By Paul Henry / in , , , , , , , , , , , , , , , , , /


As we launch into our final segment of Crash Course
Sociology, I’m sure one of the things that you’ve learned
by now is that sociology touches on everything. It helps us understand every aspect of society
– even those that we think are strictly personal,
like religion, sex, and gender. And the same is true for another aspect of
your personal life: your health, and how you
take care of it. Many of the factors that determine your health
aren’t biological, but are social and cultural. For example, research by Harvard sociologist
David Williams has shown that factors like race and class, both social constructs, can
have profound effects on health outcomes. Sociologists also explore how the definition
of disease and illness has changed over time
and varies across cultures. So just as health and medicine are regular parts
of your life as a social being, so is medical sociology. [Theme Music] Medical sociology seeks to understand
the ways that society approaches and shapes
health, disease, and illness. And we need that understanding because, whether you
realize it or not, the diseases that society deems worthy
of research, or even treatment, vary across societies. In fact, how our society treats disease has
changed an awful lot just in the last century. And that brings us to medicine, the social institution
responsible for treating disease and restoring or
improving the health of a population. But the concept we have of medicine as a scientific
field is relatively new. So let’s go to the Thought Bubble for a brief
jaunt through the history of Western medicine. The so-called ‘father’ of Western medicine
was an ancient Greek by the name of Hippocrates – yes the same Hippocrates that we get
the Hippocratic oath from – credited as one of the first Western physicians to
believe that disease was the result of a person’s lifestyle
habits and the social environment in which they lived. The Hippocratic system of medicine was
based in humoral medicine, which remained in
use until the 18th century. Humoral medicine argued that all illnesses
stemmed from imbalances of the four humors
believed to make up the physical body: black bile, yellow bile, phlegm, and blood. Under this theory of disease, if someone got
sick, you had to rebalance the humors. Got a fever? Time to get some leeches since humoral medicine
says that you have too much blood. Humoral medicine dominated Western thinking,
even into the medieval ages, when medicine came
to have strong ties to religion. Many interpreted illness as a sign of God’s
disfavor, and cures often relied on prayer or
pilgrimages to a religious site. While medical practitioners of the day still used
humoral medicine, altering the body to cure diseases
was seen as tampering with God’s will. Over time, a more scientific approach to medical
treatment emerged, building on philosopher Rene
Descartes’ theory of mind-body dualism. This was a new belief that the body was separate
from the mind and the soul. And this allowed a scientific model of
medicine to emerge, applying the scientific
method to study and treat disease. In the same way that you can study an engine,
the thinking goes, you can also study anatomy
and physiology. And, yeah, there’s a Crash Course for that. And just as you can fix an engine when it
breaks down, if you understand what’s causing
dysfunction in the body, you can fix it – without worrying that you were tampering
with the will of God. In 1847, the American Medical Association, or
AMA, was founded to promote a more systematic
approach to medical practice, by lobbying for Federal and state
regulations in medical training. The AMA also worked to set standards for the
professional practice of medicine. By incorporating a more scientific approach
to practicing medicine, the AMA helped shape
how we think about and treat disease. Thanks Thought Bubble. Now, just as how we study and treat disease
has changed throughout time, so has what we
consider ‘healthy.’ Rather than focusing only on the biology of health,
Medical Sociologists define Health as a state of
physical, mental, and social well-being. In this way, Health is a sociocultural
phenomenon, where the boundaries between
being ‘healthy’ and ‘unhealthy’ can vary a lot, depending on who you are or where you
were raised. For example: How do you know when someone
is sick? Sometimes, it’s easy to tell. When you can hear someone coughing and
sneezing from across room, it’s probably time to
pull out the Emergence-C and hand sanitizer. But other times, you can’t tell just by
looking or listening. Sometimes diseases, like lupus or diabetes,
don’t manifest with easily noticeable symptoms – which means that people who seem visibly
healthy may still be sick. Sociologist Talcott Parsons, working within
a structural functionalist framework, described the social and cultural responses
to disease through the concept of what he called
the Sick Role. Sick roles are the behaviors associated with
having an illness. To be seen as sick – and get the treatment
deserving of being sick – a person must act the
way society expects a sick person to behave. The function of the sick role is to create
a “social space” for non-normative social
behaviors related to being ill in society. So, you don’t get to stay home from school
just because you feel like it – you have to convince
your parents that you’re really sick. And unless you’ve got the stealth skills
of Ferris Bueller, that means following the
social norms expected of you: staying in bed, eating chicken soup, sleeping
a lot, sniffling, and looking miserable. So the sick role comes with certain rights –
you get to skip out on your normal responsibilities,
and you’re not held responsible for being sick. People tend to believe that you aren’t faking
illness to shirk your duties. Again, unless: Ferris Bueller. But there are also some obligations associated
with sick roles. To be ‘properly’ sick, a person must want
to get better. They must also seek the care of medical professionals. When you fulfill the sick role, you get a pass on
the normal social behavior expected of well people. But if people don’t perceive you as being ‘properly’
sick, you might not get the same amount of slack. This is why people who have invisible illnesses
are often dismissed as just being lazy. Of course, not everyone with a disease plays
a sick role. Some diseases, like HIV/AIDS are heavily
stigmatized, compelling some people to hide
their illness and “pass” as being well. And sometimes, the medical professionals
that we depend on may refuse to accept our
claims of sickness, which basically withholds your
ability to engage in the sick role. There are other critiques of Parson’s sick role, but the
point here is that being “sick” is as much a social and
cultural experience as it is a biological dysfunction. Using another sociological paradigm, that of Symbolic
Interactionism, Medical Sociologists show how health,
disease, and illness are constructed by a society. Medicalization is the process of taking social
behaviors that are within the range of what
we’d consider typical, and re-defining them as medical conditions
that need to be corrected. For example, one of the more frequently
debated conditions is Attention Deficit,
Hyperactivity Disorder or ADHD, a condition marked by an ongoing pattern of
inattention or hyperactivity and impulsive behavior. Since ADHD became recognized as a medical condition,
diagnoses have increased dramatically, going from
around 900,000 in 1990 to 10.9 million as of 2013. But people disagree about whether the growing
number of diagnoses for conditions such as ADHD are the consequence of over-medicalization
of potentially disruptive social behaviors or are
just the result of under-diagnosis in the past. And, the boundary between a ‘legitimate’ medical
condition and a medicalized one isn’t always clear. For example, there are shifting definitions
of what constitutes a disease. Usually it’s defined as a structural or
physical dysfunction of the body. So doctors assess whether a person has a disease
by looking at their symptoms and using objectively
measurable data, like blood pressure or cell counts, to determine if they match the profile
of a certain disease. But what constitutes a ‘disease’ is not uncontroversial,
and the parameters for determining whether someone
has one is politically contested. Yes, politically! Remember, sociology touches on everything! One system used to define diagnoses is called
the International Classification of Diseases or ICD,
which has been in use since 1900. It’s revised every 10 to 20 years based
on new data and changes in societal perspectives. Sometimes revisions remove prejudiced
and inaccurate definitions of disease, such as the removal of homosexuality as a
mental health disorder from the ICD in 1992. Revisions can also expand disease parameters,
like when the diagnostic criteria for autism, Asperger’s
Syndrome, and other related disorders was expanded to be called Autism Spectrum Disorder,
a category that encompasses a wider range of social
and behavioral disorders under one umbrella. This change was made based on improvements
in society’s understanding of the disorder. But it also reflects changes in American society’s
concern with these conditions. Now, another way Medical Sociologists approach
health is to look at illness. It’s sometimes said that a person walks
into a doctor’s office with symptoms, but
leaves with a disease. While a disease defines a dysfunction of the
physical, an illness is the social and cultural
response to a disease. And your perception of an illness is likely
to vary a lot depending on who you are. People have what are called illness beliefs
– assumptions about the severity and nature
of symptoms. An illness belief doesn’t have to be accurate,
but the accuracy matters less than how the
beliefs make you feel. Illness beliefs help explain why some people seek
treatment for symptoms while others may ignore them. Or why some people strictly adhere to medical
advice, while others blow it off. Factors like race, social class, gender, or age
can shape illness responses to disease as well. For example, women consult doctors
significantly more than men. Men are more likely to ignore pain, or downplay
the significance of symptoms. Social institutions can also influence illness
beliefs. Family is one of those social institutions. Did your parents make a big fuss whenever
you got sick and let you stay home from school
at the drop of a hat? Or were you raised to tough it out and not
miss school unless your arm fell off? For adults, your work environment can also
shape your illness response. In the United States, businesses are not required
to provide employees with paid sick leave. For people who aren’t able to take time off of
work without losing wages, or losing their job, only the most severe symptoms might
make them admit that they’re really sick. More broadly, institutions within health
services – hospitals, insurance companies,
pharmaceutical companies – play a major role in defining illness responses by:
1) defining what constitutes a disease, and 2) shaping who has access to
treatment. All patients are not created equal in
the US healthcare system – which patients get quality care varies by
social group and by how much our society
values certain diseases. This, in turn, shapes illness responses and
illness behaviors. And so we end up right back where we started: with the fact that Medical sociology helps us
to understand the ways that culture and society
shape health, disease, and illness. In today’s episode, we learned about what medical
sociology is and how Western approaches to medical
knowledge have changed throughout history. We then talked about what it means to be sick
and introduced the concept of the sick role. Next, we talked about how health, disease,
and illness are socially constructed. Finally, we talked about the distinction between
disease and illness and the individual and institutional
factors that influence a person’s beliefs about illness. Next week we will explore Health Outcomes
in the United States and how these outcomes
are influenced by society. Crash Course Sociology is filmed in the Dr. Cheryl
C. Kinney Studio in Missoula, MT, and it’s made
with the help of all of these nice people. Our animation team is Thought Cafe and Crash
Course is made with Adobe Creative Cloud. If you’d like to keep Crash Course free for everyone,
forever, you can support the series at Patreon, a crowdfunding platform that allows
you to support the content you love. Thank you to all of our patrons for making
Crash Course possible with their continued
support.


Leave a Reply

Your email address will not be published. Required fields are marked *