SSHM Exam Revision

1) Normal and

Pathological

2) Theoretical Approaches

3) Risk Discourses

4) Global Health

5) Pointers and

Questions

The Normal and PathologicalCanguilhem, Value Judgments,

Normal

The average –quantifiable

What ought to be

Ambiguous – has power

Descriptive but has value judgment

Pathological

Not the opposite of normal

Part of the same scale as normal –quantifiable differences

Outside the average not always pathological (diversity)

Changing norms is part of progress (Durkheim)

Canguilhem

Against medicine as aScience – medicine is an art

Aim to reopen problems

Lots of influence over 1960s thinkers e.g. Foucault

Other Thinkers

Broussais, Comte, Bernard – health and sickness not opposites

Renan – psychological conditions available through exaggerating the normal

Leriche – disease must be dehumanised in order to be studied

Arguments

The repressed always returns

The pathological is a new form of life

There can be no sickness without a sick person

The Normal and the Pathological

Normal

The average

Quantifiable

What ought to be

Not stable – historical changes

Descriptive

Value judgment – not objective

Pathological

Not the opposite of normal

Pathological and normal on the same scale

Matter of degrees – e.g. fever

Outside average not always pathological e.g. diversity

Changing norms is part of progress (Durkheim)

Canguilhem

Body not a machine

Medicine is an art

Mixture of sciences, not a science in itself

Aim to reopen problems

Influenced many key thinkers of the 1960s including Foucault

Other thinkers

Broussais, Comte, Bernard

Pathological and normal are the same apart from quantifiable variations

A matter of degree e.g. fever

Made popular by Comte and Bernard

Renan, Leriche Renan

Psychological conditions available through the exaggeration of normal

Normal can always become pathological

Links with risk

Leriche Disease must be dehumanised

in order to be studied

The sick can advance knowledge of the normal through their deficiencies

Links with Positivism

Arguments

1. The repressed always returns Scales of normal and pathological have to be in relation to each

other – cannot be objective

Terms have value judgments e.g. excess and deficiency

2. The pathological is a new form of life Change in the structure of an organ does not mean it should not be

brought back to the norm (hypertension)

Infections change the human – they will have new antibodies etc., and therefore be a new/different

3. There can be no sickness without a sick person Difference between disease and illness – the subjective and

observable

Pain is subjective – relies on the human – but

Theoretical ApproachesOntology, Epistemology, Positivism, Social Construction, Comte, Geertz

Ontology and Epistemology

Ontology – the study of being –what is reality?

Epistemology – the study of knowledge

– how do we know?

Positivism

Ontology – one reality outside

human influence

Epistemology –scientific study to achieve objective

knowledge

Coined by Comte and highly influential

Problems with methodology being too reductive and

ability to be objective

Social Construction

Ontology – there is no reality outside human influence

Epistemology –understanding

through perspectives

Associated most with Geertz

Problems with how far this can go – is

there no truth? Everything

constructed?

Ontology and Epistemology

Ontology

The study of being

What is there?

What is reality?

How can we understand existence?

What is it? E.g. what is a rock?

Epistemology

The study of knowledge

How do we know?

What is valid knowledge?

How can we obtain it?

Why is it? E.g. why is that a rock?

How do we know that is a rock?

Positivism

Linked with Enlightenment thought and scientific methology

Ontology There is one reality

independent of humans

Epistemology Through empirical scientific

study

Reality can be known objectively

Coined by Comte Sociology was to be the

‘queen of the sciences’

Assumes social facts can be measured like natural science facts

It can produce value-free and neutral understandings

Often seeks to explain how and why things happen Associated with quantitative

approaches

Problems with Positivism

Methodology

Social life considered more complex than biological life in laboratories

Experiences emerge from particular social, cultural, political, economic and historical context which cannot be easily quantified or separate

Too reductive

Objectivity

Impossible to describe something without using language which has value judgments attached

Researchers bring their own ideas and understanding to the research

Interpretivism/Social Construction

Linked with Post-Enlightenment thought in opposition to Positivism

Ontology There is no reality independent

of humans

Reality is always socially constructed

Epistemology Understandings always

dependent on the person’s perspective

Always subjective to a degree

Associated with Geertz People always attach meaning

to objects which then influence experiences and behaviours

Meanings are ‘intersubjective’ –existing between the minds of individuals

Culture should be approached in the literary approach to text

Assumes subjectivity/partiality of all knowledge

Seeks to understand how and why things happen Linked with qualitative

approaches

Problems with Social Construction

Could be taken to far

Nothing is real – everything is dependent of your view and perspective

There is no truth – only opinions

Risk DiscoursesBeck, Normal/Pathological, Medicalisation, Protodiseases

• Anticipation of catastrophe

• Manufactured risks

• Responsibility to act and manage risks

Beck

• Rose – mental health context, risk blurring the boundaries between normal and pathological

• Hacking – risk tries to bring certainty to the future

Other thinkers• Personalised medicine in

order to manage risks

• Preventative e.g. high blood pressure, cholesterol, cancers

• Protodiseases (Rosenberg) –medicialisation of risks into diseases

Risk in Medicine

Beck

Anticipation of catastrophe – not what is happening

Modernity – post-industrialisation, globalisation -contexts

Manufactured risks

Known, unknown, and unknown-unknown risks

Responsibility to act

To manage and reduce the risk

There is no such thing as zero risk

Other thinkers

Rose

Mental health context

‘Risky individuals’

Genomics and biomarkers as risk assessments

Risk blurs boundaries between normal and pathological

Hacking

Trying to being certainty to the future

Risk in Medicine

Personalised medicine

Treatment more personalised so not to increase risks e.g. high risk of breast cancer and taking the pill

Preventative medicine

E.g. High blood pressure, cholesterol, cancers

Medicalisation of risks, making them into diseases/illnesses themselves

‘Protodiseases’ (Rosenberg)

Global Health

What is Global Health

• Goal to improve health inequity worldwide

• Linked to public health and international health

• Virchow - Health has pathological and political elements

Inequality vs. Inequity

• Health inequality

• Differences in health experienced and health status

• Health inequity

• Differences in health for a significant number of people that is preventable and not a risk freely chosen

Direct and Indirect Interventions

• Upstream

• e.g. factory polluting water/river

• Downstream

• e.g. giving technical solutions to clean water for village

Approaches

• Technological

• Economic

• Sociological

• Bioethical

• Existential

What is Global Health?

Linked to public health and international health

Goal is to enhance health equity among nations and for all people worldwide

Health inequality Differences in health experienced and health status

Health inequity Differences in health for a significant number of people that

is preventable and not a risk freely chosen

Virchow All diseases have two causes: one pathological, the other

political

Institutions Involved

Governments

Bilateral organisations

Multilateral organisations

Global partnerships

Private foundations

Business/Corporate sector

Individuals

Direct vs. Indirect Interventions

Direct interventions

Downstream

E.g. Access to medical care, vaccinations, equipment/technology to improve water conditions

Indirect Interventions

Upstream

E.g. more equitable economic system, stop polluting rivers

Approaches to Interventions

Technological

Economic

Sociological

Bioethical

Existential

Pointers and Questions

What is the social?

Practice Questions

Defining ‘the social’

Make it really clear what is spoken about – political, social, economic, cultural, historical – they are all different! Don’t just say ‘social’ to be all-encompassing

There is no one definition of the ’social’ but some schools of thought:

1. Social construction/interpretive – what meaning is given to actions. Associated with Weber

2. Social is defined by the ‘conflict’ between people and institutions. Associated with Marxist tradition

3. Social defined by ‘consensus’ – the creation of social norms and how societies bind together. Associated with ‘functionalist’ thought with Parsons and Habermas

4. ‘Hybrid’ social – binding psychology and biology. E.g. the environment shapes psychological dispositions. Associated with Simmel

Questions

What are the Normal and the Pathological? And What do the Tell Us about the History of Medicine?

With Reference to a Specific Case Study, Discuss how the Experience of Illness is Shaped by Larger Social-Cultural Contexts

What can a Study of the Subjective Experience of Illness tell us about Issues of Health, Disease and Medicine that Other Approaches Cannot? Discuss.

With Reference to a Specific Example, How Might the Concept of ‘Risk’ be Useful in Critically Evaluating Issues of Health and Disease in Modern Society?