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Lecture 9

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William Magee

SOC243: Lecture 9 I. Situating health, illness and disability more systematically in cultural context II. Situating life course and illness processes in cultural context III. Beginning to situate illness experience in structural context—some considerations in service system context. I. Situating health, illness and disability more systematically in cultural context  ‘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 ideologies.  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.  Social model—assumes that disability stems solely from constraints built into the environment or social attitudes (i.e. prejudice, that leads to discrimination)  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 feels 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 itself 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  Illness/disability as ‘interruption’ – experienced as a small or tempo
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