1. Ehrenriech (Sociology of Medicine)
a. Looks at the place of medicine in modern society far more broadly than Goldman
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.
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,
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
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
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.
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
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.
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