S208 Week 6 9 May 2007   Amy: from biomedical view, acknowledging risk helps us prevent disease is it possible to separate

risk as some objective entity from an implicit, perhaps semiconscious understanding of risk for whom and risk for what? this might be a way to think of risk as socially inflicted Linda: defining acceptable risk in response to limited utility to breaking everything down (where does that get you? what do you have to refer back on?)  Bury talks about the weaknesses of social constructionism; if it is attacking a biomedical frame of reference or biomedical basis as knowing something as knowledge, you could aim the same critiques on knowledge that is based in social constructionism. it is selective, partial; a way of analyzing and doing things. it’s an ongoing theoretical dilemma that social constructionism has to deal with.  when you’re talking about the ending of the Shim article, we’re not talking about whether what’s going on is wrong or right. in our parents’ shoes, we would have done what they done. but: social constructionism allows us to see that we’ve chosen a particular path, and we’ve chosen it collectively, socially, as patients, as family members.. and we’ve chosen it without realizing we’ve chosen it, because it seems like “the way to go.” of course we want to pursue the optimistic idea that lives could be extended, but that still entails a choice, and social constructionism helps us realize that there are other choices that could be made. part of why we wrote the article is to say that at any given point, one could do something different (SI idea that interactions are emergent phenomena), yet anything doesn’t happen: what ends up happening is largely socially patterned. it’s trying to understand why providers feel so compelled to not bring up the point, and are so unable to bring up the point. clinically, they feel as if they bring up the issue, they may not be doing the responsible thing (responsible to themselves, their peers, their patients). in this classroom, nobody is going to start to get up and yell and scream. we need to understand why that is and explain why that is. there is this underlying logic that permeates the whole clinical experience, and life outside the clinical experience. risk and prevention and managing prevention. do we care about a tree that nobody has heard falling? couple things about social constructionism:  social constructionism vs. reality. this is one of those things that, along the continuum of social constructionism, people will fall in different places. some will say what is real is only what we create through language. but sociological approach to things is to understand what’s socially meaningful (the risks we care to pay attention to and collect data on and quantify in some way). that’s one sense in which social constructionism has something to say about what enters in on this horizon. there are probably lots of risks nobody knows about Alyssa: Fosket

 

 

  

not to dispute the method through which they came up with the number, but the notion that a number represents a high risk is something that was put together in a social and collective and historically specific way. yes, there is risk.. it’s not to dispute how that number came about. but a number in and of itself doesn’t mean anything until we as individuals, patients, society come together in this unorganized fluid way to say “yes, this is high risk”; then it gets embedded in multiple places, such that when a clinician is in their office seeing a patient, the patient sees the number (which has been institutionalized) and the clinician feels compelled to act upon it numbers/statistics have an eminent ability, this quality of being able to jettison the baggage, qualifications, and history that come with them; they are very portable Tania: having this risk society individualizes the problems as well as solutions one of the principles of SI is that it arises out of a philosophical tradition of pragmatism, around the early 20th century. one of the tenets is that things perceived to be real are real in their consequences. because they’re perceived to be real, they become real in social fact. when we say something is socially constructed, we’re not saying it’s not real; we’re trying to pay attention to what the consequences of that social construction are. it then has social consequences, and in those social consequences, “reality” is made. what is that we care about? what is it that we attach meaning to? what are the things that we care to interpret? that is the social reality that we as sociologists are concerned with. to say that race is socially constructed and thus not real: that’s not a conversation we’re engaging in, and in fact it goes against the very grain of social constructionism. it’s constructed to be real and we attached certain interpretations to it and develop institutions based on those interpretations; that’s how social reality is actually built up. the other conflation is to talk about some notion of a pure science that is divorced from social context / social consideration. when you look at the enterprise of science, you find people are mired in whatever social circumstances they have. because science is so often a collective enterprise, it’s often a social enterprise as well. to talk about a pure science as if it were unbiased or to knock something as being biased, as if there were an unbiased way to produce that scientific entity or disease category or risk number… what social constructionism puts on the table is the notion of social context always mattering, social conditions giving shape to what is produced (whether a quantification tool or risk assessment test or drug or particular treatment); all of those social conditions included in its production are always shaping it in some way or another. it doesn’t make sense to talk about science as somehow being separate from society or from politics. with any scientific entity, whether disease category or treatment, there’s always some shape of social shaping in there, and some sort of politics in there. and we’re not just talking about capital P Politics (legislative), we’re talking about small p politics.. power given to some cultural notion of diseases existing within individuals, thus we’ll look within individuals for the source of disease. scientific entities always carrying with them that kind of history Amy: we’ve only asked certain questions “Social Construction of What?”  spectrum: no physical reality out there outside of language, to yes, there is physical reality, social construction tells us something about what we selective choose to pay attention to

 

 

 

in 1990s, there was a physicist (Alan Sokel) who wrote a farcical article in the Journal of Social Text. he almost simultaneously published an article revealing that the Social Text article was a complete fraud. he appropriated the language from what he saw as a faddish obsession with social constructionism and managed to get an article through peer review. question become: what kind of contribution does social constructionism have if it’s able to produce this kind of phenomenon? huge implications for status of social science in the academy Hacking wrote reflection in response to these science wars he expresses frustration / growing impatience as science studies scholar with how long people can go on denying the existence of a physical reality. he uses example of quarks; he says that, without doubt, quarks exist. maybe quarks exist only b/c we care about them. why do we care that they exist? certain implications follow from that. that’s the sociological question. that’s what this science studies project is about – not about whether something exists or not. because we care about quarks, certain things follow from that. what institutions/ideas become part of the way we view the world and then have ongoing social consequences John: allows us to examine the taken-for-granted SI interested in this from the get-go. the social situation we find ourselves in – what would happen if someone got in an elevator and look at the back of the elevator? why doesn’t that happen? interactionists looking at taken-for-granted social rules and social patterning, that we’re able to get along and interpret what the other is doing, b/c it fits within our scheme of how society works

what are the implications that come from a particular social construction? Armstrong  how can this be linked to Crawford’s article from last week (health as new idiom, as having attained new cultural relevance; “unhealthy other”)?  John: nobody truly healthy  health as state that we endeavor to reach; an ongoing project  health becomes the lens through which we distance illness from ourselves (e.g., from the pregnant drinking woman)  Foucault talks about hierarchical observation. symbolic interactionists talk about the importance of social relationships; the construction of self in relation to an imagined other. who we are – there is no intrinsic, essential nature to me; who I am is set up in relation to others. not distinct boundary between normality and pathology; it’s the notion it’s not a benign relationality between ourselves and others, it’s hierarchical – we’re “better than” others  Foucault’s Panopticon  relations of positions matter. a physician who becomes a patient acts in certain ways as if he were a patient  ---- noncompliance may make sense from certain points of view  if you take the perspective that resources are completely stratified, then you would imagine the problem might be that they don’t have the resources.. that noncompliance is a

logical outcome of their lack of resources to do the things they need to do, according to risk reduction mandates  ---- his argument is about risk. the part about health promotion that promotes certain behaviors b/c of their future consequences.. there is a part within health promotion that is legitimated by notions of future consequences. risk is all about the risk of something happening to you in the future  the whole construction of risk buys us perceptions of certainty, safety.. that if one walks around with the risk of cardiac risk, that having a bypass will alleviate that. Armstrong is saying something different: that the more we try to control risk – the more anxious we get – the more we realize that life is ultimately uncontrollable. where is there contestation/resistance?  John: Crawford predicts a major social movement  “The danger of danger is that no interest is immune to the destabilizing effects of anxiety and control, control and more anxiety” (512)  is he talking about risk itself or medicine’s risk culture?