The complete sociology open book review

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Introduction to Sociology Learning Objectives  To understand the major conceptual frameworks of medical sociology  To understand how social factors create and shape health issues  To foster intellectual discussion combining medical sociology and health issues  To create students’ skills at reading, critiquing, integrating sociological theory into medical practice.

The individual can understand her own experience and gauge her own fate only by locating herself within her period, that she can know her own chances in life only by becoming aware of those of all individuals in her circumstances.

----- C. Wright Mills (1959) WHAT IS SOCIOLOGY ?  The study of society  A social science involving the study of the social lives of people, groups, and societies  The study of our behavior as social beings  The scientific study of social aggregations CLASSICAL o C. Wright Mills :: “The individual can understand her own experience and gauge her own fate only by locating herself within her period, that she can know her own chances in life only by becoming aware of those of all individuals in her circumstances “ o Comte :: coined the term sociology to apply to the science of human behavior. o Weber :: is a science which attempts to understand social action through a causal explanation of its course and effects. o Bauman :: “Sociology represents the specific knowledge and knowledge application, but also enrich the knowledge into the specific practice.”

POP o ASA :: the study of society o VIKI :: is the scientific study of human society and its origins, development, organizations, and institutions.

Sociology is the study of human social life. Human social life is complex and encompasses many facets of the human experience. Because of its complexity, the discipline of sociology has been subdivided over time into specialty areas. The first section of this book covers the foundations of sociology, including an introduction to the discipline, relevant study methodologies, and dominant theoretical perspectives. The remaining chapters focus on the different areas of study in sociology.

What do medical sociologists study?

– Social causes and patterns of health and disease – Social behavior of health care personnel and their patients – Social functions of health organizations and institutions – Relationship of health care delivery systems to other social systems Important field of study because: – Recognizes the critical role social factors play in determining or influencing the health of individuals, groups, and the larger society.

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The Development of Medical Sociology • Most early works were written by physicians focused on the connections between social conditions and health • Early sociologists did not give much attention to matters of health and medicine • Federal funding after WWII gaves sociomedical research a boost – Early collaborations with psychiatry (e.g., the Hollingshead & Redlich 1958 New Haven study, and the Srole et al. 1962 Midtown Manhattan study) – Funding forces an early emphasis on applied research • Talcott Parsons – Publishes The Social System in 1951 – First major social theorist to deal with issues of health, illness, and the role of medicine – Structural-functionalist perspective – Introduced concept of the sick role • A patterned set of expectations defining the norms and values appropriate to being sick • Practical application versus theory – Robert Straus (1957) notes division between sociology in medicine and sociology of medicine • Division found mostly in the U.S. • Initial tension between areas resolved by: • •

Orientation of most research (whether in medicine or in sociology) toward practical application due to funding pressures Convergence with main discipline of sociology: regardless of area, all sociologists receive same training; increased use of sociological theory in medical sociology

Defining HEALTH • World Health Organization (WHO) definition: – A state of complete physical, mental, and social well-being, and not merely the absence of disease or injury • Laypersons tend to view health as the capacity to carry out their daily activities – Health as the ability to function Contrasting Ideas about Health and Social Behavior • Primitive humans tended to rely on magic as the fundamental explanation of disease and illness • Hippocrates of ancient Greece represents first attempt to base understanding of the body on rational thought; recognizes contribution of the environment to human well-being • Middle Ages introduces a split in responsibility for human well-being: Church attends to social needs while physicians focus on physical ailments • Modern medicine and regulation of the body (late 18th century) • Michel Foucault (1973) describes development of modern medicine and notes split between two trends: • •

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Medicine of the species gave strong emphasis on classifying diseases, diagnosing and treating patients, and finding cures Medicine of social spaces was concerned with preventing disease, especially through government involvement in matters of public hygiene

Modern medicine rejects supernatural explanations for disease and treats it as an object to be studied, confronted scientifically, and controlled The public’s health (19th century) Systematic implementation of public health measures and improvements in public sanitation 3|Page

• • • • • • • •

Period sees declining mortality rates from infectious diseases Improvements in population’s health mainly due to improvements in diet, housing, public sanitation, and personal hygiene instead of medical innovations (McKeown 1979; Porter 1997).

Germ theory of disease (late 19th-20th century) Biomedical approach: every disease has a specific pathogenic cause best treated by removing or controlling that cause Medical practice gives little attention to social causes of health and instead focuses on treating disease and illness with drugs “Whole person” health care (late 20th-21st century) Transition from infectious to chronic diseases as leading causes of death (epidemiological transition) around mid-20th century Recognition that social environment and lifestyle practices influence chronic diseases encourages emphasis in medicine on treating the “whole person”

The Reemergence of Infectious Diseases Three epidemiological transitions in human history (Armelagos and Harper 2010): • First - occurred around 10,000 years ago – Human societies shifted from foraging (hunting and gathering) to agriculture – Marked by the emergence of novel infectious and nutritional diseases • Second - about 200 years ago – Improved nutrition and living standards, public health measures, and medical advances in developed societies led to a decline in infectious diseases and a rise in chronic and degenerative diseases • Third – beginning now – Resurgence of infectious diseases previously thought to be under control – The potential for the spread of infectious diseases has been significantly enhanced in today’s world by the globalization of trade and travel • West Nile virus – First appeared in New York City in the summer of 1999 – Initially puzzled medical personnel and public health officials, since the disease had not been seen before in the Western hemisphere – Eventually spread throughout the U.S. – Peak cases/mortality in 2006 • Sexually transmitted diseases – Represents greatest threat to worldwide health – Four factors responsible for dramatic increase in rates: • (1) Birth control pill reduced fears of unwanted pregnancy • (2) Ideology of sexual liberation and permissiveness among young urban adults throughout the world • (3) New pattern of migrant employment in developing nations spreads STDs acquired in urban areas to the countryside • (4) Availability of multiple sexual partners • Most important risk factor in exposure to infection • BIOTERRORISM – Relatively new threat of infectious diseases – Takes place when people knowingly prepare biological agents or gases and use them to deliberately induce illness and death among other people • Overt - the perpetrator announces responsibility for the event or is revealed by the attack 4|Page

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Covert - characterized by the unannounced or unrecognized release of agents; the presence of sick people may be the first sign of an attack – Examples: • 1995 release of sarin gas in Japan by the Aum Shinrikyo cult in the Tokyo subway • 1996 outbreak of gastroenteritis when a disgruntled coworker put dysentery bacteria in pastries consumed by staff members in a large medical center laboratory • 2001 anthrax sent through the U.S. mail BIOETHICS • Area of study focused on ethical decisions and practices with respect to medical care, research, and human’s rights over their bodies • Medical decisions can have profound social implications – May reflect discrimination and prejudice against particular social groups • Important cases of unethical behavior, spurring development of regulations: – Nazi experiments – Tuskegee Syphilis Study in Alabama in 1932 • Institutional review boards (IRBs) responsible for oversight of research: – Fully informed voluntary patient consent, acceptable risk–benefit ratios, guaranteed patient anonymity and confidentiality • Health Insurance Portability and Accountability Act (HIPAA) of 1996 – Regulates the handling of patient data and privacy • Also concerned with controversial areas of medical practice and research: – Funding of research by pharmaceutical companies – Practices such as “ghost-writing” academic articles on the use of medical interventions – Stem cell research – Use of human genetic material, including cloning – Abortion – Euthanasia – Reproductive technology At times, the findings of sociologists may seem like common sense, because they deal with familiar facets of everyday life. The difference is that such findings have been tested by researchers.

SCOPE OF SOCIOLOGICAL STUDIES  Groups and organization :: Family-community-town-city-clan-ethnics-groups-culture.  Social institution :: Kinsfolk-marriage-economics-politics-law-religion-education-culture-spots..  Social process :: Cooperation-competition-war-reform-revolution-public opinion-social values-social integration..  Social issues :: Employment-national division-crime-environmental pollution-population migrationracial discrimination-violence-poverty..

SOCIOLOGICAL THEORY THEORY --- a set of statements that seeks to explain problems, actions or behavior.

--- effective theory have both explanatory and predictive power.  Helps to see the relationships among seemingly isolated phenomena;  Help to understand how one type of change in the environment leads to other changes.

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Example :: Research by Émile Durkheim on suicide ---focused on rates in different countries rather than individual personality traits ---concluded that suicide rate reflected the extent to which people were or were not integrated in the group life of society ---developed a theory of suicide More scientific than previous explanations, predictive of what might lead to higher rates

STRATIFICATION OF THEORY  Macro the level of analysis that studies large-scale social structures in order to determine how they affect the lives of groups and individuals  Middle range integrating theory and empirical research  Micro the level of analysis that studies face-to-face and small-group interactions in order to understand how they affect the larger patterns and institutions of society THEORY IN PRACTICE

SPORTS AND SOCIETY Theoretical perspectives (paradigm) SOCIAL STABILITY  Social order  Functionalism  Exchange  Interaction

SOCIAL CHANGE  Conflict  Criticism  Post-modern  Involvement

Thomas Samuel Huhn (1922 - 1996) One of the most influential philosophers of science of the 12 th century

The Structure of Structure Revolutions Kuhn defines a scientific paradigm as: "universally recognized scientific achievements that, for a time, provide model problems and solutions for a community of researchers.”

FUNCTIONAL PERSPECTIVE Think of society as a living organism in which each part of the organism contributes to its survival.

Example: Hindu’s sacred cow culture The functionalist perspective attempts to explain social institutions as collective means to meet individual and social needs.

According to the functionalist perspective of sociology, each aspect of society is interdependent and contributes to society's stability and functioning as a whole. For example, the government provides education for the children of the family, which in turn pays taxes on which the state depends to keep itself running. That is, the family is dependent upon the school to help children grow up to have good jobs so that they can raise and support their own families. In the process, the children become lawabiding, taxpaying citizens, who in turn support the state.

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Functionalists believe that society is held together by social consensus, in which members of the society agree upon, and work together to achieve, what is best for society as a whole. This stands apart from the other two main sociological perspectives: symbolic interactionalism, which focuses on how people act according to their interpretations of the meaning of their world, and conflict theory, which focuses on the negative, conflicted, ever-changing nature of society.

CONFLICT PERSPECTIVE …seek to explain how the unequal distribution of resources leads to conflict between those who possess and control valuable resources, on the one side, and those who seek to increase their share of these resources, on the other…

Resource Power Status Legitimacy Class FEMINISM Feminism is a collection of movements and ideologies aimed at defining, establishing, and defending equal political, economic, and social rights for women. This includes seeking to establish equal opportunities for women in education and employment. A feminist advocates or supports the rights and equality of women.

SYMBOLIC INTERACTIONIST PERSPECTIVE  "Humans act toward things on the basis of the meanings they ascribe to those things."  "The meaning of such things is derived from, or arises out of, the social interaction that one has with others and the society."  "These meanings are handled in, and modified through, an interpretative process used by the person in dealing with the things he/she encounters."

Business casual attire

The NBA hopes improving the image of its players, presenting them as responsible, serious-minded adults rather then as overgrown teens one step removed from the neighborhood court.

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DEVELOPMENT OF SOCIOLOGY  Born from philosophy  Contribution of Durkheim  Max Web  Karl Max  Contemporary development EARLY THINKERS  AUGUST COMTE (1798 - 1857) o coined the term sociology o stress its scientific nature and to distinguish it from traditional philosophy  HERBERT SPENCER o put the idea that society is like an organism—a self-regulating system o view that the principle of survival of the fittest applies to societies and within societies.  KARL MARX (1818 - 1883) o believed that societies determined by economic forces.  EMILE DURKHEIM (1858 - 1917) o argued that the main concern of sociology should be what he called social facts  MARX WEBER (1864 - 1920) o particularly interested in the larger dimensions of society—its organizations and institutions— o sociology should include the study of “social action”.  TALCOTT PARSONS (1920 - 1979) o society is like the human body or any other living organism. Like the parts of the body (such as the limbs, the heart, and the brain), the parts of society (such as families, businesses, and governments) function together in a systematic way that is usually good for the whole. Each part helps to maintain the state of balance that is needed for the system to operate smoothly.

DEVELOPING A SOCIAL IMAGINATION  C. Wright Mills used the term sociological imagination to describe the ability to look at issues from a sociological perspective.  The sociological perspective is a quality of the mind that allows us to understand the relationship between our particular situation in life and what is happening at a social level.  When using a sociological perspective, one focuses on the social context in which people live and how that social context has an impact on individuals’ lives. ⁻ We have come to know that every individual lives, from one generation to the next, in some society; that he lives out a biography, and that he lives it out within some historical sequence. By the fact of his living he contributes, however minutely, to the shaping of this society and to the course of its history, even as he is made by society and by its historical push and shove.

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⁻ What they need, and what they feel they need, is a quality of mind that will help them to use information and to develop reason in order to achieve lucid summations of what is going on in the world and of what may be happening within themselves. It is this quality, I am going to contend, that journalists and scholars, artists and publics, scientists and editors are coming to expect of what may be called the sociological imagination.

MICHEAL JORDAN MEETS C.WRIGHT MILLS - Step one: description - Step two: local analysis - Step three: global analysis - Step four: historical analysis The Promise – C.Wright Mills People are often quick to blame others for their misfortunes. However, C. Wright Mills argues that the only way to truly understand people’s behavior is to examine the social context in which the behavior occurs. In other words, Mills believes that we need a quality of mind that he calls the sociological imagination. By using sociological imagination, we learn how social, historical, cultural, economic, and political factors influence the choices that people make and the ways in which they live their lives. As you read this article, think about how the larger social context has shaped your own choices over the course of your life.

What they need, and what they feel they need, is a quality of mind that will help them to use information and to develop reason in order to achieve lucid summations of what is going on in the world and of what may be happening within themselves. It is this quality, I am going to contend, that journalists and scholars, artists and publics, scientists and editors are coming to expect of what may be called the SOCIOLOGICAL IMAGINATION. MAJOR RESEARCH METHOD  Survey  Experimental  Field  Secondary data analysis SOME PROBLEMS IN SOCIAL RESEARCH  Specialty of human being  Study interference  Complexity of social phenomena  Specific constraints  Difficult to maintain objectivity

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Fundamental principles of medical sociology I. HEALTH, MEDICINE AND SOCIETY Pinta is a human skin disease endemic to Mexico, Central America, and South America. It is caused by infection with a spirochete, treponema lallidum carateum, which is morphologically and serologically indistinguishable from the organism that causes syphilis. After an incubation period of two to three weeks, produces a raised papule, which enlarges and becomes hyperkeratotic. Three to nine months later further thickened and flat lesions appear all over the body.

SOCIAL EPIDEMIOLOGY  The branch of Epidemiology that studies the social distribution and social determinants of health  Overlaps with fields in the social sciences, most notably medical sociology and medical geography.  Uses social concepts in order to explain patterns of health in the population.  Social epidemiology is the study of the ways in which social factors are intertwined with the distribution of disease within the general population.

Social epidemiology is a branch of epidemiology that focuses particularity on the effects of social structural factors on the states of heath. Social epidemiology assumes that the distribution of advantages and disadvantages in a society reflects the distribution of health and disease. It proposes to identify societal characteristics that affect the pattern of disease and health distribution in a society and to understand its mechanisms.

The central and initial question of social epidemiology to be answered is what effect do social factors have on individual and population health. However, the new focus on this theme using current epidemiological methods is a relatively recent phenomenon. There are several significant concepts in the field of social epidemiology: 1) the bio-psychosocial paradigm, 2) the population perspective, 3) use of new statistical approaches such as multilevel analysis, 4) significance of theory.

The relationship between social class and health has been a major research field since the beginning of public health history. Many studies have identified the disparities in health among social classes and developed several theories, such as social selection theory and socio-biological translation theory.

However, despite the long history of this research field, the effect of social class on health is not yet fully understood.

Income distribution and health is a relatively new field within social epidemiology. Three possible mechanisms for the consequences of income distribution on health are 1) disinvestment of human capital, 2) disinvestment of social capital, 3) psychological process.

Refining theories of income distribution is a major challenge in research on income distribution.

Examples of socio-structural factors in the field of social epidemiology :: 1. Social class 2. Gender 3. Race/ ethnicity 10 | P a g e

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Discrimination Social network Social capital Income distribution Social policy

Significant concepts of social epidemiology  First, the bio-psychosocial paradigm is an important concept of social epidemiology.  Second having valid and reliable measurements for social class is another challenge.  Third, Use of new statistical approaches such as multilevel analysis to determine the effects of socio-structural factors on health.  Lastly, the use of theory is another significant concept in social epidemiology. Social epidemiology requires the use of theory to build hypotheses and interpret results. Social epidemiologists select variables in statistical models based upon a conceptual framework that indicates hierarchical relationships among factors. This conceptual framework is built upon theory. Example: a model of a social class and congenital heart disease (CID), controlling for smoking implicitly assumes that social class has a direct effect on CHD independent of smoking.

Social epidemiology is a branch of epidemiology that focuses particularly on the effects of socialstructural factors on states of health. The central and initial question of social epidemiology is what effect do social factors, such as social structure, culture, or environment, have on individual and population health. However, the new focus on this question using current epidemiological methods is a relatively recent phenomenon.

SOCIAL EPIDEMIOLOGY VIEWS DISEASE “in its larger socio-ecological context in which disease agents (such as viral or bacterial agents, noxious environmental substances and dangerous technologies) have differential effects depending on the characteristics of the host (biological, genetic, psychological, and social capabilities and characteristics) and on the larger socio-cultural and physical environment. ” The major concern of the social epidemiologist is not with the health of the individual but with the health problems of the social group or social aggregate.

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THE HISTORY OF SOCIAL EPIDEMIOLOGY JOHN SNOW :: CHOLERA PERCIVAL POTT :: SCROTAL CANCER SIR PERCIVAL POTT  an English surgeon, one of the founders of orthopedy  noted for his investigation of the increase in scrotal cancer in England in 1775.  identified the specific etiological (causal) chain of events that resulted in an unusually high rate of scrotal cancer among lower class, urban whites.

CONTRIBUTION  establish the strategy of disease causation  break The chain at any of its links The etiological chain of events may begin with a given occupation (chimney sweep) into which a certain social group (lower-class, urban white Britons), next, there is usually some characteristic behavioral pattern of this occupation that brings its workers into contact with the vehicle of the disease (soot), within the frequently contacted vehicle is some agent, usually unknown, that causes the tissue change (scrotal cancer) to occur in the susceptible host (the chimney sweep).

CONTEMPORARY SOCIAL EPIDEMIOLOGY Focus on :: (1) the relationship of lung cancer to smoking (2) legionnaires’ disease (3) the relationship of myocardial infarction to occupational stress and behavioral patterns (4) health habits and mortality (5) AIDS RESEARCH ON THE RELATIONSHIP BETWEEN SMOKING AND LUNG CANCER. Goes into 4 categories :: (1) animal studies (2) retrospective studies (3) prospective studies (4) studies of cellular changes Findings show that the incidence of cancer increases with increased exposure to cigarette tar.

LEGIONELLOSIS --- A type of pneumonia (lung infection) infected by air conditioner, water supply or Inhalation of contaminated water.

--- The bacterium is named after a 1976 outbreak, when many people who went to a Philadelphia convention of the American Legion suffered from this disease.

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MYOCARDIAL INFARCTION Risk factors ::  Cigarette Smoking  Obesity  Blood Sugar  Blood Pressure  Cholesterol  Occupational Stress  Way Of Behavior HEALTH HABITS -----never having smoked -----engaging in exercise activities on a regular basis -----having less than five drinks at one sitting, -----being of average weight for height, -----getting even or eight hours of sleep a day -----with good relationship with your family.

AIDS Three transmission ways  sexual intercourse  intravenous drug use  blood transfusions Current AIDS situations in China,2012 --- estimated 780,000 people living with HIV, including154,000 AIDS patient, the total infection rate stands at 0.058 percent ---around 28,000 people died from AIDS --- At the end of September 2010, Jiangsu Province is estimated to have 5284 HIV positives, including 1693 cases of AIDS, while the cumulative cases of death were 775.

THE SOCIAL DEMOGRAPHY OF HEALTH  Age  Gender  Race  Socioeconomic Status o Income o Occupational status o Education SOCIOECONOMIC STATUS (SES) Consist of  INCOME :: spending power, housing, diet & medical care  OCCUPATIONAL STATUS OR PRESTIGE :: responsibility, physical activity and health risk associated with work  LEVEL OF EDUCATION ::person’s skills for acquiring positive social, psychological and economic resources.

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THE CYCLE OF POVERTY AND PATHOLOGY

To be poor is by definition to have less of the things (including health care) produced by society, also, in the experience of the poor in obtaining health services. Persons living in poverty and reduced socioeconomic circumstances have greater exposures to physical, chemical and biochemical, biological , and psychological, then their health status is more worse than affluent individuals.

MATTHEW EFFECT :: the rich get richer and the poor get poorer 25:29---- For whoever has will be given more, and they will have an abundance.

Whoever does not have, even what they have will be taken from them.

CONCLUSION The need to understand the impact of lifestyles and social conditions on health has become increasingly important in preventing or coping with modern disorders. As for a health practitioners, you should know the patients symptoms, but first you need to know about the behavior and lifestyles of individuals that are likely to develop disorders in the first place, then instruct them to adjust their physical conditions.

MATTHEW EFFECT In sociology, the Matthew effect (or accumulated advantage) is the phenomenon where "the rich get richer and the poor get poorer".

In both its original and typical usage it is meant metaphorically to refer to issues of fame or status but it may also be used literally to refer to cumulative advantage of economic capital.

The term was first coined by sociologist Robert K. Merton in 1968 and takes its name from a line in the biblical Gospel of Matthew: For unto every one that hath shall be given, and he shall have abundance: but from him that hath not shall be taken even that which he hath. —Matthew 25:29, King James Version.

THE FRAMEWORK OF ILLNESS ANALYSIS  Biological  Nutritional  Chemical  Physical  Social 14 | P a g e

Paper readings:  Berkman, Kawachi.

A Historical Framework for Social Epidemiology  Honjos Social Epidemiology Definition, History, and Research Examples

THEORIES OF POVERTY Theories on the causes of poverty are the foundation upon which poverty reduction strategies are based.

While in developed nations poverty is often seen as either a personal or a structural defect, in developing nations the issue of poverty is more profound due to the lack of governmental funds.

Some theories on poverty in the developing world focus on cultural characteristics as a retardant of further development. Other theories focus on social and political aspects that perpetuate poverty; perceptions of the poor have a significant impact on the design and execution of programs to alleviate poverty.

CAUSES OF PROVERTY IN THE UNITED STATES ⁻ Poverty as a personal failing ⁻ Poverty as a structural failing CAUSES OF PROVERTY IN DEVELOPING NATIONS ⁻ Poverty as cultural characteristics ⁻ Poverty as a label ⁻ Poverty as restriction of opportunities

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II. SOCIAL STRESS: sociological analysis “ My depression is somehow related to the program. I was so devoted to the program that I press myself too much. I hoped each period is perfect or better than the previous one. “ - Cui Yongyuan, famous anchor with China's Central TV "But society, including my family and leaders, seem to have little understanding of this disease. They say it's not a disease but a narrow mind or bad mood. They say I care too much about fame and couldn't stand losing it."

"Depression! Many thanks to all my friends. Many thanks to Professor Felic Lieh-mak (Cheung's last psychiatrist). This year has been so tough. I can't stand it anymore. Many thanks to Mr. Tong. Many thanks to my family. Many thanks to Sister Fei. In my life I have done nothing bad. Why does it have to be Cheung's suicide note (translation): like this?"

SOCIAL STRESS CAN LEAD TO - ANXIETY - DEPRESSION - ANGER - PHOBIA & FEARS - SUICIDE

FIGHT OR FLIGHT RESPONSE (in stress) The flight or fight response, also called the "acute stress response" was first described by Walter Cannon in the 1920s as a theory that animals react to threats with a general discharge of the sympathetic nervous system. The response was later recognized as the first stage of a general adaptation syndrome that regulates stress responses among vertebrates and other organisms.

The onset of a stress response is associated with specific physiological actions in the sympathetic nervous system, primarily caused by release of adrenaline and norepinephrine from the medulla of the adrenal glands. The release is triggered by acetylcholine released from preganglionic sympathetic nerves.

These catecholamine hormones facilitate immediate physical reactions by triggering increases in heart rate and breathing, constricting blood vessels and tightening muscles. An abundance of catecholamines at neuroreceptor sites facilitates reliance on spontaneous or intuitive behaviors often related to combat or escape.

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Normally, when a person is in a serene, unstimulated state, the "firing" of neurons in the locus ceruleus is minimal. A novel stimulus, once perceived, is relayed from the sensory cortex of the brain through the thalamus to the brain stem. That route of signaling increases the rate of noradrenergic activity in the locus ceruleus, and the person becomes alert and attentive to the environment.

If a stimulus is perceived as a threat, a more intense and prolonged discharge of the locus ceruleus activates the sympathetic division of the autonomic nervous system (Thase & Howland, 1995). The activation of the sympathetic nervous system leads to the release of norepinephrine from nerve endings acting on the heart, blood vessels, respiratory centers, and other sites. The ensuing physiological changes constitute a major part of the acute stress response. The other major player in the acute stress response is the hypothalamic-pituitary-adrenal axis.

What does "fight or flight" mean?

The term "fight or flight" describes a mechanism in the body that enables humans and animals to mobilize a lot of energy rapidly in order to cope with threats to survival.

How does it work?  A threat is perceived  The autonomic nervous system automatically puts body on alert.  The adrenal cortex automatically releases stress hormones.  The heart automatically beats harder and more rapidly.  Breathing automatically becomes more rapid.  Thyroid gland automatically stimulates the metabolism.  Larger muscles automatically receive more oxygenated blood.  The important thing to take away is that the fight or flight response is an automatic response.

How will knowing the "fight or flight" response help me with my stress?

For some people, knowing that the "butterflies" in their stomach or the muscle tension in their neck is part of the body's normal response to stress can help them feel empowered to make changes. Understanding the physiological mechanism of the fight or flight response can provide people a sense that the "machinery" of the body can be manipulated in a healthy, adaptive way to respond to stress.

STRESS It can be defined as heightened mind-body reaction to stimuli inducing fear or anxiety in the individual.

Stressful situations : Divorce, unpleasant work conditions, widowhood, unemployment etc SOCIAL STRESS RESEARCH FOCUS ON ⁻ How stress affects the mind and body ⁻ How to identify the warning signs of stress ⁻ How to develop good stress-management tech. ⁻ When to seek professional help

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---MICRO LEVEL--C. Cooley --- Looking-Glass Self W. Thomas --- Definition of the situation E. Goffman --- Life as theatre ---MACRO LEVEL--A. Durkheim --- Functionalism The functionalist perspective attempts to explain social institutions as collective means to meet individual and social needs. It is sometimes called structural-functionalism because it often focuses on the ways social structures (e.g., social institutions) meet social needs.

Functionalism draws its inspiration from the ideas of Emile Durkheim. Durkheim was concerned with the question of how societies maintain internal stability and survive over time. He sought to explain social stability through the concept of solidarity, and differentiated between the mechanical solidarity of primitive societies and the organic solidarity of complex modern societies. According to Durkheim, more primitive or traditional societies were held together by mechanical solidarity; members of society lived in relatively small and undifferentiated groups, where they shared strong family ties and performed similar daily tasks. Such societies were held together by shared values and common symbols. By contrast, he observed that, in modern societies, traditional family bonds are weaker; modern societies also exhibit a complex division of labor, where members perform very different daily tasks. Durkheim argued that modern industrial society would destroy the traditional mechanical solidarity that held primitive societies together. Modern societies however, do not fall apart. Instead, modern societies rely on organic solidarity; because of the extensive division of labor, members of society are forced to interact and exchange with one another to provide the things they need.

The functionalist perspective continues to try and explain how societies maintained the stability and internal cohesion necessary to ensure their continued existence over time. In the functionalist perspective, societies are thought to function like organisms, with various social institutions working together like organs to maintain and reproduce them. The various parts of society are assumed to work together naturally and automatically to maintain overall social equilibrium. Because social institutions are functionally integrated to form a stable system, a change in one institution will precipitate a change in other institutions. Dysfunctional institutions, which do not contribute to the overall maintenance of a society, will cease to exist.

DIFFERENCE IN MACRO & MACRO LEVEL THEORIES There are many differences between macro and micro-level theories. Micro-level focuses on individuals and their interactions. For example the relationship between adult children and their parents, or the effect of negative attitudes on older people. Some criticize on micro-level theories because they focus on what older people do rather than on social conditions and policies that cause them to act the way they do. Macro-level focuses more upon social structure, social processes and problems, and their interrelationships. For example the effects of industrialization on older people's status, or how gender and income affect older people's well being. This approach tends to minimize people's ability to act and overcome the limits of social structures. Both micro and macro-level theories can take one of three perspectives which include: interpretive perspective, normative, and conflict.

Normative perspective says rules and status exist in society to provide social control or social order.

Social order is necessary for survival. This perspective focuses upon macro-level. For example 18 | P a g e

structural-functionalism, role theory, modernization theory, and age-stratification.

Interpretive perspective says that the social world is created in an ongoing manner, via social interaction. How do we relate to each other on a day-to-day basis? It focuses upon micro-level.

Conflict perspective deals with macro and some micro levels. Causes of poverty, health disparities, distribution of life chances via, social class, and gender.

Micro level perspectives is the study of small scale structures and processes in society. It says explanations of social life and social structures are to be found at the individual level or in social interaction. George Mead said that objects and events have no meaning in themselves. Rather, people give them meaning through daily interaction. For example: gray hair is a sign of wisdom in one.

People give meanings to objects then base their actions on these meanings like some people will refuse to wear a hearing aid because it symbolizes decrepitude and weakness. Some examples of micro-level theories include symbolic interactionism, social phenomenology, and exchange theory.

Micro level theories are role theories. For example: understanding adjustment to getting older.

Elderly people are more likely to loose roles than acquire new ones. Macro level theories include age stratification theory. It focuses upon flow of age cohorts through the life cycle.

SYMBOLIC INTERACTIONISM the individual as a creative, thinking organism who is able to choose his or her behavior instead of reacting more or less mechanically to the influence of social processes. It assumes that all behavior is self-directed on the basis of symbolic meanings that are shared, communicated, and manipulated by interacting human beings in social situations.

Symbolic interactionism is a sociological perspective that is influential in many areas of the sociological discipline. It is particularly important in microsociology and social psychology. Symbolic interactionism is derived from American pragmatism and particularly from the work of George Herbert Mead.

Sociologists working in this tradition have researched a wide range of topics using a variety of research methods. However, the majority of interactionist research uses qualitative research methods, like participant observation, to study aspects of (1) social interaction and/or (2) individuals' selves.

In hypothesizing the framework for the looking glass self, Cooley said, "the mind is mental" because "the human mind is social." Beginning as children, humans begin to define themselves within the context of their socializations. The child learns that the symbol of his/her crying will elicit a response from his/her parents, not only when they are in need of necessities such as food, but also as a symbol to receive their attention. Schubert references in Cooley's On Self and Social Organization, "a growing solidarity between mother and child parallels the child's increasing competence in using significant symbols. This simultaneous development is itself a necessary prerequisite for the child's ability to adopt the perspectives of other participants in social relationships and, thus, for the child's capacity to develop a social self." The words "good" or "bad" only hold relevance after one learns the connotation and societal meaning of the words.

George Herbert Mead described self as "taking the role of the other," the premise for which the self is actualized. Through interaction with others, we begin to develop an identity about who we are, as well as empathy for others. This is the notion of, 'Do unto others, as you would have them do unto you.' In respect to this Cooley said, "The thing that moves us to pride or shame is not the mere 19 | P a g e

mechanical reflection of ourselves, but an imputed sentiment, the imagined effect of this reflection upon another's mind." (Cooley 1964) Anton Chekhov: The Death of a government clerk A clerk who finds him self at an art event, where he happens to be seated behind a VIP. Shortly afterwards, the clerk sneezes and spatters all over the VIP's bald head. His life changes from that point on. When he becomes totally occupied with an obsessive idea to show his apology and respect to the VIP. He frequently tries to apologize. Following the VIP from his office to his home. When he gets no attention from the VIP, he becomes totally depressed and starts writing him a letter of his sincere apology. This letter consumes him all night and by the end he collapses and dies on his desk while writing his last line.

C.COOLEY :: Looking – Glass Self Our self-concepts are the result of social interaction in which we see ourselves reflected in other people.

- Each to each a looking glass, reflects the other that doth pass.  THREE BASIC COMPONENTS (1) We see ourselves in our imagination as we think we appear to the other person (2) We see in our imagination the other person’s judgment of our appearance (3) As a result of what we see in our imagination about how we are viewed by the other person, we experience some sort of self-feeling, such as pride or humiliation.  Contribution ---- an individual’s perception of himself or herself as a social object is related to the reaction of other people.

----stress could result from the failure of the observer to reflect a self-image consistent with that of the subject.  Hsiao- Tung Fei: Chinese anthropologist and sociologist I look people look me The looking-glass self is a social psychological concept, created by Charles Horton Cooley in 1902 (McIntyre 2006), stating that a person's self grows out of society's interpersonal interactions and the perceptions of others. The term refers to people shaping their self-concepts based on their understanding of how others perceive them. Cooley clarified that society is an interweaving and interworking of mental selves. The term "looking glass self" was first used by Cooley in his work, Human Nature and the Social Order in 1902 The looking-glass self begins at an early age and continues throughout the entirety of a person’s life as one will never stop modifying their self unless all social interactions are ceased. Some sociologists believe that the concept wanes over time. Others note that only a few studies have been conducted with a large number of subjects in natural settings.

There are three main components of the looking-glass self (Yeung, et al. 2003).

1. We imagine how we must appear to others.

2. We imagine and react to what we feel their judgment of that appearance must be.

3. We develop our self through the judgments of others.

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W.THOMAS :: DEFINITION OF THE SITUATION So long as definitions of a social situation remain relatively constant, behavior will generally be orderly.

However, when rival definitions appear and habitual behavior becomes disrupted, a sense of disorganization and uncertainty may be anticipated.

The Thomas theorem is a theory of sociology which was formulated in 1928 by W. I. Thomas and D. S. Thomas (1899–1977): “If men define situations as real, they are real in their consequences.”

In other words, the interpretation of a situation causes the action. This interpretation is not objective.

Actions are affected by subjective perceptions of situations. Whether there even is an objectively correct interpretation is not important for the purposes of helping guide individuals' behavior.

In 1923, Thomas stated more precisely that any definition of a situation will influence the present. Not only that, but—after a series of definitions in which an individual is involved—such a definition also "gradually [influences] a whole life-policy and the personality of the individual himself."[2] Consequently, Thomas stressed societal problems such as intimacy, family, or education as fundamental to the role of the situation when detecting a social world "in which subjective impressions can be projected on to life and thereby become real to projectors.

Movie: Awaara--- a 1951 Hindi film Actor: Raj Kapoor, Raju lives as a derelict as a result of being estranged from his bitter father, a district judge, who threw Raju's mother out of the house years ago. Raju shacks up with a Dacoit (pickpocket bandit) as his surrogate father only to realize that the man is actually responsible for the original misunderstanding between his parents. Raju kills him, and then tries killing his father, but fails, is arrested, and is taken to court right before his very own father, who presides there as the Judge. Raju has his childhood girlfriend as his legal representative, and the onus is now on his father, who must pass judgment without showing any personal sentiment.

E. GOFFMAN :: Life as theatre social interaction may be likened to a theater, and people in everyday life to actors on a stage, each playing a variety of roles. A role serves as a script, supplying dialogue and action for the characters. As on the stage, people manage settings, clothing, words, and nonverbal actions to give a particular impression to others, each individual’s “performance” as a person’s efforts is to create specific impressions in the minds of others.

The Presentation of Self in Everyday Life Dramaturgy is a sociological perspective starting from symbolic interactionism and commonly used in microsociological accounts of social interaction in everyday life. The term was first adapted into sociology from the theatre by Erving Goffman, who developed most of the related terminology and ideas in his 1959 book, The Presentation of Self in Everyday Life. Kenneth Burke, whom Goffman would later acknowledge as an influence, had earlier presented his notions of dramatism in 1945, which in turn derives from Shakespeare. However, the fundamental difference between Burke's and Goffman's view is that Burke believed that life was in fact theatre, whereas Goffman viewed theatre 21 | P a g e

as a metaphor. If we imagine ourselves as directors observing what goes on in the theatre of everyday life, we are doing what Goffman called dramaturgical analysis, the study of social interaction in terms of theatrical performance In dramaturgical sociology it is argued that the elements of human interactions are dependent upon time, place, and audience. In other words, to Goffman, the self is a sense of who one is, a dramatic effect emerging from the immediate scene being presented. Goffman forms a theatrical metaphor in defining the method in which one human being presents itself to another based on cultural values, norms, and beliefs. Performances can have disruptions (actors are aware of such), but most are successful. The goal of this presentation of self is acceptance from the audience through carefully conducted performance. If the actor succeeds, the audience will view the actor as he or she wants to be viewed WHAT OUR DAILY INTERACTION DEPEND ON? In order for social interaction to be possible, people need information about other participants in a joint act.  Such information is communicated through a person’s appearance; a person’s experience with other similar individuals; the social setting; and most important, the information a person communicates about himself or herself through words and actions.

(This information is significant because it helps to define a situation by enabling others to know in advance what a person expects of them and what they may expect of him or her. ) People live in worlds of social encounters in which they act out a line of behavior, a pattern of verbal and nonverbal acts by which individuals express their view of a situation and their evaluation of the participants, particularly themselves. The positive social value individuals claim for themselves by the line that others assume they have taken during a particular encounter is termed a “FACE”. This face is an image of self projected by the individual to other people. One’s face is one’s most personal possession and is the center of security and pleasure……..

------ WRONG FACE when information about that person’s social worth cannot be integrated into his or her line of behavior ------- OUT OF FACE when he or she participates in an encounter without the line of behavior that participants in the particular situation would be expected to take.

"Face" is central to sociology and sociolinguistics. Martin C. Yang analyzed eight sociological factors in losing or gaining face: the kinds of equality between the people involved, their ages, personal sensibilities, inequality in social status, social relationship, consciousness of personal prestige, presence of a witness, and the particular social value/sanction involved.

The sociologist Erving Goffman introduced the concept of "face" into social theory with his (1955) article "On Face-work: An Analysis of Ritual Elements of Social Interaction" and (1967) book Interaction Ritual: Essays on Face-to-Face Behavior. According to Goffman's dramaturgical perspective, face is a mask that changes depending on the audience and the variety of social interaction. People strive to maintain the face they have created in social situations. They are emotionally attached to their faces,

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so they feel good when their faces are maintained; loss of face results in emotional pain, so in social interactions people cooperate by using politeness strategies to maintain each other's faces.

"Face" is sociologically universal. People "are human", Joseph Agassi and I. C. Jarvie (1969:140) believe, "because they have face to care for – without it they lose human dignity." Ho elaborates: The point is that face is distinctively human. Anyone who does not wish to declare his social bankruptcy must show a regard for face: he must claim for himself, and must extend to others, some degree of compliance, respect, and deference in order to maintain a minimum level of effective social functioning. While it is true that the conceptualization of what constitutes face and the rules governing face behavior vary considerably across cultures, the concern for face is invariant. Defined at a high level of generality, the concept of face is a universal. (1976:881-2) The sociological concept of face has recently been reanalysed through consideration of the Chinese concepts of face (mianzi and lian) which permits deeper understanding of the various dimensions of experience of face, including moral and social evaluation, and its emotional mechanisms (Qi 2011).

The symbolic interaction perspective, as reflected in the work of Cooley, Thomas and Goffman, contributes to our understanding of stress by identifying the key variable in the stress experience: the perception of the individual. How people feel about themselves, define salutation, or manage impressions can lead to the creation of stressful condition.  The ability of an individual to cope with a crisis situation will be strongly related to socialization experiences that have taught the person how to cope with new situations.  People typically cope with stress by trying to change their situation, manage the meaning of the situation, or keep the symptoms of stress within manageable bounds.

Funtionalism focuses on the influence of the larger society on individuals.

Durkheim concerned with those social processes and constraints that integrate individuals into the larger social community.  When a society was strongly integrated, it held individuals firmly under its control. Individuals were integrated into a society as a result of their acceptance of community values reinforced through social interaction with others believing in the same value system.  In explaining the differential rates of suicide among various religious and occupational groupings, he suggested that suicide was not entirely a matter of free choice by individuals.  He believed that suicide was a social fact explainable in terms of social causes.

SUICIDE, 1897 – 3 types  EGOISTIC SUICIDE people become detached from society and suddenly on their own, are overwhelmed by the resulting stress  ANOMIC SUICIDE people suffer a sudden dislocation of normative systems where their norms and values are no longer relevant, so that controls of society no longer restrain them from taking their lives

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 ALTRUISTIC SUICIDE people feel themselves so strongly integrated into a demanding society that their only escape seems to be suicide Examples of Suicide  Patton, US general (was the commander of US army during the world wars)  Sun-Kyung Cho (was a killer)  Ma jiajue (convicted and executed for murdering his roommates)  A Hindu Sati (A Hindu Sutte [in ppt]) (burning of hindu widow) The significance of Durkheim’s orientation toward social processes for the understanding of the stress phenomenon extends well beyond the issue of suicide, his notion of the capability of the larger society to create stressful situations where people are forced to respond to conditions not of their own choosing.

The advantage of macro-level forms of analysis like functionalism, however, is that this approach shows how social and economic conditions beyond the direct influence or control of the average person can create stressful circumstances that force people to respond to them. For vulnerable people, the stressful circumstances may promote ill health.

SUCIDAL BEHAVIOUR among Chinese young people The real measure of health is not the absence of disease but the ability of the human organism to function effectively within a given environment. Thus, embarrassment and psychological discomfort can be socially painful, the effects of stress can transcend the social situation and cause physiological damage as well.

These four types of suicide are based on the degrees of imbalance of two social forces: • SOCIAL INTEGRATION • MORAL REGULATION Durkheim noted the effects of various crises on social aggregates – war, for example, leading to an increase in altruism, economic boom or disaster contributing to anomie EGOISTIC SUICIDE • Where the individual is peripherally integrated into a society. The termination of their life is perceived to have little impact on others around them.

• Example :: Durkheim discovered was that of unmarried people, particularly males, who, with less to bind and connect them to stable social norms and goals, committed suicide at higher rates than married people.

ALTRUSTIC SUICIDE • This signifies cases where the individual is extremely ‘committed’ to society and this commitment can be reflected in the suicide act itself. Think back to the case of ‘hero’ suicides (the soldier, etc.). Do suicide bombers fit here?

• Example :: Durkheim stated that in an altruistic society there would be little reason for people to commit suicide. He stated one exception, namely when the individual is expected to kill themselves on behalf of society – a primary example being the soldier in military service.

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ANOMIC SUICIDE • This type of suicide revolves around norms/normlessness. In this condition, there is weak/ineffectual social regulation and the individual is most often brought into a stat of anomie by dramatic/sudden economic or social changes/disturbances.

• Example :: when man goes through extreme changes in wealth; while this includes economic ruin, it can also include windfall gains – in both cases, previous expectations from life are brushed aside and new expectations are needed before he can judge his new situation in relation to the new limits.

FATALISTIC SUICIDE • In this situation, social regulation is completely ingrained in the individual. The individual perceives that there is no real possibility of changing/coping with the oppressive order/discipline of the society. The individual feels that the only way to escape this state is suicide.

• Example :: within a prison; some people might prefer to die than live in a prison with constant abuse and excessive regulation that prohibits them from pursuing their desires.

Durkheim's concept Durkheim (1858–1917) claimed that deviance was in fact a normal and necessary part of social organization. When he studied deviance he stated four important functions of deviance.

1. "Deviance affirms cultural values and norms. Any definition of virtue rests on an opposing idea of vice: There can be no good without evil and no justice without crime".

2. Deviance defines moral boundaries, people learn right from wrong by defining people as deviant.

3. A serious form of deviance forces people to come together and react in the same way against it.

4. Deviance pushes society's moral boundaries which, in turn leads to social change.

STRESS ADAPTATION (1) the stimulus situation (2) an individual’s capacity to deal with the stimulus situation (3) the individual’s preparation by society to meet problems (4) the influence of society’s approved modes of behavior.

Social stress research focus on  How stress affects the mind and body  How to identify the warning signs of stress  How to develop good stress-management tech.  When to seek professional help Assessing the effect, be necessary to know (1) the nature of the threat itself (2) the objective social environment (3) the psychological style and personality (4) the individual subjective definition (5) the social influences (6) the duration of the threat

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III. Illness Behavior and Sick Role  DISEASE is considered an adverse physical state, consisting of a physiological dysfunction within an individual  ILLNESS is a subjective state, pertaining to an individual’s psychological awareness of having a disease and usually causing that person to modify his or her behavior  SICKNESS is a social state, signifying an impaired social role for those who are ill.

What is illness behavior? the activity undertaken by a person who feels ill for the purpose of defining that illness and seeking relief from it.

The way in which symptoms are perceived, evaluated, and acted upon by a person who recognizes some pain, discomfort or other signs of organic malfunction The concept of illness behavior was largely defined and adopted during the second half of the twentieth century. Broadly speaking, it is any behavior undertaken by an individual who feels ill to relieve that experience or to better define the meaning of the illness experience. There are many different types of illness behavior that have been studied. Some individuals who experience physical or mental symptoms turn to the medical care system for help; others may turn to self-help strategies; while others may decide to dismiss the symptoms. In everyday life, illness behavior may be a mixture of behavioral decisions.

For example, an individual faced with recurring symptoms of joint pain may turn to complementary or alternative medicine for relief. However, sudden, sharp, debilitating symptoms may lead one directly to a hospital emergency room. In any event, illness behavior is usually mediated by strong subjective interpretations of the meaning of symptoms. As with any type of human behavior, many social and psychological factors intervene and determine the type of illness behavior expressed in the individual.

Why people seek medical care by different ways?

- Religious - Self Treatment - Transportation - Finance - Low medical facility - Unfaithful towards doctors Much data support a relationship between individual interpretation if deviation in physical functioning and social and psychological factors.

Medical sociologists and other behavioral scientists want to find out how help-seeking behavior for medical care relates to the wider range of behaviors in which people attempt to obtain services generally.

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Two important concepts  Illness recognition determined by how common the occurrence of the illness is in a given population and how familiar people are with its symptoms.  Illness danger refers to the relative predictability of the outcome of the illness and the amount of threat or loss that is likely to result.

Social-Psychological Models of illness Behavior (1) visibility and recognition of symptoms (2) The perceived seriousness of symptoms (3) the extent to which symptoms disrupt family, work and other social activities (4) the frequency and persistence of symptoms (5) amount of tolerance for the symptoms (6) available information, knowledge, and cultural assumptions (7) basic needs that lead to denial (8) other needs competing with illness responses (9) competing interpretations that can be given to the symptoms once they are recognized (10)availability of treatment resources, physical proximity, and psychological and financial costs of taking action The central theme that forms a backdrop for Mechanic’s general theory of help-seeking is that illness behavior is a culturally and socially learned response. A person responds to symptoms according to his or her definition of the situation. This definition may be influenced by the definitions of others but is largely shaped by learning, socialization, and past experience as mediated by a person’s social and cultural background.

Shortcomings Although Mechanic’s theory explains the decision-making process leading up to contacting a physician, it does not explain what happens after the initial contact is made. Nor does the theory detail the manner in which the determinants and levels of definition interact with one another.

SIGNIFICANCE The social-psychological models of help-seeking behavior have emphasized the importance of selfperception as it relates to a person’s understanding of a particular symptom. Especially important is whether the person perceives himself or herself as able to perform normal social roles.

“It is not the symptoms themselves that are significant in comprehending illness behaviour, but the way in which they are defined.”

PARSON’S SICK ROLE Parsons was a functionalism sociologist, he saw being sick as a disturbance in the “normal” condition of the human being, both biologically and socially.

ROLE ---a set of connected behaviors, rights, obligations, beliefs, norms, as conceptualized by people in a social situation.

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---It is an expected or free or continuously changing behavior and may have a given individual social status or social position.

---It is vital to both functionalist and interactionist understandings of society. behavior & obligations expected from a person occupying a particular social position. e.g. “student”, “daughter”, “wife”, “mother”, “nurse”

Role conflict

TALCOTT PARSONS (1951)  Illness is disruptive for society as sick people are not able to fulfill their normal roles. It is a form of deviance.  Society instituted a special role for sick people that functions to control amount of illness in society and to return sick people back to state of health as quickly as possible The ASSUMPTION of the sick role ------Being sick is not a deliberate and knowing choice of the sick person, though illness may occur as a result of motivated exposure to infection or injury.

----- Sickness is dysfunctional because it presents a mode of response to social pressure that permits the evasion of social responsibilities.

------ Being sick, is not just experiencing the physical condition of a sick state; rather, it constitutes a social role A person may desire to retain the sick role more or less permanently because of what Parsons calls a “secondary gain,” which is the exemption from normal obligations and the gaining of other privileges commonly accorded to the sick. Hence, medical practice becomes a mechanism by which a social system seeks to control the illness of its deviant sick by returning them to as normal state of functioning as possible.

4 basic categories :: Two rights 1、The sick role is exempt from “normal” social roles.

2、The sick person is not responsible for his or her condition Two obligation 3、The sick person should try to get well 4、The sick person should seek technically competent help and cooperate with the physician SICK ROLE Sick role is a term used in medical sociology regarding sickness and the rights and obligations of the affected. It is a concept created by American sociologist Talcott Parsons in 1951.

Parsons was a functionalist sociologist, who argued that being sick means that the sufferer enters a role of 'sanctioned deviance'. This is because, from a functionalist perspective, a sick individual is not a productive member of society. Therefore this deviance needs to be policed, which is the role of the medical profession. Genuinely, Parsons argued that the best way to understand illness sociologically is to view it as a form of deviance which disturbs the social function of the society.

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The general idea is that the individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. ‘Being Sick’ is not simply a ‘state of fact’ or ‘condition’, it contains within itself customary rights and obligations based on the social norms that surround it. The theory outlined two rights of a sick person and two obligations:  Rights: o The sick person is exempt from normal social roles o The sick person is not responsible for their condition  o o

Obligations: The sick person should try to get well The sick person should seek technically competent help and cooperate with the medical professional

There are three versions of sick role: 1. Conditional 2. Unconditionally legitimate 3. Illegitimate role: condition that is stigmatized by others MEDICINE AS AN INSTITUTION OF SOCIAL CONTROL Parson’s concept of the sick role has expressed concern that medicine is indeed an institution for the control of deviance and is taking responsibility for an ever greater proportion of behaviors defined as DEVIANT. medical practice becomes a mechanism by which a social system seeks to control the illness of its deviant sick by returning them to as normal state of functioning as possible.

Parson’s sick-role model is a middle-class pattern of behavior, it emphasizes the merits of individual responsibility and the deliberate striving toward good health and a return to normality. It is oriented to the middle-class assumption that rational problem solving is the only viable behavior in the face of difficulty and that effort will result in positive gain. However, it fails to take into account what it is like to live in an environment of poverty where success is the exception to the rule.

CRITICISM (1) behavioral variation, (2) types of diseases, (3) the patient-physician relationship (4) the sick role’s middle-class orientation CONCLUSION In the light of the trend toward classifying more and more social problems as medical problems, Parson’s explanation of the function of medicine has broad implications for the future treatment of deviants in our society. Parsons views medicine as a mechanism by which a society attempts to control deviance and maintain social stability. Thus, illness is a form of deviance and that as such it is necessary for a society to return the sick to their normal functionaling.

In sociology, deviance describes an action or behavior that violates social norms, including a formally enacted rule (e.g., crime), as well as informal violations of social norms (e.g., rejecting folkways and mores). It is the purview of sociologists, psychologists, psychiatrists, and criminologists to study how these norms are created, how they change over time and how they are enforced.

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Norms are rules and expectations by which members of society are conventionally guided. Deviance is an absence of conformity to these norms. Social norms differ from culture to culture. For example, a deviant act can be committed in one society that breaks a social norm there, but may be normal for another society.

Labeling theory to health and illness

WHY in some societies, an individual may be regarded (labeled) as sick, while in other societies an individual with the same physical condition is not regarded (labeled) as sick ?

Labeling theory argues that the labeling of someone as “deviant” will make the person adopt the deviant identity eventually “Badness” versus “Sickness”  Substance abuse  Suicide  Personality disorders  Sexual deviance  Compulsive gambling  Religious or political extremism

Badness = deviant (should be punished) Sickness = not bad, but sick (should be treated)

Disease may be a biological state existing independently of human knowledge, sickness is a social state created and formed by human perception. When a physician diagnoses a human’s condition as illness, the diagnosis can and often does change the sick person’s behavior. Thus, illness is seen by labeling theory as a condition created by human beings in accordance with their understanding of the situation.

Components of Sick Role  Promotes individual health  Social control of occupancy of status ‘sick’ o Doctor as gatekeeper (legitimates illness and occupancy of sick role) o Privileges dependent on duties  Promotes health of society o Controls number of people opting out of normal roles & responsibilities o Returns sick people to health Difficulty with Sick role  Difficult to apply the sick role theory to chronic illness  Permanent state  The requirement is to enhance functioning and not encourage dependency  Friedson (1960) pointed out that physicians’ social functions extend far beyond the policy of sick role and process Freidson considers the physician as the creator of the social possibility of acting sick, medicine has the power to create illness as an “official social role”.

Freidson wants to investigate how the illness diagnosis affects both the individual’s behavior and the behavior of others toward him or her.

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IV. Practitioners : physicians The main content are :: o physicians o the professionalization of physicians o the physician in a changing society o The physician-patient relationship The Hippocratic contributions  scientific medicine  the basics of medical ethics and morality Hippocrates sought to change this conception into one in which deviations from normal physiological functioning were viewed as the major causes of illness. He felt that physicians were to be competently trained practitioners who treated those deviations systematically, morally, and ethically in their attempt to restore the patient’s health.

OATH I SWEAR by Apollo Physician, by Asclepius, by Health, by Panacea and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture. To hold my teacher in this art equal to my own parents ; to make him partner in my livelihood ; when he is in need of money to share mine with him ; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture ; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician's oath, but to nobody else.

I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.

Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I transgress it and forswear myself, may the opposite befall me.

OUT DATED  The first principle---- the close-knit, secretive nature of the brotherhood of physicians  The second principle ---- proper medical treatment  The third principle ---- avoiding any wrongdoing to, or exploitation of, their patients.  the fourth principle---- sacred of the patient-practitioner relationship DOCTOR – PATIENT RELATIONSHIP The doctor–patient relationship is central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease. The doctor–patient relationship forms one of the foundations of contemporary medical ethics. Most universities teach students from 31 | P a g e

the beginning, even before they set foot in hospitals, to maintain a professional rapport with patients, uphold patients’ dignity, and respect their privacy.

The following aspects of doctor-patient relationship are ::  Informed consent :: The default medical practice for showing respect to patients is for the doctor to be truthful in informing the patient of their health and to be direct in asking for the patient's consent before giving treatment Placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient. Sometimes patients given a placebo treatment will have a perceived or actual improvement in a medical condition, a phenomenon commonly called the placebo effect or placebo response. Does giving a sugar pill lead to an undermining of trust between doctor and patient? Is deceiving a patient for his or her own good compatible with a respectful and consent-based doctor–patient relationship?  Shared decision making Shared decision making is the idea that as a patient gives informed consent to treatment, that person also is given an opportunity to choose among the treatment options according to their own treatment goals and wishes. A practice which is an alternative to this is for the doctor to make a person's health decisions without considering that person's treatment goals or having that person's input into the decision-making process.  Physician superiority The physician may be viewed as superior to the patient simply because the physician has the knowledge and credentials and is most often the one that is on home ground.

The physician–patient relationship is also complicated by the patient's suffering (patient derives from the Latin patior, "suffer") and limited ability to relieve it on his or her own, potentially resulting in a state of desperation and dependency on the physician.  Benefiting or pleasing A dilemma may arise in situations where determining the most efficient treatment, or encountering avoidance of treatment, creates a disagreement between the physician and the patient, for any number of reasons. In such cases, the physician needs strategies for presenting unfavorable treatment options or unwelcome information in a way that minimizes strain on the doctor–patient relationship while benefiting the patient's overall physical health and best interests.  Formal or casual There may be differences in opinion between the doctor and patient in how formal or casual the doctor–patient relationship should be.

For instance, according to a Scottish study, patients want toK be addressed by their first name more often than is currently the case. In this study, most of the patients either liked (223) or did not mind (175) being called by their first names. Only 77 disliked it, most of whom were aged over 65. On the other hand, most patients don't want to call the doctor by his or her first name  Transitional care Transitions of patients between health care practitioners may decrease the quality of care in the time it takes to reestablish proper doctor–patient relationships. Generally, the doctor– 32 | P a g e

patient relationship is facilitated by continuity of care in regard to attending personnel. Special strategies of integrated care may be required where multiple health care providers are involved, including horizontal integration (linking similar levels of care, , e.g. multiprofessional teams) and vertical integration (linking different levels of care, e.g. primary, secondary and tertiary care).  Other people present : When visiting a health provider about sexual issues, having both partners of a couple present, but may also prevent the disclosure of certain subjects & according to one report, increases the stress level.

What role should the physician's personal feelings and beliefs play in the physician-patient relationship?

Occasionally, a physician may face requests for services, such as contraception or abortion, which raise a conflict for the physician. Physicians do not have to provide medical services in opposition to their personal beliefs. In addition, a nonjudgmental discussion with a patient regarding her need for the service and alternative forms of therapy is acceptable. However, it is never appropriate to proselytize. While the physician may decline to provide the requested service, the patient must be treated as a respected, autonomous individual. Where appropriate, the patient should be provided with information about how to obtain the desired service.

What can hinder physician-patient communication?

There may be many barriers to effective physician-patient communication. Patients may feel that they are wasting the physician's valuable time; omit details of their history which they deem unimportant; be embarrassed to mention things they think will place them in an unfavorable light; not understand medical terminology; or believe the physician has not really listened and, therefore, does not have the information needed to make good treatment decisions.

Several approaches can be used to facilitate open communication with a patient. Physicians should:  sit down  attend to patient comfort  establish eye contact  listen without interrupting  show attention with nonverbal cues, such as nodding  allow silences while patients search for words  acknowledge and legitimize feelings  explain and reassure during examinations  ask explicitly if there are other areas of concern How has the physician-patient relationship evolved?

The historical model for the physician-patient relationship involved patient dependence on the physician's professional authority. Believing that the patient would benefit from the physician's actions, a paternalistic model of care developed. Patient's preferences were generally not elicited, and were over-ridden if they conflicted with the physician’s convictions about appropriate care.

During the second half of the twentieth century, the physician-patient relationship has evolved towards shared decision making. This model respects the patient as an autonomous agent with a right to hold views, to make choices, and to take actions based on personal values and beliefs. Patients are acknowledged to be entitled to weigh the benefits and risks of alternative treatments, including the alternative of no treatment, and to select the alternative that best promotes their own values.

TO BE DOCTOR WHAT KIND OF FEATURES YOU MUST HAVE ?

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Physician’s professional attitude & demeanor o technical specificity o affective neutrality o universalism o functional specificity TECHNICAL SPECIFICITY reflects the general professional credentials of achieved status and autonomy, this credentials are derived from the extensive technical training and competence that qualify the practitioner. It also reflects the symbolic portrayal of the practitioner as cultural value---health. As the symbolic representative of health, the practitioner’s technical competency and prestige are typified by the awe and reverence by public.

AFFECTIVE NEUTRALITY implies social distancing, enabling the practitioner to prevent subjectivity from entering into the objective treatment process. If the practitioner becomes emotionally too close to the patient, he or she might begin to allow that emotional closeness to influence or override the objective and technical considerations of medical treatment.

The practitioners should exhibit sympathy but not empathy with the patient, understanding the patient’s feelings but not feeling them.

UNIVERSALISM Reflects the fact that the professional practitioner is obligated to treat all patients alike, regardless of their social characteristics. In other words, the practitioner should consider all patients as equals, to be given the same quality of treatment and care that their particular illness requires.

FUNCTIONAL SPECIFICITY Limits the practitioner’s behavioral arena to strictly medical matters. If this restriction is not maintained, two complications may result.

First, the patient might not receive the best possible nonmedical care. Second, the patient might be open to exploitation by the practitioner.

The making of a physician o Premed program o Basic science years o The clinical years o The internship o The residency The flow of perspectives held by medical students Basic science years First year

Initial perspective (Learn it all) Provisional perspective (You can’t do it all)

Second year

Practical perspective (Learn what the faculty want you to learn) 34 | P a g e

Clinical years

Third year

Responsibility and experience perspective

Fourth year

Practical perspective

Postgraduate and future years

The dilemma of independence and medical responsibility

SUBCULTURE : the result of medical training  TWO TRAITS  Ability to be emotionally detached from the patient  To tolerate uncertainty 3 types of UNCERTAINTY - First, an awareness of not being able to learn everything about medicine - Second, the realization that limitations existed in medical knowledge and techniques.

- Third, the problems distinguishing between personal ignorance and the limits of available knowledge.

The physician IN A CHANGING SOCIETY  The coming of corporation  The coming of the physician surplus THE COMING OF CORPORATION This transformation—so extraordinary in view of medicine’s past, yet so similar to changes in other industries—has been in the making, ironically enough, since the passage of Medicare and Medicaid. By making health care lucrative for providers, public financing made it exceedingly attractive to investors and set in motion the formation of large-scale corporate enterprises. Nursing homes and hospitals had a long history of proprietary ownership, but almost entirely as small individually owned and operated enterprises. One of the first developments in the corporate transformation was the purchase of these facilities by new corporate chains. This, in a sense, was the first beach-head of for-profit corporations in the delivery of medical care.

- the Social transformation of American medicine, 1982,Paul Starr

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Outline of Medical Sociology TOPIC 1

Evolution of the relationship of health and social behavior EIGHT IMPORTANT STAGE IN MORDERN MEDICINE  Hygiea Philosophy  Asclepius worship  Hippocrates era  Church Bound  Descartes and rationalism of the 17th century  The rapid development era of public health  Pasteur, Koch, specific etiology and germ theory  Return to the “whole person”  Reemergence of Infectious Diseases HYGEIA’S PHILOSOPHY In the natural order of things, health was to be considered a positive attribute to which men were entitled, provided they governed their lives wisely.

ASCLEPIUS WORSHIP (The cult of Asclepius) he believed that the primary role of the physician was to treat disease, and by so doing to restore health. The restoration of health was accomplished by correcting the imperfections in the human body that were caused by the accidents of birth or life.

THE AGE OF HIPPOCRATES  First, demand a rational and systematic approach to patient care, rejecting the effects of supernatural phenomena.  Second, maintained that the mind and the body affect each other; they cannot be considered as independent entities.

THE CONSTRAITS OF THE CHURCH Church assumed control of and responsibility for the general areas of the mind and of the social problems of the day. Medicine was forced to return to treating the physical ailments of the individual, apart from mental disorders or adverse social factors.

DESCARTES ---arguing that a mind-body dichotomy did indeed exist and that each was independent of the other.

--- medicine should concentrate its efforts on the physical functioning of the body.

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THE UTOPIANS – HUMANITARIANISM They studied the link between lifestyle and health, pressing for uncontaminated food, air, water, and sanitary living conditions. “the most effective techniques to avoid disease came out of the attempts to correct by social measures the injustices and the ugliness brought about by industrialization .“

THE GERM THEORY For every disease, there is a specific pathogenic cause, the best method of treating the disease was to remove or control the cause within a biomedical framework.

RESULT OF THE GERM THEORY  A view of medicine dominated in physicians’ thinking ,“magic bullets” are used to shoot down and kill the disease.  patient identity as disease rather than as a person The Germ Theory.

Scientists developed the modern approach to understanding and controlling epidemic diseases during the last quarter of the nineteenth century. In 1862 French scientist Louis Pasteur (1822-1895) showed that airborne bacteria were the cause of fermentation, thus giving rise to the “germ theory,” which replaced an older theory that attributed diseases to environmental causes. In 1876 German scientist Robert Koch (1843-1910)—who was studying anthrax, a disease of sheep and cattle—demonstrated that specific diseases were caused by specific pathogens (the agents, such as bacteria or viruses, that cause disease), and in 1879 Pasteur found that he could use the bacilli (rod-shaped bacteria) that caused various diseases to vaccinate people against them, generalizing from the discovery of the smallpox vaccine by British physician Edward Jenner (1749-1823) in the late eighteenth century.

During the 1880s and 1890s scientists identified the pathogens responsible for many diseases, including cholera, diphtheria, tetanus, tuberculosis, and typhoid.

WHO Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

“WHOLE PERSON” Health must be defined in terms of the whole person. Further, treatment must be directed toward the whole person, which can include family members and significant others, not just toward the particular physiological pathology in the patient.

REEMERGENCE OF INFECTIOUS DISEASE Social conditions obviously play a major role in disease transmission; therefore, the study of social factors relevant to the prevention and spread of infectious diseases is likely to become an increasingly important area of investigation for medical sociologists in the twenty-first century.

DUALITY IN MORDERN MEDICINE  magic vs science  individual vs population  body vs spirit 37 | P a g e

 technical vs anthropological

THE SOCIAL SIGNIFICANCE OF MEDICAL SOCIOLOGY ESTABLISHMENT  Virchow: Medicine is a social science, and politics is nothing else but medicine on a large scale.  Sigerist：The goal of medicine is social and medicine is actually a social science.  Medical model from biomedicine to bio-psycho-social

MAIN ARGUMENTS BY VIRCHOW  society be directly responsible for human being’s health  people’s health improvement determined by their economic and social conditions  measures be taken must be both medical and social

HENRY E SIGERIST (1891 - 1957)  the most influential historian of medicine in the world.  transforming medical historiography and creating the sub discipline of medical sociology. > The place of the physician in modern society: ⁻ Medicine, usually regarded as a natural science, actually is a social science because its goal is social.

Its primary target must be to keep individuals adjusted to their environment as useful members of society, or to re-adjust them when they have dropped out as a result of illness. In combating disease the physician uses methods of the natural sciences everyday, but to a social end. ⁻ And so we are beginning to see the place that physician is holding in modern society. We see him as a scientist, educator and social worker ready to cooperate in teamwork, in close touch with the people he disinterestedly serves, a friend and leader who directs all his efforts towards the promotion of health and prevention of disease and becomes a therapist.

WHAT IS MEDICAL MODEL?  the term cited by psychiatrist R.D. in his The Politics of the Family and Other Essays (1971), the “ set of procedures in which all doctors are trained."  An approach to pathology that aims to find medical treatment for diagnosed symptoms and syndromes and treats the human body as a very complex mechanism.

BIOMEDICAL MODEL  Mind/Body dualism: Medicine should focus on measuring cell’s biochemical changes by precise technique, explain symptom, interfere changes to recover the health  Reductionism: disintegrates human body to different organ, cells and molecular, the physical and chemical changes at molecular levels can explain the causality of functional changes of body  Disease is regarded as a static result between its cause and effects Wikipedia The biomedical model of medicine has been around since the mid-nineteenth century as the predominant model used by physicians in diagnosing diseases. It has four core elements.

According to the biomedical model, health constitutes the freedom from disease, pain, or defect, thus making the normal human condition "healthy". The model's focus on the physical processes, such as the pathology, the biochemistry and the physiology of a disease, does not take into account the role of social factors or individual subjectivity. Unlike the biopsychosocial model, the biomedical model 38 | P a g e

does not consider diagnosis (that will affect treatment of the patient) to be the result of a negotiation between doctor and patient.

The biomedical model of health focuses on purely biological factors, and excludes psychological, environmental, and social influences. It is considered to be the leading modern way for health care professionals to diagnose and treat a condition in most Western countries.

THE POSSIBLE DEFECTIVES OF BIOCHEMICAL MODEL 1. Incorrect clinical diagnosis 2. Improper diagnostic measures 3. Ineffective treatments 4. Unnecessary hospitalization 5. Rising health care costs 6. Extended disability status

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TOPIC 2

Medical sociology: ORGIN, STATUS & TRENDS 1854 CHOLERA OUTBREAK IN LONDON The outbreak itself was arguably the deadliest in London's history -- it literally decimated the western side of Soho, killing more than ten percent of the population there in a matter of eight days.

JOHN SNOW (1813 - 1858)    

Snow’s map Waterborne Disease---common social behavior Social measure

Charles McIntile Elizabeth Blackwell James P.Warbass Bernard Stern NIMH Straus JOHN SNOW – THE FIRST EPIDEMIOLOGIST John Snow was a British physician, born on the 15th of March, 1813. Born in one of the poorest regions of York in the United Kingdom. John Snow apprenticed as a surgeon, before becoming a physician in 1850 and moving to London.

Now, before we get into the Broad Street Pump story, we have to consider the context of the time.

Pre-1900’s, the predominant theory behind disease transmission was the “Miasma theory.” In short, this theory suggested that diseases were spread through “bad air”. It was an elegant, but incorrect theory that suggested that particles from decomposed matter would become part of the air, and this “bad air” spread disease. This was before they discovered that cholera was spread through Vibrio cholerae in water, thus debunking the Miasma theory (although it remains as a spell in Final Fantasy).

As the summer of 1854 wound down, a major cholera outbreak struck Soho, a neighbourhood in London, England. From August 31st to September 3rd, 127 people died of Cholera. Within a week, 500 people had died and around one in seven people who developed cholera eventually died from it.

This all occurred within 250 yards of the Cambridge Street and Broad Street intersection.

John Snow came in and started his investigation.

He examined the neighbourhood, and talked to everyone he could. He was looking for an underlying theme that linked these people together. He suspected some contamination of the water, but couldn’t find any organic matter in it, which you would expect under the Miasma theory. However, the more he looked, the more it seemed like the pump was responsible. Almost all the cases of cholera occurred close to the Broad Street Pump. There were only 10 cases that were closer to another pump. Of these, 5 preferred the water from the Broad Street Pump (and got their water from the Broad Street Pump) and 3 were children who went to school near the Broad Street Pump. The last 40 | P a g e

two were unrelated, and likely just background levels of cholera in the population. This was pretty convincing, but Snow mapped it out to make sure that he was on the right track. You might recognize the map – it’s what we use for our blog banner here on Public Health Perspectives.

Snow provided more evidence for his theory that the pump was responsible for the cholera outbreak.

For example, there was a brewery on Poland Street where 535 people worked, that had a pump on the premises. However, while cholera raged outside, only 5 of these people developed it. He explained this by pointing out that those who worked at the brewery were allowed to drink some of the malt liquor they made – and the foreman suspected that they didn’t drink any water at all. And even if they did, they used the pump on site.

The evidence Snow presented in favour of his findings were too compelling for the local council to ignore, and while there was resistance to this finding, Snow had said enough for the local council to remove the pump handle, halting the spread of the disease. But, as Snow later pointed out, he couldn’t be sure that this stopped the disease, and the incidence of the disease might have been declining. But the end result was the same – cholera cases went down.

That is not to say that everyone believed him. The council may have taken the pump down, but it wasn’t until 1885, when Robert Koch identified V. cholerae as the bacillus causing the disease that he had proof of his theory. He was right, but wasn’t around to see this discovery himself.

John Snow died on the 16th of June 1858, at the age of 45. His legacy still lives on, over a 150 years later. Epidemiology-related conferences still feature the Broad Street Pump in their logos and designs, and his story is one of the first budding epidemiologists hear. He has also been immortalized by the John Snow Pub at the corner of Broadwick and Lexington Streets in London, England JOHN SNOW’S CONTRIBUTION TO MODERN EPIDEMIOLOGY Cholera, an acute diarrheal illness caused by intestinal infection by the bacterium, Vibrio cholerae, leads to rapid loss of body fluids and ultimately to dehydration and shock. Without treatment, death can occur within hours [CDC (2008)]. The bacterium was discovered by the Italian physician Filippo Pacini in 1854 [Frerichs (1999)]. Interestingly, this is the same year as the cholera outbreak in London, England, for which Dr. John Snow describes in his document, “Snow on Cholera.” However, the finding of Dr. Pacini was all but ignored by scientists of the 19th century, and not officially recognized by the scientific community as a bacterium until 1965. In fact, Snow never learned of Pacini’s discovery.

During the mid 19th century, there were two theories to the notion of the origin of cholera. The first, the miasma theory, is the notion that cholera – and other diseases – arise spontaneously from swamps and decomposed material. This theory was rejected by Snow. A counter notion to the miasma theory, the germ theory, is the idea that diseases – such as cholera – are caused by activities of microorganisms, prevailing within the body. This theory was accepted by Snow [Frerichs (1999)]. It is interesting to point out here, in 1859 (the year following the death of Dr. Snow) the French chemist, Louis Pasteur, provided strong evidence against the miasma theory, via a prize winning French study.

Perhaps more stunning is the fact that Snow was able to use (careful) logic and epidemiological methods (as we will suggest in the subsequent paragraphs below which describe the 1854 London cholera epidemic), to identify the origin of cholera, with no recognition in his lifetime of the microorganism which causes cholera.

The first epidemic of cholera in Great Britain, occurred over the two year period beginning 1831 (Snow a teenager at the time). Case studies to John Snow – as to other disease scientists (detectives) – were important to learn more about the disease of interest. One particular cholera case (from the 41 | P a g e

1831-1832 epidemic) of interest to Dr. Snow, was that of John Barnes, an agricultural worker. It was believed in the case of Mr Barnes, that the time from onset of cholera, to death, was three days. Two other Barnes family members became ill (subsequent to John Barnes’ illness) with cholera and died within two days. Moreover, it was believed that John Barnes acquired his illness, via physical contact of clothing worn by his infected sister (who later died from cholera). This single case study (of 1832) provided Snow with insight as to both, the incubation period of the illness, as well as how the illness spreads. Subsequent cases studies, led Snow to believe that cholera was spread from the sick to the healthy, but that not all persons in contact with infected individuals become ill. Moreover, Snow observed that to become infected, it was not necessary to be near another infected individual. Snow concluded that cholera commences with the affection of the alimentary canal.

To suggest that Dr. Snow was a practitioner (in fact some (e.g., [Vachon (2005)]) suggest the father) in the field of epidemiology, we first need to define the term epidemiology. As defined in, A Dictionary of Epidemiology, epidemiology is, “The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems” [Last (2000)]. The word control helps distinguish epidemiology from other fields of scientific practice. As we will see, his concern with control actions, helps explain why Dr. Snow’s work in the Broad Street pump area is honored by epidemiologists and other health professionals.

Although Great Britain saw two prior epidemics of cholera – during the periods of 1831-1832 and 1848-1849, respectively – prior to the 1853-1854 epidemic, Snow writes in September 1854, “The most terrible outbreak of cholera which ever occurred in this kingdom, is probably that which took place in Broad Street, Golden Square, and the adjoining streets, a few weeks ago” [Frerichs (1999)].

Apparently, the “so-called outbreak” of cholera, essentially occurred overnight. Dr. Snow writes, making reference to the outbreak, “... commenced in the night between the 31st August and the 1st September...” Note that this observation of Snow is seen in Figure 2, as the incident cases of cholera sharply increase during the noted time period. Although Snow does not include details as to the reasoning (the initial instance for which he states the Broad Street Pump being the source of the outbreak), leading to the conclusion for which he came upon (e.g., why the Broad Street Pump?; and for that matter, why a water source for the cause of the outbreak?), he writes (regarding the outbreak), “As soon as I became acquainted with the situation and extent of this irruption of cholera, I suspected some contamination of the water of the much frequented street-pump in Broad Street, near the end of Cambridge Street; but on examining the water, on the evening of the 3rd September, I found so little impurity in it of an organic nature, that I hesitated to come to a conclusion. Further inquiry, however, showed me that there was no other circumstance or agent common to the circumscribed locality in which this sudden increase of cholera occurred, and not extending beyond it, except the water of the above mentioned pump.” An interesting observation to point out here, is the retrospective (i.e., the type of epidemiological observational study, as we would refer to today) nature of the conclusion of Dr. Snow, which provides the reader with a hint as to the epidemiological skill set he possessed. Namely, he tested the water of the Broad street pump, September 3rd, but the cholera outbreak occurred two days prior, on September 1st. He utilized a water sample in present time (9/3/1854), to draw a conclusion of the consistency of the water in the past (9/1/1854). Continued reading of the paragraph, for which the preceding quotation arose, we see once again the detail of Dr. Snow, and are introduced to the persistence of his cholera outbreak investigation. Namely, the water sample he took from the Broad Street Pump on September 3rd was not enough for him (i.e., he was not about to give up on his hypothesized notion of the Broad Street Pump water being contaminated).

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PSYCHIATRY The earliest joint between sociology and medicine.

Social Class and Mental Illness :: A Community study This landmark research produced important evidence that social factors could be correlated with different types of mental disorders and the manner in which people received psychiatric care.

Persons in the most socially and economically disadvantaged segments of society were found to have the highest rates of mental disorder in general.

Pubmed AMERICANS PREFER TO AVOID the two facts of life studied in this book: social class and mental illness.

The very idea of “social class” is inconsistent with the American ideal of a society composed of free and equal individuals, individuals living in a society where they have identical opportunities to realize their inborn potentialities. The acceptance of this facet of the “American Dream” is easy and popular.

To suggest that it may be more myth than reality stimulates antagonistic reactions.

Although Americans, by choice, deny the existence of social classes, they are forced to admit the reality of mental illness. Nevertheless, the thought of such illness is abhorrent to them. They fear “mental illness,” its victims, and those people who cope with them: psychiatrists, clinical psychologists, social workers, psychiatric nurses, and attendants. Even the institutions our society has developed to care for the mentally ill are designated by pejorative terms, such as “bug house,” “booby hatch,” and “loony bin,” and psychiatrists are called “nutcrackers” and “head shrinkers.”

Denial of the existence of social classes and derisive dismissal of the mentally ill may salve the conscience of some people. The suggestion that different social classes receive different treatment for mental illness may come as a shock, but to repress facts because they are distasteful and incongruent with cherished values may lead to consequences even more serious than those we are trying to escape by substituting fantasy for reality. …

The idea that stratification in our society has any bearing on the diagnosis and treatment of disease runs counter to our cherished beliefs about equality, especially when they are applied to the care of the sick. Physicians have deeply ingrained egalitarian ideals with their fellow citizens, yet they, too, may make subtle, perhaps unconscious judgments of the differential worth of the members of our society. Physicians, among them psychiatrists, are sensitive to statements that patients may not be treated alike; in fact there is strong resistance in medical circles to the exploration of such questions.

But closing our eyes to facts or denying them in anger will help patients no more than the belief that the Titanic was “unsinkable” kept the ship afloat after it collided with an iceberg. . . .

[A] distinct inverse relationship does exist between social class and mental illness. The linkage between class status and the distribution of patients in the population follows a characteristic pattern; class V, almost invariably, contributes many more patients than its proportion in the population warrants. Among the higher classes there is a more proportionate relationship between the number of psychiatric patients and the number of individuals in the population. . . .

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SIX MAJOR FACTORS In the growth and legitimacy of American medical sociology 1、 Intellectual endeavors and movements 2、 Social epidemiological studies 3、 Sociologists employed in medical schools 4、 Private foundations 5、 The section on Medical Sociology of the ASA 6、 Journal of Health and Social Behavior

MEDICAL SOCIOLOGY IN CHINA TWO MAJOR TRENDS  Medical sociological work trends to research relevant to health practitioners and policymakers  medical sociology and the general discipline of sociology convergence

TOPIC 3

What is medical sociology Mc Intile definition The science of the social phenomena of the physicians themselves as a class apart and separate; and the science which investigates the laws regulating the relations between the medical profession and human society as a whole: treating of the structure of both, how the present conditions came about, what progress civilization has affected and indeed everything relating to the subject.

ENCYLOPEDIA DEFINITION the study of individual and group behaviors with respect 0.to health and illness.

Thus "medical" is a misnomer, as the focus is not on medical professionals or their behaviors, but on human behavioral responses to health and illness.

NLM – Medical sociology Medical sociology is concerned with the relationship between social factors and health, and with the application of sociological theory and research techniques to questions related to health and the health care system.

HANDBOOK OF MEDICAL SOCIOLOGY – Bird, Conrad, Fremont Medical sociology is concerned with individual and group responses aimed at assessing well-being, maintaining health, acting upon real or perceived illness, interacting with healthcare systems, and maximizing health in the face of physiologic or functional derangement. It also analyzes the impact of the psychological conditions resulting from our environment on our health.

THE AMERICAN SOCIOLOGICAL ASSOCIATION Medical sociology is the subfield of sociology which applies the perspectives, conceptualizations, theories, and methodologies of sociology to phenomena having to do with human health and disease. As a specialization, it encompasses a body of knowledge which places health and disease in a social, cultural and behavioral context.

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STRAUS’s “Sociology IN medicine” “ Sociology OF medicine” SOCIOLOGY IN MEDICINE --- collaborates directly with the physician in studying the social factors relevant to a health disorder.

--- directly applicable to patient care or to the solving of a public health problem.

--- analyze the etiology or causes of the health disorders, the different social attitudes related to health.

SOCIOLOGY OF MEDICINE ---deals with such factors as the organizational structure, role relationships, norms, values and beliefs of medical practice as a form of human behavior.

--- emphases the social processes that occur in the medical setting and how these contribute to our understanding of medical sociology in particular and to our understanding of social life in general.

THE STATUS OF MEDICAL SOCIOLOGY

 medical anthropology vs medical sociology  medical psychology vs medical sociology  social medicine vs medical sociology

MEDICAL ANTHROPOLOGY :: a first cousin  different cultures and people, especially focusing on health, patients and treatments in different tribes  the beliefs or religions or notions how to influence their perception, identity, behavior relating to health or illness MEDICAL ANTHROPOLOGY EXAMPLE :  KURU DISEASE

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DIFFERENCE BETWEEN MEDICAL ANTHROPOLOGY AND MEDICAL SOCIOLOGY - Research perspectives - Methodology - Cultural interest WIKI and other sites Medical anthropology studies "human health and disease, health care systems, and biocultural adaptation". It views humans from multidimensional and ecological perspectives. It is one of the most highly developed areas of anthropology and applied anthropology, and is a subfield of social and cultural anthropology that examines the ways in which culture and society are organized around or influenced by issues of health, health care and related issues.

The term "medical anthropology" has been used since 1963 as a label for empirical research and theoretical production by anthropologists into the social processes and cultural representations of health, illness and the nursing/care practices associated with these.

Difference between sociology-anthropology ? sociology is the scientific study of human interaction while anthropology refer to the study of human kind or humanity.

In the past, the main difference used to be the fields of interests. Sociologists studied "us", meaning primarily urban, western societies, whereas Anthropologists studied "them", meaning small tribes, colonized peoples and the like.

In our days, the lines between the disciplines has blurred. The main difference seems to be methodical, as sociologists prefer a quantitative approach, with tools like polls, statistics, mass interviews etc, where anthropologists prefer a qualitative approach, meaning in-depth interviews and participatory observation.

One possible understanding of these differences is the two disciplines' respective levels of analysis.

Sociology tends to look at a society and see its institutions and structures as of prime importance, driving and creating changes. Anthropology, while not necessarily different, has more of a sense of the way a culture can change internally, through the decisions of its members.

Similarities between sociology-anthropology ?

Both sociology and anthropology are the study of human society. They look at how societies are formed and how humans behave within society.

Relationships between sociology-anthropology ?

Sociology and anthropology both study human behavior within a society. This includes how humans form societies and how they interact within them.

MEDICAL PSYCHOLOGY  the branch of psychology concerned with the application of psychological principles to the practice of medicine  the application of clinical psychology or clinical health psychology, usually in hospital, medical, or health care settings  the study and application of psychological factors related to any and all aspects of physical health, illness, and its treatment at the individual, groups, and systems level WIKI Medical psychology is the application of psychological principles to the practice of medicine for both physical and mental disorders. The American Psychological Association (APA) defines medical psychology as "that branch of psychology that integrates somatic and psychotherapeutic modalities 46 | P a g e

into the management of mental illness and emotional, cognitive, behavioral and substance use disorders". A medical psychologist does not automatically equate with a psychologist who has the authority to prescribe medication.[1] Psychologists who hold prescriptive authority for specific psychiatric medications such as antidepressants and other pharmaceutical drugs must first obtain specific qualifications in Psychopharmacology.

Heart Attack Personality "Type A": a compound of hostility, impatience, competitiveness and dominance This type of personality concerns how people respond to stress.

Friedman & Rosenman (both cardiologists) developed their theory based on an observation of the patients with heart conditions in their waiting room.

Unlike most patients, who wait patiently, some people seemed unable to sit in their seats for long and wore out the chairs. They tended to sit on the edge of the seat and leaped up frequently.

What was unusual was that the chairs were worn down on the front edges of the seats and armrests instead of on the back areas, which would have been more typical. They were as tense as racehorses at the gate.

The two doctors labeled this behavior Type A personality. They subsequently conduced research to show that people with type A personality run a higher risk of heart disease and high blood pressure than type Bs. Although originally called 'Type A personality' by Friedman & Rosenman it has now been conceptualized as a set of behavioral responses collectively known as Type A Behavior Pattern.

People with Type B personality tend to be more tolerant of others, are more relaxed than Type A individuals, more reflective, experience lower levels of anxiety and display higher level of imagination and creativity.

The Type C personality has difficulty expressing emotion and tends to suppress emotions, particularly negative ones such as anger. This means such individual also display 'pathological niceness', conflict avoidance, high social desirability, over compliance and over patience.

Type A behavior: competitive, ambitious, impatient, aggressive, fast talking. Type B behavior: relaxed, noncompetitive.

Cancer Type C Personality  Poor ability to cope with stress  Highly conscientious, responsible and caring  Deep desire to make others happy, often at their own expense  Harboring suppressed toxic emotions  History of lack of closeness with one or both parents 47 | P a g e

Search A AFFECTIVE NEUTRALITY 34 AIDS – 3 TRANSMISSION WAYS 13 AGE OF HIPPOCRATES 36 ALTURISTIC SUICIDE AMERICAN MEDICAL SOCIOLOGY 44 ANOMIC SUICIDE ANTON CHEKHOV 20 ASCLEPIUS WORSHIP 36 ASSESSING THE EFFECT 25 AWAARA movie 21 B BADNESS vs SICKNESS 30 BIOETHICS 5 BIOMEDICAL MODEL 38 - POSSIBLE DEFECTIVES 39 BIOTERRORISM 4 C COMING OF CORPORATION 35 CONFLICT PERSPECTIVE 7 CONTEMPORARY SOCIAL EPIDEMIOLOGY CONSTRAITS OF THE CHURCH 36 COOLEY: LOOKING – GLASS SELF 18, 20 CYCLE OF - POVERTY & PATHOLOGY 14 D DEPRESSION DESCARTES 36 DEVELOPING A SOCIAL IMAGINATION 8 DEVIANT 29 DIFFERENCE B/W M.ANTHROPOLOGY & M.SOCIOLOGY 45 DISEASE 26 DOCTOR PATIENT RELATIONSHIP 31 DUALITY IN MORDERN MEDICINE 37 DURKEIM’S CONCEPT 25 E EARLY THINKERS 8 EGOISTIC SUICIDE EIGHT IMPORTANT STAGE IN MORDERN MEDICINE 36 F FACE 22 - WRONG FACE 22 - OUT OF FACE 22 FEMINISM 7 FIGHT OR FLIGHT RESPONSE 16 FLOW OF PERSPECTIVES HELD BY MEDICAL STUDENTS 34 FRAMEWORK OF ILLNESS ANALYSIS 14

FREIDSON 30 FUNCTIONAL PERSPECTIVE 6 FUNCTIONAL SPECIFICITY 34 FUNCTIONALISM 23 G GERM THEORY 36 GOFFMAN – LIFE AS THEATRE 18, 21 H HEALTH 3 WHO 37 WHOLE PERSON 37 REEMERGENCE OF INFECTIOUS DISEASE 37 HEALTH HABITS 13 HIPPOCRATES CONTRIBUTION 31 OATH 31 PRINCIPLES HISTORY OF SOCIAL EPIDEMIOLOGY 12 HYGEIA’S PHILOSOPHY 36 I ILLNESS 26 BEHAVIOUR 26 DANGER 27 Definition RECOGNITION 27 J JOHN SNOW 12, 40 K KURU DISEASE 45 L LEGIONELLOSIS 12 M MACRO LEVEL 18 DURKHEIM 18 MAKING OF A PHYSICIAN 34 MAJOR RESEARCH METHOD 9 MEDICAL ANTHROPOLOGY 45 MEDICAL CARE – DIFFERENT WAYS MEDICAL MODEL 38 MEDICAL SOCIOLOGY ENCYLOPEDIA DEFINITION 44 HANDBOOK OF M.SOCIOLOGY 44 IN CHINA 44 Mc INTILE DEFINITION 44 NLM 44 STATUS’s 45 THE AMERICAN SOCIO. ASSOCIATION 44 MEDICINE AS AN INSTITUTE OF SOCIAL CONTROL 29 SOCIAL EPIDEMIOLOGY 10 CONTEMPORARY 12 VIEW DISEASE 11 SOCIOLOGY DEFINITION 2 DEVELOPMENT 8 IN MEDICINE 45

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MECHANIC’S GENERAL THEORY MICRO LEVEL 18 - COOLEY - THOMAS - GOFFMAN MATTHEW EFFECT 14 MYOCARDIAL INFARCTION 13 N O OCCUPATIONAL STRESS OUT OF FACE P PARSON’S 8 - SICK ROLE 3, 27, 28 PEOPLE SEEK MEDICAL CARE 26 PERCEPTION OF INDIVIDUAL PERCIVAL POTT 12 - CONTRIBUTION 12 - ETIOLOGICAL CHAIN 12 PERSONALITY - TYPE A/ B/C BEHAVIOUR 47 PHYSICIAN - IN CHANGING SOCIETY 35 - PROFESSIONAL ATTITUDE & DEMEANOR 34 PINTA 10 PLACEBO EFFECT 32 PROBLEMS IN SOCIAL RESEARCH 9 PSYCHIATRY 43 Q R RELATIONSHIP B/W - SMOKING & LUNG CANCER 12 S SCOPE OF SOCIOLOGICAL STUDIES 5 SHORTCOMINGS 27 SICKNESS 26 SICK ROLE - ASSUMPTION 28 - CATEGORIES 28 - COMPONENTS 30 - DIFFICULTIES 30 SIGERIST 38 SIX MAJOR FACTORS – AMERICAN SOCIOLOGY 44 SOCIAL - CLASS AND MENTAL ILLNESS 43 - DEMOGRAPHY OF HEALTH 13 - SOCIAL-PSYCHOLOGICAL MODELS 27 - STRESS 16 -

OF MEDICINE

SOCIOLOGICAL IMAGINATION 9 PERSPECTIVE 8 SCOPE 5 THEORY 5 SOCIOECONOMIC STATUS (SES) 13 SOCIAL PSYCHOLOGICAL MODEL OF ILLNESS BEHAVIOR 27 STAGES MORDERN MEDICINE 36 STRATIFICATION OF THEORY 6 STRAUS’s 44 STRESS 17 ADAPTAION 25 RESEARCH FOCUS ON SUBCULTURE 35 SUICIDE 23, 24 ALTURUISTIC 24 ANOMIC 23 EGOISTIC 23 FATALISTIC 25 Examples 24 SYMBOLIC INTERACTIONISM 19 SYMBOLIC INTERACTIONIST PERSPECTIVE 7 SYPHILIS 10 T TECHNICAL SPECIFICITY 34 THEORETICAL PERSPECTIVES (PARADIGM) 6 THEORY PROVERTY 15 THOMAS SAMUEL HUHN 6 THOMAS :: DEFINITION OF SITUATION 18, 21 TRANSMISSION AIDS TWO IMPORTANT CONCEPTS 27 TWO OBLIGATION 28 TWO RIGHTS 28 TWO TRAITS 35 TYPES UNCERTINITY 35 U UNIVERSALISM 34 UNCERTAINITY – TYPES 35 UTOPIANS – HUMANITARIANSM 37 V Virchow (Definition, Argument) 38 W X Y Z

45

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Comments DURKHEIM’S – SUICIDE BOOK 1. “ Attitudes to suicide over the centuries were more relaxed prior to monotheism. Later, attitudes and actions were controlled and manipulated by dogma and then, as the dogma was pushed away (particularly when Durkheim was analyzing the figures), suicide stopped being a mortal sin and people felt "safe" to kill themselves again albeit with the fear of being imprisoned if they failed. So that needs to be included in the research and conclusions, doesn't it? It's not just that the church made everyone feel all touchy-feely, it put the fear of god into them if they contemplated suicide.”

2. “Durkheim's ideas can be taken another way. He barely mentions the sadness, the repression, the violence, the unfairness, the inequality of traditional societies, painting a rosy and romantic view of them. What about the "deviants?" What about those who yearn for something more than what their tribe/clan/society has laid out for them? What about those who desire choice and autonomy? Or the ability to create a new community?”

3. “Nowadays, we are not fearful of eternal torture for suicide, we're unlikely to be imprisoned for attempted suicide, suicide is often used as a political act or even as an act that will take the person into paradise and we are even contemplating legalizing assisted suicide. Are all those examples because of capitalism? Perhaps it's a bit more nuanced than that. Is modern day capitalism exactly like 19th century capitalism? “ 4. “I agree with some of Durkheim's ideas. We're excessively individualistic, we are disillusioned easily and often forget the value of community, spirituality and enjoying one another in this system.Durkheim's ideas can be taken another way. He barely mentions the sadness, the repression, the violence, the unfairness, the inequality of traditional societies, painting a rosy and romantic view of them. What about the "deviants?" What about those who yearn for something more than what their tribe/clan/society has laid out for them? What about those who desire choice and autonomy? Or the ability to create a new community?”

6. “Modern studies show that during hard economic times, i.e., during recessions the suicide rate increases.

Moreover, increasingly today we live in corporate oligarchies, corporations have control of everything, and only 10 percent of the population has all the wealth. More and more people are becoming aware of this and feel impotent to effect any change because the corporations control the government through their lobbying power.”

7. “As we know a coin has two faces :: the head and the tail. Here Durkheim’s studies on the society also do have two phases :: the good phase and the bad phase” 2. STRESS 1. “Pseudo-social policing we feel compelled comply with is a fearful thought. Curious of the cause for this behavior.”

2. “Its not good when good women(or bad women) get physically or emotional abuse, maybe we as abused man should get together with a group of abuse women and see if at least our points of view are the same, may by we'll find love there where someone actually understand one another. But never oppose your strength on someone weaker, man or woman unless you're defending yourself.”

DOCTOR PATIENT RELATIONSHIP 1. “ A good doctor patient relations is very important to sustain a good society .”

2. “ Patients shouldn’t be unfaithful to doctors. Because doctors are like an elixir of life. They treat you and help you to get healthy from many adverse health conditions. So they should never be though as a mode of business.”

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1. WHAT IS SOCIOLOGY MEDICAL SOCIOLOGY

The term medical sociology first appeared in 1894, in a medical article by Charles McIntire on the importance of social factors in health. Other early work by physicians included essays on the relationship between medicine and society in 1902 by Elizabeth Blackwell, the first woman to graduate from an American medical school (Geneva Medical College in New York), and James Warbasse who wrote a book in 1909 called Medical Sociology about physicians as a unique social class.

This situation had important consequences for the development of medical sociology. Unlike law, religion, politics, economics, and other social institutions, medicine was ignored by sociology's founders in the late nineteenth century because it did not shape the structure and nature of society. Karl Marx's collaborator Friedrich Engels (1973) linked the poor health of the English working class to capitalism in a treatise published in 1845, and Emile Durkheim (1951) analyzed European suicide rates in 1897. However, Durkheim, Marx, Max Weber, and other major classical sociological theorists did not concern themselves with the role of medicine in society. Medical sociology did not emerge as an area of study in sociology until the late 1940s and did not reach a significant level of development until the 1960s. Therefore, the field developed relatively late in the evolution of sociology as a major academic subject and lacked statements on health and illness from the classical theorists. Consequently, medical sociology came of age in an intellectual climate far different from sociology'S more traditional specialties, which had direct links to nineteenth- and early twentieth-century social thought. As a result, it faced a set of circumstances in its development different from that of most other major sociological sub-disciplines.

2. SCOPE OF SOCIOLOGICAL STUDIES 3. PINTA 4. JOHN SNOW

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5. STRESS

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STRESS

The theories of Durkheim, Cooley, Thomas, and Goffman demonstrate a relationship between social interaction and stress, but they do not explain the effect of stress upon the human body.

Embarrassment and psychological discomfort can be socially painful, yet the effects of stress can transcend the social situation and cause physiological damage as well. Hence, a physiological perspective of stress must be considered. Walter Cannon (1932) believed that the real measure of health is not the absence of disease but the ability of the human organism to function effectively within a given environment. This belief was based upon the observation that the human body undergoes continuous adaptation to its environment in response to weather, microorganisms, chemical irritants and pollutants, and the psychological pressures of daily life. Cannon called this process of physiological adaptation homeostasis, which is derived from the Greek and means "staying the same." Homeostasis refers to the maintenance of a relatively constant condition. For example, when the body becomes cold, heat is produced; when the body is threatened by bacteria, antibodies are produced to fight the germs; and when the body is threatened by an attack from another human being, the body prepares itself either to fight or to run.

As an organism, the human body is thus prepared to meet both internal and external threats to survival, whether these threats are real or symbolic. A person may react with fear to an actual object or to a symbol of that object-for example, a bear versus a bear's footprint. In the second case, the fear is not of the footprint but of the bear that the footprint symbolizes. Threats in contemporary urban societies could include types of stimuli such as heavy traffic, loud noises, or competition at work, all of which can produce emotional stress related more to a situation than to a specific person or object. Whether the stressful situation actually induces physiological change depends upon an individual's perception of the stress stimulus and the personal meaning that the stimulus holds. A person's reaction, for instance, may not correspond to the actual reality of the dangers that the stimulus represents-that is, a person may overreact or underreact. Thus, an individual's subjective interpretation of a social situation is the trigger that produces physiological responses. Situations themselves cannot always be assumed beforehand to produce physiological changes.

PHYSIOLOGICAL RESPONSE TO STRESS Cannon (1932) formulated the concept of the "fight or flight" pattern of physiological change to illustrate how the body copes with stress resulting from a social situation. When a person experiences fear or anxiety, the body undergoes physiological changes that prepare it for vigorous effort and the effect of possible injury. Physiological changes in the body, as a result of stressful situations, primarily involve the autonomic and neuroendocrine systems. The autonomic nervous system controls heart rate, blood pressure, and gastrointestinal functions-processes that occur automatically and are not under the voluntary control of the central nervous system. The autonomic nervous system is delicately balanced between relaxation and stimulation and is activated primarily through the hypothalamus, located in the central ventral portion of the brain. It is composed of two major divisions, the parasympathetic and the sympathetic systems. The parasympathetic system is dominant when there is no emergency and regulates the vegetative processes of the body such as the storing of sugar in the liver, the constriction of the pupil of the eye in response to intense light, and the decreasing of heart rate. When there is an emergency, the sympathetic system governs the body's autonomic functions and increases the heart rate so that blood flows swiftly to the organs and muscles that are needed in defense. It also inhibits bowel movements and dilates the pupil of the eye to improve sight.

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6. WHAT IS ILLNESS BEHAVIOUR ?

Illness behavior, in comparison to health behavior, is the activity undertaken by a person who feels ill for the purpose of defining that illness and seeking relief from it (Kasl and Cobb 1966). According to David Mechanic (1995:1208): "Illness behavior refers to the varying ways individuals respond to bodily indications, how they monitor internal states, define and interpret symptoms, make attributions, take remedial actions and utilize various sources of informal and formal care." Some people recognize particular physical symptoms such as pain, a high fever, or nausea and seek out a physician for treatment. Others with similar symptoms may attempt self-medication or dismiss the symptoms as not needing attention.

7. WHY PEOPLE SEEK MEDICAL CARE BY DIFFERENT WAYS ?

8. PARSON SICK RULE. Each society's definition of illness becomes institutionalized within its cultural patterns, so that one measure of social development is a culture's conception of illness. In primitive societies, illness was defined as an autonomous force or ÂŤbeing," such as an evil spirit that attacked people and settled within their bodies to cause them pain or death. During the Middle Ages, some people defined illness as a punishment for sins, and care of the sick was regarded as religious charity. Today, illness is defined as a state or condition of suffering as the result of a disease or sickness. This definition is based on the modern scientific view that an illness is an abnormal biological affliction or mental abnormality with a cause, a characteristic train of symptoms, and a method of treatment.

In medical sociology, the term disease has been characterized as an adverse physical state, consisting of a physiological dysfunction within an individual; an illness as a subjective state, pertaining to an individual's psychological awareness of having a disease and usually causing that person to modify his or her behavior; and sickness as a social state, signifying an impaired social role for those who are ill. Although a major area of interest in medical sociology is illness behavior, the concept of sickness is of special interest, because it involves analysis of factors that are distinctly sociological-namely, the expectations and normative behavior that the wider society has for people who are defined as sick.

Sociologists have typically viewed sickness as a form of deviant behavior. This view was initially formulated by Talcott Parsons (1951) in his concept of the sick role, which describes the normative behavior a person typically adopts when feeling sick. Parsons saw being sick as a disturbance in the "normal" condition of the human being, both biologically and socially. Previously, the sociological study of health and illness had relied on a medical perspective in which efforts in studying sickness were limited to correlating social factors with biological factors-based on references provided by health practitioners. This medically oriented approach emphasized the physiological reality of the human organism but neglected the sociological reality that a person is sick when he or she acts sick.

The basis for describing illness as a form of deviant behavior lies in the sociological definition of deviance as any act or behavior that violates the social norms within a given social system. Thus, deviant behavior is not simply a variation from a statistical average. Instead, a pronouncement of deviant behavior involves making a social judgment about what is right and proper behavior according to a social norm. Norms reflect expectations of appropriate behavior shared by people in specific social settings, or they may be more general expectations of behavior common to a wide variety of social situations. Conformity to prevailing norms is generally rewarded by group acceptance and approval of behavior. Deviation from a norm, however, can lead to disapproval of behavior, punishment, or other forms of social sanctions being applied against the offender. Norms allow for variations of behavior within a permissible range, but deviant behavior typically violates the range of permissible behavior and elicits a negative response from other people. Most theories of deviant behavior in sociology are concerned with behavior common in crime, delinquency, mental disorders, alcoholism, and drug addiction. These forms of behavior typically offend someone.

PARSON :: THE SICK ROLE

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Talcott Parsons (1902-1978) introduced his concept of the sick role in his book The Social System (1951), which was written to explain a complex functionalist model of society. In this model, social systems were linked to systems of personality and culture, to form a basis for social order. Unlike other major social theorists preceding him, Parsons included an analysis of the function of medicine in his theory of society and, in doing so, was led to consider the role of the sick person in relation to the social system within which that person lived.

The result is a concept that represents the most consistent approach to explaining the behavior characteristic of sick people in Western society.

Parsons's concept of the sick role is based on the assumption that being sick is not a deliberate and knowing choice of the sick person, though illness may occur as a result of motivated exposure to infection or injury.

Thus, while the criminal is thought to violate social norms because he or she "wants to," the sick person is considered deviant only because he or she "cannot help it." Parsons warns, however, that some people may be attracted to the sick role to have their lapse of normal responsibilities approved. Generally, society accounts for the distinction between deviant roles by punishing the criminal and providing therapeutic care for the sick. Both processes function to reduce deviancy and change conditions that interfere with conformity to social norms.

Both processes also require the intervention of social agencies, law enforcement, or medicine, to control deviant behavior. Being sick, Parsons argues, is not just experiencing the physical condition of a sick state; The specific aspects of Parsons's concept of the sick role can be described in four basic categories: 1. The sick person is exempt from "normal" social roles.

An individual's illness is grounds for his or her exemption from normal role performance and social responsibilities. This exemption, however, is relative to the nature and severity of the illness. The more severe the illness, the greater the exemption. Exemption requires legitimating by the physician as the authority on what constitutes sickness. Legitimation serves the social function of protecting society against malingering.

2. The sick person is not responsible for his or her condition.

An individual's illness is usually thought to be beyond his or her own control. A morbid condition of the body needs to be changed and some curative process, apart from personal will power or motivation, is needed to get well.

3. The sick person should try to get well.

The first two aspects of the sick role are conditional on the third aspect, which is recognition by the sick person That being sick is undesirable. Exemption from normal responsibilities is temporary and conditional on the desire to regain normal health. Thus, the sick person has an obligation to get well.

4. The sick person should seek technically competent help and cooperate with the physician.

The obligation to get well involves a further obligation on the part of the sick person to seek technically competent help, usually from a physician. The sick person is also expected to cooperate with the physician in the process of trying to get well.

Parsons's concept of the sick role is based on the classical social theory of Emile Durkheim and Max Weber and the psychoanalytic theory of Sigmund Freud. Psychoanalytic theories of the structure of the personality (i.e., id, ego, and superego) and the unconscious assisted Parsons in developing his thoughts on individual motivation.

The sick person is presumably motivated to recover (as a result of socialization and the influence of the superego) and yet may perhaps also be motivated, either consciously or unconsciously, to desire the "secondary gain" of privileges and exemptions from daily tasks that accompany the sick role.

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TALCOTT PARSON

However, a critical event occurred in 1951 that oriented American medical sociology toward theory.

This was the appearance, in 1951, of Talcott Parsons's book The Social System. This book, written to explain a relatively complex structuralfunctionalist model of society, in which social systems are linked to corresponding systems of personality and culture, contained Parsons's concept of the sick role.

Unlike other major social theorists preceding him, Parsons formulated an analysis of the function of medicine in society. Parsons presented an ideal representation of how people in Western society act when sick. The merit of the concept is that it describes a patterned set of expectations defining the norms and values appropriate to being sick, for both the sick person and others who interact with that person. Parsons also pointed out that physicians are invested by society with the function of social control, similar to the role provided by priests and the police, to serve as a means to control deviance. In the case of the sick role, illness is the deviance, and its undesirable nature reinforces the motivation to be healthy. In developing his concept of the sick role, Parsons linked his ideas to those of the two most important classical theorists in sociology-Emile Durkheim (1858- 1917) of France and Max Weber (1864-1920) of Germany. Parsons was the first to demonstrate the controlling function of medicine in a large social system, and he did so in the context of classical sociological theory. Having a theorist of Parsons's stature rendering the first major theory in medical sociology called attention to the young subdiscipline-especially among academic sociologists. Not only was Parsons's concept of the sick role "a penetrating and apt analysis of sickness from a distinctly sociological point of view" (Freidson 1970b:62), but also it was widely believed in the 1950s that Parsons and his students were charting a future course for all of sociology through the insight provided by his model of society.

However, this was not the case, as Parsons's model was severely criticized and his views are no longer widely accepted. Nevertheless, he provided a theoretical approach for medical sociology that brought the subdiscipline the intellectual recognition it needed in its early development in the United States.

This is because the institutional support for sociology in America was in universities, where the discipline was established more firmly than elsewhere in the world. Without academic legitimacy and the subsequent participation of such well-known, mainstream academic sociologists in the 1960s, such as Robert Merton, Howard Becker, and Erving Goffman, all of whom published research in the field, medical sociology would lack the early professional credentials and stature it currently has in both academic and applied settings. Parsons's views on society may not be the optimal paradigm for explaining illness, but Parsons was important in the emergence of medical sociologyas an academic field.

Parsons's Sick Role: Conclusion Despite the considerable criticism of Parsons's sick-role concept found in sociological literature, it should be noted that this model represents a significant contribution to medical sociology. Parsons insists that illness is a form of deviance and that as such it is necessary for a society to return the sick to their normal social functioning.

Thus, Parsons views medicine as a mechanism by which a society attempts to control deviance and maintain social stability. In light of the trend toward classifying more and more social problems as medical problems, Parsons's explanation of the function of medicine has broad implications for the future treatment of deviants in our society.

Therefore, it can be concluded that Parsons's model is a useful and viable framework of sociological analysis within certain contexts. Although the theory is an insufficient explanation of all illness behavior, it does describe many general similarities and should not be abandoned. In fact, writing in a later article, Parsons (1975) admitted that he did not believe it was ever his intention to make his concept cover the whole range of phenomena associated with the sick role. Two possibilities exist: (1) using the model as an "ideal type" with which various forms of illness behavior can be contrasted or (2) expanding the concept to account for conditions generally common to most illness situations.

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9. SOCIAL-PSYCHOLOGICAL MODELS OF ILLNESS BEHAVIOUR 10. MEDICINE AS AN INSTITUTION OF SOCIAL CONTROL 11. HIPPOCRATES OUTDATED 12. EIGHT IMPORTANT STAGES IN MORDERN MEDICINE 13. SOCIAL SIGNIFICANCE OF MEDICAL SOCIOLOGY ESTABLISHMENT

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COOLEY, THOMAS and GOFFMAN :: SYMBOLIC INTERACTION (MICRO LEVEL)

Cooley, Thomas, and GoHman reflect the symbolic interactionist approach to human behavior. Based upon the work of George Herbert Mead (1865-1931), this approach sees the individual as a creative, thinking organism who is able to choose his or her behavior instead of reacting more or less mechanically to the influence of social processes (Mead 1934). That is, people define the situations they are in and respond on the basis of their definition. This approach assumes that all behavior is self-directed on the basis of common understandings symbolized by language that are shared, communicated, and manipulated by interacting human beings in social situations. Of special relevance to a sociological understanding of stress is Charles H. Cooley'S (1864-1929) theory of the "Looking-Glass Self." Cooley (1964) maintained that our self-concepts are the result of social interaction in which we see ourselves reflected in other people. Cooley compares the reflection of our self in others to our reflections in a looking glass: Each to each a looking glass Reflects the other that doth pass.

Cooley's looking-glass self-concept has three basic components: (1) we see ourselves in our imagination as we think we appear to the other person; (2) we see in our imagination the other person's judgment of ourselves; and (3) as a result of what we see in our imagination about how we are viewed by the other person, we experience some sort of self-feeling, such as satisfaction, pride, or humiliation. The contribution of this theory to an understanding of stress is that an individual's perception of himself or herself as a social object depends on the reaction of other people. Obviously stress could result from the failure of the other person (the observer) to reflect a self-image consistent with that intended by the individual (the subject).

Stress can therefore be seen as having a very definite social and personal component based on perceptions that people have in social situations.

The work of William I. Thomas (1863-1947) is also relevant in its understanding of crisis as residing in the individual's "definition of the situation" (Volkart 1951). Thomas stated that as long as definitions of a social situation remain relatively constant, behavior would generally be orderly. However, when rival definitions appear and habitual behavior becomes disrupted, a sense of disorganization and uncertainty may be anticipated.

The ability of an individual to cope with a crisis situation will be strongly related to socialization experiences that have taught the person how to cope with new situations. Consequently, Thomas makes two particularly important contributions concerning stress. First, he notes that the same crisis will not produce the same effect uniformly in all people. Second, he explains that adjustment to and control of a crisis situation result from an individual's ability to compare a present situation with similar ones in the past and to revise judgment and action upon the basis of past experience. The outcome of a particular situation depends, therefore, upon an individual's definition of that situation and upon how that individual comes to terms with it. As David Mechanic (1978:293) states, "Thomas's concept of crisis is important because it emphasizes that crises lie not in situations, but in the interaction between a situation and a person's capacities to meet it."

Erving GoHman (1922-1982) is noted for the dramaturgical or "life as theatre" approach. GoHman (1959) believed that in order for social interaction to be possible, people need information about the other participants. Such information is obtained through: (1) a person's appearance; (2) past experience with similar individuals; (3) the social setting; and 58 | P a g e

(4) of most importance, the information a person communicates about himself or herself through words and actions. This fourth category of information is decisive because it is subject to control by the individual and represents the impression the person is trying to project-which others may come to accept. This information is significant because it helps to define a situation by enabling others to know in advance what a person expects of them and what they may expect of him or her. Goffman calls this process "impression management."

Goffman says people live in worlds of social encounters in which they act out a line of behavior. This is a pattern of verbal and nonverbal acts by which individuals express their view of a situation and their evaluation of the participants, particularly themselves. The positive social value that individuals claim for themselves, by the line that others assume they have taken during a particular encounter, is termed a face. This face is an image of self that is projected by the individual to other people.

One's face is one's most personal possession and is the center of security and pleasure.

Goffman is quick to point out that a person's face is only on loan from society and can be withdrawn if the person conducts himself or herself in an inappropriate manner. A person may be in the "wrong face" when information about that person's social worth cannot be integrated into his or her line of behavior. However, a person may be "out of face" when he or she participates in an encounter, without the line of behavior that participants in the particular situation would be expected to take.

Goffman further explains that the maintenance of face is a condition of interaction, not its objective. This is so because one's face is a constant factor that is taken for granted in interaction. When people engage in "face-work," they are taking action to make their activities consistent with the face they are projecting.

This is important because every member of a social group is expected to have some knowledge of face-work and some experience in its use, such as the exercise of social skills like tact. Goffman sees almost all acts involving other people as being influenced by considerations of face. For example, a person is given a chance to quit a job rather than be fired. People are therefore aware of the interpretations that others have placed upon their behavior and the interpretations that they themselves should place upon their behavior.

Consequently, Goffman's view of the self is that it has two distinct roles in social interaction: (1) the self as an image of an individual formed from the flow of events in an encounter; and (2) the self as a kind of player in a ritual game who copes judgmentally with a situation.

This aspect of Goffman's work identifies the calculative element in dealings between people and presents them as information managers and strategists maneuvering for gain in social situations.

The symbolic interaction perspective, as reflected in the work of Cooley, Thomas, and Goffman, contributes to our understanding of stress, by identifying the key variable in the stress experience: the perception of the individual. People vary in their interpretation of situations, but ultimately it is the way in which they perceive the strains and conflicts in their roles, tasks, personal relationships, and other aspects of their life situation that causes them to feel stressed. How people feel about themselves (Cooley), define situations (Thomas), or manage impressions (Goffman) can lead to the creation of stressful conditions. People typically cope with stress by trying to change their situation, manage the meaning of the situation, or keep the symptoms of stress within manageable bounds (Pearlin 1989).

DURKHEIM: THE LARGER SOCIETY

While symbolic interaction theory emphasizes interpersonal forms of interaction, the French sociologist Emile Durkheim (1858-1917) focuses on the influence of the larger society on individuals.

Durkheim was concerned with those social processes and constraints that integrate individuals into the larger social community. He believed that when a society was strongly integrated, it held individuals firmly under its control (Durkheim 1950, 1956). Individuals were integrated into a society as a result of their acceptance of community 59 | P a g e

values, which were reinforced through social interaction with others believing in the same value system. Especially importantwere participation in events celebrating a society's traditions and also involvement in work activities.

As members of society, individuals were constrained in their behavior by laws and customs. These constraints were "social facts," which Durkheim (1950:13) defined as "every way of acting, fixed or not, capable of exercising on the individual an external constraint." What Durkheim suggests is that society has an existence outside of and above the individual. Values, norms, and other social influences descend on the individual to shape his or her behavior. Social control is, therefore, real and external to the individual.

Among Durkheim's works, the most pertinent to an understanding of the social determinants of stress is his 1897 study Suicide (1951). In explaining the differential rates of suicide among various religious and occupational groupings, Durkheim suggested that suicide was not entirely a matter of free choice by individuals. He believed that suicide was a social fact explainable in terms of social causes.

He distinguished between three major types of suicide, each dependent upon the relationship of the individual to society.

He suggested a fourth type of suicide, fatalistic suicide, where people kill themselves because their situation is hopeless, but he never fully developed the concept.

The three major types are (1) egoistic suicide, in which people become detached from society and, suddenly finding themselves on their own, are overwhelmed by the resulting stress; (2) anomic suicide, in which people suffer a sudden dislocation of normative systems where their norms and values are no longer relevant, so that controls of society no longer restrain them from taking their lives; and (3) altruistic suicide, in which people feel themselves so strongly integrated into a demanding society that their only escape seems to be suicide.

Durkheim's typology of suicide suggests how a society might induce enough stress among people to cause them to take their lives. Egoistic suicide is a result of stress brought about by the separation of a strongly integrated individual from his or her group. Durkheim uses the example of the military officer who is retired and suddenly left without the group ties that typically regulated his or her behavior. ďƒ˜ Egoistic suicide is based upon the overstimulation of a person's intelligence by the realization that he or she has been deprived of collective activity and meaning. ďƒ˜ Anomic suicide is characterized by an overstimulation of emotion and a corresponding freedom from society's restraints. It is a result of sudden change that includes the breakdown of values and norms by which a person has lived his or her life. Sudden wealth or sudden poverty, for example, could disrupt the usual normative patterns and induce a state of anomie or normlessness. In this situation, a chronic lack of regulation results in a state of restlessness, unbounded ambition, or perhaps crisis, in which norms no longer bind one to society.

While egoistic and anomic forms of suicide are both due to "society's insufficient presence in individuals" (Durkheim 1951:256), altruistic suicide represents the strong presence of a social system encouraging suicide among certain groups. Suicide in the altruistic form could be characterized as the avoidance of stress by people who prefer to conform to a society's normative system rather than risk the stress of opposing it. Examples of altruistic suicide are the practice of hara-kiri in Japan, where certain failures on the part of an individual are expected to be properly redressed by his or her suicide, or the traditional Hindu custom of the widow committing ritual suicide at her husband's funeral. In these two situations, people sense social pressure for them to take their own lives.

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Although altruistic suicide is relatively rare, stories do appear in the mass media of people killing themselves for reasons that could be considered egoistic or anomic. Yet the significance of Durkheim's orientation toward social processes for the understanding of the stress phenomenon extends well beyond the issue of suicide, since this is only one of many possible ways a person might find to cope with social and psychological stress. What is particularly insightful is Durkheim's notion of the capability of the larger society to create stressful situations where people are forcedto respond to conditions not of their own choosing.

14. WHAT OUR DAILY INTERACTION DEPENDS ON? 15. PROFESSIONAL ATTITUDE AND DEMENAORN 16. PHYSCIAN PATIENT RELATIONSHIP SOCIAL DETERMINANTS ON HEALTH

"society may indeed make you sick or conversely promote your health" (Cockerham 2013a:1).

A major development in the study of health and disease is the growing recognition of the relevance of social determinants. The term social determinants of health refers to social practices and conditions (such as lifestyles, living and work situations), class position (income, education, and occupation), stressful circumstances, poverty, and economic (e.g., unemployment, business recessions), political (e.g., policies, government benefits), and religious factors that affect the health of individuals, groups, and communities, either positively or negatively. Social determinants not only foster illness and disability, they also enhance prospects for coping with or preventing disease and maintaining health.

THE MOST IMPORTANT FACTORS DETERMINING HEATH ARE were found to be income, accumulated wealth, education, occupational characteristics, and social inequality based on race and ethnic group.

These variables have direct effects on both unhealthy and healthy lifestyles, high or low risk health behavior, and on living conditions, food security, levels of stresses and strains, social disadvantages over the life course, environmental factors that influence biological outcomes through gene expression, and other connections. Social factors are also important in influencing the manner in which societies organize their resources to cope with health hazards and deliver health care to the population at large.

Individuals, groups, and societies typically respond to health problems in a manner consistent with their culture, norms, and values.

STRAUS’s PRACTICAL APPLICATION VERSUS THEORY

The direction initially taken by medical sociology is summarized by Robert Straus (1957). Straus suggested that medical sociology was divided into two separate but closely interrelated areas-sociology in medicine and sociology of medicine.

The sociologist in medicine is one who collaborates directly with physicians and other health personnel in studying the social factors that are relevant to a particular health problem. The work of the sociologist in medicine is intended to be directly applicable to patient care or to the solving of a public health problem. Some of the tasks are to analyze the social etiology or causes of health disorders, the differences in social attitudes as they relate to health, and the way in which the incidence and prevalence of a specific health disorder is related to such social variables as age, sex, socioeconomic status, racial/ethnic group identity, education, and occupation. Such an analysis is then intended to be made available to health practitioners to assist them in treating health problems. Thus, sociology in medicine can be characterized as applied research and analysis primarily motivated by a medical 61 | P a g e

problem, rather than a sociological problem. Sociologists in medicine usually work in medical schools, nursing schools, public health schools, teaching hospitals, public health agencies, and other health organizations.

THE SOCIOLOGY OF MEDICINE, however, has a different emphasis. It deals with such factors as the organization, role relationships, norms, values, and beliefs about health as a form of human behavior.

The emphasis is on the social processes that occur in health-related situations and how these contribute to our fund of knowledge on medical sociology in particular and to our understanding of social life in general. The sociology of medicine shares the same goals as all other areas of sociology and may consequently be characterized as research and analysis of the medical or health environment from a sociological perspective. Most sociologists of medicine are employed as professors in the sociology departments of universities and colleges.

However, problems were created by the division of work in medical sociology into a sociology of medicine and a sociology in medicine. Medical sociologists who were affiliated with departments of sociology in universities were in a stronger position to produce work that satisfied sociologists as good sociology. But sociologists in medical institutions had the advantage of participation in medicine, as well as research opportunities unavailable to those outside medical settings. Tension began to develop between the two groups over whose work was more important. This situation resolved itself as two major trends emerged to significantly reduce differences among medical sociologists. ďƒ˜ First, an evolution has taken place in medical sociological work generally toward research relevant to health practitioners and policymakers. This development is largely because of the willingness of government agencies and private foundations to fund only health-related research that can help solve problems or improve health conditions. ďƒ˜ Second, a growing convergence among medical sociology and the general discipline of sociology took place. This situation is aided by the fact that all sociologists share the same training and methodological strategies in their approach to research. ďƒ˜ Theoretical foundations common throughout sociology are increasingly reflected in medical sociological work DEFINING HEALTH There is no single, all-purpose definition of health that fits all circumstances, but there are many concepts such as health as normality, the absence of disease, or the ability to function (Blaxter 2010).

The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being, and not merely the absence of disease or injury. This definition calls attention to the fact that being healthy involves much more than simply not being ill or injured. Being healthy also means being physically fit, having good social relationships with friends and family, being able to function or do things, and having a sense of well-being (Blaxter 2010). Thomas McKeown (1979) supports the WHO definition when he points out that we know from personal experience that feelings of well-being are more than the perceived absence of disease and disability. Many influences-social, religious, economic, personal, and medical-contribute to such feelings. The role of medicine in this situation is the prevention of illness and premature death, as well as the care of the sick and disabled. Thus, McKeown concludes that medicine's task is not to create happiness but to remove a major source of unhappiness-disease and disability-from people's lives. However, most studies suggest that laypersons tend to view health as the capacity to carry out their daily activities. That is, many people consider health to be a state of functional fitness and apply this definition to their everyday lives. Good health is clearly a prerequisite for the adequate functioning of any individual or society. If our health is sound, we can engage in numerous types of activities. But if we are ill, distressed, or injured, we face the curtailment of our usual round of daily life, and we may also become so preoccupied with our state of health that other pursuits are of secondary importance or 62 | P a g e

even meaningless. Therefore, as Rene Dubos (1981) explains, health can be defined as the ability to function. This does not mean that healthy people are free from all health problems, but it means that they can function to the point that they can do what they want to do. Ultimately, suggests Dubos, biological success in all of its manifestations is a measure of fitness.

CONTRASTING IDEAS ABOUT HEALTH AND SOCIAL BEHAVIOUR

Hippocrates argued that medical knowledge should be derived from an understanding of the natural sciences and the logic of cause-and-effect relationships. In his classic treatise, On Airs, Waters, and Places, Hippocrates pointed out that human well-being is influenced by the totality of environmental factors: living habits or lifestyle, climate, topography of the land, and the quality of air, water, and food. Concerns about health in relation to living habits, lifestyles, and the quality of air, water, and places are still very much with us today.

PUBLIC’s HEALTH

Awareness that disease could be caused by unhealthy social conditions and lifestyles spread through common sense and practical experience. A most significant development occurred when it was realized that uncontaminated food, water, and air, as well as sanitary living conditions, could reduce the onset and spread of communicable diseases. Prior to the advent of modern medicine, high mortality rates from communicable diseases such as typhus, tuberculosis, scarlet fever, measles, and cholera were significantly lowered in both Europe and North America through improved hygiene and sanitation. Thus, the late eighteenth and early nineteenth centuries are conspicuous for the systematic implementation of public health measures. Noting the link between social conditions, lifestyles, and health, some nineteenth-century European physicians argued that improvement was necessary inthe living situations of the poor.

GERM THEORY OF DISEASE

Most physicians in the 1800s were primarily interested in treating patients and improving the state of medical technology. They were not necessarily concerned with social reform. However, the medical doctors of the time had a history of only mixed success in curing human ailments. But as British social historian Roy Porter (1997:428) reported, "the latter part of the nineteenth century brought one of medicine's true revolutions: bacteriology." Louis Pasteur, Robert Koch, and others in bacteriological research decisively confirmed the germ theory of disease and uncovered the cause of a host of diseases, including typhoid, tetanus, and diphtheria, along with the vaccines providing immunity. Alexander Fleming followed up these advances in 1928 with the discovery of penicillin-the first antibiotic. Drug production became industrialized, which allowed mass production. The tremendous progress in the development of internal medicine, anesthesiology, pathology, immunology, and surgical techniques convinced physicians to focus exclusively upon a clinical medicine grounded in exact scientific laboratory procedures. Thus, the practice of medicine in the twentieth century rested solidly upon the premise that every disease had a specific pathogenic cause, the treatment of which could best be accomplished by removing or controlling that cause within a biomedical framework. As Dubos (1959) pointed out, medicine's thinking was dominated by the search for drugs as "magic bullets" that could be shot into the body to kill or control all health disorders.

Because research in microbiology, biochemistry, and related fields resulted in the discovery and production of a large variety of drugs and drug-based techniques for successfully treating many

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diseases, this approach became medicine's primary method for dealing with the problems it was called upon to treat.

SOCIAL STRESS AND HEALTH

Social influences upon the onset and subsequent course of a particular disease are not limited to variables such as age, sex, race, social class, and living conditions as they relate to lifestyle, habits, and customs. It is also important to recognize that interaction between the human mind and body represents a critical factor in regard to health. Social situations can cause severe stress that, in turn, affects health and longevity. In a review of stress research, Peggy Thoits (2010) concludes that (1) the impact of stress on health is substantial, (2) exposure to it is unequally distributed in the population (some people and groups experience more stress than others), (3) members of racial minority groups are burdened by additional stress from discrimination, (4) stress can continue over the life course contributing to differences in health between disadvantaged and advantaged groups, and (5) the impact of stress is reduced when people possess high levels of personal mastery (being in control of situations), self-esteem, and social support.

Stress can be defined as a heightened mind-body reaction to stimuli inducing fear or anxiety in the individual. Stress typically starts with a situation that people find threatening or burdensome. Examples of stressful situations that can affect physical and mental health include unpleasant working conditions.

PATIENT DOCTOR REATIONSHIP A major contribution of Parsons's concept of the sick role is its description of a patterned set of expectations that define the norms and values appropriate to being sick in Western culture, both for the individual and for others who interact with the sick person. Thus, the sick role views the patient-physician relationship within a framework of social roles, attitudes, and activities that both parties bring to the situation. This approach allows us, with some exceptions, to both understand and predict the behavior of the ill in Western society. The patient-physician role, like all other roles, involves a basic mutuality-that is, each participant in the social situation is expected to be familiar with both his or her own and others' expectations of behavior and the probable sequence of social acts to be followed.

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.

Neither party can define his or her role independently of the role partner. The full meaning of "acting like a physician" depends on the patient's conception of what a physician is in terms of the social role. The physician's role is, as Parsons tells us, to return the sick person to his or her normal state of functioning.

The role of the patient likewise depends on the conception that the physician holds of the patient's role. According to Parsons, the patient is expected to recognize that being sick is unpleasant and that he or she has an obligation to get well by seeking the physician's help. The patient-physician role relationship is therefore not a spontaneous form of social interaction. It is a well-defined encounter consisting of two or more persons whose object is the health of a single individual. It is also a situation that is too important to be left to undefined forms of behavior. For this reason, patients and physicians tend to act in a stable and predictable manner.

The patient-physician relationship is intended by society to be therapeutic in nature. The patient has a need for technical services from the physician, and the physician is the technical expert who is qualified and defined by society as prepared to help the patient. The goal of the patient-physician encounter is thus to promote some significant change for the better in the patient's health. Although the patient-physician relationship involves mutuality in the form of behavioral expectations, the status and power of the parties are not equal. The role of the physician is based on

an imbalance of power and the technical expertise favorable exclusively to the physician. This imbalance is necessary because the physician needs leverage in his or her relationship with the patient to promote positive changes in the patient's health.

Accomplishment of this goal sometimes requires procedures that can be painful or discomforting to the

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patient, yet the patient may be required to accept and follow the treatment plan if the physician is to be effective.

The physician exercises leverage through three basic techniques: (1) professional prestige, (2) situational authority, and (3) situational dependency of the patient.

Patient-Physician Role Relationship A third major area of criticism of Parsons's sick-role model is that it is based on a traditional one-to-one interaction between a patient and a physician. This form of interaction is common because the usual setting is the physician's office, where Parsons's version of the sick role is conceptualized. It is the setting where the physician has maximum control. Yet, quite different patterns of interaction may emerge in the hospital, where perhaps a team of physicians and other members of the hospital staff are involved. In the hospital, the physician is one of several physicians and

Why people seek medical care by different ways ?

The reasons for people ‘such different ways is due to their approach to the disease in ‘different ways’           

Some people think the disease is not so danger So may not have money Some may don’t have good medical facilities Some lack ways to reach hospital Some people take self medications Some geographical condition So may lack ‘medical insurance’ Illness recognition Illness danger Some one is afraid of modus treatment’ population structure.

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MAIN ARGUMENTS BY VIRCHOW

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AMERICAN SOCIAL ASSOCIATION

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TWO MAJOR TRENDS

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LIST 3 – 4 DEFINITION AND EVALUATE SOCIOLOGY IN MEDICINE AND SOCIOLOGY OF MEDICINE, HEALTH IN SOCIOLOGY, STRESS.

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COOLEY, W.THOMAS, E.GOFFMAN, A DURKHIEM

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