 |
 |
 |
3rd Global Conference
Making Sense of: Health, Illness and Disease
Monday 5th July - Friday 9th July 2004
St Catherine's College, Oxford
Conference Programme, Abstract & Papers
Session 5: Constructions of
Illness and Disease
Chair: Peter Colosi
The Social Construction of Disease: Why Homosexuality isn’t
like Cancer
Matthew McGrattan
Brasenose College, Oxford, United Kingdom
There are two key forms in which the view that there
are no facts of the
matter concerning the norms of health and that diseases, qua disease
status, are social constructions is advanced:
1. epistemological: the belief that a condition
is a disease reflects
the socially and culturally relative values of a particular society or
culture rather than any objective underlying facts, and
2. metaphysical: disease is constituted by
these socio-culturally
relative value-judgements.
In this paper I shall be concerned with the epistemic rather than
metaphysical claim.
I shall argue that while arguments proceeding from specific
case studies
often appear weak or fallacious---inferring directly, for example, that
constructivism is true from the mere presence of historical or cultural
variation in belief---convincing arguments can be made if understood
as
a form of inference to the best explanation. Where the best explanation
for changes in a condition’s disease status is that the beliefs
involved
do not track underlying objective facts.
I shall continue to argue that,
despite the success of arguments of this
type with respect to specific individual conditions---homosexuality,
drapetomania, etc.--- no general conclusions follow. Any such move would
be inductive---arguing from specific cases to general conclusions about
all diseases---but would fail as the features which justify the initial
inference to best explanation in cases such as homosexuality---the
presence of socio-historical variation in belief; absence of alternative
naturalistic explanations for such variation; lack of consensus about
the etiology or pathology of the condition, and so on---are absent in
the majority of cases. Concentration on well-known cases such as
homosexuality obscures the fact that such cases fail to resemble other
diagnoses in key ways, preventing any constructionist conclusions about
the former applying to the latter.
Download Full Conference Paper - 
Public Health, STDs and Oral Histories of Care
Department of Epidemiology
Aaron Goodfellow
Johns Hopkins School of Medicine, Baltimore MD, USA
Public health strategies geared towards preventing sexually
transmitted disease (STD) configure those who suffer from drug and alcohol
addiction as a source of knowledge for understanding the social factors
associated with the transmission of STDs. As such, those who seek treatment
for addiction are often on the receiving end of both intervention and
research initiatives that are designed to address the suffering associated
with chemical dependency and the behaviours that place one at risk for
STDs. The goal of such interventions is to alleviate the pain of addiction
and disease, as they are suffered in the body, and to address the more
general social conditions that place subjects at risk for chemical dependency
and STDs. The concomitant need to address bodily forms of suffering in
conjunction with the need to protect society is indexed by the configuration
of relationships (whether familial, sexual, or otherwise) as potentially
dangerous in the discourse of drug treatment and STD prevention. Such
is the case because relationships are pictured as providing the context
for drug use and STD transmission, and to possess the agency necessary
for bringing about such a condition.
My paper will addresses such an imagination
of relationship through an analysis of the ‘oral histories of care’ I
have compiled from fieldwork conducted in a residential drug treatment
facility in Baltimore Maryland. My paper will examine the implications
of modeling intervention strategies based upon the assumption that STD’s
and drug addiction are afflictions that reside within individual bodies.
I ask how forms of suffering that are dispersed across multiple relationships
and social networks might be addressed, and discuss how intervention
provides a basis for forms of sociality. My paper will end by commenting
on what it might mean to intervene in the context of decision making,
as opposed to a subjects specific decisions.
Getting By: The Lived Experience of Waiting for Transplants
Kath MacDonald
Queen Margaret University College, Edinburgh, Scotland
This study uses an exploratory approach to examine how
patients with CF and their carers cope with the rigours of chronic illness
and life on a transplant waiting list. The process of waiting for lung
transplantation in cystic fibrosis (CF) is arduous, often long, and can
be extremely stressful to the sufferer and their carers. Waiting times
are increasing due to a shortage of donors. Deaths while waiting can be
up to 40% in some centres and survival rates remain around 50% at 5 years.
Yet the demand for transplantation remains high.
METHODS:
Combinations of qualitative and quantitative approaches were used. 8 patients
with CF, 4 awaiting transplant and 4 who had been transplanted within the
previous 3 years, and 5 of their carers, were asked to recount their experiences
using a semi-structured interview technique. In addition, Quantitative
tools: COPE, Perceived stress scale (PSS), Significant Others Scale (SOS),
and the Hospital Anxiety and Depression Scale (HADS) were also used to
assess stress, support and coping methods.
RESULTS: 4
themes emerged from the interview data. Displacement, Disorder, Life in
Limbo and Readjustment to wellness. Patients' self-perception of health
appears altered at referral for transplant and a period of acceptance of
deteriorating health evolves over the continuing months of waiting. Issues
concerning emotional support, control, and "buying time" are
all seen as important in the waiting process. This has implications for
the role health professionals play during the process. Adaptive coping
strategies such as taking action, planning, positive reinterpretation and
acceptance scored highest across all groups. Depression scores were statistically
significant in the pre transplant group compared to the post transplant
group.
CONCLUSION: Coping with chronic illness while
waiting for transplant involves a variety of adaptive coping strategies.
Perception of health differs between patients and their attending physician.
Further research is required to define the role Health Professionals can
play in helping families to cope.