Kaisa Kauppinen - Constructions of Health and Illness

European Perspectives

Edited by
Ian Shaw
School of Sociology and Social Policy
University of Nottingham

Kaisa Kauppinen
Finnish Institute of Occupational Health
University of Helsinki

First published 2004 by Ashgate Publishing

Reissued 2018 by Routledge
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Ian Shaw and Kaisa Kauppinen 2004

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ISBN 13: 978-0-815-38816-6 (hbk)

ISBN 13: 978-1-351-16128-2 (ebk)

Judith Allsop Health Policy Research Unit, De Montfort University, UK

Rob Baggott Health Policy Research Unit, De Montfort University, UK

Ruby C.M. Chau Department of Sociological Studies, University of Sheffield, UK

Pru Hobson-West Institute for the Study of Genetics Bio-risk and Society, University of Nottingham, UK

Kathryn Jones Department of Public Policy, De Montfort University, UK

Ilka Kangas Department of Sociology, University of Helsinki, Finland

Kaisa Kauppinen Department of Psychology, Finnish Institute of Occupational Health, Finland

Sara O'Sullivan Department of Sociology, University College Dublin, Ireland

Hannele Palosuo Department of Public Health, University of Helsinki, Finland

Elianne Riska Department of Sociology, bo Akademi University, Finland

Ian Shaw Department of Sociology and Social Policy, University of Nottingham, UK

Anne Stakelum Department of Public Health, North Eastern Health Board, Ireland

Louise Woodward Nottinghamshire Healthcare NHS Trust, UK

Sam W.K. Yu Division of Social Studies, City University of Hong Kong

Thanks are due to Kathryn Nokes, who undertook the preparation of the CRC on this project. Many thanks are also due to both the contributors and Ashgate for being understanding of the unanticipated difficulties that emerged in this particular editorial task.

Ian Shaw and Kaisa Kauppinen

The genesis of this edited collection lies in the European Sociological Association's (ESA's) biannual conference in Helsinki in 2001. The editors cochaired the sessions on the health and illness stream. It was also from that conference that the Medical Sociology and Health Policy Research Network of the ESA finally emerged. The meeting that formed that research network also promoted the idea of an edited collection of papers around the key theme constructing health and illness. As a consequence, many of the papers in this collection have been developed from presentations made at that conference. However, the editors looked beyond the conference presentations, seeking contributions from other authors in creating a 'balanced' edition that covers the main areas of social construction as it relates to health and illness.

What has become known as the 'constructionist debate' is now one of the most important elements within the sociology of health and illness (Bury, 1996; Nettleton, 2000). This debate arose in the 1960s with Goffman's critique of psychiatry and the role of medical treatment (Goffman, 1961). The resulting discourse helped form the anti-psychiatry movement and the view that psychiatrists were powerful agents of social control (Szasz, 1970). This questioning of diagnostic categories was not limited to psychiatry. In particular, Friedson's work illustrated how diagnosis was mediated by the social and political context in which doctors were practising (Friedson, 1970). Medical belief systems are now seen to be constructed in similar ways to any other belief system (Comaroff, 1982). The examination of doctor's thinking and beliefs continues to form a strong element in contemporary sociology and that is also reflected in this edited collection. In particular in the contribution by Elianne Riska, in her study of the discourse of pathologists, and also in the ways in which rumour may be used to raise issues onto the medical agenda, as in Shaw and Woodward's study.

The 'constructionist debate' was also carried into everyday life. In the main this was due to the works of phenomenology thinkers such as Berger and Luckman (1967). They argued that everyday knowledge is creatively produced by individuals and is orientated around the practical problems of everyday life. Accordingly, to understand beliefs about disease, researchers need to examine and understand the 'common sense' notions of people in society. This has also formed a particularly strong strand in contemporary sociology and again is reflected in this collection. The chapter by O'Sullivan and Stakelum forms a very interesting study of the understandings of an Irish coastal community and the impact that the Sellafield nuclear power and reprocessing plant has upon their health. Palosuo's chapter illustrates how lay understandings of health can differ in different countries, in this case between people living in Helsinki and Moscow. Chau and Yu's chapter examines the ways in which Chinese people in Britain differentially use Chinese and western medicine and how their understandings of health shape those interactions. Another chapter in this broad theme is the contribution by Kangas. Her study of the changing views of depression and how people account for their own suffering is an insightful contribution to this theme.

A variation on the theme is how lay people operationalise their understandings into resistance and political pressure. This is reflected in Hobson-West's chapter, which focuses upon lay people's resistance to vaccinations. It is also reflected in the contribution of Allsop, Jones and Baggott and their study of health consumer groups in the policy process.

There are now many diverse strands within the constructivist debate in relation to health and illness. One approach is to consider how medical knowledge and facts become socially constructed. Another is to argue that disease entities cannot be divorced from their social context, and research explores how medical science comes to define disease categories. A third would be to look at how social relations are mediated by medical knowledge and medical labelling and this may include how medicine organises itself. A final strand is medicalisation and the way in which medicine comes to make claim over areas previously thought of as 'natural' rather than 'medical'. An example of this is Shaw and Woodward's discussion on the extent to which unhappiness may have been medicalised as depression.