Question #1-

Social beliefs and practices have physical consequences for our health. Statement points to stagnant medical model and suggests a more dynamic model is one that understands that social beliefs and practices (social environment) affect health and illness meanings in our society.

Health beliefs and practices are informed from culture, social structure, social control, social class, Western Medical Mode:

Culture: all beliefs, values, practices, objects that are shared by a group of individuals. Examples: language, beliefs of good and evil, who gets sick and who doesn’t, what it means to be ‘sick’, appropriate food, dress, manners, dress.

Social structure: all patterns of social interaction and the norms that guide behavior for these interactions: Parent-child, supervisor, employee, teacher-student, **physician-patient, physician-physician, physician-nurse, physician-HMO etc. These relationships are embedded in larger social order – institutional or social context: social context- classroom, within a school, within a school system, within economic/political structure- Democrats Republicans control school and tax $$. OR – physician-patient, within social context of HMO that is part of University Hospital (Institutional context) that is part of larger business holdings (football league, baseball league, oil companies, which are holdings of larger company – CEOs.

Social Control: system(s) by which society guarantees members will act in appropriate ways – usually appropriate is defined as making sure the social system operates – requires that order and social class are maintained. Happens through formal and informal mechanisms of social control: laws, force, violence, and persuasion. Examples: physicians: -salary or bonus is based upon - flat fee; or patients per hour/ procedures per week; conformance to policy – report cards by local state and licensing boards; insurance premiums for unauthorized procedures, malpractice suits, etc.

Social class: is one measure of social status- how you are ranked in society. Measure tells us about social power: ability of an individual or group to get what they want. Power is both objective and subjective:

Western Model: mind body dualism; physical reductionism; specific ideology; machine metaphor

Symbolic meanings of health and health practices- the placebo effect; various degrees of stress responses; susceptibility- physiological reactivity, cognitive emotional appraisal, coping, stress and power.

Social environment or social time: The importance of the time and health relationship is ignored in the medical model. The social organization of time and the ability to schedule and manage time are socially distributed and this may be in conflict with an individual (or groups) personal time biorhythm. Specific studies focus on load balance, shift work, work time/free time. All examples indicate that the greater the discrepancy between the social organization of time and the rhythms of individuals, the greater the impact on one’s health.

Question # 2-

Power is located in the social structural arrangements of society- this is described as standpoint theory. In this model, power is absolute, social control is external, power flows from top to bottom.Power is socially negotiated throughout all societal actions so knowledge and power come from everywhere and nowhere, a social constructivist position.

Situated knowledge is middle ground- where the construction of objectivity, knowledge, power, is a perceptual process: who you are -culture, power, position- give meaning to your knowledge claims, what is ultimately taken as true.

Standpoint theory emphasizes the dominance of physicians in medical hierarchy; ultimate control of resources; Nurses are subordinate, para-professionals, whose role and task it is to assist in process. This is how it always has been and women have always been in the nursing profession. (i.e. the story from one reference point, that of the physician)

Situated knowledge emphasizes: Institutions of medicine and nursing; and their historical, cultural, and structural locations. Theory emphasizes the social, political, economic reasons as to why doctoring was male profession. Historically women are caretakers; informal networking of information, Pre- 1800s practice of medicine was open, many ideologies. AMA comes into power by competition, cohesiveness, and creates a program for ultimate control in field- Flexner Report; Medicaid/Medicare Acts. These forces (non-scientific) position physicians and nurses in different structural locations, and their cultural attributes lead to differences in practices, leaving women in subordinate positions of providing care- ie, nursing.

Question # 3 -

Models’ four facets emphasize the difference between illness (subjective), disease (objective, medical model) and sickness (abstraction):

Patients engage in the narrative to order their life experience;

Narrative offers physician the opportunity to Listen: metaphors, plots, language, structure of narrative, are clues physician has to extract cultural and personal meanings from patient; Interpret: translate the narrative, or pieces of narrative, bearing in mind the three layers of meaning: symptoms, culture, and life-world; Validate: affirm the value of the narrative; because this in essence sanctions the suffering the patient has endured throughout illness

Question # 4 -

Zola’s theory of non-compliance, patients not following docs orders- can be explained through the structure of the doctor-patient relationship. Theory gains power from the medical model approach to medicine and social control and control is exemplified in doctor patient relationship. This relationship makes two assumptions: unjustified assumptions about patient; sets the problem solely in terms of structure of medical consult. Conrad recasts non-compliance in terms of patient self-regulation, as a patient’s ability to engage in social control over him/herself.

For Zola, structural issues include: physical place of encounter; quality and quantity of information gathering; communication method (includes time, tone, reassurance, technical jargon), and micro politics of encounter: physician and patient goals and expectations; socialization; labeling; reification.

Patients alter medication due to: testing (progress); controlling dependence (symbolism and level of dependence of drug); Stigma (as it relates to the medication and illness); Practical practice (anticipation of social circumstances)

Question # 5 -

Durkheim: illness is no more than deviance from norms of a social group, therefore he believes in normalcy of deviance. Parsons adds to Durkheim by exploring how society responds to deviance- the release from social expectations and obligations. Both theorists move away from medical model in that illness is a product of society, the label of illness or deviance is a social construction and applied according to society’s consensus about behavior. For Durkheim, society is locus of social control; for Parsons, it is the medical profession. (physician). Sick role defines what an individual and society can expect regarding responsibilities and privileges.

Physician controls and defines appropriate behavior in the doctor-patient relationship. This is a form of moral authority (what one should do) and is observed through four mechanisms: control and power as consequence of label; physician as gatekeeper for diagnosis and treatment; re-socialization (what roles to re-assume); restoration of patient’s identity and social order (diagnosis and label maintains the pre-established social order)

Question # 6 -

Taste is a set of objects and practices that constitute one’s set of preferences – i.e., for food, music, art, etc. These are a matter of social position in the class structure. Social structural conditions produce actions that are routine and reproduced from expectations and structure- this is the notion of habitus. So for Bourdieu, social structure is key component to understanding lifestyle as habitus provides individuals the opportunity to establish a health lifestyle.

Self-identity is constantly negotiated for individuals through their actions (praxis). Modern society forces individuals to choose from may lifestyles and it is the behavior of actors (agents) that feed into these patterned behaviors and are reproduced or transformed. For Giddens, it is individual praxis (agency) that is key to lifestyle.

Question # 7 -

Discussed in either Glik or Kleinman. Both clinical reality and alternative health are dependent upon social constructions and meanings of illness- depend upon explanatory and emotional accounts of illness for both physicians and patients.

Alternative health ideology focuses on being healed- either alleviation of symptoms, acceptance of being ill, re-negotiation of illness throughout life course. This is in NO WAY similar to western medical model that does not leave room for interpretation and negotiation of illness and meanings for patients and physicians.

Question # 8 -

Class is measured as an alternative status – gender and sex stratification in workforce. So men and women engage in different health lifestyles (choices). Men make poorer health choices (to smoke, drink, eat poorly, and have sedentary lifestyle) than do women. If women were to engage in these health choices, then gap is lessened. Life choices are constrained by the life chances women and men have available to them- supports Bourdieu, not Weber.