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Lecture 2

ANTHROP 3HI3 Lecture 2: Illness experience

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ANTHROP 3PD3 Lecture 02
January 11, 2016
Priscilla Medeiros, 1
Illness Experience
Meanings of illness and disease in Anthropological terms (medical anthropology
Influence of culture on health
History of Illness and Disease Models:
Late1960s to early 1970s
o Needed to view disease and illness as two separate constructs
Illness-disease model arises in response to patient dissatisfaction with care
o Biomedical standpoint is taken by physicians so there is a disconnect between
the patient and practitioners view of a problem
o Without an understanding between both parties, patients were not following
through with their prescriptions/treatments practitioners fault for not considering
the problem holistically
Kleinman introduces illness and disease definitions in the early 1980s
o He recognizes a gap in patterns of illness between patient and practitioner
o Argues that biomedicine reduces patient care to the treatment of a commodity
o Uses ethnography to analyze a particular culture to understand the cause and
of an illness and the predicted outcome of a disease
How the sick person and the members of the family or wider social network perceive,
live with, and respond to symptoms and disability” (Kleinman, 3) (will come up on first
assessment and midterm)
Illness (social phenomenon) is created through ongoing discourse with other
Illness Experiences:
o How cultural values and social experiences affect how we perceive and label our
bodies and our symptoms and complications of life situations and diseases
o Meanings of illness are bound in the relationships we have in our lives with other
o Illness experiences affect our understanding of health and illness
Illness Problems refer to the difficulties that symptoms create in our lives
o A highly subjective experience that is difficult to legitimize
Language of Complaints can occur in both verbal as well as nonverbal communication
o These are learned behaviours in society
Stages of Illness Experience:
o This approach affected Kleinman’s interpretations, but was made prior to
Kleinmans book
§ Alice Alcot these stages are present in her illness narrative
o 1. Symptom Experience
§ Sensing something is wrong
§ Pain, discomfort or general unease or disruption in bodily function
§ A. Recognition of pain
§ B. Cognitive recognition that illness is present
§ C. Emotional response of concern about the social implications of illness
o 2. Assuming the Sick Role
§ Accepting signs of illness
§ Individual begins to cease some of their normal activities to account for
what they are experiencing
o 3. Medical Care Contact
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§ Using healthcare services
§ Culture can affect how people treat themselves age, gender, ethnicity,
o 4. Dependent Patient Role
§ Making every effort to get well
§ Accepting that your body is suffering from an illness
§ Undergoes medical treatment
o 5. Recovery
§ Getting well or terminating treatment
o Other things that occur throughout the stages that affect recovery:
§ Loss of personal dependence
§ Loss of normal daily function
§ Burden of people in your life in order for recovery to occur
o Things to consider:
§ This framework does not account for alternative medical options because
at the time of its creation, it was not present in medicine
§ Cannot be applied to people who get ‘stuck’ in a particular stage does
not account for issues such as drug addiction
§ Negates the social, cultural and spiritual aspects of healing does not
account for different cultural perspectives of illness/healing
The Social Construct of Illness:
Individual experiences of illness vary greatly
o Patients respond very differently to identical diagnoses
Illness is how we perceive, experience, and cope with a disease or condition
Social interactions, shared cultural traditions, shifting frameworks of knowledge, and
relations of power shape illness experiences
Biomedical doctors often dismiss the concept of illness this is because disease and
biomedical is a lot easier than understanding a persons illness
o Doctors focus on curing a disease rather than healing the person as a whole
Example of HIV as an Illness:
o Cultural attitudes influence the experiences of people living with HIV/AIDS
o Cultural stigmatization affects peoples ability to access prevention and
o An individual’s experience is affected by fear of disclosure, and a negative social
attitude that may induce shame or guilt
o This is also the case with certain mental health issues:
§ People perceive these individuals as different and may feel threatened by
§ Despite education, people still stigmatizes mental illness
§ It affects the entire family, not just the individual
The Meaning of Disease:
Disease is “what the practitioner creates in the recasting of illness in terms of theories of
disorder” (Kleinman, 5)
Accounts of sickness are translated into narrow technical issues
Ignoring cultural elements causes aspects of the illness experience to be lost or missed
o Does not account for fear of dying (causing social withdrawal or divorce)
§ Or losing a job, and the repercussions of that
Disease is the problem from the practitioners perspective
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o The doctor considers eliminating the physical disease as the solution not
healing the social problems that have enhanced the disease, or similarly affected
the individual
Often underlying social or cultural determinants of daily life go unaddressed
o Diagnosis focuses on the biological aspect of a condition
Illness experiences are collected through the sensitive solicitation of sickness accounts
to negotiate an effective care plan
o Educating physicians on illness experiences in order to assemble a mini-
ethnography and negotiating what a particular diagnosis may be taking into
account the cultural, social and biological perspectives
Disease derives from a specific cause
Disease labels come about from test results to fit a patient’s condition
o Aspects of sickness (cause) may be ignored in your treatment
o For example, treating a set of conditions as the flu even if some of those
conditions don’t fall under the flu category
Example of HIV as Disease:
o HIV and AIDS is a complex of symptoms that reflect failure of the immune
o HIV destroys cells of the immune system
o AIDS symptoms cary considerably and increase susceptibility to other infections
o HIV affects everyone there is no cure
§ It is indiscriminant of age, sex, ethnicity, etc.
Accounts of Sickness:
Sickness focuses on the consequences of social responses to a person
o For example, shunning an individual for having AIDs or being obese
The sick role involves cultural, social and interpersonal expectations regarding the ill
o Leads to exemption from performing certain obligations or responsibilities
§ i.e. leaving work, limited house care, etc.
§ Breadwinner who may no longer be able to work
o Moving between stage 4 and 5 of the stages
Defitintion of Sickness:
o 1. Sickness is not regarded as the person’s fault
o 2. The individual is exempt from daily obligations to comply with medical orders
(proceeding from stage 4 to 5)
§ A person must prove the legitimacy of their illness (i.e. documentation)
o 3. A temporary state of well-being
§ Illness and disease can be more permanent than sickness
Example of HIV as Sickness:
o Experiences of people living with HIV and AIDS include consequences of the
social perceptions of these conditions
o Stigmatization or blaming of individuals because of their lifestyles increases
personal suffering
o Family members share the socially induced suffering
Culture and Health:
Health is relative to ones culture and position in society
o Being “overweight” may be acceptable in some cultures but not in others
o Having back pain can be an appropriate or inappropriate reason for missing work
depending on your culture
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