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Lecture 2

ANTHROP 3HI3 Lecture Notes - Lecture 2: Narrative, Biomedicine, Sick Role

Course Code
Priscilla Medeiros

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Lecture : Illness experience Jan 6
Chapters 1 & 2
Illness and disease models
- Kleinman makes a significant contribution to illness and disease definitions in the early
- Arises in response to patient dissatisfaction with care
o He recognizes a gap in the care continuum
- Illness and disease discussions began b/c of growing patient dissatisfaction with the
healthcare system
- Physicians seemed only concerned with treating diseases from a biomedical standpoint
- Kleinman argues that biomedicine makes patients into commodities. Rather than
helping the chronically ill to deal with suffering, the healthcare system attempts to
optimize time, money, and profit
- Kleinman uses an anthropological and physician perspective to analyze the healthcare
system, struggling to understand which perspective to take on disease at what point
can these two perspectives meet?
The meaning of illness
- DEFINITION OF ILLNESS: ho the sik peso ad the ees of the fail o ide
social network perceive, live with, and respod to sptos ad disailit page 
o Illness (how we describe its experience) is always culturally shaped
- The definition of illness carries social and cultural implications
- Illness pertains to the every day reality of having a chronic condition
- A perso’s sto aout thei illess is alled a illness narrative
o Tells us how life problems are created and how an individual addresses it
o Cultural values and social relationships shape how we treat our bodies
- Illness has meaning and can be culturally shaped
- All those involved in the illness experience of the patient share the illness experience
with them
- The experience of illness is NOT isolated to the individual affected by the condition.
- Illness problems refer to the challenges that symptoms create in our lives
o Experience is difficult to legitimize because it differs from person to person
- Illness problems refer to the difficulty and disability that illness symptoms create in our
lives (ex; pain at work, difficulty climbing up the stairs
- Our experiences of disease/discomfort are often not believed, especially if they are not
physically visible. This creates a pressure to justify what we are feeling to other people.
This is why we rely on healthcare professionals to tap into the illness experience of
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other individuals, to have a better understanding of the patients and how to proceed
instead of throwing prescriptions as a remedy
- Language of complaints are seen in both verbal and nonverbal ways
o These are learned/shared meanings in society
- Language of complaints are ways we communicate our illness, which vary based on the
Stages of illness experience
- Stage 1: Symptom experience (sensing something is wrong)
o Feelings of pain, discomfort, general unease, some disruption in bodily function
(they are yet to prove it at this point)
- Stage 2: Assuming the sick role (accepting signs of illness)
o “ik ole – individual begins to relinquish some responsibilities to get better
(ex; caregiving duties)
- Stage 3: Medical care contact (using healthcare services)
o Factors that affect if someone seeks help: Background of patient (ex; age),
gender, race, ethnicity, perception of illness (can I deal with what I am
experiencing or do I need help?)
- Stage 4: Dependent patient role (making every effort to get well)
o Patient undergoes medical treatment and tries to get better.
- Stage 5: Recovery (getting well or terminating treatment)
o Recovery until the cycle repeats itself. Factors that determine if patient gets
better or not: Severity of illness, coping ability with diagnosis, extent/nature of
social support
- We repeat this cycle over and over in our lifetimes. Personal independence and reliance
on others around you are prominent themes in getting better. There is often a thought
that the patient is burdening others by being ill.
- Illness experiences are individualized two people with the same diagnosis would
behave in very different ways
The social construction of illness
- Individual experience if illness varies greatly
- Illness is how we perceive, experience, and cope with a condition
- Complex interplay of factors: lifestyle, ethnicity, class, age, gender, macrosocial
(economic, political, institutional) forces shape our illness experiences
- Very subjective
- Illness is cultuall ostuted / it’s ho e peeie, epeiee, ad ope ith a
certain condition
- Based on cultural reactions
- Taditioalists fous o the disease odel istead of the patiet’s epeiee this is
because they are trained to look more at biological poesses to get to the oot of the
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Example of HIV as illness
- Cultural attitudes influence the experiences of people living with HIV and AIDS
- Cultural stigmatization affets people’s ailit to aess peetio ad teatet
- A idiidual’s experience is affected by fear of disclosure, and a negative social attitude
that may induce shame or guilt
- A patient seeking treatment for HIV is also contingent on their status
- Ho ill othes’ peeptio of HIV ipat e?
The meaning of disease
- DEFINITION OF DISEASE: …hat the patitioe creates in the recasting of illness in
tes of theoies of disode page 
o Accounts of illness are translated into narrow technical issues
o Ignoring social elements causes aspects of the illness experience to be lost or
o Fo the patitioe’s pespetie, disease I“ the pole
o Often underlying social determinants of daily life go unaddressed
Diagnosis focuses on the biological aspect of a condition
o Illness experiences are collected over time through sensitive solicitation to
extend support to alternative forms of care
o Disease derives from a bodily process or technical issue
o Disease laels oe aout fo test esults to fit a patiet’s oditio
Aspects of illness (cause) may be ignored in your treatment
- Practitioners transform an illness into a technical issue/biological process
- Kleinman focused on looking at disease in a holistic manner
- Often times, the patients fear family frustration and other underlying cultural/social
issues of their daily life that may be contributing to how they feel go unaddressed
- Purely focusing on diagnostics in terms of biological and psychological standpoints
negates the personal aspect
- Sensitive solicitation how to approach a patient and their caregivers to understand
the illness experience
o Read medical history chart
o Ask patient why they are coming in today
o Ask family member about their perspective
o Synthesize this information
o Recommend treatment
- What the patient thinks she/he has is not as important as understanding the illness
- It’s diffiult to easue a idiidual’s epeiee ithout attahig soe aita
- Disease laels ol patiall eopass the patiet’s epeiee
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