Sociology of Medicine (Health and Illness)



Sociology of Medicine (Health and Illness)

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Words are inadequate…

“Medical sociology centers on the social construction of health and illness –that is, a construction shaped by many elements of the social order and often independent from biomedical phenomena. In this perspective, medical sociology links together and makes sense of the varied manifestations of health and illness: biomedical data, professional practice, institutional structures, social policy, economics and financing, the social epidemiology of disease and death, and the individual experience of health, illness, and medical care. The discipline links the micro-level (self-awareness, individual action, and interpersonal communication), meso-level (hospital, medical education), and macro-level (the nation’s health status, the structure and political economy of the health care system, national health policy). This linkage ensures that individual entities are not studied in isolation from their surroundings.” –Phil Brown, ‘Themes in Medical Sociology’, Journal of Health Politics, Policy, and Law, Vol. 16, No. 3 (Fall) 1991.

“In human societies pain, like so many other physiological phenomena, acquires specific and cultural significance, and accordingly, certain reactions to pain can be understood in light of this significance.” –Mark Zborowski, ‘Cultural Components in Response to Pain’, in Journal of Social Issues, Vol. 8, No. 4, 1952.

“Within the last decade, medical professional practice has become a major threat to health. Depression, infection, disability, dysfunction, and other specific iatrogenic diseases now cause more suffering than all accidents from traffic or industry. Beyond this, medical practice sponsors sickness by the reinforcement of a morbid society which not only industrially preserves its defectiveness but breeds the therapist’s client in a cybernetic way. Finally, the so-called health professionals have a direct sickening power –a structurally health denying effect. I want to focus on this last syndrome, which I designate as medical nemesis. By transforming pain, illness, and death from a personal challenge into a technical problem, medical practice expropriates the potential of people to deal with their human condition in an autonomous way and becomes the source of a new kind of un-health.” Ivan Illich, ‘Medical Nemesis’, The Lancet, 28 May 1974, pp. 918.

“My soul is weary of my life; I will leave my complaint upon myself; I will speak in the bitterness of my soul.” Job 10:1

“Is there no balm in Gilead,

Is there no physician there?

Why then is there no recovery for the health of the daughter of my people?”

Jeremiah 8:22

Texts:

Allen, Peter L. 2000. The Wages of Sin: Sex and Disease, Past and Present. Univ. of Chicago Press.

Armstrong, Pat (with Claudia Feagin, M.D.) 1998. Universal Health Care: What the United States

Can Learn From The Canadian Experience. NY: The New Press.

Brown, Phil. 2000. Perspectives in Medical Sociology. Illinois: Waveland Press.

Budrys, Grace. 1997. When Doctors Join Unions. NY: Cornell University Press.

Charmaz, Kathy. 1991. Good Days Bad Days: The Self in Chronic Illness and Time. New Jersey:

Rutgers University Press.

Karp, David. 1996. Speaking of Sadness: Depression, Disconnection, and the Meaning of Illness.

UK: Oxford University Press.

Lather, Patti and Chris Smithies. 1997. Troubling Angels: Women Living with HIV/AIDS. Colorado:

Petersen, Alan and Robin Bunton. 1997. Foucault, Health and Medicine. NY: Routledge.

West View Press.

Recommended:

Brandt, Allan M. 1987. No Magic Bullet: A Social History of Venereal Disease in the United States

Since 1880. NY: Oxford University Press.

Contrada, Richard J. and Richard D. Ashmore. 1999. Self, Social Identity, and Physical Health:

Interdisciplinary Explorations. NY: Oxford University Press.

Dubos, Rene and Jean Dubos. 1996. The White Plague: Tuberculosis, Man, and Society. NJ:

Rutgers University Press.

Foucault, Michel. 1986. The Care of the Self: The History of Sexuality, Vol.3. NY: Vantage.

Foucault, Michel. 1973. The Birth of the Clinic: An Archaeology of Medical Perception. NY: Vantage.

Fries, Kenny. 1997. Body, Remember. NY: Plume.

Minkler, Meredith. 1997. Community Organizing & Community Building for Health. New Jersey:

Rutgers University Press.

Paillard, Bernard. 1994. Notes on the Plague Years: AIDS in Marseilles. NY: Aldine de Gruyter.

Scholarly Supplements (*):

Brown, Phil. 1991. ‘Themes in Medical Sociology’. Journal of Health Politics and Law, Vol. 16,

No. 3, (Fall).

Bury, Michael. 1982. ‘Chronic Illness as Biographical Disruption’. Sociology of Health and Illness,

Vol. 4, No. 2 (July).

Charmaz, Kathy. 1983. ‘Loss of Self: A Fundamental Form of Suffering in the Chronically Ill.

Sociology of Health and Illness, Vol. 5, No. 2.

Freund, Peter E. S. 1990. ‘The Expressive Body: A Common Ground for the Sociological of

Emotions and Health and Illness.’ Sociology of Health and Illness, Vol. 12, No. 4.

Gray, Bradford H. and Sarah R. Phillips. 1995. ‘Medical Sociology and Health Policy: Where are

the Connections?’ Journal of Health and Social Behavior, (Extra Behavior).

Levine, Sol. 1995. ‘Time for Creative Integration in Medical Sociology’. Journal of Health and Social

Behavior, (Extra Issue).

Orr, Jackie. 1993. “Panic Dairy: (re)constructing a partial politics and poetics of dis-ease.” In J.

Holstein and G. Miller (Eds.), Reconsidering Social Constructionism. NY: Aldine de Gruyter.

Pearlin, Leonard I. 1992. ‘Structure and Meaning in Medical Sociology’. Journal of Health and

Social Behavior, Vol. 33 (March).

Reinelt, Claire and Mindy Fried. 1998. ‘“I am This Child’s Mother”: A Feminist Perspective on

Mothering with a Disability’, in Families in the United States: Kinship and Domestic

Politics. Edited by Karen V. Hansen and Anita Ilta Garey. Temple University Press.

Rich, John A. and David A. Stone. 1996. ‘The Experience of Violent Injury for Young African-

American Men’. Journal of General Internal Medicine, Vol. 11: 77-82.

Schulman, Kevin A., et al. 1999. ‘The Effect of Race and Sex on Physicians’ Recommendations

for Cardiac Catheterization’. The New England Journal of Medicine, (Feburary).

Seigel, Karolynn and Beatrice J. Krauss. 1991. ‘Living with HIV Infection: Adaptive Tasks of

Seropositive Gay Men’. Journal of Health and Social Behavior, Vol. 32 (March).

Strauss, Anselm and Juliet Corbin. 1991. ‘Experiencing Body Failure and a Disrupted Self-

Image’’, in Creating Sociological Awareness: Collective Images and Symbolic Representations. Transaction.

Strauss, Anselm and Juliet Corbin.1991. ‘Comeback: The Process of Overcoming Disability’, in

Creating Sociological Awareness: Collective Images and Symbolic Representations. Transaction.

Zola, Irving Kenneth. 1991. ‘Bringing Our Bodies and Ourselves Back In: Reflections on a Past,

Present, and Future of “Medical Sociology”’. Journal of Health and Social Behavior, Vol. 32

I. Course Content & Introduction

This course offers an introduction and a critical explication and deconstruction of the fastest growing area of study within sociology: health, illness, and the social organization of medicine. “WE” appropriate core sociological principles and concepts to elucidate the experiences of illness and wellness. “WE” examine the social and cultural factors surrounding the creation and labeling of diseases, and the iatrogenic repercussions of those social constructs. “WE” consider the sex(u)al body in bio-powerful discourses on (dis)ease control. “WE” explore the meaning of illness from the voices of people who live with chronic conditions. “We” peruse the issue of familial, community, and state responsibilities as related to care-taking/care-giving actions. “WE” attempt a more than inconsequential “reading” of health inequalities grounded in “race”, gender, (dis)ability, and class individuations. Here, “WE” consider the conundrums of access to health care, inequities in medical coverage, and the problematics of a market driven ‘illness industrial complex’ where the dollar determines health-outcome. “WE” consider the influence of oppressive (racist, sexist, elitist, homophobic, phallocentric, and [We]sterncentric) social structures that make ‘health’ impossible for over 45 million Americans and billions of ‘Others’ elsewhere. Finally, “WE” study the institution of medicine –from the all-powerful HMO to social movements to unionize physicians. Guiding this intellectual, reflexive, and emotional journey is an omnipresent concern for the meaning & experience of health in a cultural milieu obsessed with (dis)ease.

II. Course Structure & Policies

Class attendance and informed participation are required. Assigned readings are to be read before each class session. Students should be fully prepared to answer questions, engage the instructor and fellow classmates, and make informed comments on assigned readings. A FOREWARNING: THIS COURSE IS READING AND (W)RITING INTENSIVE.

III. Grades & Course Requirements

The grading system for this course is based on a contract agendum. I will give you the requirements for various grade levels, and YOU must decide what level of work is appropriate for your current schedule, reading-time, work load, and writing abilities.

Requirements for the “A”/“A-” level

1. Scholarly participation & consistent attendance are required of everyone.

2. Each participant committed to the “A”/ “A-” level is required to complete three analytic reaction papers (5-7 pages in length) on assigned readings. These papers might be interpreted as either (1) a critical response to the readings for the week, or (2) a reflexive meditation on your (or your kin's) experience with the topic under study. A.R.Ps (analytic reaction papers) for a particular theme are due on the week the topic is discussed. The analytic portion of the class will constitute 20% of your final grade. LATE ANALYTIC REACTION PAPERS ARE NOT ACCEPTED.

3. Each participant committed to the “A”/“A-” level is required to (w)rite two critical essays (5-7 pages in length) on (1) Universal Health Care and/or (2) When Doctors Join Unions and/or (3) The Wages of Sin, and/or Speaking of Sadness, and/or Troubling the Angels for 30% of your final grade.

4. Finally, using a specific theme from the course as your guide, each participant committed to the “A”/“A-” level is required to further explore an area within the sociology of health and illness. For instance, former students have written research papers on topics ranging from specific illness experiences (diabetes, anorexia, HIV/AIDS, cardiovascular disease, breast cancer, etc.,) to the illness industrial complex (pharmaceutical monopolies, single payer systems, health maintenance organizations, and the de-professionalization of medical practices). Also, some students have used this course as an opportunity to conduct original qualitative health research for a bachelor’s thesis on interests ranging from HIV/AIDS mothers, syphilis and stigma, prenatal genetic counseling, and Afro-American perceptions of cardiovascular disease risk. The opportunities to use this course as a springboard for original qualitative health research are many. However, it is important to note that this option, while ultimately more rewarding in the long run, is time consuming, intellectually rigorous, and requires more than incidental familiarity with research methodology. This term project should be a minimum of 15 pages in length. It should contain at least five (5) scholarly references from medical sociology journals (see partial list below) or other health related journals. Each participant will deliver her/his project to the class in the form of a brief presentation on the last week of the semester. The term project and presentation will constitute 50% of your final grade.

Requirements for the “B”/“B+” Level

1. Scholarly participation & consistent attendance are required of everyone.

2. Each participant committed to the “B”/“B+” level is required to complete three (3) A.R.Ps (5-7 pages in length).

3. Each participant committed to the “B”/“B+” level is required to write two (2) critical essays (5-7 pages in length) on (1) Universal Health Care, and/or (2) When Doctors Join Unions, and/or (3) The Wages of Sin, and/or Speaking of Sadness, and/or Good Days/Bad Days

Requirements for the “B-” Level

1. Scholarly participation & consistent attendance are required of everyone.

2. Each participant committed to the “B-” level is required to write three (3) A.R.Ps (5-7 pages in length).

3. Each participant committed to the “B-”/“C+” level is required to write one (1) critical essay (5-7 pages in length) on (1) Universal Health Care, or (2) When Doctors Join unions, or (3) The Wages of Sin, and/or Speaking of Sadness, and/or Good Days/Bad Days.

Requirements for the “C+” Level

1. Scholarly participation & consistent attendance are required of everyone.

2. Each participant enrolled at the “C+” level is required to write three (3) A.R.Ps (5-7 pages in length).

SOME NOTEWORTHY MEDICAL SOCIOLOGY JOURNALS

1. Journal of Health and Social Behavior 9. Medical Anthropology Quarterly

2. Social Science and Medicine 10. Medical Sociology News

3. Sociology of Health and Illness 11. Journal of Women and Aging

4. Health 12. Medical Sociology

5. Journal of Health Politics, Policy and Law 13. Health Affairs

6. Qualitative Health Research 14. Family and Community Health

7. Journal of Public Health Policy 14. The Milbank Quarterly

8. Women and Health 16. Disabilities Studies Quarterly

Themes and Reading Assignments

1. Jan. 24 Introduction: Getting to Know You/Me/”WE”/He/She

2. Jan. 31 The Texts of Medical Sociology

Supplementary Readings:

1. Phil Brown. 1991. ‘Themes in Medical Sociology.’ Journal of Health

Politics, Policy and Law, Vol. 16, No. 3 (Fall). *

2. Leonard I. Pearlin. 1992. ‘Structure and Meaning in Medical Sociology.’ Journal of Health and Social Behavior, Vol. 33 (March).**

3. Sol Levine, ‘Time for creative Integration in Medical Sociology.’ Journal of Health and Social Behavior, (Extra Issue). *

4. Bradford H. Gray and Sarah R. Phillips, ‘Medical Sociology and Health Policy: Where are the Connections?’ Journal of Health and Social Behavior, (Extra Issue). *

3. Feb. 7 & 14 The Socioeconomics of (Dis)ease and Health

1. David R. Williams, ‘Race, SES, and Health: The Added Effects of

Racism and Discrimination’, in Phil Brown ed., Perspectives in

Medical Sociology, 2000 (3rd Edition), pg. 21

Illinois: Waveland Press, Inc., 1996, pp.5.

2. Janet Phoenix, ‘Getting that Lead Out of the Community’, in Phil

Brown ed., Perspectives in Medical Sociology (Second Edition), Waveland Press, Inc., 2000, pp.632.

Supplementary Readings:

1. Daniel Kass and Nicholas Freudenberg, ‘Coalition Building to Prevent

Childhood Lead Poisoning: A Case Study from New York City’, in Meredith Minkler, ed., Community Organizing & Community Building for Health, New Jersey: Rutgers University Press, pp.278. *

2. Rich, John A. and David A. Stone. 1996. ‘The Experience of Violent

Injury for Young African American Men’, in Journal of General

Internal Medicine, Vol. 11: 77-82. *

4. Feb. 21 & 28 Illness Theories: (Re)conceptualizing the ‘Panoptic Gaze’ of Bio-Power’

1. Peter Conrad, ‘Medicalization and Social Control’, in Phil Brown, ed., Perspectives in Medical Sociology (Second Edition), Illinois: Waveland Press, Inc., 1996, pp.104.

2. Deborah Lupton, ‘Foucault and the Medicalization Critique’, in Alan Petersen and Robin Bunton, ed., Foucault, Health and Medicine, 1997, New York: Routledge, pp.94.

3. Paul Starr, ‘The Growth of Medical Authority’, in Phil Brown, ed., Perspectives in Medical Sociology (Second Edition), Illinois: Waveland Press, Inc., 1996, pp.612.

Scholarly Supplement:

1. Robert Crawford. 1980. ‘Healthism and the Medicalization of Everyday Life.” International Journal of Health Services, Vol.10, No. 3.

5. March 7 Re-configuring the Body

1. Liz Eckermann, ‘Foucault, Embodiment and Gendered Subjectivities: The Case of Voluntary Self-starvation’, in Alan Petersen and Robin Bunton, ed., Foucault, Health and Medicine, 1997, New York: Routledge, pp.151.

2. Renee C. Fox and Judith P. Swazey, ‘Transplantation and the medical Commons,’ in Perspectives in Medical Sociology, pg. 389.

3. Susan Zimmerman, ‘The Medical Management of Femininity: Women’s Experiences with Silicone Breast Implants’ in Perspectives in Medical Sociology, pg. 256.

6. March 14 Curing / Caring Practices I: ‘The Illness Industrial Complex’

1. Armstrong, Pat (with Claudia Feagin, MD). 1998. Universal Health Care: What the U.S. Can Learn from the Canadian Experience. NY: The New Press.

2. Donald W. Light, ‘The Origin and Rise of Managed Care’ in Phil Brown, ed., Perspectives in Medical Sociology (3rd Edition), Illinois: Waveland Press, Inc., 2000, PP. 484.

3. Arnold Birenbaum, ‘What is Managed Care?’ in Phil Brown, ed., Perspectives in Medical Sociology (3rd Edition), pg. 455.

(Critical Essay is due on Tuesday)

7. March 21 Curing / Caring Practices II: Health Care Practitioners

1. Grace Budrys. 1997. When Doctors Join Unions. New York: Cornell University Press. (All)

2. Bradford H. Gray, ‘The Evolution of Investor-Owned Hospital Companies’ in Phil Brown, ed., Perspectives in Medical Sociology (3rd Edition), Illinois: Waveland Press, Inc., 2000, pg. 470.

(Critical Essay due on Tuesday)

8. March 28 Women and Health: Feminist embodiments of (dis)ease

1. Judith Lorber, ‘Women Get Sicker but Men Die Quicker’, in Phil Brown, ed., Perspectives in Medical Sociology (3rd Edition), Illinois: Waveland Press, Inc., 2000, pp.40.

2. Jennifer Harding, ‘Bodies at Risk: Sex, Surveillance and Hormone Replacement Therapy’, in Alan Petersen and Robin Bunton, ed., Foucault, Health and Medicine, 1997, New York: Routledge, pp.135.

3. Susan Reverby, ‘A Caring Dilemma: Womanhood and Nursing in Historical Perspective’, in Phil Brown, ed., Perspectives in Medical Sociology (3rd Edition), Illinois: Waveland Press, Inc., 2000, pp.574.

9. April 4 & 11 The (Dis)Autobiographical Body

1. 1. Reinelt, Claire and Mindy Friend. 1998. ‘“I am This Child’s Mother”:

2. A Feminist Perspective on Mothering with a Disability’, in Families in the United States: Kinship and Domestic Politics. Edited by Karen V. Hansen and Anita Ilta Garey. Temple University Press. *

2. Strauss, Anselm and Juliet Corbin. 1991. ‘Comeback: The Process of

Overcoming Disability’, in Creating Sociological Awareness: Collective Images and Symbolic Representations. Transaction. *

3. Strauss, Anselm and Juliet Corbin. 1991. ‘Experiencing Body Failure

and a Disrupted Self-Image’, in Creating Sociological Awareness: Collective Images and Symbolic Representations. Transaction. *

4. Robert Zussman, ‘The Patient in the Intensive Care Unit’ in Phil

Brown (eds.) Perspectives in Medical Sociology, 2000, pg. 540.

________________________________________________________________________

Scholarly Supplements:

1. Jean Baudrillard. 1994. ‘Crash.’ In Simulacra and Simulation. University of Michigan Press.

2. Jackie Orr. 1993. ‘Panic Diary: (re)constructing a partial politics and poetics of dis-ease.’ In J. Holstein and G. Miller (Eds.) , Reconsidering Social Constuctionism. NY: Aldine de Gruyter.

10. April 18 Sexing the Body: A ‘Bio-Powerful’ View of Sexy Diseases

1. Peter Lewis Allen. 2000. ‘The Wages of Sin: Sex and Disease, Past and Present.’ University of Chicago Press.

Scholarly Supplement:

1. Leonore Tiefer. 1994. ‘The Medicalization of Impotence: Normalizing

Phallocentricism.’ Gender & Society, Vol. 8, No. 3: 363-377.

Highly Recommended:

1. Michel Foucault. 1986. The Care of the Self. NY: Vintage.

(Critical Response Due)

The Illness Narrative

11. April 25 “Everyday is Like Sunday:” Disconnection & Chronic (Mental) Illness. The Loss of Mind

1. David Karp. 1996. Speaking of Sadness: Depression, Disconnection, and the Meaning of Illness. U.K.: Oxford University Press. (All)

Scholarly Supplement:

1. Michael Bury. 1982. ‘Chronic Illness and Biographical Disruption’. Sociology of Health and Illness, Vol. 4, No.2 (July). *

(Critical Response Due)

12. May 2 Everyday is a ‘Sick-Day’: Disconnection and Chronic (Physical) Illness. The Loss of Body

1. Kathy Charmaz. 1991. Good Days, Bad Days: The Self in Chronic Illness and Time. New York: Rutgers University Press. (All)

Scholarly Supplement:

1. Kathy Charmez. 1983. ‘Loss of Self: A Fundamental Form of Suffering in the Chronically Ill’. Sociology of Health and Illness, Vol. 5, No. 2.

(Critical Response Due)

12. May 9 & 16 Life with HIV/AIDS: On the Distinctions Between ‘(dis)ease’ and ‘(ill)ness’

1. Patti Lather & Chris Smithies. 1997. Troubling the Angels: Women Living With HIV/AIDS. Colorado: Westview Press. (All)

Scholarly Supplement:

2. Karolynn Siegel and Beatrice Krauss. 1991. ‘Living with HIV Infection: Adaptive Tasks of Seropositive Gay Men’. Journal of Health and Social Behavior, Vol.32 (March). *

(Critical Response Due)

13. May 23 Research Presentations, Course Evaluation, &

Research Papers Due (“A”/“A-” Contracts)

Instructor: Lee Garth Vigilant, B.A., California State University at Bakersfield; A.M., Boston College; Ph.D., Boston College.

Electronic Mail: vigilant@mnstate.edu

Telephone: 218/236-2034 (Office M.S.U.M)

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