From a sociological standpoint, illness is not only a moral status (such as crime or sin) but also a form of deviance. To sociologists, labeling some- thing deviant does not necessarily mean that it’s immoral. Rather, deviance refers to behaviors or conditions that socially powerful persons within a given culture per- ceive, whether accurately or inaccurately, to be immoral or to violate social norms. We can tell whether behavior violates norms (and therefore whether it’s deviant) by seeing if it results in negative social sanctions. This term refers to any pun- ishment from ridicule to execution. (Conversely, positive social sanctions are rewards that range from token gifts to knighthood.) These social sanctions can be enforced by parents, police, teachers, and peers, as well as doctors. Later in this chapter, we’ll look at some of the negative social sanctions imposed against ill persons.
For the same reasons that the medical model doesn’t recognize the moral aspects of illness labeling, it doesn’t recognize the political aspects of that process. Although doctors sometimes participate actively in these political processes— arguing, for example, that insurance companies should cover treatment for newly labeled conditions such as fibromyalgia—few doctors recognize how politics un- derlie the illness-labeling process in general. In contrast, sociologists point out that any time a condition or behavior is labeled an illness, some groups will benefit more than others, and some groups will have more power than others to enforce the definitions that benefit them. As a result, open political struggles often emerge around illness definitions (a topic we’ll return to later in this chapter). For exam- ple, U.S. vermiculite miners who were constantly exposed to asbestos dust in their work and who now have strikingly high rates of cancer have fought with insur- ance companies and doctors in clinics, hospitals, and the courts to have “asbes- tosis” labeled an illness. Meanwhile, the mining companies and the doctors they employ have argued that no such disease exists and that the high rates of cancer in mining communities are mere coincidences.
Finally, the medical model of illness assumes that each illness has not only unique symptoms but also a unique biological cause. Modern medicine assumes, for example, that tuberculosis, polio, and other infectious dis- eases are each caused by a unique microorganism. Similarly, doctors continue to seek limited and unique causes of heart disease and cancer, such as high-cholesterol diets and exposure to toxins. Yet even though illness-causing microorganisms exist everywhere and environmental health dangers are common, relatively few people become ill as a result. By the same token, although cholesterol levels and heart disease are strongly correlated among middle-aged men, many men eat high-cholesterol diets without developing heart disease, and others eat low-cholesterol diets but die of heart disease anyway. Belief in unique biological causes discourages medical researchers from asking why individuals respond in such different ways to the same health risks and encourages researchers to search for magic bullets—a term used by Paul Ehrlich, discoverer of the first effective treatment for syphilis, to refer to drugs that almost miraculously prevent or cure illness by attacking one specific etiological factor.
In sum, to sociologists who work from a critical perspective, illness is a social construction, something that exists in the world not as an objective condition, but because we have defined it as existing. This doesn’t mean that the virus causing measles does not exist or that it doesn’t cause a fever and rash. It does mean, though, that when we talk about measles as an illness, we have organized our ideas about that virus, fever, and rash in only one of the many possible ways. In another place or time, people might conceptualize those same conditions as manifestations of witchcraft, as a healthy response to the presence of microbes, or as some other illness altogether. To sociologists, then, illness, like crime or sin, refers to biological, psychological, or social conditions subjectively defined as undesirable by those within a given culture who have the power to enforce such definitions.
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