Chronic Illness and Social
(Dis)ability
Week 21
Sociology of Health and Illness
Recap
• Thought about how health and illness are
structured by society
• Considered the ‘sick role’, medicalisation,
surveillance medicine and ‘lay’ understandings
of health
• Considered social inequalities and health
Outline
• Look at chronic illness as biographical
disruption
• Consider to what extend disability is
socially constructed
• Consider the points of intersection and
contestation between these two ideas
The rise of chronic illness
• The 20th saw a move from acute illness to
chronic illness
• Existing theories (eg ‘sick role’)
could not easily explain these conditions
• The meaning and experiences of
‘living with’ illness began the focus
of sociological attention
Illness as
narrative reconstruction
• Understandings of causes are constructed
through the meanings and interpretations
that are placed on it
• People make sense of their condition (why
me?) in relation to their social
circumstances
• This may not coincide with biological
explanations
Illness as
narrative reconstruction
• Williams (1984) interviewed people with
rheumatoid arthritis
• Complex understandings which rejected
potential biomedical explanations
– Bill
Made links to bad workplaces
– Gill
Gender roles
– Betty God’s purpose
• Narratives can become a coping
mechanism
• How useful do you think the idea of illness
narratives is in explaining:
– The social construction of illness?
– The why me question of individuals?
Illness as
biographical disruption
• Bury (1982) argued that the onset of
chronic illness should be seen as a
‘biographical disruption’
• A person’s identity is under
threat as it changes their
previously ‘normal life’
• They need to reassess their lives and
perhaps adapt/take on a ‘new’ identity
Illness as
biographical disruption
• Issues include dealing with the uncertainty
of symptoms or life expectancy
• Learning to live with an altered body or
status
• Deciding whether or not to
disclose condition/symptoms/issues
Stigma
• Goffman highlighted the ways in which
bodies and illnesses come to be
stigmatised
• Stigma arises when an deeply discrediting
attribute become known
• It realigns an identity
from ‘normal’ to ‘discredited’
• What conditions can you think of that are
stigmatised?
• How do you think this will impact on
biographical disruption
Perspectives on Disability
From the Victorian Period onwards two
dominant perspectives on disability
1.
disability as a tragedy which has
required the assistance of charity
2.
disability as illness which has required
treatment by professionals
Disability Movement
• In the last 40 years, people with disabilities have
challenged these ideas
– Separation of illness and disability
– Push for independent living and civil rights
– The social model of disability
• Successes include the Disability Discrimination
Act and benefits paid directly to people with
disabilities
The social model of disability
• This model argues that is not physical or
mental impairments
• Societies failure to cope with
their needs
– Physically through the
build environment
– Mentally through
disabling attitudes
Maintaining Control
• The Independent Living Movement has
focused on the aims of control
– Right to employment
– Allowances for personal assistance
• Needs need to met without disempowering
the person with impairments
• To what extend do you think that the
experiences of disability are socially
constructed?
Competing theories
• Seeing illness as always biographically
disrupting is problematic
– Seen as inevitable part of ageing?
– Reinforce some ideas about the self?
• Does it reinforce the idea of bodily
impairments as a personal tragedy?
Competing theories
• The social model of disability has been
critiqued for overemphasise physical and
economic barriers
• It ‘fits’ better with static rather
than deteriorating conditions
• It does not easily explain how people
adjust to bodily pain or impairment
Summary
• Considered a range of theories which look
at the experience and meaning of chronic
illness and disability
• Coming to terms with different bodies can
cause a re/conceptualisation of the self
• Stigma and social barriers impact of
experiences of impairments
Next week
• Look at sociological understandings of
mental illness
• Consider relationships between social
problems and mental health
• Look at the impact of racism and sexism in
diagnosis and treatment