The Social Construction of Illness
The following article is concerned with social anthropology
with regard to illness. Rogers (1991) discusses anthropological
theories for explanations of health and illness, in the context
of the beliefs, understandings and practices of specific groups.
It discusses the different perceptions of illness, describing
how illness is socially constructed by identifying the meanings
different cultures attach to the cause and concept of illness,
for example, Hopwood (1997 pp153-154) describes the Navajo societies
belief in the cause of illness being, ",..the discord characteristic
in male-female relationships is a fundamental component of disease."
The acceptable customs, beliefs and values within cultures
around the world are discussed, drawing our attention to Western
biomedicine as a cultural construct therefore being seen as an
alternative in a variety of complementary healing systems.
The key themes covered within the article include conceptions
of the body. Here Hopwood describes Western Europeans and Americans
seeing the body in terms of a 'plubming' or 'combustion engine/machine'
model. Hopwood (1997)
A clerical officer offers a similar perception of health and
illness as cited in Rogers (1991 pp 196) "I do not think
God or religion has anything to do with your health. No one but
you and the mechanics of your body are responsible...nothing
can cure you but medicine and rest. No man [sic] can perform
a miracle and make you walk."
In contrast to this view point Kleinman (1985) as cited in
Hopwood (1997 pp 153) comments on, "...traditional Confucian
thinking, the body is seen as part of the social, not personal
domain." To explain these views Monckton (1997 pp 2) says,
"People from different cultures have different ways of looking
at events around them - the same is true when considering perceptions
of the body."
The causes of illness are considered, in particular Hopwood
draws attention to two main types of causes, the personalistic
and naturalistic. "In a personalist theory, illness is believed
to be caused by the deliberate action of a sensate agent. This
agent could be a god, ancestor or witch,.." Hopwood (1997
pp 153) Aggleton (1990 pp15) when discussing beliefs of illness
states, "Some societies explain the onset of illness by
recourse to supernatural forces: wrathful gods or ancestral spirits..."
Hopwood (1997 pp153) comments on, ",.. naturalistic theories
tend to see sickness in terms of a disturbed natural equilibrium."
In particular she states the Humoral theories.
Cultural-bound illnesses are explained in terms of, "...people
of different cultures actually suffer from different illnesses."
Hopwood. (1997 pp154) Here she discusses a variety of illnesses
around the world and how they are only experienced in particular
cultures. Hopwood suggests that coronary heart disease is a cultural-bound
illness in the Western industrial world.
Although The World Health Organisation Report (1998) identifies,
"Coronary heart disease and stroke account for 12 million
deaths a year... These and other noncommunicable diseases now
cause 40 % of all deaths in developing countries,.." This
suggests coronary heart disease is not just limited to the Western
Evidence suggests this is because, ",..as their economies
grow, noncommunicable disease will become more prevalent, largely
because of the adoption of "Western" lifestyles and
their accompanying risk factors..." The World Health Organisation
When discussing biomedicine and science Hopwood argues that
biomedicine can be seen as a cultural construct as opposed to
scientific. Chalmers (1996) as cited in Furnham et al (1999 pp
190) notes "...health belief systems shaped by cultural,
economic and religious factors affect the experience of health
and illness decisions about treatment and satisfaction with the
Hopwood identifies the types of treatments and the emphasis
the countries she discusses put on bodily parts and illness in
Western industrial countries and how they differ, although the
initial assessments are similar.
In concluding her article Hopwood (1997 pp 155) identifies
the importance of the placebo effect, placebo meaning 'I shall
please'. "...never underestimate the effect of placebo within
any practice, including those of biomedicine and complementary
and alternative medicine."
Placebos are mainly identified
as, "...an inert substance or "fake"surgery or
therapy, used as a
control in an experiment or given to a patient for its possible
or probable beneficial effect." Carroll (2001 pp 1) There
are a number of reasons why they are said to be beneficial. Many
people believe that it is psychological due to either a real
effect caused by belief or to a subjective delusion. Some people
say that at least part of the placebo effect is because an illness
or injury taking its natural course, the body healing itself.
Another theory is that a process of treatment involves showing
attention, care, affection and enthusiasm to the patient may
itself trigger physical changes in the body that promote healing
through the release of chemicals, such as endorphin. Carroll
"From the medical perspective, therefore, to refer to
the placebo effect is to draw attention to a spurious outcome
dependent upon people's 'magical' beliefs." Radley (1994
pp 96) If this is the case the placebo effect could work in reverse,
for example, Hopwood (1997 pp 154) describes Voodoo death as,
"...a person who believes that a sorcerer is trying to kill
him will actually sicken and die,.." Therefore this suggests
if you believe strongly about something you could possibly make
Placebo effects can be seen within all areas of healing systems,
including those of biomedicine and alternative medicine. Within
biomedicine placebo effects are used to measure the effectiveness
of drugs, assess the importance of a doctor-patient relationship
and to assess the conditions people experience, such as pain.
Thus placebo effects are 'used' in a scientific way within biomedicine.
Although the effectiveness of placebos can be seen through the
powers of suggestion, the empathy and charismatic personality
of the healer-patient relationship, which are mainly prevalent
in alternative healing relationships.
Sharma (1992) as cited in Radley (1994 pp97) comments on the
relationship with the alternative practitioner, "They appreciate
the technical opportunities provided by modern medicine, yet
value the relationship they can establish with a practitioner
of alternative medicine.
A further resource that supports Hopwood's findings throughout,
particularly when discussing causes of illness, is the work of
Aggleton (1990) Society Now - Health, chapter one - defining
health. Within this chapter he offers explanations for illness
that include, supernatural forces and lay beliefs. When discussing
the importance of lay beliefs Aggleton (1990 pp 15) comments
on Helman (1978) stating, ",.. people attending the practice
in which he worked... distinguished between hot illnesses such
as fevers, and cold illnesses such as chills and cold."
This supports Hopwood's claim about lay beliefs, "... the
common British aphorism 'feed a cold, starve a fever'. A cold
should be treated by its opposite.., whilst a fever ... is believed
to be best treated by cold..." Hopwood (1997 pp 153)
This review has raised the question, how important are beliefs
for providing a basis for social systems including the health
system and how important are they to the individual?
There are also other influences involved in explaining health
and illness which need to be addressed, such as political, economic
and institutional influences, which cannot be separated from
this issue. Monckton (1997 pp 3) supports this by stating, "...there
is no single, 'correct' way of looking at medicine, illness or
Aggleton, P. (1990) Society Now - Health. London. Routledge.
Carroll, R. (2001) the placebo effect. Available from: http://skepdic.com/placebo.html
Furnham, A. et al (1999) Beliefs about health and illness
in three countries: Britain, South Africa and Uganda. Psychology,
Health and Medicine 4. (2) Available from: http://alidoro.catchword.com/v1=4906277/cl=8/nw=1/rpsv/135485064:2L.189;1pp.
Hopwood, A. (1997) The social construction of illness and
its implications for complementary and alternative medicine.
In: Complementary Therapies in Medicine. 5 London. Pearson Professional
Ltd. pp. 153, 154, 155.
Monckton, J. (1997) The Task of Medicine. Available from:
http://www.rccm.org.uk/costtask.htm. pp. 2, 3.
Radley, A. (1994) Making Sense of Illness - the social psychology
of health and disease. London. SAGE publications. pp. 96, 97.
Rogers, W. (1991) Exploring Health and illness - An Exploration
of Diversity. Hertfordshire. Harvester Wheatsheaf. pp. 196.