- Changing perceptions about what causes disease – the nature of risk,
behaviour and responsibility reflect powerful moral beliefs. These beliefs,
in turn, affect patterns of social behaviour and the organization of health
- During the 19 century medical theories stated the hereditary qualities of
susceptibility to particular diseases. Late 19 century – germ theory
emerged – a single pathogen was invariably associated with a specific
disease, this organism could be isolated and grown and used to reproduce
the disease. Researchers realized it was possible for individuals to be
infected but remain free of disease.
- Thus, there was a focus on the organism as the cause of the disease and
the social environment was diminished. However, germ theory was
found to be lacking later on as infectious diseases declined. Thus the
material conditions of life – sanitation, nutrition etc. became more
important in patterns of infection.
- The bacteriological revolution had the effect of “depersonalizing” disease
– they no longer possessed the same moral valence they had in the past.
(The world of medicine became secular and rational) Offered the
possibility of disconnecting disease from its historical associations with
sin and idleness. Diseases were seen as the random chain of events that
brought together a microorganism, a “vector” and human beings. This
was called the de moralization of disease.
- The attribution of “disease” had the effect of reducing individual
responsibility. For instance – even alcoholism became a disease. Disease
implies a lack of volition, or at least a failure of individual agency.
- APPEAL OF THE BIOMEDICAL MODEL – If disease was caused by a single
microorganism, then destroying the organism offered the promise of
conquering disease. However this also lost credibility for it failed in
identifying a single cause for chronic diseases like cancer – organism could
also become resistant to effective chemotherapies. - There was thus a shift from INFECTIOUS to CHRONIC – systemic disease
was a transformation in the meaning of disease. Germ theory lost
credibility as drugs could not target systemic chronic diseases. LED TO A
NEW RECOGNITION of environmental and behavioural forces as
determinants of disease.
- This significant change in patterns of disease during the first half of the
20 century encouraged a “new” epidemiology. Researchers rather than
just tracking microbes seen to cause disease began to investigate risk
factors: Social, environmental and behavioural. This new epidemiology
offered potential for the moral categorization of wide range of
- For instance – the recognition that cigarette smoking causes serious
diseases and the eventual decline in smokers is characteristic of the
postwar shift regarding risk, disease and behaviour. There is a clear
criticism of the germ theory’s emphasis on specific causality. Cigarette
labelling served the purpose of shifting responsibility for smoking and its
risks to the individual smoker from the industry. It was a “voluntary”
- In the 1970’s attention was centered on the question of responsibility for
disease and its prevention. The goal of health rested with individuals who
in the past decades had given up their healthy in an orgy of avarice and
greed. Values of self-discipline were emphasized. The mantle of
responsibility in the quest for health would now be carried on the
shoulders of the individuals.
- Disease was now viewed as a failure to take appropriate precautions
about publicly defined risks, a failure of self-control, an intrinsic moral
failing. (American government wanted to reduce health expenditure)
- The fitness movement departed from its historical focus on general well-
being to being essential for disease prevention. Exercise became another
aspect of the “medicalization” of American culture.
- The fitness revolution did not focus on team sports, but the battle within
the body. The goal was victory over the uncertainties of the body. Good
behathour could now be grounded in biomedical rationality.
- 20 Century United States – a series of political and moral
conflicts. Is there a right to health care? Or a duty to be healthy?
- As effective as values of moral responsibility may be in serving to define
healthy behaviours, they represent an important irony. According to this, those who continue to take risks must be held accountable for the results.
But this denies broader social responsibilities for health and disease. This
neglects the fact that behaviour is sometimes beyond the scope of
- To stress individual accountability is to deny that some groups may be
more susceptible to certain behavioral risks (for instance education, race
and class make a difference) Nevertheless such people are considered
ignorant and stupid. For instance – drug use becomes pre-eminently an
aspect of individual agency (JUST SAY NO CAMPAIGN)
- Why was there such a panic about aids? 1) It strikes the young 2) it is
communicable 3) deadly (has no cure) Aids is caused by the moral failure
of individuals. Those who are infected are responsible for their plight.
- In this discourse one’s moral failings are clearly perceived as having
powerful social implications by placing others at risk. In the case of HIV
this has been made explicit with the idea of the “innocent Victim”.
- Lifestyle has become a critical part of contemporary moral discourse.
The punishment theory of disease ascribes moral blame to those who get
sick or those with special relations to them. Religious versions hold that
god punishes them in order to encourage virtue. These views are not only
irrational but influence policies and cost lives.
Looks at sub Saharan Africa which is the epicenter of the Virus. For
compassionate as well as pragmatic reasons, we need to find solutions in
these regions. An obstacle to cooperation is the indifference and distrust
by those on wealthy countries to the misery of others.
Punishment theory of disease – the view that being bad can directly cause
disease, and when it does, blame should be placed on those that get sick.
It DOES NOT employ a causal concept of responsibility but rather a moral
concept of blame. A person with HIV would be morally responsible for
infecting others if he could have done otherwise. A person is casually
responsible if he unknowingly donated blood that was infected. Religious punishment theory of Disease.
Secular Punishment theory of disease.
The association of disease and blame is ancient. According to religious
versions, illness is divine punishment; it is inflicted on humans to punish
How does this theory fail? In 3 ways. It fails as a General Account. One of
the greatest tragedies of AIDS is that millions of infants are born with it.
Yet they have done nothing wrong. So it does acknowledge that innocent
people do get sick. WE should have some way of distinguishing the “guilty
sick” from the “innocent sick”. 2) Nothing follows about how we should
treat others. If someone is already sick, why can’t give them additional
punishment. If they have been warned by a divine being, maybe we
should consider them blessed. 3) Explains the obscure with the more
obscure – We end up appealing to the intentions of a deity. This
explanation creates more confusion and undermines rational enquiry. We
disagree about what constitutes God’s intentions and how to resolve
these disputes – this undermines this view.
It fails as a general account – who do people get sick? Infants infected do
not have a bad lifestyle. Why do good people and their relatives
sometimes get sick, while bad people don’t? Which risky behaviour makes
people morally blame worthy for their sickness? 2) Cannot reliably ascribe
Blame. When do we know when someone is blame worthy for getting
AIDS? In some cases socioeconomic and cultural factors make it hard for
people to act otherwise. What about someone trapped in a social
structure where they acquired HIV because the only means they have for
feeding their family is engaging in risky sexual behaviour.
It is dangerous because it invites us to divide people up as “innocent” or
“guilty”. We need to stop thinking of the world as US AND THEM. IT also
undermines compassionate care for people and can be used as an excuse
to abandon those in need. The very nature of AIDS is constructed through language and in particular
through the discourse of medicine and science. This construction is only
real in certain ways – so far as it guides research or facilitates control over
the illness. Thus, language cannot help us determine what AIDS really is.
AIDS is not just an epidemic of a lethal virus but an epidemic of meaning
Implications of diverse conceptualizations of blood – confusion about
transmission causes half the US population to refuse to give blood. People
believe you can catch it through casual contact.
Ambiguity and uncertainty are features of scientific inquiry that must be
linguistically and social managed. No clear line can be drawn between
facticity of scientific and non-scientific misconceptions.
We need to understand Aids both as a material and a linguistic reality.
AIDS AND HOMOPHOBIA – CONSTRUCTING THE TEXT OF THE GAY MALE
Male homosexual text has figures significantly in genera