• Focus on “medicine” • Social aspects of medicine, health, disease • Social factors shaping medicine – Social labelling & social control – Sick role – Patient-doctor relationship – Disease-illness distinction – Medicalization Social labelling • Order & disorder – normal & abnormal • Social labeling & illness, disease, disability – Who is to be called ill, diseased, disabled is determined by the individual’s social position and society’s norms rather than by universal and objectively defined signs and symptoms • A person is labeled in the course of social negotiations • de-labeling difficult • At each decision point it may be possible to return to the normal label STRUCTURE-FUNCTION & MEDICINE • Doctor-patient relationship – Institutional integration • Institutions defined as a society's recurrent patterns of activity – The “sick role” (T. Parsons) • Illness as a form of “deviance” – Physicians & return to equilibrium – Alcoholism? Poverty related health issues? – Compliance as solution? – Local healthcare system Abnormality/Deviance & the Sick role (T. Parsons) • Rights: – The sick person is exempt from “normal” social roles. • relative to the nature and severity of the illness – The sick person is not responsible for his or her condition. • An individual’s illness is usually thought to be beyond his or her own control • A morbid condition of the body needs to be changed and some curative process apart from person will power or motivation is needed to get well. • Obligations: – The sick person should try to get well. The first two aspects of the sick role are conditional upon the third aspect – The sick person should seek technically competent help and cooperate with the physician. Disease-Illness distinction • DISEASE — as a bio-scientific concept – Abnormalities in the structure & function of body organs & systems • ILLNESS -- lay concepts – Illnesses are “experiences” of disvalued changes in states of being & in social function • Biomedicine presses the practitioner to construct disease as the subject of study & treatment medicalization • the process by which health or behavior conditions come to be defined and treated as medical issues • the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat • The process of medicalization typically involves changes in social attitudes and terminology, and usually accompanies (or is driven by) the availability of treatments Challenging medicine: theoretically • Medico-centricism – Disease and mortality are problematic and require medical intervention • Focus on disease (not illness) – obscures social conditions and experience – Focus on disease and the right that professionals have vis a vi individuals – Patient’s fault if there are problems • Critical theory Critical Theory, Social Structure, Medicine • Questions about the neutrality/objectivity of medicine, use of technology, science • Ideology -- a system of shared beliefs that legitimize particular behavioral norms & values at the same time they claim & appear to be based on empirical truths • ideologies transform power (potential influence) into authority (legitimate control) Medicine & Social Structure: critical theoretical perspective • E.g. compliance as ideology transforms physician’s theories about the proper behavior of patients into a series of research strategies, research results, & potentially coercive interventions • that appear appropriate • & that reinforce physicians authority over health care Science, Medicine, Social Structure: critical theoretical perspective • Science names the structure of situations in such a way that the attitude contained toward them is one of disinterestedness • its style is restrained, spare, resolutely analytic – objectifies moral sentiment • Science is diagnostic, critical, dimension of culture • Social control • Objectivity? - actively concerned with the establishment & defense of patterns of belief & value The social production of health • Shift from disease focus of medicine • Shift from focus on medicine • Same emphasis on power, inequality, social relationships/organization/structure • Social characteristics play a predominant role in determining sickness and health status • Occupation related to health • Social position: class, ethnicity, gender, age • disease & feelings of sickness not determined solely by underlying biology Society and health • Correlations: number of operations performed and proximity of number of surgeons in the area – Available technology • Class, environment, residence, distributions of cancer • Drapetomania, Gambling, alcoholism, learning disabilities, childbirth & medicialization • The social need argument -- ? Society and health • Social relations of sickness which produce forms and distributions of sickness in society • Sickness is the process through which worrisome behavioral and biological signs, particularly ones originating with disease, are given socially recognizable meanings resulting in socially significant outcomes • Sickness is a process for socializing disease and illness • The social order is embedded in medical beliefs Society and health • choices & forms of medical interventions & transactions are determined by sickness (not illness or disease) • Medicine continues to divorce disease from its social relations of production – Ignoring power differentials that originate and reside in arrangements between social groups and classes • Symbols of healing are equated with power • Medicine is an ideological practice
Basic Features and Strategies of Women's Empowerment of A Developing Urban Area - A Case Study of Memari Municipality, Purba Bardhaman, West Bengal, India