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| WHO Definition of Health 1984 |
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Definition
| Extent to which individual can i. satisfy needs and ii. cope with environment. / Biological model: Absence of biological disturbance |
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| LaBonte's Criteria for Good Health |
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Definition
| Vitality, Social Inclusion, Being able to do what satisfies oneself, Control over life, Sense of purpose |
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Definition
| The idea of normal only developed in the 19th century. Prior to that, patients were considered on a case to case basis. |
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Definition
| Normal is a balance between pathological excess or deficiency. |
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| Abnormality has a distinct pathology - the 'average' normal becomes the 'ideal' normal. |
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| Statistical Definition of Normality |
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Definition
| Anything that is statistically infrequent is abnormal (This does not take into acount the desirability of deviation, eg IQ) |
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| In 1961 found that mental diagnosis is often influenced by the disorders psychiatrists like to treat. |
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| In 1975 found that post-mortem studies only agreed with diagnosis in 66% of the cases - Things have changed since. |
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Medical label acts as a social agent.
'Mind is not an organ, cannot suffer from disease.' |
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| Surveyed 600 patients, of which 60% experiences post-label stigmatization, 44% from healthcare. |
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Definition
| Found that patients are reluctant to disclose feelings due to fear of stigma |
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Definition
| The association of diagnosis with labeling makes it a moral judgement and thus will vary between doctors of differing backgrounds. |
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| The deviant status of a patient can become the master status and become dominant in how that person is perceived by others (eg diabetic, schizophrenic etc). |
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| Stigma prevents individuals functioning in society. |
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Definition
| Extending stigma artificially due to pressure to conform to a social expectation - eg deaf man pretending to be mute. |
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Term
| 'Felt stigma' vs. 'Enacted stigma' |
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Definition
| In felt stigma there is no active marginalization but the fear and shame keep the individual from social inclusion. In enacted stigma there is active discrimination due to the condition. |
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Definition
| Anti-Psychiatry Movement: Rejects the medical model of mental illness, claiming that it depersonalizes patients. Holds that psychosis is always a natural reaction to an intolerable situation. |
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Sick role:
Two duties: Desire to recover as quickly as possible and cooperation with the medical profession
Two rights: Temporary deviance from social roles until individual returns to health |
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| Parson on professional role |
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Definition
Medical professionals must:
i. Apply a high degree of knowledge, be objective and emotionally detached.
ii. Benefit of community over personal.
iii. Be guided by rules of professional practice.
iv. In return has the right of inquisition into personal/physical life of patients and sometimes authority over it.
HENCE doctor is the GATEKEEPER of the sick role. |
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Definition
| Since doctors must act both on behalf of society and the individual, they are given a moral role for which they are not trained. |
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| Feinstein on the doctor-patient relationship |
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Definition
| Two parallel thought processes: Disease framework (Hx/Ex/Ix/Diagnosis) vs. Illness framework (ideas/expectations/feelings/understanding of patients' experiences). |
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Definition
| - 'Bodily idiom' - Non-verbal language is essential for communication - What is said has to be backed up by body language, clothing, setting. |
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Definition
- Claims that knowledge is subjective and that it is shaped by those who generate it (formation of an 'episteme').
- We scrutinize the body looking for differences (The 'medical gaze')
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Definition
| Portrayal of the female sex as passive and of the male sex as active in biology: sperm and egg. |
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Definition
| People age successfully when they adapt to their new role of disengagement from their usual social activities. |
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| Continuity and Activity Theories |
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Definition
| People age successfully when they manage to continue the activities they practiced when they were young. |
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Term
| Structural Dependency Theory |
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Definition
| Old age is determined by governments' social policy, eg retirement age. |
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Definition
| 1999, claims that ageism is an epidemic in the NHS: >65 yo women not invited for breast cancer screening, a fifth of heart units operate an age-related admissions policy, clinical trial cancer investigations exclude the elderly. |
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Definition
| Racism and discrimination may cause mental distress |
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Definition
1980 - Shows a continued 'class gradient' demonstrating large differences between morbidity and mortality between classes (Between classes 1-5 mortality doubles).
Explanations: Rejected: Artefactual, social selection - Accepted: Materialistic, Psychosocial/Behavioural. |
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| Follow-up of Black Report (1980) |
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Definition
| Acheson (1998) and Marmot (2000's) claim that problem still exists. |
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Definition
| 'Inverse care law' Policies least favour those who need care the most. |
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Physicians give worthless treatments to meet lay expectations.
Folk ideas people have of illnesses often include a set of causes that bring with them moral implications. |
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| Denial of death is ubiquitous and a result of our inability to conquer ith with religious/scientific forces. |
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| Commonplace to see the period of dying as an opportunity for heroism. |
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Definition
| Medical advances had very little to do with the decline in infectious diseases and early mortality - mostly the effect of public health improvements. |
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Definition
| Statistics do not support widely-held view that hospitalisation of births caused the decline in mortality of mothers and their infants. |
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Definition
| Encouraging all women to give birth in hospital cannot be justified on grounds of safety. |
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Definition
Medicalisation is an 'epidemic' and doctors are imperialists.
Medical practice sponsors sickness and claims that iatrogenesis is a major driving force for illness.
- Patients are 'hooked'
- Iatrogenicity: Clinical, Social, Structural |
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Definition
| Medicine is seeking a monopoly on all social problems. |
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| Friedson on professionalism |
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Definition
| Professions are given a position of dominance and no one checks if social contract is maintained. The moral decisions doctors have to make are outside the parameters of their 'social contract'. |
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Definition
| 3 types of healthcare: Folk/Individual-Popular/Traditional. |
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| Hierarchy of Resort through which patients assess which sector is appropriate for their condition. |
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| Argues that while medicalization has largely outpaced demedicalization, it must be remembered that the process is bidirectional. |
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Definition
| If current behaviour of doctors and public continues unabated, eventually every well person will be labeled sick. |
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Definition
Medicalization of masculinity:
- Viagra, sperm counts and infertility.
- Medicalization does not only affect the groups traditionally deemed as vulnerable. |
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Definition
| ADHD is a biomedical construct. |
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Definition
- Argues that while medicalization has largely outpaced demedicalization, it must be remembered that the process is bidirectional.
- All illnesses are socially constructed at the experiential level. - Medical knowledge is often shaped by interests.
- Some illnesses are embedded with cultural meaning that shapes how society responds to the afflicted.
- Also, different degrees: Obesity vs. Internet Addiction |
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Definition
| If current behaviour of doctors and public continues unabated, eventually every well person will be labeled sick. |
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Definition
Medicalization of masculinity:
- Viagra, sperm counts and infertility.
- Medicalization does not only affect the groups traditionally deemed as vulnerable. |
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Definition
| ADHD is a biomedical construct. |
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Definition
| If current behaviour of doctors and public continues unabated, eventually every well person will be labeled sick. |
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Definition
| The needs of psychiatry are overestimated due to the diffusion of traditional boundaries and medicalisation. |
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Definition
| Female sexual dysfunction may be a pharma construct but the label may improve the quality of some women's lives. |
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Definition
| In 1959 connected the recovery rates of patients quite directly with the morale of the nursing staff. |
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Definition
| Psychological stress impairs early wound repair following surgery. |
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Definition
Patients are unique individuals and no two people ever experience the same illness.
Concept of diagnosis needs to change to match our understanding of how individuals are affect in varying ways by a disease. |
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Definition
| The real measure of health is the ability of the individual to function in a manner acceptable to himself and to the group of which he is part. |
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Term
| Feinstein, Field and Kleiman |
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Definition
| All made the disease-illness distinction. |
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Definition
| Distinguishes the physical body from the non-physical mind. Influenced science to tend to ignore the mind. |
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Definition
| From static to dynamic definition of health: Ability to adapt and self manage in the face of social, physical and mental challenges. |
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Definition
| Warn against focus on symptoms in the context of eating disorders. |
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Definition
| Patient-centredness and the 'patient activation' approach may be beneficial as it is more likely to produce compliance and greater health outcomes. |
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Definition
Reminds us that society is very reluctant to provide access to the sick role in people with 'medically unexplained symptoms'.
- Doctors are dismissive of MUS patients, while they want the 'permission to be sick' to gain the empathy from society. |
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Term
| Bennett et al / Gilbert Lewis |
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Definition
The paradox of Hansen's disease (leprosy) - Despite the natural resistance of the majority of the population of it, it is still associated with social stigma.
- Gilbert Lewis stresses the effect experts from the Leviticus have had on Western's society's perception of leprosy, as it is there associated with sin. |
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Definition
- Stigma is labeling, stereotyping, separation and status loss and always occurs in a power-imbalance situation.
- Has been found to significantly impact life outcomes (income, general health, mortality) |
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Term
| Rosenhan experiment (Science, 1973) |
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Definition
"On being sane in insane places":
1st stage: Send pseudopatients - All diagnosed and taken in - Then act normally, no change.
2nd stage: Agree to send pseudopatients for staff to pick out - Staff picks out 41/193 - None were sent.
- Conclusion: "it is clear that we cannot distinguish the sane from the insane in psychiatric hospitals" |
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Definition
| Bangladeshi immigrants - Sweat loss, exercise, attitudes towards diabetes. |
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Definition
| Narrative reconstruction necessary when considering causality to understand the patients' non-compliance. |
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Definition
How do we go from social inequality to health inequality?
- Economic capital(housing, consumption, recreation)
- Interpersonal support
- Cultural capital (Education, Knowledge, Skills, Health Enhancing Values) |
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Definition
| Likens health inequalities to social murder. |
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Definition
Income inequality is a good predictor of social health gradients.
Ill health is not merely the result of different exposures to material circumstances but also involves psychosocial processes. |
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| Link and Phelan on policy implications |
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Definition
i. Interventions should require analysis of the root cause.
ii. Modest impact on many diseases might be more beneficial that major impact on one disease.
iii. Individual-based risk factors that lie relatively close to disease in a causal chain overlook important sociological processes. |
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Term
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Definition
| Medicine is a vocation with a body of knowledge and skills put into service for the good of others - The epitome of an ethical service. - Since professional status is granted by society, the society's needs must be met. - Changes in doctors' attitudes due to peer pressure and self interest and increasing media attention consist well-established challenges to medical professionalism. |
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Definition
| Dissection is means of facing up to emotional challenges and attitudes and thus consists a form of medical socialization. |
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| Image of medical student hard at work highly valued in the world of medicine. |
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Definition
| Argues against medical professionalism and claims that it has risen as a result of power and commerce and that it is not a sufficiently complex skill. The professional autonomy is a result of political and economic processes and is not socially granted. |
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Definition
| 'After-birth abortion' should be granted in all cases where abortion is, including cases where the newborn IS NOT DISABLED. |
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| The fallacy of discussing consent as a binary entity: Consent and unconsent are graded on a scale from hypothetical, to implied, to express. |
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Freedom - doing what one wants to do
Autonomy - doing what one wants to do on the basis of thought and reasoning |
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| 'No necessary biological reason why life expectancy should be 48yrs longer in Japan than in Sierra Leone.' |
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| 'Into whatever homes I go, I will enter them for the benefit of the sick.' BUT 'In purity and according to divine law I will carry out my life and act." |
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Definitions of health:
Negative - Absence of illness
Functionally - Ability to cope with everyday activities
Positively - Fitness and well-being |
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| Coined the term 'moral entrepreneur' |
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