Chapter 10 Constructing Disability and Living with Illness
Understanding Illness: It’s Not Just Biological
Health and illness are often though of as medical categories; however, according to sociologists these
are also social phenomena that cannot be understood fully by biomedical criteria.
Several studies have pointed to the importance of lay health beliefs in people’s understanding of the
body and have demonstrated how health beliefs may vary between different social and cultural or ethnic
There is an assumption that people experience pain in a universal way. That pain can be measured
objectively and that, therefore, we can compare magnitudes of pain between individuals.
Social class can also be a factor in how illness is defined.
Kenneth Davidson explore meaning of disease and illness among different social-class groups in rural
northeast community of Nova Scotia
o He looked at three groups: Class I (those who achieved high professional, occupational, and
educational status), Class II (the majority of wage earners in the community, including trades and
small business owners), Class III (those with little training or education, high seasonal
o He found that those in Class III tended to take a stoical view of illness and suffered considerable
pain and discomfort before they sought medical help or defined themselves as being ill.
Illness is socially constructed; that is, out meaning of illness are shaped through out interactions with
The meaning of illness is also influenced by an individual’s identity, time, and place.
While in everyday life the terms disease and illness are frequently conflated into the term illness,
sociologists tend to make a distinction between disease and illness.
Illness is a more subjective phenomenon; it is something that people experience when they believe that
they are well and may be considered an embodied experience.
A further distinction is sickness, which refers to the actions a person takes as discussed by Parsons in his
concept of the sick role.
Irving Zola points out that the process by which people construct symptoms, as illness is a complex one.
o Zola argues that neither the obviousness of a symptom, the medical seriousness, nor objective
discomfort can account for the point at which a person converts to a patient.
o He found that the reason people sought medical treatment was related to their social-
psychosocial circumstance, such as an interpersonal crisis, perceived interference with social or
personal relations, or interferences with work or physical activity.
o Zola concluded what while the symptoms were there, the perceptions of those symptoms differed
considerable: The very labeling and definition of a bodily stats as a symptom as well as the
decision to do something about it is itself part of social process.”
From both a biomedical and sociological approach a distinction must be made between acute illness and
An acute illness typically develops quickly, last for a short period of time and often goes away without
the use of medications or surgery.
A chronic illness, on the other hand, in ongoing, recurrent, noncommunicable, often degenerative, and
has no cure.
A number of reports have shown that chronic disease accounts for a significant portion of morbidity and
mortality among Canadians.
Constructing Chronic Illness
Susan Wendell reminds us that practical concepts of chronic illness has to be patient-centred or illness-
centred, rather than simply being based on diagnosis or disease classification. o She makes a distinction between ‘healthy disabled’ and ‘unhealthy disabled’
o By ‘healthy disabled’ she is referring to ‘people whose physical conditions and functional
limitations are relatively stable and predictable for the foreseeable future’ and whose
impairments may not be apparent.
o ‘Unhealthy disabled’ are people with obvious impairments that limit their participation in various
activities on a regular basis.
George Herbert Mead states that the self is a social product that arises only in interaction with others.
o For Mead, the self is ‘that which can be can object to itself’; it is ‘reflexive’ that is, it can both
subject and object.
Freund et al. write that chronic illness often leads to a radical assessment of one’s self in relation to
one’s past and one’s future, in light of changed and changing capacities.
Certain chronic illnesses carry a great deal of stigma.
People with chronic illnesses face a number of common problems in terms of organizing their social
environments, in terms of the attitudes of others, and in terms of their sense of self.
A major consequence of having a chronic illness can be the loss of independence.
Many chronically ill persons subscribe to this ideology and view dependency as something negative, as
a loss of so-called normal life.
Also Freund et al. explain, for some people pain, requirements of treatment, and lack of access to
everyday activities foster isolation; others may socially withdraw because they are unable to deal with
the chronic problems, thus setting in motion a spiral of increasing isolation: ‘The less one can or want to
do, the less one socializes; but the less one socializes, the more other withdraw, and in turn the more the
person with chronic illness withdraws.’
In other words, over time the chronically ill individual can become marginalized from social activities,
which result in a diminished self.
Anselm Strauss and Barney Glaser’s now classic work on chronic illness pointed to the limitations of a
biomedical approach for understanding the complexity of chronic illness.