandharmaurial.
FinallyinPart4weeaminetheomplarrayoforaniarionthatmakeupommpraryalthare.
nyttmpttoeloreurrDChealthiuernuttakeaccount0healthcareasaocialintitution,'heprovisionofhealthcarebusinandnrmprr}'halthripn.
e.
Th\sy[hatrgaoihealthrprviioniindie.
eivthalutha0ieryholdaboutialandindividualreponsibillrypreenrionerusureandm[impnantlytheltemt~hihbuineimr[areblt.
'nroertheontirunoofdiandmdlalintrvntin.
hiuarparticularlimportantfornureathe'beomekeyplayerintheproviionofhealthcarethroughmvtowrdprfinalirin,vidndin[rtiryeduarinandinthhangingrIfnure.
ialbiCONCLUSIONio0y0frsanalernatlveleorecalIosore13tIref!
cIenIcalandques10lng,InordrtorvalacialfaorsIflunc'nhcaupnocesandJcoseqnees0conemporaryhalhandillnessarns.
ThisISImporantornuror109Iaorld0oClalchange,andunandl9abouhlns.
noJUStas-basleaning,ISseerasaVIalpar0bInganUfeIcoemporarysocleyrIngismarhesodalinteractionofhumanindividuals:REVIEWQUESTIONShewayinwhiChYOUVI23KEYTERMS7TheoriesLabelLnUfechaCantliedicahsatlooFeministMedicaldominancFunctionalismMedicaluncertainPost-structuralismPowerSodalconstructionProfessioSymbolicinteractionPublicissuesandprivatetroubles2ConceptsSickrolSocialstructureandagenBureaucracyotiologicalimaginatIOnDeviseSoc.
alclassDiscour~StigmaGenderVictimblaminIdeologyIneouali·schapter.
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2004,TheSocIOloglCOIOuesAnIntroductIontotheStudyofSocIalUfe.
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