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SOC309Y1 (60)


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Robb Travers

SOCIOLOGY309 NOTES/READINGS: - 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 care. - During the 19 century medical theories stated the hereditary qualities of th 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 th 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 behaviours. - 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” health risk. - 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 individual agency. - 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. (Victim blaming) - 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 them. 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 and signification.  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 BODY:  Male homosexual text has figures significantly in genera
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