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Chapter 1-5, 7, 8, 10, 11, 14 & 15

ANTHROP 3HI3 Chapter Notes - Chapter 1-5, 7, 8, 10, 11, 14 & 15 : Chronic Pain, Diabetic Retinopathy, Narrative

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1-5, 7, 8, 10, 11, 14 & 15

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Anthro Midterm Review
Chapter 1:
Meanings of illness, disease, and sickness
Illness refers to how the sick person and the members of the family or wider social network
perceive, live with, and respond to symptoms and disability
oThe illness experience includes categorizing and explaining the forms of distress caused
by pathophysiological processes; the illness experience is culturally shaped
oIllness behaviour consists of initiating treatment and deciding when to seek care from
professionals or alternative practitioners
oIllness problems are the principal difficulties that symptoms and disability create in our
oIllness complaints are what patients and their families bring to the practitioner
Disease is what the practitioner creates in the recasting of illness in terms of theories of
disorder; the practitioner reconfigures the patient’s and family’s illness problems as narrow
technical issues, disease problems
oDisease is the problem from the practitioner’s perspective
oIn terms of the biomedical model, disease is reconfigured only as an alteration in
biological structure or functioning
Sickness is the understanding of a disorder in its generic sense across a population in relation to
macrosocial processes (economic, political, institutional)
Chapter 2:
Additional meanings of illness (personal, social, emotional)
Narrative: Alice Alcott
Film: Alicia Mercado
Third meaning of illness> illness soaks up personal and social significance from the world of the
sick person; it transfers vital significance from the person’s life to the illness experience
The central meaning is loss, a common significance of chronic disorder
Alice Alcott:
oA.A. is a 46 year old white Protestant female with a history of juvenile onset diabetes
mellitus compounded by cardiovascular complications. At age 10 she developed
diabetes and was frequently hospitalized through age 18. She has by now had to use
insulin for more than 35 years. She was told to not have children as it would worsen her
diabetes, but she refused and had two normal babies. At age 30 she experienced some
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visual problems, and was diagnosed with diabetic retinopathy. While her vision has
worsened, she is able to read, drive, and carry out almost all other daily activities. At age
40, she had her toe amputated because it was gangrenous, at age 42 she had another
one amputated. Later she had her leg from below the knee amputated. She had always
put her pain on the back burner, which resulted in these amputations because she had
not come in earlier for diagnosis. For the first time in the course of caring for this patient
over 20 years, her physician found her irritable and depressed. Her family confirmed
this. The decision to amputate her leg was made only with great reluctance and much
anger by the patient, and following a trial of a high-dose intravenous antibiotic. She was
noncompliant and withdrawn from staff and family. It was apparent she was grieving
her many losses. Her Calvinist cultural background emphasized values of rugged
individualism, self-reliance, industry, perseverance, and moral strength. Over and over
again it is apparent that Alice put off seeking care because of her beliefs. For her, a
stoical style of expressing illness problems, a characteristic use of denial, and a
crescendo of symptoms that are specially serious for her illustrate the first layer of
illness meanings. In most cases of chronic illness, health professionals have become
accustomed in cases like A.A’s to examining how the personal domain of passions and
inner turmoil worsen the illness experience.
Chapter 3:
Private vs. public pain
Narrative: Howard Harris
If there is a single experience shared by virtually all chronic pain patients it is that at some point
those around them come to question the authenticity of the patient’s experience of pain
Somatization is the communication of personal and interpersonal problems in a physical idiom
of distress and a pattern of behaviour that emphasizes the seeking of medical help
There are three types of influences that intensify the illness experience and promote
overutilization of health care services: social conditions that encourage expressions of distress,
cultural idioms of misery that use a language of bodily complaints to represent personal and
interpersonal problems, and individual psychological characteristics
When our personality type is such that we exaggerate the significance of stress or anxiously
ruminate about our bodily processes, then amplification of physical symptoms is enhanced; our
cognitive style, affective state, and verbal and nonverbal forms of communication contribute to
the effect
Existing pathology may be exaggerated by the meanings of situations and relationships, or by
institutional constraints such as disability claims; but such somatization also stems from our
prior experience of the symptoms and our current anticipatory fears of, and need to control,
symptom exacerbation
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