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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 industrial world.

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 Report (1998)

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 healing provided."

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 (2001)

"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 it happen.

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 disease."

REFERENCES

Aggleton, P. (1990) Society Now - Health. London. Routledge. pp. 15.

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/13548506[19990507]4:2L.189;1pp. 190.

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.