The Hong Kong Polytechnic

University

CC2434 Sociology for Health Studies

Semester Two 09/10

Lecture 1—
Introduction: Thinking Health
Sociologically

Prepared by Sky Lau 1

 Health & Sociology

Sociology for Health Studies

What is HEALTH? What is SOCIOLOGY?

Prepared by Sky Lau 2

 What is Health?
• Question 1:
– Think of someone you know who is very healthy.
Who are you thinking of? How old are they?
What makes you call them healthy?

• Question 2:
– What is meant by "healthy" on you own
perception? Any criteria for you to think of it?

Prepared by Sky Lau 3

 Lay Concepts of Health
• Blaxter's Health and Lifestyle Survey (1990)
– Health as "not-ill"
– Health as "reserve"
– Health as "lifestyle"
– Health as "physical appearance"
– Health as "energy or vitality"
– Health as "social relationships"
– Health as "function"
– Health as "psycho-social well-being"
• Overall, health can be defined:
– Negatively as the absence of illness
– Functionally as the ability to cope with everyday activities
– Positively as fitness and well-being

Prepared by Sky Lau 4

 WHO's Definition of Health
• The WHO (World Health Organization) Model
– "a state of complete physical, mental and social well being, not
merely the absence of disease or infirmity"
 physical health
 mental and intellectual health
 emotional health
 social health
 spiritual health
 vocational health
• "a condition of well being, free of disease or infirmity, and a
basic and universal human right" (Saracchi, 1997)

Prepared by Sky Lau 5

 What is Sociology?
• Sociology is concerned with the study of human
society in terms of the interaction between individuals
and society.
• We are experiencing certain social/external forces that
influence our beliefs and behaviors and establish some
predictability and regularity to our lives in the society.
• Basic chracteristics of sociology
– Individuals as a "blank slate" in the society
 nature vs. nurture
 socialization (social norms and regulations)
– Society represents more than just the sum of individuals
– Individuals as "voluntaristic" members in the society?!

Prepared by Sky Lau 6

 What is Sociology?
(cont'd)
• There is a strong interplay between individuals
(agency) and society (social structure).

social structure agency

• "Social structure" refers to the social patterns or

recurring arrangements that we experience in our daily
lives (from cultural customs to social institutions).
• "Agency" refers to the ability of people, individually and
collectively, to determine their lives, to change their
environment, and to influence the wider structure.

We are shaped by society, and in turn

shape society!!!
Prepared by Sky Lau 7
 What is Sociology? (cont'd)
• "Sociological Imagination" (C. Wright Mills, 1959)
– "a quality of mind essential to grasp the interplay of men and
society, of biography and history, of self and world"
– "many private troubles cannot be solved merely as troubles,
but must be understood in terms of public issues...public issues
must be revealed by relating them to private troubles"

• Major aspects in sociology of health and illness

– Interactional aspect
 doctor-patient relationship
– Health services utilization
 health care system and its provision
– Health occupations
 professionalization of doctors and nurses
– Social construction of illness
 disability and mental illness; stigmatization
– Political aspect
 medicalization; health inequality

Prepared by Sky Lau 8

 Thinking Health
Sociologically
How the past
Historical influences the
present?

How we can How our culture

improve on what impacts on our
exists? Sociological lives?
Critical Analysis Cultural

How particular forms Subject Matter:

of social organization Structural Health
shape our lives?
Prepared by Sky Lau 9
 Thinking Health Sociologically
(cont'd)
• To conclude, our body/health/illness is not merely limited to
the "medical" sphere but also intricately bound up with so-
called "social forces".
• Health and illness are not merely physical experience but
also social experience.
• Simply speaking, the focus of Sociology for Health Studies
or Medical Sociology is broader than just "medicine".
Ruderman (1981) defines medical sociology as
– "the study of health care as it is institutionalized in society,
and of health or illness, and its relationship to social factors"
• we would be one of the sick
individuals
We need to study, • we are part of the societies
because • we are in the part of health
care system
• we are the health care
The End
providers 10
 The Hong Kong Polytechnic
University
CC2434 Sociology for Health
Studies
Semester Two 09/10

Lecture 2—
Durkheim & Suicide

Prepared by Sky Lau 11

 Gloomy Sunday (by Rezso
Death is no dream,
Seress)
Sunday is Gloomy, For in death I'm caressing you
My hours are slumberless, With the last breath of my soul
Dearest, the shadows I live with I'll be blessing you
are numberless
Little white flowers will never Gloomy Sunday
awaken you Dreaming
Not where the black coach of I was only dreaming
sorrow has taken you I wake and I find you
Angels Asleep in the deep of
Sundayhave no thought of ever
is gloomy My heart
returning
with shadows you I spend it all
Would they beI have
angrydecided
if I thought Dear
My heart and to Darling I hope that my dream
of
endjoining
it all you
Gloomy Sunday never haunted you
Soon there'll be flowers and My heart is telling you how much
prayers that are sad, I wanted you
I know, let them not weep, Gloomy Sunday
Let them know that I'm glad to go
Prepared by Sky Lau 12
 Historical Background
Great Transformation (18C
to 19C)

The French The Industrial The

Revolution Revolution Enlightenment
revolutionary rise of rise of
democracy capitalism reason

• The collapse of traditional communities and social

order
• The shifting positions of power, wealth and privilege
• The reconciliation of sacred values with political and
economic realities
• The role of individuals in emerging mass society
THE RISE OF
INDIVIDUALISM
Prepared by Sky Lau 13
 Durkheim & Suicide
• Two central concerns:
 To tackle the issue of the significant
rise of individualism and the great
challenge to social integration in
modern society
 To establish "Sociology" as a
rigorous scientific discipline which
could provide the normative cement
for modern society
• Society is not
reducible to
individuals
Emile
• Individuals could not Durkheim
be fully understood in
isolation from the
society Prepared by Sky Lau 14
 Durkheim & Suicide (cont'd)
• In Durkheim's view, the reasons for studying suicide were
quite strategic:
– To face the rising suicide rate in our modern society
– To challenge the understanding that the patterning of
one of the most psychological, intimate and individual
acts rests not upon psychological foundations but upon
the patterning of "social facts"

Durkheim's primary aim was

to explain how individual
pathology was a function of
social dynamics!!!

Suicide
Rates

Prepared by Sky Lau 15

 Extra-Social Factors: Insanity
The relationship between suicide and insanity, by gender (the data of
Denmark in Insane
1845-1856)
per 100 persons Suicides per 100
persons
Men 45 75
Women 55 25
In insane asylums, there were more female
inmates than male ones, but men kill
themselves more than women did.
The relationship between suicide and insanity, by religion (the data of
Prussia in 1869-1872)
Insane per 1000 Suicides per million
persons persons
Protestant 0.80 187
s
Catholics 0.87 69
Jews Insanity was more
1.42 frequent among 96
Jews, but
they had a low suicide rate.
Prepared by Sky Lau 16
 Extra-Social Factors: Race &
Heredity
The relationship between suicide and race, by provinces (the data of
Austria in 1872-1877) Germans per 100
Provinces Suicides per million
persons persons
Purely German 95 to 100 106

Majority 53 to 71 125
German The suicide rate does not increase in regular
proportion to the relative importance of the real or
German
Suicides supposed
at different ages (perGerman 9 to
million) 37
elements.
(the data of France 140
in Minority
1835-1844)Men Women Men Women If heredity constitutes
a definite mechanism,
< 16 2.2 1.2 51 to 60 217.9 74.8 capable of being
transmitted fully
organized, it should
16 to 20 56.5 31.7 61 to 70 274.2 83.7 become active during
the very first years.
21 to 30 130.5 44.5 71 to 80 317.3 91.8 But the opposite takes
place. Suicide is
extremely rare in
31 to 40 155.6 44.0 > 80 Prepared
345.1by Sky
81.4
Lau children and grows17
steadily from age to
 Extra-Social Factors: Climate
Lay explanations:
Proportional share of each season in
the annual total of the suicides (1000) • heat increases the
Denmark Belgium France
of each country excitability of the nervous
system and the cerebral
Summer 312 301 306 functions
• over-excitement triggers
Spring 284 275 283 off violent act and increases
Autumn 227 229 210 the risk of insanity
No. of suicides at different months (the data of•France
more people commit
in 1866-1870)
Winter o
F 177
Suicides195 201oF suicide in summer
Suicides
Durkheim argues
Jan 36.12 68 Jul 66.12 100 that the highest
Feb 39.20 80 Aug 65.30 82 suicide rate in
Mar 43.52 86 Sep 60.26 74 summer is not
related to the
Apr 50.18 102 Oct 52.34 70
increase in
May 57.56 105 Nov 43.70 66 temperature but
Jun 62.96 107 Dec 38.66 61 due to relatively
Prepared by Sky Lau intensive social 18
life.
 Extra-Social Factors: Imitation
專家：張國榮自殺增尋死意欲 9 小時 6 跳樓 5 人死
社署高級臨牀心理學家陳耀基說，外國早有研究指出，一些知名度極高
的人士 ( 如紅歌星 ) 自殺具傳染性，影響的不僅是其擁躉或歌迷，更會
影響每個階層的市民，傳媒報道的篇幅、日數，均與感染程度有關。
《明報》 2003 年 4 月 3 日

戴妃喪生後多人輕生 張國榮死恐引自殺潮
香港大學自殺研究及預防中心總監葉兆輝擔心，歌手張國榮自殺，或會
刺激 20 至 40 歲人士仿效。葉兆輝指出，英國曾有研究發現，戴妃死後
頭一周，整體平均自殘的頻率，比預期高 44.3% ，其中女性最顯著，升
66.1% ；戴妃葬禮後 1 至 4 星期，自殺個案則比預期高 17.4% 。當中又
以女性較為顯著，升 33.7% 。
《明報》 2003 年 4 月 3 日

Durkheim argues that even if suicide can be

contagious, it does not affect the social suicide-
rate. It only affects those who are already so
inclined.
Prepared by Sky Lau 19
 Durkheim's Theory of Suicide
• Definition of suicide:
"The term suicide is applied to all cases of death resulting
directly or indirectly from a positive or negative act of the
victim himself, which he knows will produce this result."
(1951:44)
"SOCIETY" IS THE CAUSE OF
SUICIDE!!!
The social bonds of our society appear in two ways:
• Social Integration—the cohesion between the individuals and
the society
• Social Regulation—the restrains imposed by the society on
individual
Social needsNormal
and wants Pathological Form Types of
Ingredients Form Suicide
Social When in Defective Egoistic
integration balance, integration suicide
the Excessive Altruistic
individual is integration suicide
"protected"
Social from Defective Anomic
Prepared by Sky Lau 20
regulation suicide regulation suicide
 Durkheim's Theory of Suicide
(cont'd)
excessive integration
Altruis
m
High

Social Integration
defective regulation excessive regulation

Anomi Fatalis
e Low Social High m
Regulation

The balanced Low

point of social
integration and Egoism
defective integration
social
regulation Prepared by Sky Lau 21
 Defective Integration: Egoistic
Suicide
Egoistic suicide is resulted from too much
individuation and too little social integration.
Those individuals who are not sufficiently bound to
(1) social groups and are left with
Religious Thelittle social was
difference support
that or
Integration
guidance tend
Protestant to commit
Catholic Jews suicide.
Protestantism encouraged
s s
individual free inquiry and,
Austria 312 301 306 unlike Catholicism, it did not
offer priestly and sacramental
Prussia Sui. (per
(2) Family284 275 283 supports.
million)
Integration
Unmarried Married A sense of
Hus. with chil. 205
Age Men Women Men Women integration
Hus. without chil. 478
was
Wife with chil. 45
40-50 976 147 295 95 developed
Wife without chil. 158
within a
(3) Political
50-60 1445 178 470 136 family unit.
Integration
1865 1866 1867
Political crises increased the
intensity of collective sentiments
Italy 678 588 657
and stimulate patriotism.
Austria 1464 1265 1407 Prepared by Sky Lau 22
 Excessive Integration: Altruistic
Suicide
Altruistic suicide is resulted from too much social
integration. Those individuals who are so attached to
the social groups may lose their individuality and
could not resist the pressure to sacrifice the self for the
Durkheim pointed out some examples of altruistic
group's interests.
suicide especially in primitive society and modern
army:
• the suicides of the old or very ill
• the suicides of women on their husbands' death
• the suicides of followers or servants on the death of
their chiefs
• the suicides of soldiers, e.g. the
Japanese Kamikaze

Prepared by Sky Lau 23

 Defective Regulation: Anomic
Suicide
Anomic suicide is resulted from the breakdown of
social regulation during times of rapid social change
and turbulence. The society collapses and all the usual
norms and patterns of life fall apart, leaving Individuals
confused
Social and unsure of what is happening in the near
change,
e.g.future.
economic crisis,
widowhood

Normative breakdown

Appropriate norms are failed

to emerge to promote and State of disequilibrium
regulate group relations

Prepared by Sky Lau 24

 Excessive Regulation: Fatalistic
Suicide
Fatalistic suicide is resulted from the excessive
degree of social regulation. For those individuals
whose futures are pitilessly blocked and passions are
violently choked by oppressive discipline tend to
Mainly
commit applying to highly restrictive societies, fatalistic
suicide.
suicide can be found among slaves in ancient slavery
societies.

The slaves
have no
alternative to
enslavement
under the
masters.

Prepared by Sky Lau 25

 Criticisms & Implications of Durkheim's
Theory of Suicide
• Durkheim provided no precise definition and measurement of
integration and regulation and even if he did, he never suggested
what levels constitute "defective" and "excessive". (J.P. Gibbs)

• The strongest critique came from interpretative sociologists

– Douglas
 Durkheim failed to take into account the motive for and meaning
of the suicide
– Taylor
 Symphisic Suicide (relationships)—Sacrifice Suicide and Appeal
Suicide

• Durkheim's objection was not psychology in general, but the

attempt to explain social facts in terms of individual psychology.

• The most important contribution is the understanding of how

underlying structural forces, i.e. social integration and social
regulation influence suicidal behavior.

• Both societal forces and psychological states of individual are

crucial in explaining suicide.
Prepared by Sky Lau 26
 The Hong Kong Polytechnic
University
CC2434 Sociology for Health
Studies
Semester Two 09/10

Lecture 3—
Parsons and the Sick Role

Prepared by Sky Lau 27

 Social Order and Deviance
• The operation of social norms How does
– The socially prescribed patterns of society
function
behavior shared by people in various
smoothly?
social contexts or in a wider society
• The analogy between human body and society
– Human body: different interdependent parts Talcott
– Society: different social systems interlocking together Parsons
State of Equilibrium
Human body: Society: social
homeostasis harmony by shared
norms and values

• Conformity to norms lead to societal acceptance and

approval of behavior but deviation from norms may cause
disapproval of behavior and by
Prepared social
Sky Lausanctions. 28
Social Order and Deviance (cont'd)
• Two forms of social sanctions to maintain social order
– Formal social sanctions: by enacted laws or social authorities
(social welfare agencies, medical practitioners)
– Informal social sanctions: by gossips
• Sickness is dysfunctional to the social system
– Sickness as Deviant Behavior
– Sick person = criminal

• Medical profession is functional to offset the sick person by

curing, controlling and preventing them to get suffered from
disease
– Medical profession as Social Control Agency
– To serve as a gatekeeper to help patients get back normal
functioning and to prevent any possible malingering
– The medical responses of diagnosis and therapy (consultation, drug
prescription, hospitalization) as the process of reintegration of
patients and their social groups
Prepared by Sky Lau 29
 The Sick Role
• The amount of illness can be controlled through the socially prescribed
roles for doctors and patients
• "The SICK ROLE evokes a set of patterned expectations that define the
norms and values appropriate to being sick, both for the individual and
for others who interact with the person."

Two Rights: Two Obligations:

• The sick person is exempt • The sick person should
from normal role try to get well as soon as
performance and social possible
responsibilities
(secondary gains). • The sick person should
seek professional medical
• The sick person is not advice and cooperate
responsible for his or her with the doctor
condition.
Patient: Sick Role

Prepared by Sky Lau 30

 The Sick Role (cont'd)
Three Rights: Four Obligations:
• Granted right to examine • Apply a high degree of
patients physically and to skill and knowledge to
enquire into intimate the problem of illness.
areas of physical and • Act for welfare of patient
personal life. and community rather
• Granted considerable than for self-interest.
autonomy in professional • Be objective and
practice emotionally detached
• Occupies position of • Be guided by the rules of
authority in relation to professional conduct
• Specificity
the patient
• Affective
Neutrality
• Universalism Doctor:
• Collective Professional Role
Orientation
Prepared by Sky Lau 31
 Patient-Doctor (P-D) Relationship

An
Asymmetrical
Relationship

• The P-D relationship is by its nature asymmetrical which is necessarily

that the doctor has to restore the patient to a normal level of functioning
• The doctor's advantageous position rests on three inter-related leverage
points:
– Professional prestige: technical skills and official certification
– Situational authority: health care is true seller's market
– Situational dependency: health care cannot be self-provided

Prepared by Sky Lau 32

 Patient-Doctor (P-D) Relationship
(cont'd)
Szasz & Hollender's (1956) Elaboration of the Sick-Role Model into 3 Models of P-D Relationship

Model Doctor's Patient's Clinical Application of Prototype of

Role Role Model Model
Activity- Does Recipient Acute trauma, coma, Parent-infant
Passivity something delirium
to patient

Guidance- Tells Cooperator Acute infectious Parent-child/

Cooperatio patient illness Parent-
n what to do adolescent

Stewart & Roter's (1989) 4 Types of P-D Relationship

Mutual Helps Partnership Most chronic illness,
• The effects Adult-adult
of Social Distance
Patient patient Doctor
Participatio to Control psychoanalysis
– A sense of separation, difference, and
inability to identify with each other
Control help
Low High
n produced by a myriad of social
himself characteristics
– Social class & gender
Low Default Paternalism • The influence of Structural Context

High Consumeri Mutuality

Prepared by Sky Lau 33
st
 Criticisms of The Sick Role
• Type of Illness
– A differentiated nature of Acute Illnesses and Chronic Illnesses
Acute Illnesses—occur suddenly, peak rapidly, and run their course in
a relatively short time (influenza and fever)
Chronic Illnesses—run their course in a relatively longer time and
result in the steady deterioration of bodily functioning (diabetes and
heart disease)
The assumption of "intent to get well" is irrelevant if the (chronic)
illness is, by definition, permanent
The sick role is not necessary temporary
– An ambiguous form of illnesses
Pregnancy/Menopause

提倡月經假 尊重女性地位及需要 梁耀忠

根據「人口住戶健康調查」，平均每 5 名年齡介乎 15 至 64 歲香港女性，就有 1 名
受到月經痛的困擾，當中 15 至 24 歲女性組別的發病率更高達 40%... 「月經痛」
是她們認為工作較男性最辛苦之處 ... 現時有 32 萬打工姊妹，正受到月事問題的困
擾。提倡月事假，既可尊重女性地位及需要，亦可證明香港是一個文明社會，故本
人建議，由政府部門先行，再推廣至各大私人機構。 《明
報》 2006 年 3 月 28 日
Prepared by Sky Lau 34
Criticisms of The Sick Role (cont'd)
• Type of Illness (cont'd)
– A stigmatized category of illness
 Stigma—a powerful discrediting and tainting social label
 STDS, AIDS, leprosy, epilepsy
 Result in various forms of discrimination
 Questioning the objective and professional diagnosis and
treatment by medical practitioners
• Behavioral Variation
– An assumption of the universalistic character of patients
regardless of age, gender, ethnicity, religion, and social class,
etc
– Middle-class orientation
 Legitimate exemptions from normal obligations vary enormously
according to social class
 Functional incapacity to accept the sick role by lower class
patients
– The sick role is not always voluntary
Prepared by Sky Lau 35
Criticisms of The Sick Role (cont'd)
• P-D relationship
– An ideal P-D relationship suggested in the sick role theory
Patient: compliant, passive and grateful
Doctor: universally beneficent, competent and altruistic

"I dun think "Entry

so. It into the
sick role
depends."
VS is
voluntary
."
– Neglect the conflict of interests between patients and doctors
Patient non-compliance and medical malpractice
– Pattern of relationship changed, the client is a target of
preventive techniques rather than strictly therapeutic measures

Prepared by Sky Lau 36

 Implications of The Sick Role
• Parsons' sick role as an "Ideal Type"
– Parsons' defence
– Does not exist in reality
– Based on selected aspects of behaviors typical in certain contexts
– Served as bases for comparison between different socio-cultural
circumstances
• Parsons' sick role as a significant contribution to medical
sociology
– Sickness as a form of deviance
– Medicine as a form of social control so as to check deviance and
maintain social stability
– To bring the important concept of Medicalization
– To unveil the social dynamics of P-D relationship

Prepared by Sky Lau 37