Revision tool - just some notes and a few questions/pointers and only on a few topics. It is unlikely to make much sense if you have no previous knowledge
Social Science, Health and Medicine Foundations exam revision
1.
SSHM Exam Revision
1) Normal
and
Pathological
2)
Theoretical
Approaches
3) Risk
Discourses
4) Global
Health
5) Pointers
and
Questions
2.
The Normal and Pathological
Canguilhem, Value Judgments,
Normal
The average –
quantifiable
What ought to be
Ambiguous – has
power
Descriptive but has
value judgment
Pathological
Not the opposite of
normal
Part of the same scale
as normal –
quantifiable
differences
Outside the average
not always
pathological (diversity)
Changing norms is part
of progress (Durkheim)
Canguilhem
Against medicine as a
Science – medicine is
an art
Aim to reopen
problems
Lots of influence over
1960s thinkers e.g.
Foucault
Other Thinkers
Broussais, Comte,
Bernard – health and
sickness not opposites
Renan – psychological
conditions available
through exaggerating
the normal
Leriche – disease must
be dehumanised in
order to be studied
Arguments
The repressed always
returns
The pathological is a
new form of life
There can be no
sickness without a sick
person
3. The Normal and the Pathological
Normal
The average
Quantifiable
What ought to be
Not stable – historical
changes
Descriptive
Value judgment – not
objective
Pathological
Not the opposite of normal
Pathological and normal on
the same scale
Matter of degrees – e.g.
fever
Outside average not always
pathological e.g. diversity
Changing norms is part of
progress (Durkheim)
4. Canguilhem
Body not a machine
Medicine is an art
Mixture of sciences, not a science in itself
Aim to reopen problems
Influenced many key thinkers of the 1960s including
Foucault
5. Other thinkers
Broussais, Comte, Bernard
Pathological and normal are
the same apart from
quantifiable variations
A matter of degree e.g. fever
Made popular by Comte and
Bernard
Renan, Leriche
Renan
Psychological conditions
available through the
exaggeration of normal
Normal can always become
pathological
Links with risk
Leriche
Disease must be dehumanised
in order to be studied
The sick can advance
knowledge of the normal
through their deficiencies
Links with Positivism
6. Arguments
1. The repressed always returns
Scales of normal and pathological have to be in relation to each
other – cannot be objective
Terms have value judgments e.g. excess and deficiency
2. The pathological is a new form of life
Change in the structure of an organ does not mean it should not be
brought back to the norm (hypertension)
Infections change the human – they will have new antibodies etc.,
and therefore be a new/different
3. There can be no sickness without a sick person
Difference between disease and illness – the subjective and
observable
Pain is subjective – relies on the human – but
7.
Theoretical Approaches
Ontology, Epistemology, Positivism, Social Construction, Comte, Geertz
Ontology and
Epistemology
Ontology – the
study of being –
what is reality?
Epistemology – the
study of knowledge
– how do we
know?
Positivism
Ontology – one
reality outside
human influence
Epistemology –
scientific study to
achieve objective
knowledge
Coined by Comte
and highly
influential
Problems with
methodology being
too reductive and
ability to be
objective
Social
Construction
Ontology – there is
no reality outside
human influence
Epistemology –
understanding
through
perspectives
Associated most
with Geertz
Problems with how
far this can go – is
there no truth?
Everything
constructed?
8. Ontology and Epistemology
Ontology
The study of being
What is there?
What is reality?
How can we understand
existence?
What is it? E.g. what is a rock?
Epistemology
The study of knowledge
How do we know?
What is valid knowledge?
How can we obtain it?
Why is it? E.g. why is that a rock?
How do we know that is a rock?
9. Positivism
Linked with Enlightenment
thought and scientific
methology
Ontology
There is one reality
independent of humans
Epistemology
Through empirical scientific
study
Reality can be known
objectively
Coined by Comte
Sociology was to be the
‘queen of the sciences’
Assumes social facts can be
measured like natural science
facts
It can produce value-free and
neutral understandings
Often seeks to explain how and
why things happen
Associated with quantitative
approaches
10. Problems with Positivism
Methodology
Social life considered more complex than biological life in
laboratories
Experiences emerge from particular social, cultural,
political, economic and historical context which cannot be
easily quantified or separate
Too reductive
Objectivity
Impossible to describe something without using language
which has value judgments attached
Researchers bring their own ideas and understanding to
the research
11. Interpretivism/Social Construction
Linked with Post-Enlightenment
thought in opposition to
Positivism
Ontology
There is no reality independent
of humans
Reality is always socially
constructed
Epistemology
Understandings always
dependent on the person’s
perspective
Always subjective to a degree
Associated with Geertz
People always attach meaning
to objects which then influence
experiences and behaviours
Meanings are ‘intersubjective’ –
existing between the minds of
individuals
Culture should be approached
in the literary approach to text
Assumes subjectivity/partiality of
all knowledge
Seeks to understand how and
why things happen
Linked with qualitative
approaches
12. Problems with Social Construction
Could be taken to far
Nothing is real – everything is dependent of your
view and perspective
There is no truth – only opinions
13.
Risk Discourses
Beck, Normal/Pathological, Medicalisation, Protodiseases
• Anticipation of catastrophe
• Manufactured risks
• Responsibility to act and
manage risks
Beck
• Rose – mental health context,
risk blurring the boundaries
between normal and
pathological
• Hacking – risk tries to bring
certainty to the future
Other thinkers • Personalised medicine in
order to manage risks
• Preventative e.g. high blood
pressure, cholesterol, cancers
• Protodiseases (Rosenberg) –
medicialisation of risks into
diseases
Risk in
Medicine
14. Beck
Anticipation of catastrophe – not what is happening
Modernity – post-industrialisation, globalisation -
contexts
Manufactured risks
Known, unknown, and unknown-unknown risks
Responsibility to act
To manage and reduce the risk
There is no such thing as zero risk
15. Other thinkers
Rose
Mental health context
‘Risky individuals’
Genomics and biomarkers as
risk assessments
Risk blurs boundaries
between normal and
pathological
Hacking
Trying to being certainty to
the future
16. Risk in Medicine
Personalised medicine
Treatment more personalised so not to increase
risks e.g. high risk of breast cancer and taking the pill
Preventative medicine
E.g. High blood pressure, cholesterol, cancers
Medicalisation of risks, making them into
diseases/illnesses themselves
‘Protodiseases’ (Rosenberg)
17.
Global Health
What is Global
Health
• Goal to improve
health inequity
worldwide
• Linked to public
health and
international
health
• Virchow - Health
has pathological
and political
elements
Inequality vs.
Inequity
• Health
inequality
• Differences in
health
experienced
and health
status
• Health inequity
• Differences in
health for a
significant
number of
people that is
preventable
and not a risk
freely chosen
Direct and Indirect
Interventions
• Upstream
• e.g. factory
polluting
water/river
• Downstream
• e.g. giving
technical
solutions to
clean water
for village
Approaches
• Technological
• Economic
• Sociological
• Bioethical
• Existential
18. What is Global Health?
Linked to public health and international health
Goal is to enhance health equity among nations and for all
people worldwide
Health inequality
Differences in health experienced and health status
Health inequity
Differences in health for a significant number of people that
is preventable and not a risk freely chosen
Virchow
All diseases have two causes: one pathological, the other
political
20. Direct vs. Indirect Interventions
Direct interventions
Downstream
E.g. Access to medical care,
vaccinations,
equipment/technology to
improve water conditions
Indirect Interventions
Upstream
E.g. more equitable
economic system, stop
polluting rivers
23. Defining ‘the social’
Make it really clear what is spoken about – political, social, economic,
cultural, historical – they are all different! Don’t just say ‘social’ to be all-
encompassing
There is no one definition of the ’social’ but some schools of thought:
1. Social construction/interpretive – what meaning is given to actions.
Associated with Weber
2. Social is defined by the ‘conflict’ between people and institutions.
Associated with Marxist tradition
3. Social defined by ‘consensus’ – the creation of social norms and how
societies bind together. Associated with ‘functionalist’ thought with
Parsons and Habermas
4. ‘Hybrid’ social – binding psychology and biology. E.g. the environment
shapes psychological dispositions. Associated with Simmel
24. Questions
What are the Normal and the Pathological? And What
do the Tell Us about the History of Medicine?
With Reference to a Specific Case Study, Discuss how the
Experience of Illness is Shaped by Larger Social-Cultural
Contexts
What can a Study of the Subjective Experience of Illness
tell us about Issues of Health, Disease and Medicine that
Other Approaches Cannot? Discuss.
With Reference to a Specific Example, How Might the
Concept of ‘Risk’ be Useful in Critically Evaluating Issues
of Health and Disease in Modern Society?