社会医学基本理论双语

1、Contents preface Defining Health and Medicine Sociological Perspectives on Health and Medicine Social Capital and Health Part 1 Preface Section 1.1 A Story of Social Medicine Seventeen-year-old Jim Davis (a pseudonym) was checked into the rehab center two days age by this parents. Today, he is curle

2、d into a fetal position on the bed in his room, his body convulsing. Periodically, he gets up screaming and tears the sheets off his bed or throws a chair against the wall. Jim is going through withdrawal, but from what? Is he addicted to heroin, perhaps, or cocaine, alcohol, or even nicotine? No, J

3、ims psychologist explains that Jim is an Internet addict. A high school senior and, until recently, honors student, Jim spends more than six hours a day on-line. He quit long-distance running and withdrew from other extracurricular activities to have more time for the Internet. Then he began skippin

4、g classes and calling in sick to his part-time employer. His parents insisted that he cut down his time on-line, but Jim couldnt seem to do it. When they removed Jims computer from his room, he at first become depressed, but then he went into a rage, threatening to kill himself if his parents did no

5、t return his computer. Thiss when the decided to seek professional help, which eventually led to Jims admission to a rehabilitation center that usually treats drug and alcohol abusers. Clinicians report that they are seeing an increasing number of people with Internet addiction, a compulsive disorde

6、r similar to uncontrollable gambling, binge eating, and drug and alcohol abuse. But sociologists see these report as the latest example of medicalization, the process of defining a behavior or condition as an illness in need of medical treatment. Sociologists believe that illness is not simply a bio

7、logical or physiological condition. Rather, illness is socially constructed. What gets defined as illness has as much to do with a societys culture as with objective symptoms. Section 1.2 Relations of Concept and Theory The structure of a theory: concept, variable, proposition, hypothesis. Concept A

8、bstract of phenomena Relations of concept and theory: concept is a section of theory; a theory is made up of a group of logic- related concepts. Variable Concept with multi-dimension. Proposition A statement about the characteristic of a concept or the relations of a group of concepts. Categories of

9、 proposition: axiom, law, hypothesis. Hypothesis A tentative statement about the relationship of related-variable. Part 2 Defining Health and Medicine Section 2.1 What is health? Some people define health as simply the absence of illness, but this vague definition raises more questions than this ans

10、wers. For example, when should we consider a person is ill when that person is unable to perform normal social roles? On the one hand, an individuals assessment can be problematic because research shows that while most people consider their very good or excellent, only a small percentage is complete

11、ly free of physical ailments at any given time (U.S. Department of health and human services,1996). On the other hand, if we define health solely in terms of the absence of disability or incapacitation, we overlook the thousands of people who are ill but who continue to carry out their daily activit

12、ies for a variety of reasons, such as economic necessary. As these examples illustrate, health is multidimensional. In addition to a physiological dimension, health also has psychological and social dimensions. Consequently, we have adopted the World Health Organizations definition of health as a st

13、ate of physical, mental, and social well-being. This definition makes the point that we cannot consider a person healthy if she or he is emotionally distressed or living in a hazardous environment, even if the person is free of physical illness. Section 2.2 Health and Society Standards of health var

14、y cross-culturally. Standards of health vary over time Standards of health reflect the dominant values and norms of a society Health is affected by a societys level of economic development. Standards of health vary cross-culturally What is considered healthy or wholesome in one society may be regard

15、ed as unhealthy or harmful in another. For instance, physical conditions that would be diagnosed as serious skin diseases by U.S. physicians are not considered even symptoms of illness by the Kuba of Sumatra. Definitions of health and illness may also be manipulated for political reasons. For exampl

16、e, in Japan, where the national government owns the countrys largest cigarettes manufacturing company, any medical reports that warn of the health hazards of smoking must also include claims about cigarettes benefits, such as how smoking cigarettes contributes to creativity. Standards of health vary

17、 over time Little more than a century ago, physicians believed that hysteria was caused by the uterus breaking free and moving through the body. Thus, by definition, all hysterics were women, and the “cure” was removal of the uterus (hysterectomy). Hysteria, which is today called histrionic personal

18、ity, is still a medically recognized disorder, but it is not thought to have a physical cause, nor is it only diagnosed in women; 25 to 50 percent of individuals with histrionic personality are men. Standards of health reflect the dominant values and norms of a society Consider that in the United St

19、ates, where individualism is highly prized, some people develop a phobia of being embarrassed, whereas in Japan, where group welfare is valued over the individual, some people develop a fear that they might embarrass others. Health standards may also be used to enforce norms. In many West African co

20、untries, for example, young women are expected to be virgins when they marry. To guarantee marriage ability, parents usually have their daughters “circumcised” (their external genitals are removed and the vagina is sewn closed except for a small opening to allow the passage of menstrual blood), even

21、 though the procedure often results in complications, including shock, hemorrhage, and tetanus. In this countries, the circumcision serves as a means of social control to ensure young womens conformity to their societys sexuality norms. Health is affected by a societys level of economic development.

22、 Economically undeveloped societies have high rates of illness and health, especially from preventable infectious diseases. As a society develops, death from infectious diseases declines dramatically, so that industrialized societies enjoy the highest standards of health. This does not mean that ind

23、ustrialized societies are illness-free, however. Infectious diseases may be under control, but industrialization generates other health problems. Only in industrialized societies, for example, do workers contract life-threatening illnesses because of occupational exposure to cotton fibers, coal dust

24、, asbestos, mercury, and numerous chemicals. Section 2.3 What is medicine? Medicine is the social institution established to identify and treat illness and promote health. Goals of medicine: prevention of disease, relief of suffering, care of the ill and avoidance of premature death. Section 2.4 Med

25、icine and Society Just as health reflects the culture and structure of a society, so does medicine. We usually think of medicine after the factthat is once we have gotten sick, we rely on medicine to make us better. This kind of medicine, curative medicine, focuses on treating people who are already

26、 ill. In contrast, preventive medicine seeks to establish conditions that keep illness from occurring. In the United States, preventive medicine has been getting more attention in recent years. We are all family with the current campaigns to quit smoking and “eat heart healthy”. But for the most par

27、t, medicine in United States has traditionally emphasized cure than prevention, an emphasis that follows logically from our societys values of individualism and free enterprise. The individual is supposed to determine his or her own health needs, find a source of health care, and pay for that care p

28、rivately. Part 3 Sociological Perspectives on Health and Medicine The Structural Functionalist Perspective Evaluating the Structural Functionalist Perspective The Symbolic Interactionist Perspective Evaluating the Symbolic Interactionist Perspective Section 3.1 The structural functionalist perspecti

29、ve The structural functionalist perspective on health and medicine was formulated largely by Talcott Parsons (1951). According to Parsons, a healthy population is essential to society. Health people can perform the social roles necessary to keep society functioning optimally. Illness, then, is dysfu

30、nctional because it prevents people from performing their social roles, at least temporarily. Thus, the social institution of medicine plays a vital role in the overall functioning of medicine by making members healthy. Of course, everyone gets sick sometimes and when they do, Parsons argued, they f

31、ollow a socially prescribed role. Physicians also have specific role expectations. Section 3.1.1 The Sick Role Parsons identified four characteristics of the sick role, the behaviors defined by a society as appropriate for people who are sick. First, sick people are excused from their usual responsi

32、bilities, such as attending class or working. However, while saying youre sick might initially evoke sympathy, you wont be excused from your obligations for long unless your illness is verified by a recognized expert, such as the school health service or your physician. Second, sick individuals are

33、considered “worthy” of others sympathy only if they did nothing to precipitate their illness. Consider, for example, the recent lawsuits brought against the tobacco industry by smokers with serious illnesses. Juries have been reluctant to award damages because the plaintiffs knew smoking was harmful

34、 to their health, but kept doing it anyway. Third, the sick person must display a sincere desire to be well. Someone who claims to be ill to avoid work, get out of a sociology exam, or be pampered by others is not considered legitimately sick by society. Finally, the sick person must do everything p

35、ossible to get well. If the sick person makes no attempt to get medical help or ignores “doctors orders,” he or she relinquishes legitimate claim to the sick role. The help-seeking element of the sick role reads us to consider the role of help provider, the physician. Section 3.1.2 The Physicians Ro

36、le According to Parsons, the physicians role has two components. One is to evaluate peoples claims of illness, assessing whether they are really sick and, if so, determining the cause of their ailment. The second component of the physicianss role is to cure the sick so they can carry out their norma

37、l social roles. Section 3.1.3 The relationship between the physicians role and the sick role the physicians role and the sick role are interdependent. First, patients must supply their medical history and symptoms in order for the physician to fulfill the first component of his or her role. Then, to

38、 fulfill the second components, the physician depends on the patient to follow instructions. Despite this interdependence, the specialized knowledge of the physician makes the physician-patient relationship unequal. The level of inequality varies cross-culturally, but the physician always has the up

39、pers hand in the relationship. Parsons did not view patient-physician inequality negatively, though. The physician simply knows what is necessary for a person to get better, so the patient should defer to him or her. Section 3.2 Evaluating the Structural Functionalist Perspective Parsonss analysis o

40、f the sick role shows how social norms impinge on both health and illness. Parsons also correctly depicts the physician as the gatekeeper to the sick role. But parsonss ideas have also been criticized. Some, for example, say that Parsonss concept of the sick role implies that a person as only tempor

41、arily ill and can be restored to normal functioning relatively quickly. This is true if the person is suffering from an acute illness, which , though often serious, is curable. But chronic illnessprolonged illness that may be controlled, but not curedis permanently incapacitating and prevents a pers

42、on from ever resuming normal social roles. Parsons is also criticized for putting too much emphasis on individual responsibility while downplaying the social structural factors that can affect health. For instance, Parsonss claim that people who contribute to their own affliction have no legitimate

43、claim to the sick role overlooks the fact that social structural factors also shape peoples behavioral choices. Advertising, for example, promotes a great deal of unhealthy behavior, including smoking and alcohol consumption Finally, Parsons has been criticized for ignoring the negative consequences

44、 of social inequality for health and medicine. Sick people may wish to get well, for example, but their access to medical care may be limited by their financial status. Section 3.3 The symbolic interactionist perspective Symbolic interactionists are primarily concerned with the meanings people give

45、to their social interactions, so they focus on how health and medicine are socially constructed. Quite apart from objective symptoms, health and illness are socially defined by the members of a society. In Lithuania, for example, there are about as many rear- end car collisions as in Norway and the

46、United States, but Lithuania never report the lingering neck pain, called whiplash, commonly reported by Norwegian and American accident victims. Lithuanians dont have stronger neck muscles and their cars arent safer, so why dont they get whiplash? Researchers believe the answer lies in how the situ

47、ations are socially defined. In Lithuania, people are not accustomed to suing one another for any reason, let alone accident liability. Lithuanians do not have personal injury insurance; if they are injured in an accident, the governments public health insurance program pays the medical bills. When

48、a rear-end collision occurs, they define it as a major inconvenience, not because they will miss work because of neck pain, but because it is so difficult to get spare car pats in Lithuania. In contrast, in Norway, which has the highest number of whiplash cases in the world, there is much to be gain

49、ed from defining a rear-end collision as an injury- producing event because insurance companies generously compensate individuals for chronic disability caused as injury suits are commonplace, rear- end collisions are defined as injuries heal on their own within a few days or weeks and require littl

50、e or no treatment. This is not to say that accident victims in Lithuania never experience neck pain, or that people on Norway and the United States only pretend to be in pain. Rather, according to symbolic interactionists, the social expectations that individuals attach to an event shape how they ex

51、perience it and the meanings they give to the experience. Symbolic interactionists are also interested in how medical treatment is social constructed. Think about your most recent visit to a physicians office. After being seated in the waiting area, you were probably escorted to an examining room by

52、 a nurse, who took some basic medical information (your weight, temperature, and blood pressure). Once the nurse finished, you are left to wait for the doctor. The doctor wasnt difficult to recognize since she or he had several props that designated the status doctor. For example, the doctor probabl

53、y wore a white lab coat with a stethoscope protruding from the pocket. The two of you may have initially exchanged small talk, but the conversation was likely limited to you answering the doctors questions. Although the doctor may have addressed you by your first name, you invariably used the title

54、“doctor” when addressing her or him. The doctor also probably used a specialized vocabulary, referring to your sore throat as “pharyngitis” or your swollen pinky finger as your “fifth digit” Each element of the interaction, including the props and the language, contribute to the social construction

55、of the statuses physician and patient and the physician- patient relationship. The relationship itself is clearly hierarchal, with the doctor assuming the role of authority. Section 3.4 Evaluating the Symbolic Interactionist Perspective The symbolic interactionist perspective is valuable for emphasi

56、zing the social nature of health and medicine, which we typically think of only in biological terms. In fact, the definitions people attach to particular behaviors or conditionslabeling them healthy or unhealthy, well or sickoften derive as much from nonmedical factors as from medical ones Neverthel

57、ess, the symbolic interactionist perspective has been criticized for downplaying the objective reality of health and illness. After all, people do get sick and suffer debilitating physical illness, regardless of whether they are professionally diagnosed or socially labeled sick. Illness can also exi

58、t independent of self-definitions. For example, an underweight women who considers herself overweight and refuses to eat will experience harmful physical changes that can eventually cause death, even as she defines her dramatic weight loss as healthy. Finally, critics charge the that symbolic intera

59、ctionists overlook how social inequality affects who and what gets defined as sick or well. And how a person so defined is treated by the medical community Part 4 Social Capital and Health Section 4.1 What is Social Capital? Social capital refers to the institutions, relationships, and norms that sh

60、ape the quality and quantity of a societys social interactions. Increasing evidence shows that social cohesion is critical for societies to prosper economically and for development to be sustainable. Social capital is not just the sum of the institutions which underpin a society. It is the glue that