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University of California - San Diego
Culture, Art, & Technology
Gerald Doppelt

1. Ehrenriech (Sociology of Medicine) a. Looks at the place of medicine in modern society far more broadly than Goldman and Grooman. i. Looks at medicine as a network of social relationships in which doctors exercise various kinds of medical paternalism, who is being controlled by whom? To what ends and consequences? For who’s interest? b. Concept of the sick role – an institutionally defined role that is extremely important, in which doctors control the entry and exit of the sick role. i. Ex: If you feel sick and have an assignment due, you go to the clinic and tell the doctor. If the doctor certifies you as sick, then you get a slip signed by the doctor, then you are officially in the sick role, and you can get an extension for this deadline. ii. Control is fundamental to the order of society. What is involved in the entry of the sick role? (1) The patients undergo a suspension of individual moral responsibility and judgment, and (2) exemption of simple individual duties, (3) conditional on the patient recognizing the sickness as a bad things, and accepting an obligation to get better, as defined by Carsons. iii. Also control the exit from the sick role. iv. Alot of sociology is developed in the 19 century. 1. The rigid feudal society, based on condition and custom and rigid caste, was slowly dissolving and being replaced by a competitive market society, where individuals are no longer serfs or peasants, but can go onto the competitive market and sell their labor. 2. This is a period of social change. In a competitive society no longer governed by rigid customs, what generates social order? What are the sources of deviance from the norms of society? c. Deviance follows many different concepts, such as sin, illegal crimes, and not working. The sociological insight into the nature of order is that society, in order to maintain order, needs groups of people who can identify and control deviance. If this cannot happen, society can fall into disorder. i. It follows then that sickness is a form of deviance that must be controlled, and must be stigmatized as undesirable. No society can allow for everyone to be in the sick role. Physicians and doctors control this deviance by controlling entrance into the sick role, which can now be seen as a social construct, but not as a status of physical illness. th ii. E.G. In the 20 century, as more and more human problems are taken to qualified people and the sick role, and the conditions for sick role expand, the area of individual moral responsibility shrinks, a problematic cause of the expansion of the sick role. iii. What about subjective feelings? Do they fall under the role of doctors to regulate and control, or is this something under your responsibility? 1. E.G. Depression can be seen as a medical condition, thus removing this as an individual moral responsibility. d. Scientology and technology show a future in which individual and moral responsibility continually shrinks, even in terms of emotions, as they now provide mood-altering medications. Any time an individual problem (depression, impotency during sex, etc.) becomes labeled as sickness, it now becomes the responsibility of a third party, rather than the individual. What problems become your responsibility, and what problems become the responsibility of doctors, physicians, etc.? i. E.G. Social workers must separate the legitimately poor and unemployed from the illegitimately poor, who are lazy and do not recognize the duty of work. 2. Parsons a. Who defines sickness and health? i. These value judgments are relative across cultures, in terms of what is desirable (health) and undesirable (sickness) across cultures (Parsons). ii. Sickness and disease are a departure from health. b. E.G. An entire community can be sick or ill by Western standards, but not ill in their own society. The Rockefeller Sanitary Commission of Bookworm. In areas of North Africa, some were infected by a parasite, something that is seen as undesirable in Western society, but is seen as fine in the native society. c. E.G. Dischronic spinal chritosis, symptomized by spots on the skin, can be cured with drugs. However, in one SouthAmerican Indian tribe, spots are regarded as normal and desirable. In fact, those lacking the spots are considered abnormal and excluded from marriage. i. We may assume that we know the cause of these spots, and they don’t. But in Parson’s point of view, even if we know the conditions for these symptoms that are desirable, it wouldn’t even matter. d. How about conditions that are considered diseases in many cultures? This is because they all share a set of common values. 3. Freetsons a. Argues that medical professionals do not merely control entry into the sick role, but are also decision makers on conditions for sick role, using medical definitions. They define what counts as admissible for sick role entry. b. The sick role expands exponentially, as doctors and medical professionals expand the conditions for sick role entry, leaving less and less individual moral responsibility to exercise control over their own well being. c. E.G. There was at time in a book for illnesses where homosexuality and masturbation were considered to be illnesses. There was a change in social and cultural attitudes, not any medical discoveries or changes that constituted this change. d. E.G. Self-defeating personality disorder may be argued as not an illness, but a situation that some women confront as getting identified and treated as overzealous homemakers, working overtime to meet the needs of the family, with no time for themselves, experiencing low self-esteem. Thus, it can be argued that this is not illness but a cultural or social stereotype. (Tatser) e. E.G. There were lots of individuals doing keyboard punching, doing productivity schemes. They would be monitored by managers, and those who weren’t productive enough “not punching enough keys” could be demoted or fired. Some women developed pain in their hands, so they had to work slower or not at all. This condition became defined in medical law as repetitive use syndrome. Some believed that the women wanted that condition to get some time off, and medical aid would pay for it. Is that an illness or a failure to perform? If an illness, it cannot be grounds for firing, and must be treated by medical aid. 4. Ehrenriech a. Tests are a major means of prevention and early treatment, but that does not mean that tests also have side effects. b. Anew drug can be safe in terms of clinical trials, and can be more effective than a placebo, but it is not as comparatively effective as the other drugs already publicized, but this is not a criterion of the FDA. Meaning there are an abundance of drugs out there on the market that usually treat the same or similar conditions. c. We need trials to determine comparative benefits of drugs, which is a knowledge deficit for doctors and patients. i. Arecommendation is for regulatory agencies like the FDAshould approve new drugs only if it is proven that they are better than the other drugs out there. 1. For pharmaceutical companies who fund new drug research, they should enforce clinical trials for comparative effectiveness research. d. Every drug has risks and benefits, and affect different people in different ways. 5. Taveris a. What is an illness or disease and who decides? b. According to Ehrenriech, doctors exercise exclusionary and co-optative control. i. Exclusionary control is the exercise of the power by physicians a
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