8.1: THE EXPERIENCE OF ILLNESS IN PLACE
Social Construction of Illness
As the above examples demonstrate, cultural attitudes affect how medical conditions will be perceived and how individuals with health problems will be regarded by the wider community. There is a difference, for instance, between a disease, which is a medical condition that can be objectively identified, and an illness, which is the subjective or personal experience of feeling unwell. Illnesses may be caused by disease, but the experience of being sick encompasses more than just the symptoms caused by the disease itself. Illnesses are, at least in part, social constructions: experiences that are given meaning by the relationships between the person who is sick and others.
The course of an illness can worsen for instance, if the dominant society views the sickness as a moral failing. Obesity is an excellent example of the social construction of illness. The condition itself is a result of culturally induced habits and attitudes toward food, but despite this strong cultural component, many people regard obesity as a preventable circumstance, blaming individuals for becoming overweight. This attitude has a long cultural history. Consider for instance the religious connotations within Christianity of “gluttony” as a sin.[39] Such socially constructed stigma influences the subjective experience of the illness. Obese women have reported avoiding visits to physicians for fear of judgment and as a result may not receive treatments necessary to help their condition.[40] Peter Attia, a surgeon and medical researcher who delivered a TED Talk on this subject, related the story of an obese woman who had to have her foot amputated, a common result of complications from obesity and diabetes. Even though he was a physician, he judged the woman to be lazy. “If you had just tried even a little bit,” he had thought to himself before surgery.
If you have difficulty viewing the video above, use this link https://www.ted.com/talks/peter_attia_is_the_obesity_crisis_hiding_a_bigger_problem
Subsequently, new research revealed that insulin resistance, a precursor to diabetes, often develops as a result of the excess sugars used in many kinds of processed foods consumed commonly in the United States. As Attia observes, high rates of obesity in the United States are a reflection of the types of foods Americans have learned to consume as part of their cultural environment.[41] In addition, the fact that foods that are high in sugars and fats are inexpensive and abundant, while healthier foods are expensive and unavailable in some communities, highlights the economic and social inequalities that contribute to the disease.
The HIV/AIDS virus provides another example of the way that the subjective experience of an illness can be influenced by social attitudes. Research in many countries has shown that people, including healthcare workers, make distinctions between patients who are “innocent” victims of AIDS and those who are viewed as “guilty.” People who contracted HIV through sex or intravenous drug use are seen as guilty. The same judgment applies to people who contracted HIV through same-sex relationships in places where societal disapproval of same-sex relationships exists. People who contracted HIV from blood transfusions, or as babies, are viewed as innocent. The “guilty” HIV patients often find it more difficult to access medical care and are treated with disrespect or indifference in medical settings compared with superior treatment provided to those regarded as “innocent.” In the wider community, “guilty” patients suffer from social marginalization and exclusion while “innocent” patients receive greater social acceptance and practical assistance in responding to their needs for support and care.[42]
The stigma that applies to “guilty” patients also ignores the socioeconomic context in which HIV/AIDS spreads. For instance, in Indonesia, poor women can make considerably more money as sex workers than in many other jobs: $10 an hour as a sex worker compared to 20 cents an hour in a factory.[43] Sex work may be the only form of employment available in a patriarchal society. In a similar way, poverty and a lack of other choices contribute to a decision to engage in sex work in other societies, including in sub-Saharan Africa where rates of HIV infection are among the highest in the world. Poverty itself is one of the greatest “risk factors” for HIV infection.[44] The clear relationship between poverty, gender, and HIV infection has been the topic of a great deal of research in medical anthropology. One example is Paul Farmer’s classic book, AIDS and Accusation: Haiti and the Geography of Blame (1992), which was one of the earliest books to critically evaluate the connection between poverty, racism, stigma, and neglect that allowed HIV to infect and kill thousands of Haitians. Projects like this are critical to developing holistic views of the entire cultural, economic, and political context that affects the spread of the virus and attempts to treat the disease. Partners in Health, the non-profit medical organization Paul Farmer helped to found, continues to pursue innovative strategies to prevent and treat diseases like AIDS, strategies that recognize that poverty and social marginalization provide the environment in which the virus flourishes.
