I feel like this course has now come full circle now that we’ve talked about end of life care and elderly care. From the social determinants of health to how the medical professions view death and terminal illness, I can see how our society came to revolve around health and fitness. The concept of the patient and patient experience though, is what really stood out to me, even though I’ve never been hospitalized and I can’t relate to this.
Medicalization is defined as the process of defining previously non-medical conditions or behaviors as medical, subject to medical professional attention and treatment. However, there has been debate what the purpose is of medicalizing an illness. Some argue the purpose is for doctors and authoritative figures to turn people into patients to be able to control and manage them, while others argue that the purpose is for “sufferers” to become objects of attention by becoming patients. My question is, do you think there are other incentives or reasons behind medicalizing an illness besides the two listed above? If so, what are the other possible incentives?
According to WHO’s first global estimates of herpes infection, more than 3.7 billion people under the age of 50 – or 67% of the population – are infected with herpes simplex virus type 1 (HSV-1). The “herpes” we know as an STD is genital herpes caused by HSV-2. WHO’s latest journal article highlights that HSV-1 is also an important cause of genital herpes.
HSV-1 causes lesions on the lips or around the mouth commonly referred to as cold sores or fever blisters. It’s primarily transmitted by oral-to-oral contact. Both oral and genital herpes viruses can sometimes be spread, even when you do not have mouth sores or blisters.
This report should raise concerns on the unequal distribution of healthcare and necessary infrastructure resources. Based on WHO’s data, we can found that the rate of infection is significantly higher in regions such as Africa and South-East Asia than regions such as the US. Fewer people in high-income countries are becoming infected with HSV-1 as children, likely due to better hygiene and living condition. One implication of policy making is to provide more access to hygienic water as well as other resources to underdeveloped regions. At the same time, public education is also important because most people get infected as children. For example, some parents chew food for their children and pass the virus to them.
HSV-1 infected disease is also a good example for illnesses affected by social factors. According to WHO, though the virus is highly infectious and incurable, symptoms such as blisters only occur when the patients’ immune system is under stress. Some people, if they get a lot of sun exposure, they’ll get an outbreak, or women during pregnancy or when they have their menstrual periods.
The high estimated proportion of the herpes infection has significant effects. Even in the region that has the lowest rate (Americas: 178 million women (49%), 142 million men (39%)), nearly half of people under 50 are infected. This undermines what we define as an illness. There have been such comments from the public as: “It is not herpes; it is cold sores” or “Everyone is infected”. These comments surely exaggerate the facts. However, it reflects how the big number can reduce people’s definition of a certain illness. If over 99% of the adults are infected with HSV-1 worldwide, would it still be recognized as an illness or simply an accepted impairment in our immune system.
We need to acknowledge that, people who are infected with herpes, even the HSV-1, are stigmatized in most societies. Will the new WHO findings promote the de-stigmatization of the diseases? Due to the high infection rate? WHO has stated that “People with orolabial herpes symptoms may face social stigma, and can experience psychological distress as a result.” On the other hand, this finding may evoke panics among the public and accentuate the stigmatization on sexual activity as general. For example, on the website of Centers for Disease Control and Prevention, several suggestions were given. “The only way to avoid STDs is to not have vaginal, anal, or oral sex.” “If you are sexually active, you can do the following things to lower your chances of getting herpes: Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results.” Not only do those suggestions emphasize the isolation of infected population but also propose a preferred way of conducting sex. This a good example how the disease and they way people perceive it can shape the public’s view on sex and certain sexual conduct such as multiple partners.
In this week’s readings, we read a lot about the two different models of illness. Growing up as the daughter of a doctor and and aspiring to be a doctor myself, I had always taken more of the medical perspective. Reading the article “The Social Construction of Illness: Key Insights and Policy Implications” actually made me think a lot differently about the concept of illness. However, it was really difficult to accept this point of view because I had always thought of illness as having one single, biological cause and that it could be treated with a biological agent. I can understand the sociological model, that assigning an idea to the illness itself changes how we experience it, but the two models seem like two antagonistic ideas. Is there any way to reconcile these two ideas, to take into account that a biological agent may cause a disease but that social factors also shape how we experience that disease? Would a model that takes both of these ideas into account not give us a more expansive view of human illness or disease?
In the article “The Social Construction of Illness: Key Insights and Policy Implications” Conrad and Barker discuss the impact stigma can have on an individual with an illness. One of the most interesting portions of this article and something I believe most people do not think about is the metaphorical connotations associated with certain illnesses and how this can affect those afflicted with the disease. Conrad and Barker give the example of the metaphor of “obesity as sinful” and how this would either deter or encourage an individual’s support towards public policies aimed at reducing obesity. It seems counter intuitive that the negative connation associated with an illness would make people less likely to want to help lessen the prevalence of this illness, since it would seem as if people would want to reduce the prevalence of an illness they view with such disdain. I think if people would be discouraged to support public policies aimed at reducing certain illnesses, the people with these illnesses would end up like those who are coping with illness experience that is discussed later in the article. Barker and Conrad describe these people managing chronic illness as becoming “increasingly cut off from the routines of conventional life—unable to work, spend time with family, socialize with friends, or move about freely. Thus, the foundation on which a sense of self is based can be lost, there is nothing to look forward to, and nothing to do; time is experienced as unchanging.” This seems like a depressing but likely fate for those who have no support for their illness due to the negative conations associated with this illness. All in all, this makes me wonder if the negative connation associated with an illness would be more likely to discourage or encourage others from supporting approaches to reduce the illness or help those with the illness cope? Would cultural and religious difference impact the decision to support public policies?
As I was reading about the two different models of illness, medical and sociological, I felt strange thinking about illness as a subjective matter. I think that we are in a time period of technological change and that in many cases our knowledge base has not caught up with the sensitivity the technology we have tests with. I can imagine a future where the medical model of illness takes hold and rather than having two models there is instead a sociology of illness rather than a social definition of illness. One of the main problems is that science overwhelmingly recognizes humans to have one “set-point”, while what may be abnormal for one person may be normal for another. Hopefully this idea will change and the medical field will be able to recognize that different types of people have different is factors depending on their age, ethnicity, lifestyle, gender, and every other factor that makes up who they are.
If doctors start thinking about illness as a social problem more than a scientific problem I fear that progress in the scientific fields could halt and we could lose the next great discovery of our time. If someone is sick then it is due to a biological cause and with enough research and effort someone will find out how to change that “sickness”. Whether or not someone should change that sickness because of social factors I don’t think is a question doctors and researchers should be answering.
In Peter Conrad and Kristin Barker’s article, they explain the concept of social constructionism and say that “the emphasis is on how meanings of phenomena do not necessarily inhere in the phenomena themselves but develop through interaction in a social context.” In other words, the disease itself may have an entirely different meaning than the illness, based on social context, cultural differences, lack of knowledge, and different perceptions. They also claim that a “stigmatized illness can make an illness much more difficult to treat and manage” and then go into the example about HIV/AIDS and how people are less likely to seek help for their condition. Because technology heavily influences social behavior and experiences today, do you think this has anything to do with how we view illnesses and diseases? Technology, especially the Internet, allows information to be public, available, and accessible as well, so is it bad that all this excess information is available since the public is able to interpret it however they want to? Should we be focusing on educating and reducing the stigma in society instead of giving out all this information to the public?
In Barker’s article, illness is described as being socially constructed. The author explains that some illnesses are more influenced and affected by the culture while some illness are stigmatized. This stigmatization affects those who are diagnosed with the illness, because they now have to cope with both the stigmatization as well as the side effects of the particular illness.
What causes a given illness to be stigmatized by society? For those illnesses that are affected by stigma, how can we address this issue through the implementation of social policy?