MEDICAL SOCIOLOGY

ILLNESS NARRATIVES AMONGST THE ELDERLY: DEFINITIONS AND DYSFUNCTIONS

Aileen Ye

Illness Narratives amongst the Elderly: Definitions and dysfunctions! Physiological breakdown is a natural process of ageing and to be ill can be a subjective experience of feeling unwell or the result of chronic disease. Illness can be a social status conferred by others1, determining how people play out sick roles. Illness can also be self-assumed, where individual autonomy can be exercised in its identification and management. The aim of this paper is to find out how the elderly define illness, and to see how illness can be socially caused and constructed. Additionally, do the elderly have any dysfunctional ways in relating to self and others in relation to their sick roles? Illness can be framed using medical or social models. From a medical standpoint, health is the absence of disease (Blaxter, 2010) and illness represents a biological breakdown of the body, causing functional disabilities. Getting well infers seeing the body as a machine that breaks down and needs fixing or managing in order to conform with societys norms. The role of medicine is to cure diseases, usually through treatment and drugs. However, as getting ill is part of growing old, the interviewees see the role medicine plays as, not to get the body functioning at optimal levels, but to a level where they need less help managing their daily routines. The social model sees illness as being influenced by social factors. It recognizes that health and illness vary between different groups. This model takes a preventive approach (Stow College, 2002), and sees health as more than just the absence of disease. According to the World Health Organization, health is a state of complete physical, mental and social well-being. Getting ill can be attributed to thoughts and emotions (an individuals own or others), and different cultures have different ideas

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A medical diagnosis or a label conferred by family and peers. 2

Aileen Ye

about what it means to be healthy and ill, which play a part in understanding how illness influences interaction and conflict with others2. Respondent A is 74, middle class Indian Catholic, and has been homemaker for 53 years of her marriage. She carries herself well and speaks well despite having only O level education. She has osteoporosis, osteoarthritis, high potassium levels, memory problems and a worn muscle in the shoulder. Respondent B is a 78-year-old Indian Catholic-convert, and was an executive in the automobile industry who retired at 60. He had a heart attack at 74, along with glaucoma, gout and pancreatic cancer. Respondent C is a working class Chinese, 64 and a free thinker. She is currently a library administrator that obtained her diploma while working, and is due to retire next year. She had a hysterectomy at 46 and has high blood pressure, high cholesterol, glaucoma, mild diabetes and routine fainting spells. Respondents A and B are happily married and live with a grandson in a semi-detached house in Changi. They are highly regarded in their community, volunteer as prison counselors, and receive regular visits and help from neighbors, friends and relatives. While A maintains a low potassium diet, B has a high sugar diet, and used to smoke and drink. Respondent C lives in a mansionette3 along a busy intersection near the exit of a highway with her retired husband and two working-adult daughters. Both respondent C and her husband do not get along well and are hoarders. They live independent lives from their daughters and constantly quarrel, but are co-dependent. They do not engage in recreational activities with each other beside having meals, buying household necessities and taking care of their one aged parent, so respondent C usually does exercise on her own like golf and

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Medical professionals, healthcare providers, family, peers A five-room, double storey HDB flat, with a balcony. 3

Aileen Ye

zumba4. Where C is unwilling to admit that hoarding is a mental disorder she does acknowledge to feeling depressed. According to Talcott Parsons (Stow College, 2002), the sick role involves both the right to be exempted from normal role obligations (such as work or commitment to others) and to be looked after, as well as the obligation to want to get better by seeking help from others and following doctors instructions. When asked how they decide when they are sick, when to seek help and how they respond and cope with the symptoms of illness, both females A and C gave practical reasons like not being able function without impairment or lethargy in their daily activities, whereas Bs family has to decide for him. For e.g. he had his heart attack while gardening and was taken to a doctor only when someone noticed him persistently rubbing his chest. When the doctor asked him, Do you know you had a heart attack? he nonchalantly replied, Oh I just had some pain lah5. B does not come across as being willing to seek help. Conversely C says, sickness is a burden to others and a helplessness to yourself, these thoughts motivate me not to be sick, when you are old you are defenseless. Both A and C may have greater willingness to seek help (medical and domestic) because they are women. However, where A has a network of support and says, I just want to remain mobile for as long as possible, C views that she lacks a support system and needs to help herself. She manages her own healthcare but did not save for it like A and B and relies largely on Medisave6. While A and B have their second daughter to depend on to arranging appointments and ferry them to and fro the hospital, C commutes to doctors appointments herself and uses exercise to offset an !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Latin dance fitness program. slang, which is sometimes used to take away seriousness from a situation. 6 National medical savings scheme where individuals put aside part of their monthly income 7% - 9.5% (depending on age group) into their Medisave Account to meet their future personal or immediate family's hospitalization, day surgery and certain outpatient expenses.
"!Singaporean
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Aileen Ye

unhealthy diet and bad sleeping habits (watching television past 3 am every night). Although C views being sick as being disruptive, she does not follow doctors advice like sleeping early and managing her diet better. This could be due to the fact that she lives a lonely life and uses food and television as a coping mechanism. Lastly although B has people who care for him and watch his symptoms and diet, he does not like to be policed and views illness as a private matter, choosing to be jovial rather than one that acts out his illness. Hence, health and illness can be socially defined and constructed. How the elderly act, is determined by the sickness labels and meanings they attach to themselves, as well as whether they accept or reject the labels given by others and whether they acknowledge they have mental disorders. The motivation to seek medical help also defers with social status, gender and cultural background. For A and C, being females, they defer to medical professionals and give high regard to doctor-patient interaction when it comes to labeling their sickness. A is more meticulous than C when it comes to doctor-patient interaction whereas C is less vocal and will get a second opinion from a TCM7 doctor. B gets pressurized to seek help and sees the role of the doctor as someone to manage pain and obtain medication from, when his usual panadol popping and going to sleep routine does not curb pain and discomfort. It takes a lot for B to decide that he is ill enough to warrant a doctor, whereas A and C see doctors to prevent further complications to their daily routine (work for C) and long term health (worn out shoulder muscle for A). With regard to religious beliefs and practices, respondent A hundred percent believes that as a Catholic, doing good and being good contribute to health and well-being whereas C goes to the temple to give offerings in times of need: when she feels disenchanted, underappreciated or stressed. B, being a former Hindu, !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
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Traditional Chinese Medicine 5

Aileen Ye

sees counseling as giving back to society. A and B believe in individual agency while C believes that her circumstance is just a product of old age and has to make do with it. While A and C manage their household work equally with C tending to the garden and minor household repairs and A handling domestic chores, C does not get help from her husband and suffers from the second-shift8 . She also ignores her hoarding problem and sees efforts from her daughters to help as interfering and being disrespectful. While A and B see old age and having more illnesses as a natural process, C sees old age and illness as a loss of youth and significance to family (role as a mother, authority figure) as well as society. A and B compare their definition of illness to peers and C compares her definition of illness to her past. A and C view that the environment and social well-being contribute to elderly illness. They try to interfere with the process of biological breakdown by taking supplements and exercising. B has an aversion to illness; he does not like to be labeled ill, to fall ill or think about it at all. Therefore, Bs attitude toward illness can be disruptive to his loved ones especially his wifes health and Cs refusal to accept help for her hoarding can negatively impact her health as well as those around her. It also reduces their propensity to socialize with her, which could in turn reduce her health damaging behaviors. In conclusion, all three respondents differ in their construction and experience of illness in terms of social status and prestige, culture: race and ethnicity, gender, level of education, marriage, lifestyle, living environment, religion and mental disorder, with A and C similar on levels of gender and B and C similar on issues of privacy. Lastly both B and C have dysfunctional ways of relating to self and others in relation to their sick roles, even though B rejects his sick role.

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Womens work at work and at home (domestic work) 6

Aileen Ye

Works Cited ! Blaxter, M. (2010). Health, 2nd ed. Cambridge, UK:Polity. Stow College. (2002). Medical and Social Models of Health. Retrieved July 10, 2013, from socialscience.stow.ac.uk: socialscience.stow.ac.uk/rab/hnc_health/modelsofhealth.htm ! !