Escolar Documentos
Profissional Documentos
Cultura Documentos
LNESS
Chapter
individ.uals who collude in their own social control to reproduce distress
ing .·.
SUMMARY
" ... [P]olitical and entrepreneurial interests are, above all, driving what is to
In this chapter we continued our discussion of mind, body, and society relation be defined as abnormal today.... We are no longer in a mood where normal
ships, emphasizing the. role of emotions in social interaction. Some research means average; we are in an era of amelioration, enhancement, and pr?gre�s
on
social support .was critically reviewed. The distribution of power is an importa through increasing intervention into the 'mistakes' of nature. However, m this
nt climate, the environmental, social, and political factors that, rather than genes,
factor in influencing the availability and quality of supportive social relation
ships. contribute to so much disease, are eclipsed, and tend to be removed from
We then looked at some of the stressful aspects of interaction that come
playing. Those in subordinate social statuses may be more vuln.erable to
from role :m
professional and public attention. Research in connection th these factors re
dra mains relatively underfunded .... [W]hen, under the gmse of health promo
maturgical stress and more likely to lack resources to cope with such stress. �
The tion, individual bodies and individual responsibility for healt are made the
chapter consluded with a discussion of dramaturgical stress and health. cornerstone of health· care, moral responsibility for the occurrence rf zllness and pathol
I
ogy is iflen diverted.from where it belon�s (on pe�ennial p:oblems of inequality, ex�
�
ploitation, poverty, sexism, and raCl�m) and z�apprdpnately placed at t efiet rfz�dt
.
viduals designated as abnormal or at nsk of bemg so because of therr biOlogical .
makeup" [emphasis added].
Soz;rce: Margaret Lock, "Accounting for Disease and Distress: Morals of t�e Nor;m�
and Abnormal:' p. 273 in G. L. Albrecht et al., eds., J!�ndbook o/Soczal Studzes zn
·
Health and Medzczne. London: Sage, 2000.
• Illness as Deviance
The Sick Role
· The Medicalization of Deviance
The Medicalization of Moral Authority
Social Control and Power
Siclmess and Social Dissent ·
125
OF SICKNESS 127
THE SOCIAL MEANINGS
126 THE SOCIAL MEANINGS OF SICKNESS
as faci� scars,
consider deviant such bodily conditions
what do�s it. mean to be sick? In some ways a tree's disease is similar to a wid ely as to whe ther they
· shor tness and paleness. One cultural
standard .
, for example,. consider.
sa
. �uman s disease: Trees can recover or they can die of disease; branches be 0 besity, tmg forti tude ,
on a man's chest to be desirable,. represen
'
. ta .
am oun t of hair .
n-
come hfeless, leaves Wither, and roots and trunks function poorly. Unlike trees' cer ted as too effen
liness. Much less hair on. the �hest IS trea
m
however, humans must also grapple with the experiential aspects of sickn s�. robustness, and man d amm al- Ike. Oth er cul�ures (a�d sub
considered coarse � �
·
l
s has greatly increased, however; modern medica
Although having pneumonia is a legitimate excuse for not reporting to work er sons suffering chronic illnesse
the sick person is expected to act sick and try to get well. The employer would b� k tervention does not appear
c
so potent in the face of such
illness
condit ions.
does not fit Parsons's sick role pattern (Radley,
less than happy to see the supposedly sick employee at a baseball game later The nature of chroni
� the necessity of a1_1 "intent to get well" is irrele
day, for example. According to P�rsons, pa: of trying to get well involves seeking 1994). Obviously, his assumption of
. on, permanent. His sick role conception presumed
competent health care from a tramed physiCian. The social expectations for a ant if the illness is, by definiti
son with pneumonia thus include going to a doctor, obtaining and taking the :hat the benefits were conditional,
but chronic illnesses make most of the conditions
Unlike acute infectious disease, chronic ailments
doctor's prescription, and otherwise conforming to whatever regimen the doctor meaningless (Alexander, 1982). r.
ered partly the fault or the responsibility of the suffere
ordered. Thus, he tied the sick role inevitably with the role of medical professionals. are more likely to be consid .
of chicken pox, for examp le, to b e the Sick
(Parsons was especially interested in the development of professionalism as a fea Whereas few people consider a case
ture of modern society.) In his �sage, the sick role directly implies the patient role; fault, lay and medica l concep tions of many chronic conditions, such as
er son's
�
by contrast, we explore t e patient role as a sep�ate rol�, which sick persons may
.
� mg cancer, high blood pressure, and cirrhos
is of the liver, are believed to be
the sufferer's own lifestyle.
or may not enter, dependmg on whether therr sickness IS brought to the attention brought on-at least partially-by .
nt grounds for exemptiOn
of medical professionals (see Chapter 10). Feelings about whether a chronic illness is sufficie
ambiguous. Because the condition is not tem
Parsons's concept of the sick role is valuable in that it highlights the social from normal responsibilities are also
more proble�atic for both the ��fferer and
control functions of how society treats sickness. It also emphasizes the extent to porar y, the exemptions are all the _ _
just how disabling IS the conditiOn? Often
which social definitions of sickness reflect larger cultural values of modem Western those who would grant the exemptions.
want total e�emption from non:nal re
1972: 124). persons suffering chronic illnesses do not
societies (Parsons, The cultural narrowness of this concept is partly
from fulfillmg �orne usual duties. �
due to Parsons's explicit focus on mid-twentieth-century American values (for sponsibilities, but the illness prevents them
ed by the sick role, persons With
example, individual achievement and responsibility). The sick role, however, is not Chapter 7 shows, due to societal values enforc
negotiating such concessions. As a
as clear cut as Parsons's model suggests. Four problems with his approach are chronic illness have considerable difficulty
l, the sick role allows temporary
discussed next. means for maintaining stability and social contro
exemptions from normal role requirements without chang£ng those requirements:
do not fit the sick role
The Sick Role Is Not Necessarily Temporary Parsons's conception of the Similarly, many other "deviant" health conditions
ambig uities about expectations.
sick role is based on only one, relatively narrow class of health problems. The oblig model of acute diseases and thereby lead to
ap be treated as sick? W hat about
ations and exemptions described in his model appear to fit serious, acute illnesses Should a person born with a physical handic
ions as pregnancy
� �
reasonably :vell. Acute il esses c aracteristically occur suddenly, peak rapidly, accident victims or the mentally ill? Should such
norma l condit
surrou nds the role
ambig uity
and run therr course (that Is, result m death or recovery ) in a relatively short time. or menopause be treated as sickness? Considerable
treated as someh ow "deviant"
Examples include influenza, measles, and scarlet fever. expectations of those whose health conditions are
Chronic illnesses, by contrast, are of long duration-typically as long as the yet do not fit the (acute) sick role.
sufferer li�es. They often result in the steady deterioration of bodily functioning.
The Sick Role Is Not Always Voluntary Parsons's model holds that the
Examples mclude emphysema, diabetes; multiple sclerosis, epilepsy, and heart dis
sick role, is motivated to as
ease. Furthermore, some acute illnesses are considered chronic when they become sick person, in exchange for the advantages of the
agents of social control in the
a continuing pattern in an individual's life; examples include chronic bronchitis, sume that role and voluntarily cooperate with the
the preceding example of th�
asthma, and ulcers. Additionally, a number of chronic, disabling conditions (such appropriate therapy for the deviant condition. In
discomfort and fear of compli
as paraplegia from a car accident) do not involve any ongoing disease, but may worker with pneumonia, for example, the person's
to see a doctor, have blood tests
result in an ambiguous, lifelong sick role. .
cations would presumably motivate the individual
and take medications. Parsons
� �
thou? IDCU1Y acute conditions can be cured (or are self-limiting), most and X-ray s, get bed rest at home or in a hospital,
the sick person voluntarily
chrome conditions are permanent. Treatment of chronic illness is aimed at best at thus assumed that, in contrast to criminal deviance,
controlling the deterioration caused by the disease and at managing the illness. Many enters the socially prescribed role.
even when they feel ill.
of the most dangerous acute (usually infectious) diseases of earlier generations Not all persons, however, want to enter the sick role,
ency the role often entails; many
have been brought under control in developed countries through improved sanita Many people resist the expected childlike depend
especially in the hospital. A
tion, nutrition, housing, and the like. Inoculations, antibiotics, and other medical others have strong aversion to medical treatments, �
negative n10ral evaluation
treatments have· also had some effect in curing infectious diseases (although, as Scottish study of lower-class women found considerable
r and Paterson, 1982). Some
Chapter 2 shows, their role has been somewhat overstated). The proportion of of persons who give in, or "lie down;' to illness (Blaxte
THE SOCIAL MEANINGS OF SICKNESS
13 1
130 THE SOCIAL MEANINGS OF SICKNESS
ciety. Historically,· however, the legitimate exemption of sick persons from various Cultural expectations of the sick role also vary, perha
legitimacy they accord vanous
obligations has been highly variable. The criteria for such an exemption may also dence indicates that cultures differ in the degree of
responsibilities (see Morris,
differ according to gende�, social class, and subcultural expectations. illnesses and their resulting claims to exemption from
sick role amon? con
Legitimate exemptions from work obligations, for example, vary enor 1998). For example, neurasthenia is a legitimate basis of the
mously, typically according to social class. Unskilled workers, for example, often temporary Taiwanese, whereas in the Unite d � tates it is
.
a far less common dmgno
assurm ng the sick role (see, for ex�ple,
have no paid sick days, whereas many white-collar workers are given an annual sis or culturally recognized reason for
Hispa nic backg round would be more hkely
allowance of such days of absence proportionate to their rank or seniority. Indeed, Kleinman, 1980). Similarly, persons of
the idea that absence due to sickness should not be a basis for dismissal is rela than those of Anglo-Saxon heritage to consid er a certain "fri ?� t" (susto) � such as
le assaila nt, to be a legttn nate basis for the
tively recent; even today sickness is not a legitimate exemption for many workers, being startled by an animal or a possib .
s
es vary in how they under stand variou
and they have no legal protection of their jobs. sick role (Baer et al., 1998). Because cultur
THE SOCIAL MEANINGS OF SICKNESS 133
132 THE SOCIAL MEANINGS OF SICKNESS
vegetative state, while upholding hospital employees' refusal to cooperate with One of the social control functions of physicians is the role of gatekeeper
their wishes (Cruzan v. Missoun� Department ifHealth) 497 U.S. 261, 110 S.Ct. 2841
(S ton e, 1979) , making them responsible for separating t�e "dese�g" �r�m the
1990) . Although t�s c�se was essentially about whether the parents' judgmen� .
"undeserving" claims for sympathy and social support, Sick leave, disability pay,
was adequate su� stitutiO� �or the pati�nt's own decision, the cultural authority
health insurance, hospitalization, and so on. Physicians became the chief arbiters
attached to hospital-adrmmstered mediCal technology took the decision out of of claims for workers' compensation for repetitive strain injuries; not surprisingly,
the parents' area of legitimate authority. company doctors selected by manufacturers or insurers typically were less likely to
Even in instances in which the medical ability to prevent death is more certify the injury or provide sympathetic care than were perso?al physiciar:s (Reid
doubtful, greater legitimacy is given to medical rather than parental authority. In et al . , 1991) . Similarly, from 1952 to 1979, when homosexuality was considered a
1994, for example, a California court ordered that a Hmong Laotian child suffer
legitimate basis for denying a person U.S. citizenship, �sychiatrists were given the
ing from leukemia be removed from her parents' custody because they refused power to certify that a homosexual should be thus demed (se� Szasz, 1970) .
medically prescribed chemotherapy for her; more than 200 Hmong demonstrated W hen a person is certified as deviant, the agency of social control must then
against the deci�ion, which overruled the parents' ethnic and religious objections deal with this offender. Religious responses to deviance include counseling, moral
to Western medical treatment (New York Times) 1994c) . in dignati on, confession, repentance, penance, and forgiveness. Legal responses in
Social Control and Power clude parallel actions, such as legal allegations, confession, punishments, rehabili
tation, and release with or without the stigma of a record. In the medical model,
The labeling of deviance is an issue of legitimacy on another level as well the responses entail other parallels: diagnosis, therapy, and counseling.
f�r the power to define sickness and to label someone as sick is also the power t� The process of reintegrating the deviant individual into the social group is
.
discredit that person (Zola, 1983: 276-278) . If a person's mental health is called therapy, which for even relatively minor deviance involves a form of social cont:ol
�nt� 9uestion, the rest of society does not have to take that person seriously. The (such as getting a young mother "back on her feet" so she can resume he� f�y
mdiVIdual then becomes the locus of the so-called problem. During the Vietnam responsibilities). The social control functions· of therapy are most clearly evident m
W�r a physici�n refused to train medical personnel for the army, claiming that his
'. such situations as the kidnapping and forcible "deprogramming" of persons with
r�hg10us co�sCience compelled him to refuse this service. The army insisted that deviant religious or political views (Robbins and Anthony, 1982) and the mental
hi� �ompuls10ns were psychological rather than religious (Fenn, 1978: 57) . By thus hospitalization of political dissidents (Freidson, 1970: 246; see also Turner, 1977;
rmsmg doubt about his psychological health, the army was able to evade his reli Medvedev and Medvedev, 1971) .
gious dissent as well as his legal claim to protection under the First Amendment of The use of psychoactive drugs for social control is one area of particular
the Constitution. concern. Several U.S. and Canadian studies have documented the very large pro
.
�edical co�tro.l in defining deviance also produces medical power in certify portion of the elderly receiving drugs that affect the central nervous system, such
mg �eVIance, ':hich Is an�ther aspect of social control. The societal acceptance of as tranquilizers, analgesics, antidepressants, sedatives, hypnotics, and anticonvul
.
�e�Ic� �efinit10ns . of deVIance giVes the medical profession unique power to cer
. sants. One function, deliberate or not, of the use of these drugs is the management
t�fy mdividuals as sick or well. If a back disorder is a legitimate basis for taking the of elderly persons. For example, older persons need shorter but more frequent pe
sick :ole (and thus to be excused from work or to claim insurance), a physician is riods of sleep than younger adults, but sedatives are often prescribed in many in
considered the appropriate agency for certifying a valid claim. Sick persons typi stitutions to try to keep the elderly in an eight-hour sleeping pattern, so the staff
cally use "feeling" terms to describe internal states that they experience as illness; can·better supervise them at night (Harding, 1981; see also Harding, 1986) .
they say, for example, "I don't feel good" or "I feel too dizzy to stand." When the Similarly, difficult-to-manage school children are often prescribed Ritalin (or
bodily source of feeling sick is not obvious to their audiences, they need doctors' its competitors, Adderal, Concerta, Metadate CD, and so on) to calm their excess
�ubstantiation t? legitimate their claims (Telles and Pollack, 1981) . Putting a med activity and get them to pay attention to their learning tasks. U.S. patients use
Ical label on an Illness can be beneficial when it validates and demonstrates serious 90 percent of the world's production of Ritalin, prescribed to up to 6 percent of
c?ncer� about patients' symptoms and gives some meaning or coherence to their elementary and pre-teen schoolchildren for a variety of behavioral disorders
distressmg expenence . , thereby supporting their efforts to manage the illness (Environment News Service, 2001) . In 2000, doctors wrote almost 20 million
(Br?om an� Wood;vard, 1996; Lorber, 1997) . Doctors, however, often resist diag monthly prescriptions for these stimulants; most were written for children, espe
nosmg ambiguous illnesses (especially contested categories such as chronic fatigue cially boys. Sales for Ritalin and related stimulants were $758 million, an incre�se
syndrome) because they do not want to encourage patients to take the sick role. of 13 percent since the preceding year (Zernike and Petersen, 2001) . Other child
�ey are thus caught betwe�n conflicting roles for themselves: physician as pa hood behavioral disorders (for example, Oppositional and Defiant Disorder, Anx
.
tient advocate and patient-claimant versus physician as agent of social control. iety_Disorder) are increasingly treated pharmacologically, as well.
138 THE SOCIAL MEANINGS OF SICKNESS
THE SOCIAL MEANINGS OF SICKNESS 139
dissent from other social roles. Many social historians consider the epidemic of which sickness may be the expression o f social dissent about frustrated and unmet
hysteria among Victorian women to be an expression of their dissent against human needs . They stated:
the constraints of their social roles (Sicherman, 1978) . Similarly, workers' job
dissatisfaction is often expressed by high rates of absenteeism for sickness.
In summary, we wish to stress that while illness symptoms are biological entities they
Sickness is not necessarily an effective form of dissent, however. Waitzkin are also coded metaphors that speak to the contradictory aspects of social life,
(1971) suggested the sick role has latent (that is , not recognized or intended) func expressing sentiments, feelings, and ideas that must otherwise be kept hidden. &
tions that maintain the status quo in society and reduce conflict and change. For patients-all of us-we can be open and responsive to the hidden language of pain and
example, if disgruntled workers take sick leave to relieve the tensions of their job protest, rage and resistance, or we can silence it, cut it off by relegating our com
plaints to the ever expanding domains of medicine ("It" is in the body) or psychiatry
satisfaction, the sick role reduces the likelihood that those tensions will be addressed
("It" is in the mind) . Once safely medicalized, however, the social issues are short
politically, such as in a confrontation with management. The sick role instead
circuited and the message in the bottle-the desperate plea for help and the scream of
provides only a temporary safety valve to reduce pressure in various institutional
protest-is forever lost. (Scheper-Hughes and Lock, 1 99 1 : 422-423)
settings, such as the family, prisons, and the military.
Although the sickness may not be able to change social arrangements , such
Metaphorical aspects of sicknesses are linked with meaning and order.
as social class or gender hierarchies, it may be effective in obtaining actual advan
tages or relief for the sick person. Some secondary gains of sickness, such as re
ceiving extra attention in the family, may be such a result. For example, many PROBLEMS OF MEANING AND ORDER
Mrican societies have special healing cults for women, such as the zar cult of the
predominantly Muslim peoples in Ethiopia, Egypt, Sudan, and Somalia. Some an Illness is upsetting because it is experienced as a threat to the order
and meanings
thropologists have interpreted the zar affliction, in which the sick person is be by which people make sense of their lives. Suffering and death
create problems of
lieved to be possessed by spirits, as women's assertion of dissatisfaction with their meaning not simply because they are unpleasant, but also because
they threaten the
lack of social and economic power (Lewis, 1971) . Taking the sick role can be a fundamental assumptions of order underlying society itself (see,
for example,
relatively successful (albeit manipulative) assertion of power of the subordinate Berger, 1967: 24) . For the individual, illness and affliction can likewise
be experi
members of the society. It poignantly expresses women's dissent, but does not enced as assaults ort the identity, and on the ability to predict and control
central as
fundamentally alter the social arrangements. pects of one's own and one's loved ones' lives. Healing, in all cultures,
represents an
Similarly, sickness is sometimes the attempt to cope (although not always con attempt to restore order and to reassert meaning.
structively) with an intolerable social situation, as discussed in Chapter 4. Sickness Illness disrupts the order of everyday life. It threatens our ability
to plan for
expresses frustration, dissatisfaction, and anger turned against oneself. Alcoholism th� immediate or distant future, to control, and to organize. Even
a relatively
and other substance abuse, depression, and suicide exemplify this potentially self mmor malady, such as a head cold, can disturb the order of daily
life; how much
defeating attempt. To interpret, for example, the alcoholism of a middle-aged, un more so can serious, potentially fatal, or debilitating illnesses, such
as cancer or di
employed, impoverished Native American on a reservation as a purely individual abetes, throw our lives into disorder! A study of the impact of
childhood leukemia
sickness is thus. to miss the likelihood that it is the expression of his frustration and found two characteristic experiences of sufferers and their families
: uncertainty
hostility in the face of his utterly marginalized social condition (Scheper-Hughes and the search for meaning (Comaroff and Maguire, 1 98 1) .
and Lock, 1991; see also Kleinman, 1997) . Medical systems in all cultures restore order in the face of illness
in a number
Likewise, to interpret an immigrant woman's severe case of "nerves" as a of ways. Diagnostic action, whether accomplished by divination
or computer
quaint relic of old-country folk beliefs misses the meaning of nerves (or "nervios/' tomography scan, divine revelation or physical examination, is a means
of naming
"nevra/' and so on) as a physical expression of real distress (Finkler, 1989; see also the problem and giving it a culturally recognizable form. Naming
the illness im
Guarnaccia et al. , 1989) . Her distress, expressed in the physical symptoms of poses order on a previously chaotic set of experienc es, thereby
giving the sick
"nerves," may be produced by the perceived disorder of daily life in a society person a set of expectations and some basis for acting. Etiologies
likewise contribute
where she experiences exploitation as a worker and discrimination as a member of to restoring a sense of order, because they identify a causal relationsh
ip between
an ethnic minority. Her "nerves " may be a reaction to a lack of meaning and per sickness and socially prescribed normal or ideal social relationsh
ips . In applying
ceived assault on self-esteem from living in a culture that lacks the values by which particular etiologies to a given illness episode, the medical process
ritually reaffirms
she would have been honored in her native culture (Lock, 1990). these values (Young, 1976) .
Scheper-Hughes and Lock (1991) argued that modern medicine has so thor The healing process in many cultures (including our own)
addresses not
oughly individualized its image of sickness that it has lost sight of the extent to only individual disruption but also disordered social relations.
The individual
142 THE SOCIAL MEANINGS OF SICKNESS
THE SOCIAL MEANINGS OF SICKNESS 143
Box 6. 1
Body symbolism works on several levels; often the body and its parts are
us ed as metaphors. For example, when we say a person is upright, we are referring
Sickn ess and the Disor dered Socia
l Realm
to b oth a moral evaluation and a physical posture. Similar body metaphors are ap
The phras "hais cuqj txub kaum txub" (to
� speak of all kinds of things) aptly descri pli ed wh en we evaluate people as spineless, underhanded, open-eyed, heartless,
bes
the wo ld Iew f the Hmong culture : Every
� : � thing in the world is connected, no event cold-blooded, brown-nosed, blue-blooded, sinister, thick-skinned, or gutless. Social
occurs � IsolatiOn from o�hers, and "you
can miss a lot by sticking to the point." relations are likewise reflected in body metaphors, such as, "He is a pain in the
�
Lia Lee was om m 1 981 , m _
a U.S. hospital, to recent immigrant Hmon ass," or "They are thicker than blood."
.
parents from Laos. L�a had epilep
you and you fall down." For five years,
sy, which the Hmong describe as "the spirit
catche � Consider all the symbolic meanings we give to various body parts and body
attemp ted to control her seizures witho
she was treated by American doctors who
products, including hands, heart, womb, hair, eyes, milk, blood, spit, feces, and
ut taking into account the parents' under
standmg of therr _
causes and best treatment. It was clear to
sweat. These meanings are not inherent in the physical properties but are applied
her parents Foua and N
� � by a social group. In socialization, we learn our society's meanings. A baby is not
Kao ee, that Lia' soul was lost; presum
and frightened L1a _
ably, her sister Yer had sl
s soul out of her body. The seizures were
� ed the do �� born with an aversion to the sight of blood. A young child rriust learn to be dis
. caused by a spirit dab that
caught L1a. It was also clear to the Lees that
the medicine should be taken only for a
gusted by the feel of feces (usually only after having played with them and receiv
week and should be complemented by
neeb1 Hmong medi"cm · e, and sacn"ficmg
ing several reprimands).
, · ·
pigs
and chicke
· ns. Yer s carelessness had caused Lia's seizur
es and the Lee family "kn Through the meanings attached to the body, social structure shapes indi
�
"
that the return of Lia's soul to her body
wellne ss, would not be attained by Western
was the remed . The restoration of or
medicine alone.
r' �: vidual bodily expression. At the same time, bodily expression reflects the social
structure. Numerous studies of various cultures, including Western industrialized
Source: Anne Fadiman, The Spirit Catches societies, have shown how core values are revealed in body-related beliefs and
You and You Fall Down) 1 996, pp. 2 1 -23, 100-10 9.
practices, such as eating (Banks, 1992; Lupton; 1996a; Turner, 1982); beauty
and adornment (Kunzle, 1981); birth and death (Comaroff, 1984; Davis-Floyd,
1992); sex (Foucault, 1978; Turner, 1984); pollution and cleanliness (Classen,
disorde�ed body is �y an expression of the disord 1994; Douglas, 1966; Elias, 1994 [1978]); fitness and healthy "lifestyle" (Bordo,
� ered social relations. For in
stan�e, m orn_e Chnst:I� grou s, healing a troubled 1993; Lupton, 1995; O'Brien, 1995); and health and healing (Comaroff, 1985;
,� p marriage involves bringing
the , body (Wife and children) mto proper relationship Crawford, 1984; McGuire, 1988).
(namely submission) with
the �'head" (husband and father). Healing in the�e group
. s rest;res order through
healing the metaphoncal body (McGuire, 1982, 1988 The Meaning of Affliction
). In Western culture, the im-
portance of the body as a natural symbol suggests
. that illness and healing may be Illness is also upsetting because it raises the questions of meaning: W hy is
ways of sym- bolizmg order and meaning on several levels. this happening to me? W hy now? W ho's responsible? How could God allow this
to happen? W hy do the good suffer and the evil prosper? In many cultures, the
The Body as a Symbol
medical system and the religious system are inextricably interwoven. Religious
. .
�e �uman body is a natural symbol. The meanings of the symbol are meaning is thereby connected with illness explanations.
mtrm s1c m it, but are socially constructed and attached to not In his analysis of religious systems, Weber noted the importance of theodi
it. As Douglas (1970: 93)
stated: des, or religious explanations of meaning-threatening experiences, for sickness,
suffering, and death ([1922] 1963: 138-150). Theodicies tell the individual or
The � ocial body constrains the wa group that the experience is not meaningless but is rather part of a larger system of
� the physical body is perceived. The physical
�
expenence o the bod , always modified
� by the social categories through which order, a religious cosmology (see also Berger, 1967 : 24). Some successful theodicies
� own, sus tams a partic lar view of society
� . There is a continual exchange of mean
it is
are in fact nothing but assertions of order. A woman discussing her personal mean
mg� between the two kinds of bodily
experience so that each reinforces the
cate ing crisis after her husband's premature death said, "I finally came to understand
gon�s of the other. _AB a result of this intera
medmm of expressiOn.
ction the body itself is a highly restricted that it didn't matter whether I understood why he died when he did, but that God
had a reason for it, and that was all that mattered." For this believer, knowing that
Thus, she argued �at bodily control is social contr an order exists behind events was more important than knowing what that order
ol, and attitudes toward the was (McGuire, 1982). Theodicies do not necessarily make the believer happy or
body reflect the social concerns of the group (Douglas,
1970: 11-18). even promise future happiness; they simply answer the question, Why do I suffer?
������ -------
144 THE SOCIAL MEANINGS OF SICKNESS THE SOCIAL MEANINGS O F SICKNESS 145
At the same time that Western societies are experiencing the increasing med woman Still suffered greatly from a hysterectomy she had undergone six years
.
icalization of authority, Western medicine is having difficulty dealing with
earlier. As she explained, "It meant losing a huge part of my future." Unmarned ,
ers' problems of meaning. Anthropologists remind us that however well vvP,<;:tp,,..., childless, and only 29 years old' she lost hopes
and dreams for the future. She
medicine deals with the symptoms the sick person suffers, it fails to address of
· ·
societies is its differentiation from other institutions that provide meaning and be from a threat to the coherence of a person's world.' As noted m Chapter 4, a sense
longing. Institutional differentiation is the process by which the various institu� f oherence itself is related to health and healing. People suffer from a loss of
tional spheres in society become separated from each other (see Parsons, 1966). For 0:U ectedness-links with loved ones, valued social roles, and gr�ups that are
example, religious functions are focused in special religious institutions, which are : portant to them. AB Chapter 7 shows, the illness �xperience often mvolves sue�
separate from other institutions, such as the educational, political, and eccmc,rnjc losses. In the face of affliction, people seek meamng and order to address this
The medical institution has limited itself to the cure of disease, as a biophysical en essential coherence (Cassell, 1982; see also Antonovsky, 1984).
tity, and to the physical tending of the diseased individual. Provision of me:anm2:
and belonging is treated as relatively unimportant for healing and relegated to
private-sphere institutions of family and religion. These private-sphere institutions SUMMARY
are allowed, even encouraged, to handle the meaning problems of the sick, but only
so long as their beliefs and actions do not interfere with the medical management Sickness is not merely the condition of an individual, but is also �elated to the
.
of the disease (McGuire, 1985). larger social order. It is connected with mor� issues and the Imputat�on of respon
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Just as the physical body is a potent symbol of one's selfhood, so too are sibility for deviance from social norms. SoCiety de�s With such de�Iance through
experiences of suffering linked with one's identity. Practically, being unwell implies social control mechanisms, including the sick role. SICk role expectatwr:s, hov:vever,
being disabled, in the sense of being made unable to do what one wants or needs to vary historically and cross culturally. The discrep�cies between the Ideal nnage
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do ; it implies reduced agency. It means losing some control (an especially impor of the sick role (based on certain forms of acute illness) and chrome an� other
tant quality in this society) , and it involves losing one's routines-the very patterns nonacute conditions result in ambiguous expectations for tho� e who� society de
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by which daily existence is ordered (Cassell, 1982; see also Comaroff, 1982). fines as sick. The medicalization of deviance and the social stigma of illness hi?h
Suffering is not connected with disease or pain in any precise causal or pro light the social control functions of medicine, w�ch are yet another connect10�
portionate way. The pain of childbirth, for example, may be more severe than the between power and health. The medical professiOn ha� successfully asserte� pn
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pain of angina, but it generally causes less suffering because it is perceived as tem macy in the defining deviance and the corol�ary function �f �ertifymg deVIance,
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thereby becoming a primary moral authonty �n modern soci�tles.
porary and associated with a desired outcome. A disease may be incurable yet .
cause little suffering if it does little damage to the person's sense of self and ability A related issue is the problem of meamng created by illness, suffermg, �d
to engage in everyday life. For example, a chronic fungal infection may cause less death. Because of the importance of the human body as a natural symbol, bodily
suffering than a temporary but disfiguring episode of Bell's palsy. Many people control and healmg practices reflect social relationships and c?ncerns. The prob
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may seek help and healing less for disease itself than for suffering and affliction. lems of meaning brought on by illness are particul�ly �Iffi�ult m modern Wes �ern
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Cassell (1982: 639) has suggested that suffering poses difficulty for the bio medical settings, due to the differentiation of medical �stltuti?ns from me�g
medical system because it is "experienced by persons, not merely by bodies, and providing institutions such as religion and f�y. The bwmediCal model, With Its
. .
has its sources in challenges that threaten the intactness of the person as a complex nearly exclusive focus on physical condih�ns does not deal adequately With
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social and psychological entity." He observed that medical personnel can unknow suffering and the subjective experience of afflictiOn.
ingly cause suffering when they do not validate the patient's affliction, and when
they fail to ackri.owledge or deal with the personal meanings the patient attaches to
the illness. Cassell (1982: 642) noted that "people suffer from what they have lost
of themselves in relation to the world of objects, events and relationships." One