INTRODUCTION: THEORIES AND PERSPECTIVES

A. HOW DO YOU KNOW WHEN YOU ARE ILL?

1. SYMPTOM ORIENTATION2. CAPACITY ORIENTATION3. FEELING STATE

ORIENTATION

B. HEALTH IN RELATION TO SOMETHING: CONSTANT COMPARISON

1.NORMATIVE NATURE OF HEALTH AND

ILLNESS

•a. HOW TO FEEL, BEHAVE OR BE

•b. ILLNESS PROTOTYPES

(1) SIGNS ANDSYMPTOMS

(2) LABEL

(3) CAUSE

(4) SEQUELA

(5) TREATMENT

(6) CONSEQUENCES

•c. SOURCE(1) CULTURE:

ZOBROWSKI(2) PARENT AND FAMILY(3) PERSONAL(4) MEDICAL PROVIDERS

(5) MEDICAL MEDIA

•d. BODILY BACKGROUND

EXPECTATIONS

2. HEALTH EVALUATIONS ARE SITUATED

•a. EVALUATIONS ARE NORMATIVE AND SITUATIONALLY SPECIFIC

•b. DRIFT AND HEALTH EVALUATIONS: MATZA

3. HEALTH, SITUATIONS AND INSTABILITY

•a. HEALTH AND ILLNESS AS EXPRESSION

OF RELATIONSHIP TO

ENVIRONMENT

•b. EPIDEMIOLOGY TELLS WHO IS AT RISK OF MAINTAINING GOOD OR POOR RELATIONSHIP

•c. WHO’S CRITERIA DO WE USE AS TO GOOD OR POOR RELATIONSHIPS?

C. TWO MAJOR PERSPECTIVES

1.REALISTS, ABSOLUTISTS OR POSITIVIST

•a. DISEASE IS EMPIRICAL, OBSERVABLE

AND MEASURABLE(1) IT HAS A BIOPHYSICAL

BASIS

(2)TRADITIONAL MEDICAL MODEL

(a) DISEASE IS THOUGHT TO STAND FOR ITSELF; COMES WITH LABELS; REALISTS POSITION

•b) DISEASE INDEPNDENTOF INTERPRETATION OR EVALUATION; OBJECTIVE

(c) MEDICINE REVEALS BIOPHYSICAL

REALITY; REVEAL “NATURAL DESIGN”

(d) REALITY FROM: ANATOMY,

PATHOLOGY, PHYSIOLOGICAL CHEMISTRY, GENETICS, CELLULAR BIOLOGY

(e) CRITERIA:

PATHOLOGICAL, STATISTICAL, POSITIVE [WHO] CAPACITY AND DEVELOPMENTAL

( f) MEDICINE AS AN “OPEN” VS

“CLOSED” DISCIPLINE

(3) KOSA & ROBERTSON SUGGEST:

(a) GERM THEORY: DISEASE AGENTS

AND MAGIC BULLETS(b) EPIDEMIOLOGICAL

THEORY: HOST, AGENT

AND ENVIRONMENT; PUBLIC HEALTH

(c) CELLULAR & GENETICCONCEPTIONS: CELL CHANGES AND CHRONIC DEGENERATIVE DISEASES

(d) MECHANISTIC CONCEPTIONS: DEFECTIVE PARTS REQUIRE SURGICAL INTERVENTION

2. CONSTRUCTIONISTS, INTERACTIONISTS, IDEATIONAL PERSPECTIVE: SUBJECTIVE INTERPRETATIONS

•a) ILLNESS AS SUBJECTIVE

•b) SUBJECTIVE SIGNS AND SYMPTOMS

•c) ASSUMPTIONS:

(1) DISEASE IS SUBJECTIVE,

ONLY ILLNESS EXISTS

(2) DISEASE INDEPENDENT

OF OBSERVATIONS?

(3) EASILY SEEN IN: MENTAL ILLNESS, ALCOHOLISM AND OTHER STIGMATIC DISEASES; CAN YOU LOBBY?

(4) ALL DISEASES ARE SOCIAL

PROBLEMS: OBJECTIVE CONDITION AND SUBJECTIVE INTERPRETATION

(5) MEDICINE GIVEN BODY,

RELIGION GIVEN DEITY RELATIONS, AND LAW GIVEN RELATIONS OF MEN WITHIN IN FRAME-WORK OF LAWS

(6) MEDICINE AS SOCIAL AND MORAL ENTERPRISE

(7) WE CREATE, SUSTAIN AND TRANSFORM DEFINITIONS OF HEALTH AND ILLNESS

(8) DISEASE AND ILLNESS VARY

INDEPENDENTLY, BUT NOT TOO INDEPENDENTLY; CONSISTENCY AND COLLAPSE

(9) STUDY

CONSEQUENCES OF LABELING SOMETHING AS DISEASE OR ILLNESS

(10)WHAT IS DEFINED AS DISEASE IS NOT ALWAYS BIOPHYSICAL, BUT THE RESPONSE [ILLNESS BEHAVIOR] IS ALWAYS SOCIAL, PSYCHOLOGICAL AND CULTURAL

d. MEDICAL MODEL AND EPIDEMIOLOGY DISENTANGLE ETIOLOGY BY CONSTRUCTING THEORY. CONSTRUCTIONIST LOOK AT THE INTERACTION OF INDIVIDUAL AND ENVIRONMENT AND THE CONSEQUENCES OF LABELING

E. DUBOS: “IN ESSENCE HEALTH AND ILLNESS OR DISEASE ARE AN EXPRESSION OF A RELATIONSHIP WHICH WE ARE MAINTAINING WITH OUR ENVIRONMENT AND

NOT A PHYSICAL ATTRIBUTE INDICATED BY AN ABNORMAL PART OF US OR PROCESS IN US.”

1. BUT ENVIRONMENTS ARE ALWAYS CHANGING, BECOMING AND EMERGING2. ADAPTION AND EQUILIBRIUM

OR PERFECT HEALTH IS NEVER MAINTAINED

3. PARABIOLOGICAL NEEDS AND VALUES; URGES AND STRIVINGS NOTHING TO DO WITH SPECIES SURVIVAL

4.SACRIFICE BIOLOGICAL FOR HIGHER FORMS OF LIFE “CONCEIVED IN THE SOUL RATHER THAN EXPERIENCED IN THE FLESH;” CULTURE EVOLVES FASTER THAN ABILITY TO ADAPT BIOPHYSICALLY

5.MIRAGE OF HEALTHF. SUMMARY