University of Cambridge
Social Context of Health and Illness
Stigma and Chronic Illness
a) Aging population due to improvements in sanitation, nutrition, and medical treatments
deferring mortality.
b) Effective prevention and cures for infectious diseases which had been among the main
causes of death until the late 19th century
c) A shift from conditions such as osteoarthritis or heart disease being considered part of
aging as inevitable part of life (“died of natural causes”), to diseases to be addressed by
medical care.
Long term sick role
➢ Ameliorating symptoms, rather than a return to health, may become the goal (“remission
society”, Frank 2013).
➢ A long-term patient may not be reliant on a familiar doctor for knowledge or treatment, but
become experts themselves and may shop around for the best healthcare (Shilling 2002;
Higgins et al. 2014).
Higgins et al (2014): ‘General practitioners’ management of long term sick role’
• Examining the role of GPs in the management of long- term sickness absence
• Uses Parson’s sick role to support argument
• Found that GPs put more weight on the preferences and needs of their patients than they
did on the requirements of the patients’ employing organisations
• The GPs approach to patients and their tendency to favour their patients care was
underpinned by the ideology of holistic care and patient advocacy, as well as the fact that
the GPs are in close contact with their patients and hold long term relationships with them
, • Some evidence that GPs would be prepared to forfeit their role as validators of sick leave
– could be due to the workload burden of processing sick leave applications or from the
need to deal with both employers and employees
• Due to the pressure from the state and capital to reduce the financial burden of patients
in the sick role, this preparedness for GPs to forfeit their role as validators of legitimate
long term sickness absence could mean in future GPs will no longer have this power
• GPs are therefore under pressure to balance their concerns for the individual and for the
collective
Normality
➢ chronic illness may be very disruptive but also “normal” in a sense.
➢ visibility of the condition to others and assumptions about what is normal lead to felt threats
of shame, guilt or loss.
Sanderson et al (2011): Shifting normalities: interactions of changing conceptions of a normal
life and normalisation of symptoms in rheumatoid arthritis
1. Continuing normality: normal life unchallenged manageable symptoms – invisible
disability
2. Disrupted normality: unpredictable symptoms and variable treatment efficacy – unable to
provide for family
3. Struggling for normality: presenting a normal life whatever the cost
4. Fluctuating normality: life isn’t normal when I’m in a flare – although a background of
painful, swollen joints and fatigue was considered normal – flares of inflammation were
considered abnormal and prevented a normal life for their duration
5. Resetting normality: normal life includes my illness e.g. longer term arthritis
6. Returning to normality: normal life reinstated and no symptoms (e.g. this is real possibility
for those responding well to anti-TNF therapy/do not have severe joint damage. Also
characterised by a feeling of going back in time to pick up life that had been left at onset
of arthritis)
Weiner (1975): defined normalisation as any behavioural attempt used to maintain a normal
life including covering up, keeping up and pacing
Social Context of Health and Illness
Stigma and Chronic Illness
a) Aging population due to improvements in sanitation, nutrition, and medical treatments
deferring mortality.
b) Effective prevention and cures for infectious diseases which had been among the main
causes of death until the late 19th century
c) A shift from conditions such as osteoarthritis or heart disease being considered part of
aging as inevitable part of life (“died of natural causes”), to diseases to be addressed by
medical care.
Long term sick role
➢ Ameliorating symptoms, rather than a return to health, may become the goal (“remission
society”, Frank 2013).
➢ A long-term patient may not be reliant on a familiar doctor for knowledge or treatment, but
become experts themselves and may shop around for the best healthcare (Shilling 2002;
Higgins et al. 2014).
Higgins et al (2014): ‘General practitioners’ management of long term sick role’
• Examining the role of GPs in the management of long- term sickness absence
• Uses Parson’s sick role to support argument
• Found that GPs put more weight on the preferences and needs of their patients than they
did on the requirements of the patients’ employing organisations
• The GPs approach to patients and their tendency to favour their patients care was
underpinned by the ideology of holistic care and patient advocacy, as well as the fact that
the GPs are in close contact with their patients and hold long term relationships with them
, • Some evidence that GPs would be prepared to forfeit their role as validators of sick leave
– could be due to the workload burden of processing sick leave applications or from the
need to deal with both employers and employees
• Due to the pressure from the state and capital to reduce the financial burden of patients
in the sick role, this preparedness for GPs to forfeit their role as validators of legitimate
long term sickness absence could mean in future GPs will no longer have this power
• GPs are therefore under pressure to balance their concerns for the individual and for the
collective
Normality
➢ chronic illness may be very disruptive but also “normal” in a sense.
➢ visibility of the condition to others and assumptions about what is normal lead to felt threats
of shame, guilt or loss.
Sanderson et al (2011): Shifting normalities: interactions of changing conceptions of a normal
life and normalisation of symptoms in rheumatoid arthritis
1. Continuing normality: normal life unchallenged manageable symptoms – invisible
disability
2. Disrupted normality: unpredictable symptoms and variable treatment efficacy – unable to
provide for family
3. Struggling for normality: presenting a normal life whatever the cost
4. Fluctuating normality: life isn’t normal when I’m in a flare – although a background of
painful, swollen joints and fatigue was considered normal – flares of inflammation were
considered abnormal and prevented a normal life for their duration
5. Resetting normality: normal life includes my illness e.g. longer term arthritis
6. Returning to normality: normal life reinstated and no symptoms (e.g. this is real possibility
for those responding well to anti-TNF therapy/do not have severe joint damage. Also
characterised by a feeling of going back in time to pick up life that had been left at onset
of arthritis)
Weiner (1975): defined normalisation as any behavioural attempt used to maintain a normal
life including covering up, keeping up and pacing
