Illness and Health: Social Constructs of Culture

30th March 2012

‘Words, like the chisel of the carver, can create what never existed before rather than simply describe what already existed. As a man speaks, not only is the thing he is declaring coming into existence, but also the man himself.’

Heidegger

The ideas of illness and health are socially constructed within each society of every culture. These common terms cover a diverse range of connotations for which there has been no general agreement over their meaning. Foucault contended that medicine is one of a number of related disciplines that have shaped the body as a site liable to the expression of social relationships (Sargent 196:168). From an anthropological view, it is important to understand the meaning and implications of health and disease, in order to look at it in relation to health, policy and service provision, and at its broader context in any given society. It is also important to distinguish between professional and lay people’s perspectives on health and illness, as societal concepts are frequently divergent, as well as to consider the varying perceptions of illness in identifying ‘what counts as a recognizable symptom’. Scotch (1963:30; See also Singer 2011) noted that, “medical scholars have literally for centuries been aware of the social dimensions of health and illness and have, in their research, focused on a variety of social and cultural variables”.

Regardless of the system of medicine being examined, indigenous ethno-medical practices or western biomedicine, medical anthropologists explore the ways in which it is “socially, culturally, and historically constructed and show how its perspectives influence the lives of its patients” (Sargent, 1996:165). Curtis (1996, 2005) for example, claims that the western biomedical model of health is dominated by a scientific or mechanistic approach, in which the body acts like a machine, where by if broken needs to be repaired i.e. treating people who have already become ill. She states that the medical model has neglected other influences that shape health outcomes, such as social, cultural, economic and environmental factors (Curtis and Taket, 1996:28, 268) Further criticisms of the mechanistic model include the idea that it is overly simplistic and not always applicable, since the body cannot always be repaired. Curtis, however, goes further claiming that the systems emphasis lies on diagnosis of disease leading to ill health rather than in preventing disease and promoting good health, that is that the focus of the model is on the treatment rather then the prevention. In many westernized countries this is the model that we are most familiar with as a result of our cultural exposure.

In contrast to the biomedical model presented, many medical anthropologists defined health as a broad construct, consisting of the physical, psychological, and social well being of an individual, including role functionality (Singer, 2011:15). What has changed over time is that distinctions have been made between “disease ”[1], an etic construct describing biological or physiological irregularities, that are commonly indicated by a set of signs and symptoms, and the emic perception of illness as the culturally structured, personal experience of being unwell, which entails the experience of suffering, indicated by the persons feelings of pain, discomfort and the like (Singer, 2011:15, Field 1976:176,334). This implies that disease is something that can be diagnosed and treated by biomedical professionals, whereas patients experiencing illness may not necessarily be able to be diagnosed or treated under this system. According to Curtis and Taket (1996, Field, 1976:343) you can have illness without disease and vice versa, the concept of illness is therefore subjective and the concept of disease objective. Curtis (2005) contends that this is a further limitation of the medical model in “ that it is not very effective in giving social meaning to illness”.

Different medical systems are the product of specific worldviews and the dominant ideologies of the corresponding community. Often, it is found that ‘choices’ for a particular medical system are dependant upon factors such as education, beliefs, norms and values, socio-cultural and economic environments of the community. Blaxter and Patterson researched the beliefs and attitudes to health and medical care, inter-generational relationships, and social history of members pertaining to class within society. Their study consisted of 47 interview transcripts with members representative of the ‘grandmother’ generation. For the purposes of their study, the ‘grandmother’ generation was defined as women who, between the years of 1950 and 1953 were of social class IV or V, gave birth to a daughter in the City of Aberdeen, who herself is of social class IV or V and who also had a child or children born in the same city, and was still living in the City and in contact with the grandmother. Therefore the study’s focal group were generally around 50 years of age and of a socially disadvantaged background. It was found that these women only reported themselves as ill when they could no longer perform their daily tasks. Regardless discomfort and disability many reported their health as satisfactory. One woman (G29) interviewed was found to have been sterilized, wearing a collar, taking valium for headaches and receiving a gratuity payment every 6 months, but yet she still claimed that “Healthwise I would say I’m OK (sic)” and “not really off work a lot” (1982:29). The fact that health and illness are not essentially biological entities but also have deep socio-cultural implications allows for the expression of peoples self definitions in terms of dependence on their mental and physical state and the symptoms in which they define as illness. In this way the idea or concept of both health and illness makes them a social construct of the individual community being examined. Sedgwick claimed, “Outside the significance that man voluntarily attaches to certain conditions, there are no illnesses or diseases in nature.” Diseases, lesions, infections, contagions, fractures of bones, tumorous growths, ruptures of tissues all occur as natural events but “do not- prior to the human social meanings we attach to them- constitute illness, sickness, or disease” (Sedgwick 1981:120-121 in Joralemon 2010:2).

The notions of health and illness are fundamental constituents of the social values of human society in that they articulate many of the underlying assumptions toward the meaning of life and death (Shina, 2008:179). As a result of this, perceptions of health are, in many cases, based on or merged with religious or moral considerations about existence. Their differences in orientation frequently reflect the basic cultural or structural differences, between groups, toward health. In many “simpler societies” (sic) sickness is explained by impersonal malevolent forces or conditions, which seek to attack humans through the agency of witchcraft and demonic possession (Shina, 2008:180). Concepts of illness functions within the cosmology of good and evil forces, and are used as explanatory devices to justify evil and misery. In this way notions of illness have been set in a system of beliefs that attempts to explain and justify the presence of human pain and suffering. Foster (2010:105) states that, in a multitude of accounts it is found that “the kinds of cures, the modes of diagnosis, curing techniques, preventative acts and the relationship of all these variables in the wider society of which they are part, derive from beliefs about illness causality.”

According to Brown (2000:13), the Azande, a central-African people, describe the chronic conditions associated with endemic gambiense Trypanosomiasis as diseases caused by witchcraft. The anthropologist, Evans-Pritchard during his studies of Azande society characterized their belief in witchcraft as a mechanism enabling people to feel that their misfortunes are not due to their own ignorance, ineptitude, or bad luck, but are the result of identifiable individuals who can be influenced. Since the accused individual is someone who is perceived to exhibit antisocial behavior, these beliefs functions in upholding the moral ideologies of society. In another example, Evans-Pritchard reported the suicide of a man who was angry with his brothers. When the mans body was found hanging from a tree, all readily acknowledged that he had hanged himself, the cause of death however, was considered witchcraft. One of the Azande explained to Evans-Pritchard that “… only crazy people commit suicide; if everyone who was angry with his brothers committed suicide there would soon be no people left in the world; if this man had not been bewitched he would not have done what he did do” (Evans-Pritchard 1937:71, Peters-Golden, 2009:15). The Azande believe that humans employing witchcraft rather than disease and sickness are responsible for the majority of all deaths. According to Peters-Golden, once the supernatural premise that all people are capable of witchcraft and are able to inflict harm others with it is granted, the Azande argument becomes logical.

Through this is it possible to maintain that definitions constituting both ‘health’ and ‘illness’ vary between individuals, families, social groups and classes and that customarily, in many societies, health is conceived as more than simply the absence of disease symptoms, but rather a balanced relationship between humans, the natural, and the supernatural. The process of ‘becoming ill’ involves both subjective experiences of physical or emotional change and the conformation of these changes by other people. In order for this conformation to occur there must be a common agreement between what constitutes health and abnormal symptoms and signs. Therefore both the characteristics of illness and the communal response toward it are largely a result of socio-cultural ideology. It is frequently noted that different societies regard health differently, alternative medicines are often unaccounted for, and the social and economic state of a particular society may affect the way illness is dealt with. Health and illness therefore are socially constructed and cannot be studied in isolation from other aspects of any given society, especially its religious, social, political and economic organizations, as its association with these is based upon a certain predefined sets of socially developed assumptions, values and worldviews.

Notes

[1] The concept of illness and dis-ease is derived from the old French word aises meaning ‘comfort’, and indicates the notion that illness involves discomfort or a lack of ease through the lack or power and control that we experience during the ordeal (Shina, 2008:179).

References

Blaxter, M. and Patterson, E.,1982, Mothers and daughters : a three-generational study of health attitudes and behaviour, Heinemann Educational Books, London, U.K.

Brown, J., 2000, “Human African Trypanosomiasis: Ethnomedical and Biomedical Relationships,” NEXUS, Vol. 14: Iss. 1, Article 2.

Curtis, S. and Taket, A., 1996, Health and Societies: Changing Perspectives, Edward Arnold, London, U.K.

Curtis, S., 2005, ‘The geography of health: a British point of view’, Espace Populations Sociétés, 1995-1 La géographie de la santé en question, pp.49-58

Evans-Pritchard, E.E., 1937, Witchcraft, oracles and magic among the Azande, Clarendon Press, Oxford, U.K.

Field, D., 1976, ‘The Social Definition of Illness’, in Tuckett, D. (ed.), An Introduction to Medial Sociology, Travistock Publications, London, U.K.

Foster, G.M, 2010, ‘Disease Etiologies in Non-Western Medical Systems’, in Brown, P.J. and Barrett, R. (eds.), Understanding and Applying Medical Anthropology, Second Edition, McGraw-Hill, New York, N.Y.

Joralemon, D., 2010 Exploring Medical Anthropology, Third Edition, Prentice Hall, Upper Saddle River, N.J.

Peters-Golden, H., 2009, Culture Sketches: Case Studies in Anthropology, 5th Edition, McGraw-Hill Higher Education, New York, N.Y.

Sargent, C.F. and Johnson, T.M. (eds.), 1996, Medical anthropology: Contemporary Theory and Method, Revised Edition, Greenwood Publishing, Westport, C.T.

Scotch, N., 1963, ‘Medical Anthropology’, in Seigel B.J. (ed.), Biennial Review of Anthropology 1963, Stanford University Press, Stanford, California

Sinha, A.K et al., 2008, Bio-Social Issues in Health, Northern Book Center, Daryagan, New Delhi.

 

 

 

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