How would you define “disease”? What makes something a disease? We all have pretty clear ideas of things that we think are diseases—and they are—but within a sociohistorical context. Take for example someone that we might consider mad or psychotic. In some age and society past, they may have been an oracle. It is conjecture that some diseases such as Williams syndrome may account for the rich lore regarding elves—supposedly magical beings that were very friendly and musically talented. Regardless, it becomes clear quickly that “disease” is a sociohistorically relative label. It’s safe to say that a disease is a conception of improper functioning that becomes stigmatized and always involves a social component. I don’t mean to fruitlessly inject skepticism into our modern conceptions of health and disease (well, maybe a little—and hopefully not fruitlessly), but rather stress the inevitable social component to health, disease, and health care. Take, for example, the frightening disease of aging, the bane of our golden years, Alzheimer’s disease. Unknown by many, prior to the early 1970s when researchers decided to get funding for Alzheimer’s research, it was considered simply as dementia that occurred linearly with the process of aging. Early onset and very severe cases may have been considered pathological, but for the most part it was just seen as the normal trajectory of the mind as the body approached the end of its years. Nowadays, even approaching the end of one’s years is shifting in the same direction. The disease of aging, the unjust shortening of telomeres and impact of external forces on our biological selves, is the greatest disease to conquer. We see this everywhere around us—anti-aging products, the focus on youth and beauty and vitality—just open up a magazine and you’ll get the message that getting old is not to be accepted and we should try to stay young as long as possible. Scientific research on the possibility of inhibiting telomere-shortening (the biological mechanism of intrinsic aging) is marking the shift we are taking towards stigmatizing aging as pathological, something to be treated and cured. The example of Alzheimer’s is particularly useful because it has traveled down this path already and follows a parallel progression. When researchers made the paradigmatic shift in the 1970s to stigmatize the cognitive declination of aging, it was a socially calculated move based on the alignment of social forces that control research, medicine, and health care. Some of the researchers on this front even admitted that they had to paint Alzheimer’s as their metaphorical cancer in order to have any chance of getting grants to do research. This is still true today, with the joke that you just have to throw “cancer” into the title of your research proposal in order to get it funded. When this was done, a wide range of severities in cognitive decline were taken as “Alzheimer’s disease” and it became a thing that many people could get, and so the money came in and knowledge about Alzheimer’s became widespread. Again, I do not mean to say that Alzheimer’s is not a “real” disease or that mild cognitive decline isn’t “true” Alzheimer’s, but it is clear from the history and the context of research developments that, only recently have we embraced the conception that old age should be a relatively burden-free time period in one’s life and that if anything interrupts that, it should be corrected or prevented. However, the real story of social influence is not necessarily in our conception of disease and health but in research and funding and subsequent developments in health care.
A large proportion of medical research and pharmaceutical developments is driven by …the common good and the dream of great health for all? Not quite. More like … drug companies and the search for profit. The so-called “Pharma’s Market” is the driving force behind many of the medicines that we have today and many more that are in development or clinical trials. Continuing with the Alzheimer’s example, if there is an option between funding non-lucrative, everyday preventative measures for Alzheimer’s, such as doing crossword puzzles and other mental exercises, or something like a drug that you can take every day for the rest of your life to delay the onset or decrease the severity of Alzheimer’s, then I’m sure you can guess where the funding and focus will go. Again, this is not to say that medicines we have are unnecessary or even unhelpful, it is just to highlight the social forces driving research and impacting our approach to health care.
Modern social conceptions influence practice as well. A large portion of health care in the U.S. is directed towards treating the specific pathology that afflicts a person’s body. Due to this, one trend in modern healthcare hovers around the idea that we should treat what is going wrong, correct it (often with medication), and then move on to the next patient. This trend in institutional health care has trickled down into our own personal practices as well. Headache? Common cold? –Take a couple ibuprophen and it should clear up. To reemphasize, I do not mean to downplay the effective treatments that we have or to say that this is the way it is with no exceptions. However, it seems that if we broaden the scope of health care and put more resources into preventative care and health education, we might be able to save some resources in the long run and improve people’s health.
An additional socially influenced feature of our system of care is our focus on the patient. Well, of course…they’re the one with the disease or health problem, right? Yes, but we oftentimes have become so accustomed to our system of health care that we forget there are alternative approaches. For example, we treat the independent individual because they need the help, but in some other countries sickness is more of a family affair. The whole family is present in the hospital if a member is sick and care instructions are prescribed to the family unit. They also cook for the sick member and bring their own bed sheets because hospitals are small centers that are typically not visited and much more treatment is done on a local scale. In the U.S., we also have many practices like this but more emphasis is placed on the individual patient. There are many ways of doing things and many different ways work, but approach to treatment is largely a socially-dependent factor. To return to the Alzheimer’s example once more, it is the contemporary social practice to treat people with this disease in their home setting or in a nursing home setting where highly attendant and specialized skill can meet their needs. We go about this care in a parenting-like role because we feel they do not have the capacity to keep themselves in order. Just to reiterate my caveats once more—this is not to say that this approach is wrong or to suggest that people afflicted by Alzheimer’s don’t have a disease and have the ability to autonomously care for themselves; I mean to draw notice to the social component influencing treatment. Our societal conceptualization of the “self” as the cognitive agent making a person what he or she is influences this method of treatment. We see Alzheimer’s patients as not being themselves which is why it is such a scary disease and why we have to act in a parental role to help them take care of themselves. A sort of avant-garde treatment/therapy for Alzheimer’s involves a slightly different conceptualization. Instead of meeting all their needs for them, in drama therapy, Alzheimer’s patients engage in a sort of free-flowing, participatory story-telling in which people will hold up cards with cues and one patient will talk, creating a story, and then another card will be held up and the story will be continued by another person, just like popcorn. This is just one example of a slightly different spin on social utility and cognitive ability that manifests in different forms of health treatment and therapy. Mental health and care in general is one area in which the influences of social forces are particularly evident.
Switching gears slightly, another way in which social forces affect health care is by influencing what diseases and disorders people are susceptible to. The variety of vaccinations that you are required to have depending on where you live or work or travel makes plain this fact. Another biting example, perhaps of more immediate relevance, is seen with eating disorders. In this area, society plays an undeniable, and oftentimes frightening, role. Eating disorders are only known of in developed nations and research has shown that they become more prevalent as wealth increases and food becomes plentiful. It also shows that adolescent girls who read magazine articles about dieting and weight loss are likely to engage in unhealthy eating habits. As Whitney and Rolfes put it, “Our society sets unrealistic ideals for body weight, especially in women, and devalues those who do not conform to them. Anorexia nervosa and bulimia nervosa are not a form of rebellion against these unreasonable expectations, but rather an exaggerated acceptance of them. In fact, some people fail to recognize the health dangers and endorse eating disorders as a lifestyle choice. Some 200 websites encourage, support, and motivate users to continue their lives with anorexia and bulimia.”
If many of these problems that are manifested in one’s health are the result of social forces and processes then, rather than focusing our treatments on the outward symptoms, perhaps we should treat the social roots of the issue so that we can improve the health of society and transition to a system of less costly, more effective preventative care. And even in scenarios where social forces are not the cause of health problems, it is important to be aware of the social influence on methods of treatment and forms of health care.
With the current state of the U.S. health care system: 1. our treatment of mental illness, 2. our new push into genomic territories for understanding and treatment, 3. our system of pricing and other economic realities shaping health care, 4. the current state of reform and ideas for future change, and 5. the underlying social influences on disease and treatment—where the future of treatment and health care goes will depend on how all the individual wheels turn and how changes filter down through the system. Whether our societal conceptions of health and treatment will change any time soon is tough to say—many say they must, money often says otherwise, others support varying degrees of change, and others are indifferent. All that is clear is that our mindset, methods, and modes of health care represent a dynamically evolving system that influences our lives in myriad ways.
Sources:
Ballenger, Jesse. “To Conquer Confusion: The Struggle for a Coherent Framework for Dementia in Modern Medicine.” Mechanisms of Mind. 7A Sparks Building, University Park. 15 Mar. 2013. Lecture.
Whitney, Ellie, and Sharon R. Rolfes. “Eating Disorders.” Understanding Nutrition. 13th ed. Mason, Ohio: Cengage Learning, 2013. 258. Print.
