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    9 views11 pages

    Rosenberg Framing Disease

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    AntelmoJunior

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    © All Rights Reserved
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    FRAMING DISEASE ce Studies in a aS Cultural History ein / edited by Judith Walzer Let CHARLES E. ROSENBERG Moris Vogel and JANET GOLDEN R RUTGERS UNIVERSITY PRESS. New Brunswick, New Jersey ‘CONTENTS Acknowledgments xd (Charles B. Reber var FRAMING DISEASE 1 From Brights Dsate to End-Stage Renal Ditete Sun]. 12 Emergence of Rheumatic Fever the Nineteenth century 20 Pate C. Bg ‘5 Parasesand the Germ Theory of Disease 38, Jota Fertey 4 "Definite and Materia: Goronary Thrombesi and Cardiologts inte 1020550 tripe Laarnce DISEASE AS FRAME 5 The Metitization of Suicdein England: Laymen, Physicians, sand Cultural Change 1500-1870 85 Michel MacDonald (6 American Physicians “Discovery of Homosexual, 180-1000: ‘ANew Diagnosis ina Changing Society 104 Bert Hasen 17 From Psychiatrie Syndrome to “Commune” Disease: The CaseofAnoreiaNeres 184 Joon Jes Bramerg {8 Prom MyalgcEncephalitiso Yuppie Fu A History of Chronic Fatigue Syndromes 15% abot A Arooite NEGOTIATING DISEASE: THE PUBLIC ARENA 8 Thelsionof Medical Certsny:Sicoss nd the Pleo oduseia Disabil, 1950-1960" 185 (Gerlé ork and Did Rrer 10 The Legal Art of Pychiasie Diagnose: Searching for Reliability 206 Jost A. Tighe MANAGING DISEASE: INSTITUTIONS AS MEDIATORS. 1. Quid pro Quoin Crow Ines: Tuberculosis in Penoylans, 1876-1995 220 Baar Bates 12. Stories of plea, 1880-1980 248 Elin Deger vers DISEASE AS SOCIAL DIAGNOSIS (19 "The Sick Poor and the State: Arthur Newahelme on Porerty, 27 see and Responsiy215 Ione (GF) Henry. Sigert: Hs tmerprestions ofthe History of Dare aude Fusreot Medicine 297 las ee Lif Cnet $19 odes 523, INTRODUCTION Framing Disease: Illness, Society, and History (CHARLES E, ROSENBERG Meneame, an often-quoted Hippocratic teaching explains, Meng espe rec etic art dcr rss es Pe ear eg enon oar a soeait pene ate ircee av iettiegaeerigire iste Demet mue nhean mete cate Sa te ona erect is Sn Eaeeeentys Rte eee tem rien tom ig tearine specie oie agile Seas cet eel biestot So decal ttcand imbue —ieepyeho Menai, tacion ee eragureelancie Eicon outs tacegcepein Ser oni eeece eet i raat cee reer Pelee ore meet rented Staple et ar ar se Ficer of taman csease that exredin a purely biological sense eae percent ashe ae ‘Neveritelca iis furs datin oot clteres daesse doesnot exe So eS her iene amc ‘An daring the pst century that naming proces hs become in renin coral ool anwellsn cca heugiasnng the ro fan nsome useful waysbe dsinguised) Many pyran so aye Sons have chosen, for example to iabe cera Lchaviors as disease ‘ren when aso remain uncer, snd pss aonensten— Grecan tthe instances acelin htnnfoney chronic faigne ‘Syndrome and “hypersctiy® Mone generaly aces to heath xe $Hroctored around the leglmacy bl nto agreed-upon diagnoses Therepeutia to is ongatiaed sound dugasate debsions, Bese encepis imply consetn, sed lpitiate nvidia bebvior® aad poy ‘Much ee writen arn he pt wo decades abt theo conrtructonef lines Butinaninperantesae ht sno more han ‘tology specaliaedreatomentof the tram thatasen and women foustrct thenslves culturally Every arpen ofan dius enty ‘Sonsracted so, ao, dase Alough the socal constructions postion has low something of ts ove during the past doa as Foret reminded ws hit medical thought nd patie are rarely ee of culurel constraint even in aes seemiigly tech, Ex PEeiegseknet to gna and emote for kn vale tre enterprv Ie noacient tat several generations of anibropelogsts have ssduouay concerned themselves wih dicate concept eo: Weter carn or grad poo elogie at once Incorporate and sneionssoesys fundamental waysornganing ‘word, Mesizine ia the contemporary Wes i by no means divteed Tromauchstinies, ~ ” ‘Some ofthese socal constraints elect and incorporate vale, at tage and satay teladonships inthe larger care (of which phystian tke thei patieme ae par But meting, Kk he siete {sities o which thas beens cont inked in hepa century. Sctfa social syem Even ts ical aspects seemingly ie sober tothedemandcof cultural assumptions aches forexargle,aties ‘bereits reshaped py he sare Inualecul worlds and nastaional stares of parce con ‘munis and subcgaimuniie of lenis and physicians. Dilferences [Bapecay i inaeatonal sting, inaeadensc runing for xanple, anal play arte i the process rough which pysicans formulae Snd agree upon defnons of dastein term bth concep or ‘mation and uldate apple n proce. late se, the desig tin "socal history ofmedicine eat atlogea! trac constosion of daca” Every aspect of medicines history w cently “socal ‘hth aon rw ray rahe bet Inthe Following pages Ihave, ofc svoded the term social con ssruton [fel th thas tended to oretemphiie Senate nds $Bilthe degre of sehtrarsem inherentn the negations that ult In acepted disease pictures. The sca constrctoist argument has Teused in adaioe, ons hand of eltrally resonant Gagoases— ‘cr chlor aerate, and homreiy, force ‘whi baopakologal mechanim wether unproven or unprovabe TKinvokesmmoregetapariclarsleofeahuraeiscam and partic: Eetoomat in ete te 1 ough hema ed 3 vision of knowlege ands purveyor st raonaliers and legato Srsinary uniting of an oppresae soc order For athe ex {ons have chosen tous the hs programmatically charged metaphor “rn” ahr tha “nary 1 dcr he atoning fc Pnatory and daniicatory schemes of particular dieses Biology, Heber on apes ayo sai ect Taming concepeul and nstiuional espones oda tubers tnd cholera, for example, offer eller ptees to frame fora. Sty would-be framers. ‘uring the past two decades, soil sents, hitorany, ad phys cians hate shown 2 growing interes. in ease and ts hstory "The ‘Sueno pd soil Contncionat ion of Gear only ome epee gE arautlernd oocer: Schl eee ite Hoyo ee Kereta and incorporated a nueber of separtes ao a abays ‘oraten, tends, One ste emphasis smong profession horas fn socal ibory andthe experience of ordinary men and women Pregnancy and chibi, for example ike epee dese fae cunt years become an seeped part ofthe wand hors canon, ‘second focus of erestn dss cantersom publeheath poly snd $lsked concer with explanation ofthe demographe change Soc tel with he teninetera and early tenets centres Howe much ‘redit should goto specie medical inven for the dee in ‘mortidty and lengthening ite spans aod how mach to changed co ‘pom ad vocal Cramastees” The poy plans se parce: {tis propo toe me Feokee ool be alee {herapeutererenton, how uch peevesion and socal melons pels. Teich inthe pa generating of what ibe In which dese plays ey rl, for example, nthe Spanith conquest of err ard South Arai! North thc eal te ot Alemography ona quuntatinely oem yenerauon of torsos snd otistry on growing numba of demogtspher For bk dips, theta o ml dea ident procs ate te or Meeting ie mechani underyiagchungetn morbidity snd 0 ‘ly. Typed rates, for example can fll ue tometing reer more preche sot munipal snaion and pubic heath sminstraton {han can aggregate annual moray gues to which cabreas a the senesborn dene may have contfbted: nally, and perha ‘Tuy intents growing intrest nthe way dese ditions ‘and hypothetical elope can serve as tol of vcs control a labels Tor deviance and sa ratonale forthe lesan of watt ration. ‘Ripe Lagat strays reheat rao often buen assoc wih areaivaticemphanson tho ‘Sxlconsruction of diese ® Such interpretations a one spect of ‘more general scholar iter in the retsons among knowledge, the proestions, and socal power. The nore eta ineined among tach ‘rout besecatgts of Kowledge have sen phsians xara Sd agent of» broader hegemonic enerpre, andthe "medic Son" af sodesy arene spect of 3 controling and legiimating ological ate (Often st sight fin cah of these emphases are ft the process of djseae dent and second the eansequences of such deftaons theives of indivi i the maksng an canon of pubic poy. ‘and in de srucuiag of medial ear, We hve in general, fed 0 focuson the connection between olga evens perception by ps. Septand ran dh cli ef oma cnt ic sent out this perception, Yet. this proceso ecogestion and ‘Fadonalation a sigan probiem ini one tha rend any tingle generations efor to shape mtistcory conceptual ras for ‘ose iotogial phenomenaitregerds sof spec eer ‘Where an underying patophyssogial bss for «putative disease renaiosproblemat stn akoholum, or example, we have another Sorta famemaking. but one that nevertheless eft in se he aust and prdige of an unarbiguovsy soma model of ie {ese Thay he wc gina and nce plus of sy seme lm onthe rine ofvane claractrc mechan is reductionist tender logealy and hstrcally te another characteristic of our thinking about dese pectin Sree texan of adn psc cya fara Sipectofsntelecstand moraliegitmcy If itisos specie is ot Secu and ssnlerer ior cnled tobe spay sd a ect ‘cade often the nuance rembusemen,couhecaon Wi an greed ‘pon diagno Clinictne and pobcmskers have long been aware of| the imsaton of ch refacon nyiey ofconcepesling dese buthave done lite to moderate lncesing prevaesce Framing Disease Diseare begins with perceived and often physically manifest yp- toma. And medicine's Hatori ongins ie inslereryatempes ttl Festored health snl an explanation for thee misfortune. That search For healing counsel consatted the Mors bars forte phyitant sora role, And an essential aspect of tis oe deveaped around the yo pt name othe inane confor Exes SSE Ee behener ina ens Sangre bat iam a undentndatie dara be ental one hase fom te psi pin of view Diagnosis and prognen the inte. Iecunl slscial ring of ease, Rave says ee cena 0 te Sscor patient atonal “The proces of framing inviabl includes an explanatory compo. nent; howand why didamanor woman comerosiffet roma parr slmeat? Physicians since easel anaiquy Rave always found intellee- ‘Sl materia at hand nth which to explain phenomena they have been asked ore impoing vome spective machin or ater anotierscgpagstody Th ofan symptom ‘scans have always been dependent on time bend itll tool seking ind, demonstateandeginate patterns the be ‘dering tnitese of cna phenomens they eheounter in he ‘herd pace. Inancent ne for example Flerence to cooking preset Faia source fora aeaphoral unr of he ys metab, the aggregate Functions of whies determined the piyselogial balance that consticedheahor disease Now atthecn Stthetwenseth century hypothetical acoimmunemechanir or he ‘etyed ad sb effect of ia infecone are often sed to explain dius dronie spams Toa physica inthe ate eighteen and fly nineteenth entries, as weave humoral model af thine were-pavoclrlyimporapt—and used to rauonalze sich sfeapetc memuresar dng pring andthe sof dre {is Wah the emergence of pathologie anatomy i the esly mine: ‘ecru century. hypothetical mevorls Forder were ineremingy {Gshioned in tertte of specie lesons or characteris functional changes that would ft modied, produ lesons over ime Fer ‘nention had slready provided an eaperimental bas for metaphors ‘explaining epidemic dase, suggesting the ways i which a small ‘quantity of infectious material might contaminate and bring about Fathlogal change ns much larger subarae (nthe ane ‘ter aply—orsucceason of human bodes) The ger theo {ied anther kindof framework for posing 4 enor Bry ase ‘BSonumi order on clsie coniguatins of Cina! symproms and sxmortem ndings. Ie seemed nly mater of time belore phys ine word be abi to understand ll hen ytrous il ha ad ppusiad ther profession predecesors for lle the relevant Bthogenic mictoorganiams Reed ono found and their physlog fal and biochemical elfecs deciphered Ths wan an era at well Known, nh energetic physicians "dscovered mictoorganis te- Spon for almost every HT Ron to mankind “The major plot seems obvious. In crafting an explanatory frame: work phytase employ atrt of modular constuction, wag intl eet buiding ‘elements arabe to their parc plat ad generation. But the reslingconcpon of enene and te byphet STetgin are not apy aban knbwiodge, the mul of eos ad Scademie debotes, They ineviably playa tle in mediating doctor patient nteracions. Ia earlier cenue ly and medial eof di {Ss nape to ae er othe sed Snowe teed to Structure aod mediate itracons between doctors pate sil at Hes Today, knowledge is increasingly specaled and segreated snd Liypersons are more ily toacerpt mesial judgments on faith Di ‘ie procedures at agreed-upon dues etepore are url ‘more important They guise both the phyeans teenth po ‘nis expectations Disease a Frame ‘Once eralized in the form of specced sen a xing Inparccttr individuals dseaye sees stretorng factor sito sca co ae hea ce ras 1 Would hardly have srprned leper inthe we cet or4 pague ‘em nthe fourteenth, Nor insnother way wold tare surprises xual invert ath end ofthe aseteenth entry “These insaneesremind ur of anunher of inportn fics Oneathe role played by lypertns ae well a pycansinshaping the to expe Henge of sine Another tbat the at of diagnosis ake ean the experience of ilines. Logealy relate to tis pint the way i sk Ech dst ies wth niu configura of va Jarra, ands triggers dseare specie rexponses Once ar ‘lated and accepted, dese enles betame “actor compe etek sil neers Sach neotaonshve eongtd feninuous history The ainccendh century may have changed the se tnd inlet ots ofa gon, bt ad ot Inlate te socal erat of deme concepts the emotional ge sce of diagno oee ade a “s The capaattn of Capposte in the laeninatcenth century created anew set of pute valentin that seemed con ‘Gover a stand introduted anew arable defining te felngs a paar insu abot hele ad of sce abou he im ria nt en connie aguas "questions of talve and responsbiny a8 nell epistemological Stsus Was the sesolca victim of siknes orf wife mmoriy? Shes, what was ts somatic bss? And Wa mechanism could no be enor coal yore va ray Sere ca ace al ey eeclireentenel te eee ann area ene cena oe esi ne tery re entre in ener SE et aan es 1 ek ocr acai ies Selected are eee See Eompitea emer nama generate sea ag tre depres for are ers ee ee ee Fearon bebe tease ene cee ay tae me nt eet a a a Neg pr Cem y Sheietner state RES crenata ae eet ens Doe aa cee ee ee etc ma an re Scenes eoemormeaan eats, Soren ieee, i i i en Cee eee See ee ee we ner me Ten Ee a nay sche od cet ea oe ea, fee merge ee se rere te cee Ee ee ee aa Se cbt walaney mb Sec pagiue. hiro patentee rac se ‘iets cnsegarcls, xc dds wh afk no Seeger esyepy e oe aea ieee ie Wee ene Fear agcer treat oeria aca Seis Gaon nra ian Se conti di gee cata Important soil resource fevered ci sudenly covered wi an Presper peloenpetiactias Sewn at tarpon cologne eters ‘ecelectanp otha Sor aniae aie ieekones ie seas ce cigeetiemee nS iphone isennet ce ise Be in eed SEE eerie eect eplperetracn erate ry iu Miers pine Een pena cata oa Individaliy of Disease Disease ieeyoaby social acto, hat a actor na rtrd. censor teraction at boundaiwin ich {tcan phy is socal role ae often shaped by its loge chsracer “Ths, chronic and acme dbcaser pret wry diferent socal real ilty bth co the Individual to his hor fay, and to sae, n't trator sory, for example, one ether sured or ed of page ‘rcholera. Chronic kidney duct or tubercle by conta, aye {longer wellre protien for community and econo sd ertona cllemas or prtclar amie Inthe eee of scone di ‘See eels ent ns, for expe, programs and poles mediate the compleerelatouaip noo Tinh ani edaaattandaieicers ee The biological character of paras denes both pic health pies andtherspeuse options ewe and chronic ih cbrousy cor font pias, gvecnents and mal nts with ny ferent challenges but arte infos themache vay, for example their medes of tanamtason and thos have diferent socal enact os Ts tds ond oy the ed chang dd aah ny opera roast pac {overnment may interdict waterborne nfrtions ke yphod nd cho ‘rath mnie need to ser individual bab ‘Negotiating Disease ‘The negations surrounding the definton ofan response to ds- cqoe are cenplet nud poled “They ich copa od dace Pinary clemeny, inttatinal and publ ple responses, and the {fjusimens of particular individuals and thelr fois nvelved at all levels ste doctor patencreaonship. Insp aes yal a data —ecout eh- solitons for sample, when court weigh pen of ot guilty by ‘eas of lnunity, oF when a workers compensation board deatls ‘nether paricufarlines ra conseqoence tte camants Work. In {he cour the lal proceedings become a proxy fora debate between empty protean vee Sosy tne orl deen par od level of profesional walning, and eonfcing vocal roles ant de bates abut brown lung and sibel are anecher example sol ‘efotnton in which tueresed pertcipnts interact to produce og iy srvary but socally wae # ken provona, solutions to Alspuce. In such ass, egrecment pon adehnition of disease con pro ‘ide dhe bas for medited compromise and adminiratve acon, ‘Conversely, fale to read a contzuaus ato he exttenc, origin ‘imielcourseofsparsclar samen may prolong confi. Dieaseean ‘eteensra dependent rare insuch negated stuaon: yet once Sort opon feces acorn hated cing epics ‘eidingsoell decion making int iore general sense, dase clasicaons sere to raenaize, mediate, and legitimate relationships between indlvidals and sts isin abrensracsocty Theta exemplar Payment schemes here tincoate Experiences of isividuae are wansformed into the neatly ordered ‘cutyoree of diagnostic tble—and dhs mtble for Bstenveraie tte In hu wenssanovalogil ale ind of Rosetta Stone promding ‘ta for tnslation etneen tro very fferet jet ructrally ere ‘pendent reams Diagnoses arc rendered itera machine resdabie, Him beings ae tsb easly exegorzd Disease as Social Diagnosis For centuries disease specific and generic—hat so played nother ro that of helping to fame dest about sod and sa le See ications fone creat tinfndex of and monty comment on Soc. Phiscans ae soil commentators have used the difference beeneen “normal and ex treordinay lees of schnes as ah impicindiament of pathogenic ‘cvronmental dreumseance A perceive gap deteen the "a ad {he "ought" benween the rel andthe ess, ha oien conse poverful atone forsocal ation "The meaning of parse pol [ance to contemporaries might well thouphtofan be lcm oF agra of parse wat sara wat ong beste ‘etal seas mere again th presale wore, for ecmple about the slarsingfetence feamp and Rep {Sldeae he frequency of death and disabling chen yours ‘male popalstion underined thence for reforth in exning camp and irrack srrangemeont. Scalers in Europes new indies foitedto the premlence of fever andintt dente ung tenement Svelers at evidence of the need for vironmental ror: the intracne and unguestoneddipaiy between ural sad wba mor Wily and morta sms presented a compeling ene for pul: ‘lh efor Becwen he giteeth cur andthe prt ths ling disparity hs always played ole ln dacuon of psc beauhiand sodalerdrenment : ‘One could easy ce scores of parallel insancs, Deas thusbecame both the ocrsion and he agenda for an ongoing dicoure concern tng the interrlaonship of Sate ple, medal responsi and in dlvidal cup. Tr cu Inde to nk of any pcan lire of soil debut and tensions of race, gene, cand industizaton—in whch hypothe diese bologes have no Served to project and atonal widely held values and ates: The brea harely come, terest outbreak of AIDS oferty cenphater it Unity and Diversity ‘Ina mach quoted esayof 1963, the media historian Orel Temkin mace the istory of The Scene Approach te Disease’ Spat En {iy ad Individual Sktnese” He organined his analysis of disease [ALNESS, SOCIETY, AND HISTORY wait ccc uo dia enced rion, oe he Sem omagea arr aa scare een! rae arn ee alerts sata Seon ce Sy Soup” Niece tela Sea ey ttl eae, Sasi ami pape eben See raceme errs EGS mete sitar ata elt a SER eta serena SALA tt a ea at pg mt Dorel pa lS tee we ‘Sas ppp ce tole =e rhe esuonbetweensoca oghrendsocalnrocure Ahough EES aya tac nd emt oa SOW Sar Peseta dpe ce Eee sSoatldepenamerind ccna iret Ei ices sfc et red Sook NOTES 1, Pordonsof hay ae epee or ape rom the authors “Diase salty Pat er bo uy 6 ap ns dereprnced ah permits 2 Dist cn sod Eur i Be ser a aonony—vith inv spots amanged in vom orscioparing seucre Fort ore get

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