The Cultural Meaning of Illness

Many medical sociologists contend that illnesses have both a biological and an experiential component, and that these components exist independently of and external to each other. Our culture, not our biology, dictates which illnesses are stigmatized and which are not, which are considered disabilities and which are not, and which are deemed contestable (meaning some medical professionals may find the existence of this ailment questionable) as opposed to definitive (illnesses that are unquestionably recognized in the medical profession) in the medical field (Conrad and Barker 2010).

For instance, sociologist Erving Goffman (1963) described how social stigmas hinder individuals from fully integrating into society. In essence, Goffman (1963) suggests we might view illness as a stigma that can push others to view the ill individual in an undesirable manner. The stigmatization of illness often has the greatest effect on the patient and the kind of care they receive. Many contend that our society and even our healthcare institutions discriminate against certain diseases—like mental disorders, AIDS, venereal diseases, and skin disorders (Sartorius 2007). Facilities for these diseases may be sub-par relative to facilities aimed at addressing and alleviating other conditions; they may be segregated from other healthcare areas or relegated to a poorer environment. The stigma attached to a specific condition may keep people from seeking help for such conditions, consequently being detrimental to the individual’s and society’s well-being.

Contested illnesses are those that are questioned or questionable by a fraction of medical professionals. Disorders like fibromyalgia or chronic fatigue syndrome may be either true, objective, and tangible illnesses or, as argued by some medical professionals, may exist only in patients’ heads. This dynamic can affect how a patient seeks treatment and what kind of treatment they receive.

The Sick Role

Sick role is a term used in medical sociology regarding sickness and the rights and obligations of the affected. It is a concept created by the American sociologist Talcott Parsons in 1951. Parsons argued that the best way to understand illness sociologically is to view it as a form of deviance that disturbs the social functioning of society. The general idea is that the individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. “Being Sick” is not simply a “condition”; it contains within itself customary rights and obligations based on the social norms that surround it, and therefore plays a role in everyday, normative interactions.

Parsons’ theory outlined two rights of a sick person along with two obligations. The sick person’s rights are: being exempt from normal social roles, and not being responsible for their condition. Conversely, the sick person’s obligations include trying to get well and cooperating with medical professionals.

The Social Construction of the Illness Experience

The idea of the social construction of the illness experience is based on the concept of reality as a social construction. In other words, there is no objective reality; there are only individual perceptions of it, which are always relative and involve a process of construction. The social construction of the illness experience addresses the way some patients control the manner in which they reveal their diseases, and the lifestyle adaptations patients develop to cope with their illnesses.

Figure 1. The Mosby pain rating scale helps health care providers assess an individual’s level of pain. What might a symbolic interactionist observe about this method? (Photo courtesy of wrestlingentropy/flickr)

In terms of constructing the illness experience, culture and individual personality both play a significant role. For some people, a long-term illness can have the effect of making their world smaller, leading to a life that is more defined by the illness than by anything else. Their illness becomes their marker, or their focal status. For others, illness can be a chance for discovery, for re-imagining a new self (Conrad and Barker 2007). Culture plays a substantial role in how an individual experiences illness. Widespread diseases like AIDS or breast cancer have specific cultural markers that have changed over the years and that govern how individuals—and society—view both the condition and the individual directly affected by the condition.

Today, many institutions of wellness acknowledge the degree to which individual perceptions shape the nature of health and illness. Regarding physical activity, for instance, the Centers for Disease Control (CDC) recommends that individuals use a standard level of exertion to assess their physical activity. This Rating of Perceived Exertion (RPE) gives a more complete view of an individual’s actual exertion level, since heart rate or pulse measurements may be affected by medication or other factors (Centers for Disease Control 2011). Similarly, many medical professionals use a comparable, somewhat universal scale for perceived pain to help determine pain management strategies.

The Social Construction of Medical Knowledge

Conrad and Barker show how medical knowledge is socially constructed; that is, it can both reflect and reproduce inequalities in gender, class, race, and ethnicity. Conrad and Barker (2011) use the example of the social construction of women’s health and how medical knowledge has changed significantly in the course of a few generations. For instance, in the early nineteenth century, pregnant women were discouraged from driving or dancing for fear of harming the unborn child, much as they are discouraged, with more valid and evidence-based reason, from smoking or drinking alcohol today.

Has Breast Cancer Awareness Gone Too Far?

Figure 2. Pink ribbons are a ubiquitous reminder of breast cancer. But do pink ribbon chocolates do anything to eradicate the disease? (Photo courtesy of wishuponacupcake/Wikimedia Commons)

Every October, the world turns pink. Football and baseball players wear pink accessories. Skyscrapers and large public buildings are lit with pink lights at night. Shoppers can choose from a huge array of pink products. In 2014, people wanting to support the fight against breast cancer could purchase any of the following pink products: KitchenAid mixers, Master Lock padlocks and bike chains, Wilson tennis rackets, Fiat cars, and Smith & Wesson handguns. You read that correctly. The goal of all these pink products is to raise awareness and money for breast cancer. However, the relentless creep of pink has many people wondering if the pink marketing juggernaut has gone too far.

Pink has been associated with breast cancer since 1991, when the Susan G. Komen Foundation handed out pink ribbons at its 1991 Race for the Cure event. Since then, the pink ribbon has appeared on countless products, and then by extension, the color pink has come to represent support for a cure of the disease. No one can argue about the Susan G. Komen Foundation’s mission—to find a cure for breast cancer—or the fact that the group has raised millions of dollars for research and care. However, some people question if, or how much, all these products really help in the fight against breast cancer (Begos 2011).

The advocacy group Breast Cancer Action (BCA) position themselves as watchdogs of other agencies fighting breast cancer. They accept no funding from entities, like those in the pharmaceutical industry, with potential profit connections to this health industry. They’ve developed a trademarked “Think Before You Pink” campaign to provoke consumer questioning of the end contributions made to breast cancer by companies hawking pink wares. They do not advise against “pink” purchases; they just want consumers to be informed about how much money is involved, where it comes from, and where it will go. For instance, what percentage of each purchase goes to breast cancer causes? BCA does not judge how much is enough, but it informs customers and then encourages them to consider whether they feel the amount is enough (Think Before You Pink 2012).

BCA also suggests that consumers make sure that the product they are buying does not actually contribute to breast cancer, a phenomenon they call “pinkwashing.” This issue made national headlines in 2010, when the Susan G. Komen Foundation partnered with Kentucky Fried Chicken (KFC) on a promotion called “Buckets for the Cure.” For every bucket of grilled or regular fried chicken, KFC would donate fifty cents to the Komen Foundation, with the goal of reaching 8 million dollars: the largest single donation received by the foundation. However, some critics saw the partnership as an unholy alliance. Higher body fat and eating fatty foods has been linked to increased cancer risks, and detractors, including BCA, called the Komen Foundation out on this apparent contradiction. Komen’s response was that the program did a great deal to raise awareness in low-income communities, where Komen previously had little outreach (Hutchison 2010), therefore justifying their seemingly contradictory goals.

What do you think? Are fundraising and awareness important enough to trump issues of health? What other examples of “pinkwashing” can you think of?