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THE SELF IN SICKNESS
AND IN HEALTHClara Valverde RN BSc
Aquo Training Teamwww.equipoaquo.com
The interruption of one’s biography
While healthy, one takes for granted one’s body
And what else? What changes with illness? How would one be seen
differently? (social meanings) How would it affect one’s idea of
“success”? How would it interrupt one’s
biography?
Medicalization of society
How does it feel to be a patient? How does the health care system see
the patient? Gender differences. How does the patient see the health
care system?
Medicalization of society
What does the doctor want to talk about?
What does the patient want to talk about?
Medicalization of society
Medicalization is a social process in which bodies and social circumstances are defined from a biomedical perspective requiring biomedical intervention.
Today it is not the stethescope nor the scalpel that does the fundamental work of medicine; it is the ideas conveyed in words
that persuade us that what is done is right and good.
Trish GreenhalghUnder the Medical Gaze
Medicalization of society
The “battle of narratives” in the doctor’s office
(Arthur Kleinman, Arthur Frank, Abel and Browner, Rita Charon,
T. Greenhalgh, C.Mattingly, L.Garro)
The doctor hides his doubts and fears behind a shield of invincibility and he
forgets that it is only a shield.
Eric J.CassellThe Healer’s Art
Medicalization of the self
How does the doctor take power?
How does the patient give the doctor power?
Possible problems with this situation?
Science’s job now-a-days is not so much to tell The Truth, but to tell a truth and then make it look like The Truth.
David LockeScience as Writing
Medicalization of the self
Embodied knowledge: what one feels in one’s body.
Empathic knowledge: another’s experience that one identifies with.
(Abel and Browner 1998)
Scientists make things that are only probably true seem definitely
true.
David Locke
Truth claims What are some “truth
claims” that doctors make that are reproduced in society?
How are they reproduced?
Expected Illness Behaviours
What does society expect the ill person to do, not to do, to be like, not to be like, to look like, not to look like?
What does society expect the ill person to think, hope for?
Are some behaviours seen as “better” than others?
To always be looking for a cure is not an adaptative behaviour.
M.J. Montbriand
Expected Illness Behaviours
How does society see slowness, weakness, confusion, vulnerability?
Could they be accepted values, just as accepted as the “can-do” attitude?
I wake up with it. I feel like I’ve done something wrong. I have this horrible feeling, like I’m really bad, like I should make up to someone, even get forgiveness. I often can’t shake it till I’m on my way to work. Sometimes at night I dread going to sleep ‘cause I know I will wake up with it.
Moira, legal assistant, lives with lupus
Sick and Tired of Feeling Sick and Tired: Living with Invisible Chronic Illness(Donoghue and Siegel 2000)
Expected Illness Behaviours
Guilt:
How does “blaming the victim” work?
Why does it work? Who does it?
Medical encounters tend to convey ideologic messages supportive of the current social order.
Howard Waitzkin
Invisible Chronic Illnesses or Disabilities
How does it affect one’s self having an illness or disability that is invisible?
Advantages and disadvantages of the fact that it is invisible
Three types of invisibility in the new chronic illnesses such as Chronic Fatigue Syndrome-Myalgic Encephalitis (CFS-ME), Multiple Chemical Sensitivities (MCS), Fibromyalgia (FMS), Gulf War Syndrome (GWS), etc:
1. The person is not seen because s/he is at housebound
2. S/he has no outer signs of the illness (“but…you don’t look sick”)
3. When s/he says s/he has CFS, MCS, FMS or GWS, people do not believe him/her
Juliene Lipson PhDUCSF
Diagnosis or Definition?
What are the advantages of having the diagnosis?
What are the disadvantages of having the diagnosis?
Reclaiming the Self What would help the ill
person find his own definition of what it is to have that illness, to find meaning to his or her new life?
What would hinder?
I have changed. Like you. But in a different way.
Paul Verlaine
