Health Age 1AA3 Winter 2014 Notes for Exam Review

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Health, Aging and Society
Geraldine Voros

Exam Review 2014-04-12 6:06 PM Introduction 1 - 3 • Grey Nuns o Labor of love, no set price o Used to be the average age of 65 and 1600 in Quebec o Now it is average age of 82 and only 574 left ▯ It decreased because now people want to run it for money not out of love • Sociology Perspective o Interested in the relationship between ▯ Health beliefs and culture ▯ Health behaviors and education ▯ Health needs and health care ▯ Economic structures and health care services ▯ Political structures and health care services ▯ Technological innovations and health care services • Health and aging involves a critical perspective o Challenges conventions, norms, philosophies and theories in policy and practice o Pays particular attention to diversity, difference, rights and social justice o Is dedicated to the transformation and change where needed o Will at times, draw on philosophy and social theory to make arguments o Embraces, but also critiques, multiple methods and theories Jackson Article “Key Methodological Approaches” 4 - 6 • The Positivist Approach o Augste Compe and Emile Durkheim o Proposed that sociology goes through three stages ▯ Theological stage ▯ Metaphysical stage ▯ Positivist stage o Objective approach ▯ Designed to minimize bias, is impersonal and seeks its authority in fact, not opinion o Durkheim ▯ Need to look at social facts objectively ▯ Observe the patterns ▯ Patterns of regularity can be studied statistically ▯ Entitled to our opinion but need quantitative facts o Star paradigm ▯ Five institutions but added the six for the roles of health and illness understood as social roles ▯ Parsons • Sick role and non medical sick role • Positivist Assumptions about Science and Human Behaviors o All behavior is naturally determined ▯ Each outcome is produced by one or more external cause o Human are part of the natural world ▯ Human behavior could be studies using methods employed on the behaviors of other species, language complicates things o Nature is orderly and regular ▯ Nature world is orderly, predictable, patterns in nature are identifiable, random event simply reflect our inability to comprehend fully the natural forces at work o All objective phenomena are eventually knowable ▯ No intellectual limits to our knowledge on nature o Nothing is self-evident ▯ Must test ideas systematically o Truth is relative ▯ Dynamic element to our knowledge o Knowledge comes from experience ▯ Knowledge is gained through our senses • Values in research o Value-free, avoid personal values • Research Methods o Experiments o Surveys o Secondary data • Criticism of positivism o Value free research is an unattainable goal • Interpretative Approach o Max Weber o How people make sense of their lives, define the situation and their sense of self develops in interaction o Role modeling ▯ The extent to which an individual chooses to emulate someone else’s attitudes and behaviors o Values in research ▯ Values are relative o Research Methods ▯ Participant observation research o Criticism ▯ Reject that all values are equally valid ▯ field study doesn’t allow generalization o Critical Approach ▯ Feminist theory ▯ Marx and Simmel ▯ Human relations are characterized by conflicting interests ▯ exploitation ▯ One group tries to improve to the expense of less powerful groups ▯ Researchers feel the need to advocate fro social justice on behalf of those less fortunate ▯ Critical approach role of values in research ▯ Absolutist view of value ▯ Research methods ▯ Historical materials ▯ Macro and micro variables ▯ Criticism ▯ Reject absolute values ▯ Too selective Stone Article “Excerpts from Policy Paradox” - 7 • Who gets what, when and how • Equity is the goal for all sides in a distributive conflict o Used chocolate cake as an example 1. Equal slices but unequal invitations o if your not in the class you don’t get 2. Unequal slices for unequal ranks, but equal slides for equal ranks o The students a little bit of cake, while professors a lot with whip cream 3. Unequal slices, but equal blocks o distributed by sex, but boys would get more blocks because there are generally more girls 4. Unequal slices but equal meals o if you came late, you don’t get the best picking tin the meal but bigger slice of cake 5. Unequal slices but equal values to the recipients o if your diabetic don’t eat, if not you do get, that way the diabetic save their health and non, there pleasure 6. Unequal hunks but equal starting point o give each person a spoon 7. Unequal slices but equal statistical slices o name in a hat 8. Unequal slices but equal votes o democratic voting to those who are polite, and early Efficiency/cost effectiveness o sustainability ▯ best way to organize human activities to yield the most o evidence based medicine ▯ determine before hand if someone needs a x-ray or not Security / social capital o need carries more weight than desire or deservingness ▯ work with meritocracy, put an 80 year old in a wheelchair o objective needs and objective programs ▯ whoever comes, needs it, gets it Liberty/individual vs. collective rights o community social purpose trump individual choice ▯ example of smoking allowed in lecture room now banned o collective right o there are limits to liberty Kleinman Articles (1) “Health care system as Forms of Social and Symbolic Reality & (2) “The inner structure of health care systems” 8 – 14 Three dimensions • professional sector o cloak of confidence ▯ doctors, nurses • beliefs, choice and decision roles, relationships o family-based • folk sector o herbal o message therapy • Patients and healers in the Context of culture o physical environment o clinical reality ▯ social and cultural context of sickness o sick person o psychobiological ▯ symptoms o symbolic ▯ reality mediating sickness and care • Social structure of reality o healthy care are socially constructed o becomes our reality at two levels ▯ external interpersonal environment ▯ norms ▯ communication with each other ▯ our own internal intra-psychic space • Figure 3 o popular sector ▯ least understood, non-professionals ▯ illness is first defined here ▯ family is most active and widely used o popular sector steps ▯ illness first encountered in the family 1. perceiving and experimenting symptoms 2. labeling and valuating the disease 3. sanctioning a particular kind of sick role 4. deciding what to do and engaging in specific health care-seeking behavior 5. applying treatments and therapy from other sectors of the health care system ▯ Popular sector ▯ is diffused ▯ multiple opinion on what you might or should do – defined as a sick family member ▯ health and health maintenance ▯ Special care applied to each, with different languages, communication and a separate culture o Professional Sector ▯ Most powerful sector ▯ Institutionalized ▯ Defined as a patient ▯ Indigenization ▯ The cultural re-altering of professional clinical care to a greater or lesser degree • RCSI delivery methods ▯ Popularization • Scientific health concepts are altered and diffused after they enter the popular health sector • Washing hands and singing happy birthday ▯ Research by physicians are systematically limited to problem-frames; biomedicine • Solutions offered fit professionally sanctioned-frames and are evaluated from that standpoint ▯ Professional dominance • Self fulfilling prophecy • Embrace data/research ▯ Medical/professional ideology • Blind conviction ▯ Moral offense • Failing to comply with professionals request ▯ Folk Culture • Folk sector • Client • Two parts of folk sector o Sacred ▯ Shaman ▯ Ritual curing o Secular ▯ Herbalism ▯ Yoga • No or little follow up research Art Duerksen o 55 year old o joined the ironman triathlon to raise money for charity o main artery at the top of his brain stem became blocked, suffered brain damage o trained himself slowly and had the strength to complete the race o Paradigm points to consider ▯ How we incorporate the folk, popular and professional In our lives affects our well being ▯ Individuals differ in conscious understanding ▯ These choices influence the outcome and how we come about it ▯ How we think, feel, social factors react affect all our social well being ▯ Kleinman distinguishes between two aspects of social reality ▯ Social cultural world is social reality per say ▯ Bridging reality that links the social cultural world with the psychological and biological realist is termed the symbolic reality Women Healers and Patients (lecture) Men wanted to take over the medical profession • Executed an ‘active takeover’ • Why did it happen o Men dream in controlling healing (medicine) and related institutional organizations o Their views are different regarding health care – extrinsic (male) vs. intrinsic (female) Midwifery • Historically women have been seen as healers • Witch craze o An era of political and religious contamination around women • Women healers were seen as a threat o Politically ▯ She could become apart of the working class and into the rich o Religiously ▯ Church was afraid of free thinkers o Sexuality ▯ Women’s role in society should only be at home ▯ Evil thinkers were a threat since thought that if they thought it would bring catastrophic situations • Control mechanisms to subjugate women to the role of patient o Conservation of energy theory ▯ One organ works at the extent of other ▯ To think takes energy therefore to work would take energy and your body cannot do both at the same time o Myth of female frailty ▯ Pms-ing ▯ If she was always tensed then had to get ovaries removed to relax • Florence Night and Gill o Convinced women that girls could not biologically designed to become doctors, but only nurses, only until they got married Davis Floyd/ Gender Ritual and Birth • Davis Floyd – Gender Ritual and Birth o Child birth occurs in a socially constructed area o Way society treats childbirth reveals the way they treat women o Visible and invisible ways women’s bodies are seen as a defective machine • Ritual stages (Know what each stage means) o Separation from previous social state ▯ The definition of yourself has changed ▯ When you are told you are pregnant you switch from a girl to a women ▯ Need to rest ▯ Take things more seriously o Transition, they are neither one thing or another ▯ Failure to strive if she doesn’t lose the weight ▯ Mother is seen as a bystander to the baby ▯ Failure to thrive ▯ The child is ill ▯ The mother is not doing her job right ▯ Break down of old beliefs ▯ Need to learn to construct new cognitive categories of being a mother, parent, caring for a child and what does it mean o Integration, absorbed into new social state ▯ What does it mean to be a mother o Cognitive restructuring of ritual ▯ Process of childbirth is transformed to a cultural right of passage to a patriarchal status quo ▯ Symbolic message is felt through the body • Routine obstetric procedure o It is now seen that the hospital is giving life not the mother • Cognitive matrix o Ritual not arbitrary, transmit belief system into emotions, minds and bodies lead to profound understanding of a belief system o Hospital sets a techno centric model of reality o Technocratic paradigm ▯ Ideology of technological progress ▯ Believe that the nature is being improved when controlling it with technology ▯ Technocratic paradigm ▯ Model of reality forms the philosophical basis of both western bio-medicine and Western Society • Philosophically assumed 1. Universe is mechanistic 2. Follows predictable laws 3. One can discover this through science and manipulate it through technology • Mechanization of obstetrics o Assembly line, production of goods (baby) mothers body was a birthing machine hospital a technocratic factory, mother are seen as a secondary • Repetition and redundancy that women are mechanized and in need of the hospital o Electronic monitoring o Iv line o Hospital gown Cognitive reduction must be achieved through these four o Repetition o Hazing o Strange making o Symbolic inversion Cognitive stabilization o Mediates between cognition and chaos o Confidence on part of the mother, and convention is expected Cognitive transformation o Symbolic message fused with individuals emotions and beliefs Affectivity ad intensification o Rituals are emotionally charged and ensure long term learning Preservation of status quo o Shows the power structure, and legitimizes the doctors position as the patriarchal privilege Positions dictate power relationship o Delivery is toward t the doctor, women laying down man standing up Episiotomies and Caesarian o Legitimize that childbirth is not a natural but a surgical procedure Raz Moda – B.C. • Dream Team Approach to Birthing • Choices o Deliveries 1/3 by midwives o 1/3 by doctors o 1/3 by obstetrics/gynecologist specialist • Dream Team does not compete for clients/patients, specialists are called if there are complications • Normalization is the goal for Dream Team • Comfortable relationship between mother and the delivery entourage Armstrong and Armstrong “Contradictions at Work” • WW2 expanded the need for health care in Canada, 1960s universal health care in provincial and federal governments took place • Nursing expands and attempted to unionize • Evidence based medicine developed at McMaster o Ottawa ankle rule • Nurses failed to recognize that the doctors power came from their class and gender more so than their science degree • The response of the nurses was the development of the Ontario Health Coalitions grass rots movement which mobilizes through city hall – protesting against the exploitation of nurses and ancillary workers • Technology increases precision but restricts independent judgment and fragments care Boddy Article “Trance and Possession Disorder” • Diagnostic and statistical manual of mental disorder DSM o It is a learned behavior o In some societies sit is integral part of everyday life, considered normal and excepted with society o It seen as if it lends self knowledge, and self confidence o Possession by a male spirit who takes control of a women’s body speaks to the man as if man-to-man, dispensing advice that would other wise be impossible o In order for trance to be normal is must be apart of the collective culture, it is the protesting and resistance self versus the compliant self Ward Article “Excerpts from a World Full of Women” • Theory o Powerless women ▯ Possession of a male spirit to speak to her husband to renegotiate o Cults of affliction ▯ Women who feel their aspiration and intelligence are not being met or utilized o Dramatization ▯ A connection to the mother line and others for support as the dramatization of conflicts are presented given the possessions • Becoming possessed o Becoming a Shaman, is empowering, neutralizes the negative situation of a breakdown • Zar Therapy o It works by making the women recognize her dissociated feelings as separate from herself • Western Psychotherapy o Tells the patient to accept and integrate the dissociate feeling as apart of their self, take ownership and work through it • The male conspiracy or dominance is not the central problem, the over-determination of women, over socialization, and having a moral self image more narrow than their actual life experience example codes of modesty and chastity • Possession = cultural resistance Kinsley Article “Healing in Contemporary North American Christianity” • Illness is seen as an awakening, God teaches someone something through their illness o The illness being cured leads to acknowledging a divine purpose • Christianity o Sin causes illness directly, it is a punishment from God • Other Assertions o Healing is admitting ones since, healing it renewal o The illness is Satan seeking to undermine the human commitment to God o The person is the victim o Can avoid being victimized by joining prayer groups • Groups structures and practices o Small healing groups ▯ Private setting ▯ Low key ▯ Lay people who do not claim healing powers ▯ Democratization of routine healing ▯ Anyone in the group can do this ▯ Expect small changes in the habit, attitude, daily routine ▯ Seen as maturing of one’s spiritual sojourn ▯ Regularly pray for those who have made the request o Large Healing Group ▯ Famous faith healers ▯ Powerful healing touch ▯ Personal charisma ▯ Affects healing process o Type of psychotherapy ▯ Calling forth ▯ Re-experiencing painful memories ▯ Giving it up to God o Discernment ▯ Coming to a true or complete understanding of one’s illness = healing self knowledge o Allopathic, biomedicine neglects the patients contextualization in this community Gaisson and Bouchard “Other Touch Research on Terminal Cancer Patients ” • used Rogers nursing conceptual module o the model describes human beings and environment as energy fields in mutual interaction with each other o nurse and patient extent beyond their physical bodies, each being an energy field within the others environment o in state of health, the energy flows with freedom o in illness, the energy field is blocked and departed and manifested by imbalanced patterns in the patients energy flow ▯ the nurse uses her hands to asses the imbalances in the patients energy flow, by using the therapeutic touch o seen as human and natural way to intervene “Music and Wellness” (lecture) • Music becomes o Transcultural o Deterriotoralizing place and identity o Reflects traditions of dominant nations o Consideration that there is an emotional internalization of music by listeners o Creation of soundscape ▯ Atmosphere and environment where it is mentally occupied in the moment o Used by people to transport them from current situation to others, that may help them feel better • Bono & U2: Possession Trance? o Advocates health, welfare and justice o Offers an idealism and optimism o Socially and politically aware o Rebellious and defiant o Spoke of the physical emotional and social consequences of military conflict o Politically inspired work by Martin Luther King o Spoke of the concern of the information age o Against poverty, and that one should not die alone o Speaks for a need for religious co-existence and transcendence, does not speak on behalf of one religion • Celebrity Diplomacy and politics o Initiated awareness of inequality in Farm Aid, Band Aid, Live Aid o Influence funding for health related initiatives ▯ Product red ▯ Products an d credit card contributing money to global fund for foreign aid fighting AIDS., tuberculosis and malaria ▯ Develop think ta ▯ Debt ▯ Aids ▯ Trade ▯ Africa • Generated over 400 million for debt relief in developing nations • Saved 5 million lives • Created international AIDS program • Doubled the non-loan international financial assistance to Africa • Health message in songs o Macro Scale ▯ Focuses on opportunity for health and access to health care, speaks to location and distance ▯ Criticized • For short efforts , one famine hear now but what about after o Micro scale ▯ Reference to the individuals settings ▯ Engaging with the personal situations, feelings and sense of place Rosalie Rebollo Pratt “Medicinal Music” (lecture) • Soundscapes are as complex as the human mind, and give many meanings to own personal interpretation o He openly criticized companies who said they’ll give donations like the g.a.p. o Counter-criticized since he’s rich, but moved to Ireland to pay
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