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SHDH2040 SOCIOLOGY
OF HEALTH STUDIES
Topic 2 Development of medical sociology
 Key concepts
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 Well being, health, normal function

 Epidemiology
 Chronic illness
 Stress
 Symbolic interactionism
 Anomic suicide
 Modernization
 Lecture Flow
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The focus and boundary of health care service

Our definition on health

How people live their lives

Structural change of society

 Lecture Flow
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1. Introduction
2. Defining Health
2.1 Different definitions
2.2 Implication of different definitions
3. Different models and concerns
3.1 Primitive model
3.2 “The birth of clinic” on early modern period
3.3 Germ theory of disease
3.4 Return to the “Whole Person”
3.5 Reemergence of infectious diseases
3.6 Social stress and illness
3.6.1 Social causes of stress
3.6.2 Life events and chronic strains
 Lecture Flow
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4. Symbolic interactionism on social stress

4.1 Introduction
4.2 Theory of Looking Glass Self
4.3 How symbolic interaction creates stress
5. Functionalist approach on suicide
6. How change of social structure affects human
psychology
 1. Introduction
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 As we have illustrated, what makes medical sociology important

is the critical role social factors play in influencing the health of
individuals or social groups.

 Health is not simply a matter of biology but involves a number

of factors that are cultural, political, economic, etc.

 Thus, the phenomenon and understanding of health also change

along with the structural transformation of society from
traditional to modern society.


 2. Defining Health
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2.1 Different definitions

 There is no single, universal definition of health that fits all

circumstances.

 Most common understandings on health are:

 Health as normality

 The absence of illness

 The ability to function

 Well-being
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 The World Health Organization (WHO) defines health as

a state of complete physical, mental, and social well-
being.

 Not merely absence of diseases and injuries.

 Discuss
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 Which definition of health do you take?

 What is meant by the term “well-being”?
 Can modern medicine help people reach such
status?
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2.2 Implication of different definitions

 Thomas McKeown (1979) supports the WHO definition.

 He points out that feelings of well-being are more than

the perceived absence of disease and disability.

 Many influences—social, religious, economic, personal ,

and medical contribute to such feelings.
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 In this situation, the role of medicine is not to create

happiness but to remove one of the major sources of
unhappiness from people’s live, i.e. disease and disability.

 But, laypersons tend to view health as the capacity to

carry out their daily activities. If people are ill, or injured,
they face the curtailment of usual round of daily life and
even create sense of meaningless.

 Therefore, health can also be defined as the ability to

function.
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 Different definitions on health imply different roles

of medicine on peoples’ live.

 It affects the dynamic and cooperation between

medicine and other kinds of knowledge.


 3. Different models and concerns
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3.1 Primitive model

 In primitive society, people already recognized a cause-

and-effect relationship between doing certain things and
a symptoms of a disease.

 But they did not understand much about the functioning

of the body, magic became an important component of
belief and health care.
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 Primitive people thought that illness was caused by evil

spirits. They use animals, plants, stones, etc. to expel
harmful spirt from a diseased body.

 To evaluate: how does it meet the different definitions on

health?
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3.2 “The birth of clinic” on early modern period

 According the M. Foucault, in the late 18th century,

modern medicine replaced the metaphysical notion of
sickness by a positivistic( 實證 ) understanding.

 The human body became an object of study and

observation in order that physiological processes could
be demystified and brought under medical control.
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 The discipline developed into two streams:

 Medicine of the species:

the human body became a subject of regulation
 Medicine of social spaces:
government involvement in regulating the conduct of daily
life. Setting up social norms and expectations on behavior
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 Clinics were established to both treat patients and train

doctors. There were also systematic implementation of
public health measures.

 Ironically, lots of physicians and scholars found that the

decline in deaths from infectious diseases in the second
half of the nineteenth century was mainly due to
improvements in diet, housing, public sanitation, and
personal hygiene instead of medical innovations.
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3.3 Germ theory of disease

 Most of physicians in the 1800s were primarily interested in

treating patients and improving the state of medial
technology.

 The latter part of the 19 th century brought one of medicine’s

true revolution: bacteriology. Scientific research decisively
confirmed the germ theory of disease and uncovered the
cause of a host of diseases, along with the vaccines providing
immunity.
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 Alexander Fleming discovered penicillin—the first

antibiotic.

 Drug production became industrialized and mass

produced.

 Medicine’s thinking was dominated by the search for

drugs as “magic bullets” that could be shot into the body
to kill or control all health disorders.
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3.4 Return to the “Whole Person”

 By the late 1960s, polio and smallpox were largely eradicated and
infectious diseases had been severely curtailed in most regions of
the world.

 This situation induced a major change in the pattern of diseases,

with chronic illness replacing infectious diseases as the major
threats to health.

 It is characterized by the emergence of chronic diseases such as

cancer, heart disease, and stroke as the leading causes of death.
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 This transition to chronic disease meant that physicians

were increasingly called upon to deal with the health
problems of the “whole person”.

 By that time, it is not only radical thinkers but many of the

most respected figures in medicine were insistent that
treating the body as a mechanical model would not produce
true health.

 The need to understand the impact of lifestyles and social

conditions on health has become increasingly important.
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 This situation has promoted a closer association between

medicine and the social sciences of sociology, anthropology
and psychology.
 To put in diagram
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3.5 Reemergence of infectious diseases

 The first epidemiological transition occurred 10,000 years ago

when human societies shifted form hunting and gathering to
agriculture.
 Emergence of novel infectious and nutritional diseases

 The second transition began about 200 years ago as improved

nutrition and living standards, public health measure.
 led to a decline in infectious diseases and a rise in chronic and
degenerative diseases.


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 We are now entering a third epidemiological transition.

 There is a resurgence of infectious diseases previously
thought to be under control.
 Globalization, urbanization, and global warming are
contributing to this change.
 The crowded conditions of urban living ensured that
infectious diseases would spread more quickly and that
disease-causing micro-organisms would persist within the
community for longer periods of time.
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 For example:
 Some pathogens have shown a remarkable ability to
resist antibiotics
 Certain disease-transmitting insect have successfully
resisted pesticides.
 Mad cow disease in Great Britain

 SARS in Asia

 West Nile Virus in United State

 AIDS
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3.6 Social stress and illness

 It is important to recognize that interaction between the

human mind and body represents a critical factor in regard to
health .

 Social situation can cause severe stress that, in turn, affects

health and longevity.
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 Scientists concludes that:

1. The impact of stress on health is substantial,
2. Exposure to it is unequally distributed in the population.
3. Member of racial minority groups are burdened by
additional stress form discrimination
4. Stress can continue over the life course
5. The impact of stress is reduced when people possess high
levels of personal mastery, self-esteem, and social
support.
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3.6.1 Social causes of stress

 Stress can be defined as a heightened mind-body reaction to stimuli

inducing fear or anxiety in the individual.

 Cannon (1932) formulated the concept of the “fight or flight” pattern

of physiological change to illustrate how the body copes with stress
resulting from a social situation.

 Physiological changes in the body primarily involving the autonomic

and neuroendocrine systems. E.g. heart rate, blood pressure, and
gastrointestinal functions.
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 However, most threats in modern society are symbolic, not

physical, and they do not usually require a physical response.

 A number of studies have shown that the human organism’s

inability to manage the social, psychological, and emotional aspects
of life can lead to the development of cardiovascular complications
and hypertension, peptic ulcers, muscular pain, compulsive
vomiting, asthma, migraine headaches, and other health problems.

 Sociologist identified two major types of social stressors: life event

and chronic strains.
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3.6.2 Life events and chronic strains

 Examples of life events are: divorce, marriage, or losing one’s

job.

 Typically, the stress associated with life events originates in

negative situations (such as heavy debt).but on certain occasions
it may come from positive circumstances (such as wedding).

 The accumulation of several events in a person’s life eventually

builds up to a stressful impact.
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 “Chronic strain” means the relatively enduring conflicts,

problems, and threats, which many people face on a daily
basis.

 Chronic strain includes role overload, such as the strain

associated with work and being a parent.
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 4. Symbolic interactionism on social stress
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4.1 Introduction

 George Herbert Mead who developed this micro perspective viewed

the individual as a creative, thinking organism who is able to choose
his or her behavior instead of responding mechanically to the
environment.

 This approach assumes that all behavior is self-directed on the basis

of common understandings symbolized by language that are shared
and communicated.

 Charles Cooley developed the theory of “Looking-Glass Self” basing

on this approach.
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4.2 Theory of Looking Glass Self

 the looking-glass self is a sociological concept that a person's self

grows out of society's interpersonal interactions.

 in the looking-glass self, a person views himself or herself through

others' perceptions and in turn gains identity.

 Identity, or self, is the result of the concept in which we learn to

see ourselves as others do.
I, me, self
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 Beginning as children, humans begin to define themselves

within the context of their socializations.

 The child learns that the symbol of his/her crying will elicit a
response from his/her parents, not only when they are in need
of necessities such as food, but also as a symbol to receive
their attention.

 The sense of ‘good’ vs. ‘bad’, ‘right’ vs. ‘wrong’ thus develops.

 This makes the child develops the ability to adopt the

perspectives of other participants in social relationships and,
thus, to develop a social self.
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 Through interaction with others, we begin to develop an

identity about who we are, as well as empathy for others.

 There are three main components of the looking-glass self

(Yeung, et al. 2003).
1. We imagine how we must appear to others.
2. We imagine the judgment of that appearance.
3. We develop our self through the judgments of others.
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 In other words:
"The thing that moves us to pride or shame is not the mere
mechanical reflection of ourselves, but an imputed sentiment,
the imagined effect of this reflection upon another's mind."
(Cooley 1964)

 The mechanism of imagined social roles and norms

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4.3 How symbolic interaction creates stress

 This process of interpretation depends much on the individual’s

“definition of situation”.

 However, when rival definitions appear and habitual behavior becomes

disrupted, a sense of disorganization and uncertainty may happen as a
result.

 Adaptation to a new situation involve stress control.

 This explains how life events and chronic strains create stress in our
everyday life.
 5. Functionalist approach on suicide
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 Emile Durkheim, one of the most important classical

sociologists, suggested a four-fold model of suicide to
illustrate how a society might induce enough stress
among people to cause them to take their lives.

1. Fatalistic suicide
people kill themselves because their situation is hopeless.

2. Egoistic suicide
stress brought about by the separation of a strongly
integrated individual from his or her group.
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3. Anomic suicide
overstimulation of emotion and a corresponding
freedom from society’s restrain
it is a result of sudden social change that includes the
breakdown of social values and norms (anomie 失範 )

4. Altruistic suicide
the strong presence of a social system encouraging
suicide among certain group
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 The major increase in suicide rate falls in the type of

anomic suicide.

 Durkheim explain the increase of anomic suicide as the

result of modernization and differentiation of society that
destroy common belief and value consensus.

 What Durkheim wanted to stress is the importance and

functioning of norms and values, which help people to
define fulfillment.
 6. How change of social structure affects human
psychology
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Anthony Giddens: The Transformation of Love and

Intimacy

Pre-modern Societies Contemporary

Societies
Localization Globalization
(traditional) (detraditionalization)

- Ritual and Repetition - Egalitarian

- Patriarchy - Loosening the grip of
tradition
- Enhancing people
lives autonomously
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Romantic Love Confluent Love

- Heterosexual - Androgynous
- Natural gender - A new form of social
differences relation: pure relation
- Idealization of the gender - Plastic sex
attributes - Autonomy and Reflexivity
- Basis for marriage - Constant / Emotional
- Patriarchy Communication
- Life-long commitment Egalitarian
- Fluidity and Instability
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Ontological security Psychological Insecurity

- Restricts the openness - Unique life-course

of counterfactual paths
futures - Difficult to predict the
- Socially approved consequences
framework of lifespan

 For Giddens, the globalized and fluid contemporary life

creates anxiety because of unpredictability.

 Some people will seek different kinds of addictive

behavior as relief of such feelings.
 To sum up…
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The focus and boundary of health care service

Our definition on health

How people live their lives

Structural change of society