ANTHROP 3HI3 Study Guide - Midterm Guide: Arthur Kleinman, Narrative, Sick Role

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Anthropology 3HI3 Midterm
Jan. 16th Lecture: Illness Experience
1. Anthropological discussions around illness and disease model began in the late 1960s
and early 1970s.
a. Growing patient dissatisfaction with medical care model
b. need to consider illness and disease as two separate entities
i. physicians only seemed concerned with identifying and treating a disease
from a biomedical standpoint
c. 1980s: Arthur Kleinman proposed classic definitions of illness and disease
d. From this perspective: gap in our healthcare system in what the patient
experiences and what the doctor treats.
2. The Meaning of Illness
a. persons sto aout thei illess = illness narrative
i. how life problems are created
ii. how they are addressed
iii. how cultural values are involved
iv. how social relations shape perception of our bodies
v. how we label our bodily symptoms
vi. how we interpret the illnesses effects on our life situation
b. Meanings of illness are created within relationships; this extends to the
caregiver, family members, friends, and to the patient.
c. language of complaints = both verbal (e.g., a sigh) & nonverbal communication
(e.g., cradling of the wrist).
d. local knowledge of what it looks like for someone to be in pain
3. Stages of Illness Experience
a. (1) Symptom Experience: some individuals sense that something is wrong
i. feelings of pain, discomfort, general unease, disruption in bodily
b. (2) Assuming the Sick Role: takes place if the individual accepts the symptoms
they are experiencing are a sign of illness, then the transition is made to the sick
c. (3) Medical Care Contact: use of health care services.
i. number of factors that influence whether an individual decides to seek
medical attention, including background of the patient such as age,
gender race and ethiit, ad the patiets peeptio of the illess.
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d. (4) Dependent-Patient Role: patient and physician agree that treatment is
necessary, the individual takes on the dependent-patient role.
i. patient undergoes the medical treatment and its expected to make every
effort to get well.
e. (5) Recovery: individual will either recover or terminate the treatment.
i. severity of the illness
ii. individuals coping ability with the diagnosis
iii. extent of their social support network will determine the impact of the
illness on the patient.
* We repeat this cycle every time we become ill.
4. The Social Construction of Illness
a. Illness = subjective experience, it varies from person-to-person.
b. People respond in very different ways to identical diagnoses, especially when it
comes to following the stages of illness experience.
c. Example of HIV as Illness:
i. Cultural attitudes influences the experiences of people living with HIV
and AIDS
ii. Cultural stigatizatio affets peoples ailit to aess peetio ad
iii. A idiiduals epeiee is affeted  fea of dislosue, ad a egatie
social attitude that may induce shame or guilt
d. Example of HIV as disease:
i. HIV and AIDS is a complex of symptoms that reflect failure of the immune
ii. HIV destroy cells of the immune system
iii. AIDS symptoms vary considerably and increase susceptibility to other
iv. HIV effects everyone and there is no cure for HIV infection
5. Accounts of Sickness
a. sick role(introduced by Kleinman): involves cultural, social and interpersonal
expectations regarding the ill or diseased pesos ehaiou.
i. exemption from performing certain social obligations or responsibilities.
ii. For example, a homemaker may no longer be expected to cook and
clean, and a breadwinner may be allowed the luxury of not going to
6. Definition of Sickness
a. “ikess is ot a pesos fault – consider social determinants (e.g., income and
social status, education, gender etc.) of as a way to explain the cause of disease.
b. exempt from daily obligations to comply with medical orders.
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i. exemption from everyday obligations requires sick individual to prove the
legitimacy of their disease or illness.
c. sick role = temporary state
7. Culture and Health
a. health = elatie to oes ultue ad positio i soiet
b. WHO definition s= oes ailit to ope ith eeda activities and to being a
fully functioning human being.
c. Does it consider the emotional, spiritual, moral, and metaphysical effects on
oes sese of ell-being?
8. Cultural knowledge = essential for addressing the health needs of the community, which
a idel; this eates a eed to udestad the ouits leel of koledge o
the differences between illness and disease.
9. Meanings of Illness Narratives
a. Individuals order and reorder their experience of illness differently each time
they tell it because meanings change and detail changes depending on our
audience (e.g., home, public clinic, private office, grocery store).
10. Social Determinants
a. Illness and our understandings of a health condition are socially constructed and
influenced by the social determinants of health.
b. Social determinants do not exist in isolation of one another.
c. WHO study on the social determinants of health:
i. WHO commissioned a study of the social determinants of health in 2008.
ii. CONCLUDED: primary causes of poor health = unequal distribution of
power income, goods and services.
Film: Alicia Mercado
1. What are some of the reasons for her lack of adherence to medical therapy and follow-
a. Social stressors (being driven out of her apartment) and depression.
b. Side effects and fears about potential consequences of medications.
c. Use of complementary/alternative therapies (home remedies).
2. Put yourself in the position of her practitioner when she was missing appointments and
not caring for herself. What could you do to help (i.e., what is your role as the
a. Provide support and consider brief counseling in the office.
b. Enlist the support of key family members or other individuals who provide social
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