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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?
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