SOCIOLOGY OF HEALTH AND ILLNESS
Introduction and models of health & illness
To understand the diff btwn population and clinical perspective
Health sociology: definition
o Preconditions and assumptions: Caring, issues, religious connotations, traditional medicine, culture
o 95% has nothing to do with medicine
o Biomedical conception of illness
o Various models compete with each other
o Models are used according to the context-Bio medical model is of no use in pandemics like covid 19, precautions
are necessary.
Medical/health sociology
• First half of the 20th century: medicine and sociology as separate disciplines
o Health issues are within the domain of physicians and biological sciences
o Durkheim, Weber, Marx: little attention for the role of medicine and health in society
• After WWII: cooperation between physicians and sociologists
o Sociology in Medicine: sociological research that serves the needs and interests of medicine; the goal is
to provide solutions to medically defined problems (e.g., improve doctor-patient relationships, detect
social causes of disease);
o Sociology of Medicine: sociological study of health, illness and institutions of health care, as a means of
understanding the society; the goal is to gain understanding of social life in general
A) Health sociology (or medical sociology)- Straus
= a theory oriented research field, committed to the study of social structure and culture and social
change and their consequences for behavior, social interaction and social relations in the field of
illness and health
Models of health and illness
LITERATURE
Can we use biomedical model to help sociological arrangement?
Health, disease, illness & sickness: concepts
A) Health
• Biomedical model: Health is the absence of disease
1
,• Lay beliefs: capacity to carry out daily activities; people can feel themselves healthy, even if they suffer from
chronic conditions (e.g., diabetes, arthritis, … ) -Bradby
• WHO: A state of complete physical, mental and social well-being and not merely the absence of disease
Being sick does not necessarily relate having a disease
B) Disease, illness, sickness
• A syndrome = a meaningful cluster of symptoms, indicating an underlying disease
• Disease (een ziekte) = an abnormality of the body or mind that causes discomfort, dysfunction, distress, or death
to the person afflicted or those in contact with the person
• Illness (zich ziek voelen) = the condition of poor health, experienced by a person (regardless of whether (s)he has
a disease)
• Sickness (ziek gevonden worden) = the social classification of someone deemed diseased, which can also occur
independently of the presence or absence of disease or illness
5 models of health and illness
1) Biomedical model
dominant way of thinking – due to its great success in treating infectious diseases (eg.smallpox)
a- Core assumptions
1. All illnesses arise from an underlying abnormality within the body, referred to as a disease
2. All diseases give rise to symptoms; other factors may influence the consequences of the disease, yet they are not
related to its development or manifestations
3. The removal or attenuation of the disease, using medical procedures, will result in a return to health
b- Example
E.g, Appendix-Surgical operation removes appendix and the health can be brought back.
There are symptoms of appendicitis, causes, …
c- General implications
1. Health is the absence of disease
2. Reductionism: all behavioral manifestations of disease (including “mental diseases”) must be seen in terms of
physiochemical principles
2
, →How an individual behave when he has a disease e.g, appendix, how is the behaviour, arranged in
psychochemical process.
3. Exclusionism: what cannot be explained by physiochemical principles, cannot be considered as a disease
4. Mind/body dualism: mind and body can be treated separately, are 2 diff realities
→How mind deviates from the reality.-underline bodily dysfunction leads to abnormal behaviour cause
disease.
d- Implications for treatment
1. Mechanical metaphor: the body as a machine, and physicians as engineers (Nettleton, 2006)
2. Technological imperative: emphasizes the merits of technological interventions
3. Drugs as “magic bullets” that can be shot into the body to cure or control afflictions
4. The patient is a victim of circumstances with little or no responsibility for the presence or cause of the illness
5. The patient is a passive recipient of treatment, although cooperation with treatment is expected
→a myocardial infraction from a biomedical clinical perspective
e- Examples that questions the biomedical model
Underline cause of a depression is a disease
Depression after a death of a loved one is not a
depression but it’s a basic, obvious reaction.
➢ “Some people with positive laboratory findings are told that they are in need
of treatment when in fact they are feeling quite well, while others feeling
sick are assured that they are well” (Engel, 1977)
They find a cause- people with chronic fatigue syndrome feels less important -
Political implications.
3
, 2) Biopsychosocial model
• Illness has to be viewed as a result of interacting mechanisms at the cellular, tissue,
organismic, interpersonal and environmental levels
• Biological factors play a role, but are insufficient conditions for the emergence of
disease as a human experience (illness).
• Psychological and social factors have an impact as well.
→experience of illness, not about disease
George L. Engel (1977, p. 133): “By evaluating all the factors contributing to both illness, rather than giving primacy
to biological factors alone, a biopsychosocial model would make it possible to explain why some individuals
experience as “illness” conditions which others regard merely as “problems of living”.
a- Implications for the treatment procedure
1. The personal experience of the patient is an important source of clinical information
o does not only determine a patient’s illness experiences, but also whether the patient is deemed sick
2. Treatments limited to the correction of bodily dysfunctions are not sufficient to heal most diseases
3. The success of a treatment strongly depends on the doctor-patient relationship; hence the characteristics of this
relationship are very important
E.g conflicts,.
Biomedical and bio psychosocial are
clinical.
Minor aspect of the whole issue.
We tend to see every health issue with
the clinical perspectives.
We don’t see the links.
3) Evolutionary model
Darwinian model looks at dysfunction in an evolutionary model, which is different →it doesn’t look at functional and
dysfunctional
Some behaviours being dysfunctional is because these behaviours are not reproduction →we look at person
environment fit
For Darwinian model the context is crucial!!
4
Introduction and models of health & illness
To understand the diff btwn population and clinical perspective
Health sociology: definition
o Preconditions and assumptions: Caring, issues, religious connotations, traditional medicine, culture
o 95% has nothing to do with medicine
o Biomedical conception of illness
o Various models compete with each other
o Models are used according to the context-Bio medical model is of no use in pandemics like covid 19, precautions
are necessary.
Medical/health sociology
• First half of the 20th century: medicine and sociology as separate disciplines
o Health issues are within the domain of physicians and biological sciences
o Durkheim, Weber, Marx: little attention for the role of medicine and health in society
• After WWII: cooperation between physicians and sociologists
o Sociology in Medicine: sociological research that serves the needs and interests of medicine; the goal is
to provide solutions to medically defined problems (e.g., improve doctor-patient relationships, detect
social causes of disease);
o Sociology of Medicine: sociological study of health, illness and institutions of health care, as a means of
understanding the society; the goal is to gain understanding of social life in general
A) Health sociology (or medical sociology)- Straus
= a theory oriented research field, committed to the study of social structure and culture and social
change and their consequences for behavior, social interaction and social relations in the field of
illness and health
Models of health and illness
LITERATURE
Can we use biomedical model to help sociological arrangement?
Health, disease, illness & sickness: concepts
A) Health
• Biomedical model: Health is the absence of disease
1
,• Lay beliefs: capacity to carry out daily activities; people can feel themselves healthy, even if they suffer from
chronic conditions (e.g., diabetes, arthritis, … ) -Bradby
• WHO: A state of complete physical, mental and social well-being and not merely the absence of disease
Being sick does not necessarily relate having a disease
B) Disease, illness, sickness
• A syndrome = a meaningful cluster of symptoms, indicating an underlying disease
• Disease (een ziekte) = an abnormality of the body or mind that causes discomfort, dysfunction, distress, or death
to the person afflicted or those in contact with the person
• Illness (zich ziek voelen) = the condition of poor health, experienced by a person (regardless of whether (s)he has
a disease)
• Sickness (ziek gevonden worden) = the social classification of someone deemed diseased, which can also occur
independently of the presence or absence of disease or illness
5 models of health and illness
1) Biomedical model
dominant way of thinking – due to its great success in treating infectious diseases (eg.smallpox)
a- Core assumptions
1. All illnesses arise from an underlying abnormality within the body, referred to as a disease
2. All diseases give rise to symptoms; other factors may influence the consequences of the disease, yet they are not
related to its development or manifestations
3. The removal or attenuation of the disease, using medical procedures, will result in a return to health
b- Example
E.g, Appendix-Surgical operation removes appendix and the health can be brought back.
There are symptoms of appendicitis, causes, …
c- General implications
1. Health is the absence of disease
2. Reductionism: all behavioral manifestations of disease (including “mental diseases”) must be seen in terms of
physiochemical principles
2
, →How an individual behave when he has a disease e.g, appendix, how is the behaviour, arranged in
psychochemical process.
3. Exclusionism: what cannot be explained by physiochemical principles, cannot be considered as a disease
4. Mind/body dualism: mind and body can be treated separately, are 2 diff realities
→How mind deviates from the reality.-underline bodily dysfunction leads to abnormal behaviour cause
disease.
d- Implications for treatment
1. Mechanical metaphor: the body as a machine, and physicians as engineers (Nettleton, 2006)
2. Technological imperative: emphasizes the merits of technological interventions
3. Drugs as “magic bullets” that can be shot into the body to cure or control afflictions
4. The patient is a victim of circumstances with little or no responsibility for the presence or cause of the illness
5. The patient is a passive recipient of treatment, although cooperation with treatment is expected
→a myocardial infraction from a biomedical clinical perspective
e- Examples that questions the biomedical model
Underline cause of a depression is a disease
Depression after a death of a loved one is not a
depression but it’s a basic, obvious reaction.
➢ “Some people with positive laboratory findings are told that they are in need
of treatment when in fact they are feeling quite well, while others feeling
sick are assured that they are well” (Engel, 1977)
They find a cause- people with chronic fatigue syndrome feels less important -
Political implications.
3
, 2) Biopsychosocial model
• Illness has to be viewed as a result of interacting mechanisms at the cellular, tissue,
organismic, interpersonal and environmental levels
• Biological factors play a role, but are insufficient conditions for the emergence of
disease as a human experience (illness).
• Psychological and social factors have an impact as well.
→experience of illness, not about disease
George L. Engel (1977, p. 133): “By evaluating all the factors contributing to both illness, rather than giving primacy
to biological factors alone, a biopsychosocial model would make it possible to explain why some individuals
experience as “illness” conditions which others regard merely as “problems of living”.
a- Implications for the treatment procedure
1. The personal experience of the patient is an important source of clinical information
o does not only determine a patient’s illness experiences, but also whether the patient is deemed sick
2. Treatments limited to the correction of bodily dysfunctions are not sufficient to heal most diseases
3. The success of a treatment strongly depends on the doctor-patient relationship; hence the characteristics of this
relationship are very important
E.g conflicts,.
Biomedical and bio psychosocial are
clinical.
Minor aspect of the whole issue.
We tend to see every health issue with
the clinical perspectives.
We don’t see the links.
3) Evolutionary model
Darwinian model looks at dysfunction in an evolutionary model, which is different →it doesn’t look at functional and
dysfunctional
Some behaviours being dysfunctional is because these behaviours are not reproduction →we look at person
environment fit
For Darwinian model the context is crucial!!
4
