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Lecture 9

SOC243H1 Lecture Notes - Lecture 9: Narrative, Mental Disorder, Soteriology

Course Code
William Magee

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SOC243: Lecture 9
I. Situating health, illness and disability more systematically in cultural
II. Situating life course and illness processes in cultural context
III. Beginning to situate illness experience in structural contextsome
considerations in service system context.
I. Situating health, illness and disability more systematically in cultural
‘Narrative reconstructions’ – i.e. stories one tells about illness that draw on
cultural understandings, make shared meanings with others possible, and act
as a form of ‘self repair’ (when accounts are demanded)
i.e. ‘I was asked questions about what I might have been doing to bring
cancer into my life (i.e. was I still smoking? Had I been sunbathing too much?
Was I eating a balanced diet?).’
Problems: unwanted sympathy, advice
Where do these discourses come from? Refer to last lecture (cancer
surgeon moral entrepreneur promoting a new moral perspective; argues
that people can control cancer through self knowledge. People with an
optimistic attitude more likely to survive)
o Attitudes have fairly deep ideological base
Ideological base of attitudes towards illness and the ill:
Ideologies are systems of attitudes and beliefs about public matters in
institutional domains (ie. Systems of beliefs about money in the domain of
economy, systems of beliefs about knowledge and truth in the domain if
science, systems of beliefs about health in the domain of medicine).
o Organize how people think (even if they’re not conscious about it
o Institutional domains related to that particular institution (i.e.
economics, medicine)
o Meta-ideologies: dominant institutions of culture organize the other
Meta-ideology: The composite ideology that emerges in a society when the
ideologies of multiple institutional domains are combined (i.e. medicine,
science, family)
i.e. political-economic institutions may dominate in liberal capitalist
societies: Positive thinking fits with broader context of liberal/individualist
ideology that is fuelled and sustained by economic interests i.e. happiness
through consumption, or fitness (the ideology of health consciousness or
‘healthism’, etc.)
There might be over arching meta ideologies, and they organize their beliefs
and attitudes in different ways
Text outlines competing ideologies based on disabilities
Models of disability as ideologies:
Medical model of disability assumes disability stems from impairments (ie,
anomaly, defect, loss or other significant bodily function) or mental disorder.
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Social modelassumes that disability stems solely from constraints built
into the environment or social attitudes (i.e. prejudice, that leads to
Ex. Deaf - biological diversity (think of it as someone with different ears)
social model
Medical model critiqued for individualizing disability and putting
condescending and discriminatory practices
Social model critiques ignoring the experience of disability
o It liberates people to acknowledge their social suffering, but limits
them in sharing their ‘corporeal: suffering with each other.’
An integrative model is proposed that combines the social and medical
models. This model is not less ideological: i.e. some disability activists view
the integrative model as ‘arcane’, ‘incomprehensible’ (academically
oriented), undermining the emancipatory potential of the social model.
Pain makes the medical model more appropriate
Bringing in the body in pain
We are ultimately alone in experiencing extreme pain communication of
pain is rarely sufficient to allow even the most caring others to know how it
o Pain is not constant (usually comes in waves)
Thus the ability to focus with others who have similar pain about that pain
(or impairment) may be critical to warding off isolation
Dr. Frank (U of C) this kind of account giving (having to give accounts) can
have interpersonal problems the person is further alienated from their
body as it is ‘made strange’ to self in an effort to provide accounts to others
o The more you talk about your body, the more it becomes an object of
Ethnicity, social identity, gender ideology and the expression of pain
The way they express pain can help them manage that stress of the stigma
1952 Zborowski study men in treatment for back pain by ethnic group:
Jewish, Italian, Irish and ‘Old American’
Italian and Jewish patients vigorously expressed their pain (‘ perhaps
exaggerated’), and Irish were stoic (said nothing) ‘Old Americans’ fell
between the two
Cultural implication: Pain expression has a different implication for
masculinity indifferent cultures
Structural implications: rights and responsibilities differently structured
Italians want relief through analgesics (pain killers) to get back to work,
Jewish resisted analgesics, wanted the problem taken care of, expressed
more worries about the long term implications
o Doesn’t say what kind of jobs they held so that part unclear
II. Situating illness and illness narrative in temporal/life course context
Some people born with disability/illness
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