Social construction of illness,

diagnosis and medicalisation

Dr N.S Awunor MBBS, MPH, FMCPH
July 2021
Outline
• Introduction
• Clinical management and the social history
• Social construction of illness, diagnosis and medicalisation
• Conclusion
Introduction
• Health is a state of physical, social and mental well being and not
merely the absence of disease or infirmity (WHO)
• Health is the ability to adapt and to self manage (Huber, 2011)
• The social environment plays a role in health and well being
• Medical sociology is:
The study of social causes and consequences of health and illness
(Cockerham, 1995)
The study of society in so far as it concerns health and disease
Social construction of illness and medicalisation

Social constructionism
• A disease does not exist until the social institution of
medicine creates a representative diagnostic category
Disease classification systems
• ICD- International Classification of Diseases
• DSM- Diagnostic and Statistical Manual of mental disorders
Introduction
Illness: A type of deviation from a set of norms representing health and normality
• Deviation could be:
Biological deviance- medicine
Social deviance- sociology
• Disease (objective) vs illness (subjective)
Contested illnesses: Conditions for which individual patients and patient groups
demand medicalisation e.g
• chronic fatigue syndrome
• irritable bowel syndrome
• somatisation of psychic distress
• tension headache
Clinical management and the social history

• The medical history • Physical examination

Biodata • Laboratory finding
Presenting complain
History presenting complain • Diagnosis & differential diagnosis
Past medical history • Management plan
Systematic review
Family history
Social history
Occupational history
Obstetric and gynaecological history
Drug history
Social history
• Alcohol intake
• Smoking
• Sexual behaviour
• Illicit drugs and addictions
• Housing and health
• Educational status
• Socioeconomic status
• Marital status and type of marriage
• Social support
• Employment status
Medicalisation
• Medicalisation is the process by which a non medical problem
becomes defined and treated as a medical problem usually in terms
of illnesses or disorders
The sick role

• When individuals fall sick they play out a role which was first
described by Talcott Parsons
The four basic aspects of the sick role are:
• Exemption of the sick individual from normal social role or
responsibility
• Non responsibility of the individual for his or her condition
• The desire of the sick person to get well
• The obligation to seek out competent help
Doctor – patient relationship
• The patient has a unique relationship with the doctor/ health
practitioner
Type of Doctor-patient relationships
• Activity - Passivity model
e.g in emergency situations
• Guidance- Cooperation model
e.g DOTS therapy for pulmonary tuberculosis
• Mutual participation model
e.g chronic diseases like diabetes mellitus, hypertension
Doctor – patient relationship
Criticism of Parson Doctor- Patient relationship
• It does not apply to all illnesses
• There could be social and/ or cultural barriers to communication
• There is a growing number/use of non physician practitioners
• Health care provision is increasingly being delivered by teams
• Increasing involvement of patient families in the treatment process
Doctor – patient relationship
The role of the doctor/health practitioner
• It is an institutional role set
• The doctor functions as the social control agent for society
The doctor/ health practitioner is expected to serve with:
• Technical specificity
• Functional specificity
• Affective neutrality
• Universalism
Miscellaneous considerations

• Treatment adherence and continuity of care

• Social support
• Peer groups
• Support groups
Conclusion
• Understanding the sociological considerations in illness and its
diagnosis could improve treatment options and outcomes
• The sick role and doctor-patient relationship provides a sociological
perspective towards understanding how individuals engage with the
health system
THANK YOU FOR LISTENING