Eath and Epidemiology: Sociologivsl Issues


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Theoretical Perspectives: Durkheim, Feminism, Goffman

Readings: Health in Australia pp 12-14 and 21-22
Society & Health: Social theory for health workers pp 194 216 and Chapter 5 pp 112-135

1. Suicide and Emile Durkheim

Durkheim is best known for his work on social order and disorder and the affect of these on individuals particularly with regard to suicide.
According to Durkheim, people are creatures whose desires are unlimited. Unlike other animals, we are not satisfied when our biological needs are fulfilled. The more one has, the more one wants and fulfilling needs only stimulates more needs. Because of this, desires can only be held in check by societal control. Society imposes limits on individual s ambitions in terms of regulations (tax, the legal system, prison etc). When social regulations start to break down, the controlling influence of society (in terms of moral guidance) on individuals is no longer effective and individuals are left to their own devices.
Durkheim distinguished 4 types of suicide according to the relation of the individual to the society. He saw suicide as possible when there was an imbalance either in social integration or regulation. The first 2 types are linked to the moral dimension anomie which occurs when there is an imbalance of means and needs, a de-regulation in peoples lives, a loss of moral certainty, a loss of control or a loss of group support.
Durkheim divided anomie into 4 categories:
acute economic anomie sporadic decrease in the ability of institutions (such as religion) to regulate and fulfil social needs.
chronic economic anomie long term decrease in social regulation (capitalism and industrialisation don t produce happiness).
acute domestic anomie -sudden changes in life situations (death of a partner breakdown of a relationship).
chronic domestic anomie marriage and the different sexual and behavioural regulations for men and women (marriage over-regulates women but more bachelors commit suicide).
The second type of suicide linked to the moral dimension is fatalistic suicide  where there is extreme regulation and unrewarding lives eg slaves and prisoners.
Social integration provides the other 2 types of suicide; egoistic suicide results when there is too little social integration. Those individuals who are insufficiently bound to social groups (and therefore to values, traditions, norms and goals) are left with little social support (eg unpartnered males commit suicide at higher rates than couples).
The second social integration type altruistic suicide occurs as a result of too much social integration. Self-sacrifice is the defining trait. In the case of excessive regulation, individuals are so integrated into social groups that they loose their individuality and become willing to sacrifice themselves for the groups interests even if that sacrifice includes their own life. For example the Hindu normative requirement that widows commit ritual suicide upon the funeral pyre of their husbands, or in the

case of harikiri, the individual is so strongly attuned to the demands of his society that he is willing to take his own life when the norms so demand.
Durkheim argues in effect that the relation of suicide rates to social regulation is curvilinear high rates being associated with both excessive individuation and excessive regulation.

2. Othered Women: Feminist Perspectives

There are many feminist perspectives encompassing the different political shades and diverse views in this population. However all have some aspects in common
” A focus on the social constructedness of gender (that males and females are in fact very similar apart from some biological differences and that any other differences have been socially constructed by upbringing, education and media images).
” An acceptance that women are oppressed  that if you compare males and females there are economic and status differences between the work of males and females.
” An emancipatory orientation  that if you give women information about their inferior and exploited positions they will be in a better position to challenge differences.

Taking one feminist perspective which is not explored in detail in your texts an existentialist feminist perspective  here the focus is on the stereotypic medical construction of women. This would involve the construction (usually by male health professionals) of women s extra visits to the doctor as  inappropriate , leading to a classification of them as  neurotic thus facilitating the extra prescriptions for tranquilisers which statistics indicate does happen. This stereotyping allows women to be constructed as  other i.e. because of their  different mental and physical characteristics.
The male body and the male psyche are seen to represent the  norm (and this has been evident in textbooks) and are more highly valued. While the female body is seen as complex and  difficult fraught with hormonal discrepancies and chaotic possibilities and therefore of lesser interest in terms of value, practice and research. In the  othering process only female s reproductive arena has been valued because of its potential for medicalisation and the development of lucrative health businesses.
We now move away from individuals largely at the mercy of social institutions to a theorist who looks at individuals who are strong and who develop coping strategies to survive within these institutions and perhaps at the same time may be instrumental in bringing about changes in them.

3. Illness and Deviance: Erving Goffman

Goffman was interested in how we as individuals manage to resist the powerful forces put upon us by institutional and social structures.

Total institutions

His work on psychiatric institutions is a good example of a powerful institution but one where resistance can be seen. Goffman used his part time position as a physical education instructor in an American psychiatric institution to observe and document the culture, which developed in the wards. He noted that the institution imposed its power by systematically stripped away patient s concept of self by a rite of passage or ritual where an individual s clothes and possessions were taken and the inmate was showered and dressed in institutional clothes. Photos were then taken and

hospital rules and timetables taught and reinforced. Getting released from the institution was subject to sanctions, and was a reward for compliance to drug regimes, attending counselling where appropriate, and demonstrating reformed behaviour patterns  in other words the deviant behaviour of the patient with a mental disorder has been exorcised by medical regimes. Despite the rigidity of the environment, inmates used the following creative strategies to maintain a sense of self:
” Not co-operating with authority (deviant) (using toilet paper to roll cigarettes)
” Appearing to co-operate with authority by enrolling in counselling sessions (but actually so they could initiate sexual contact with the opposite sex)
” Withdrawal (into reading books and watching TV)
” Illicit activities (gambling and drinking)
” Negotiation with sympathetic staff

This study indicates that in many cases the patients retained and reinforced their own ways of thinking and being and indulged in what Goffman has referred to as  front stage and  backstage performances and it was interesting to note that staff in the institution did the same  maintaining the rule