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147 9 The Social Construction of Illness Medicalization and Contested Illness Kristin K. Barker, Oregon State University about gender (i.e., norms and standards concerning femininity and masculinity) are not biologically mandated; therefore, the ideas and the social practices they institutionalize are alterable. Social constructionism has been a centerpiece, theoretically and substantively, of the subfield of medical sociology. Stated in brief, its chief contribution has been to demonstrate just how complex the answers are to the seemingly straightforward questions, What is an illness? What is a disease? But before taking on these questions, it’s useful to trace the intellectual origins that inform a sociological approach to social constructionism. From its inception as a discipline, sociology has approached ideas as reflections of the specific historical and social environments in which they are produced. The founding sociological thinkers—Karl Marx (1818–1883), Max Weber (1864–1920), and Emile Durkheim (1858– 1917)—each addressed the relationship between the ideas or beliefs of a society and the social and material conditions of that society. Published in 1936, Karl Manheim’s Ideology and Utopia represented a significant advance in the sociology of ideas. Manheim urged sociology to study empirically how peoples’ historical context and their station in life (i.e., class) condition their ideas. In the 1960s, Berger and Luckmann (1967) articulated the link between ideas, including taken-forgranted or commonsense knowledge about reality, and everyday social interaction. In more recent decades, feminist and postmodern sociologists This chapter makes a case for the usefulness of a social constructionist approach to medical sociology , emphasizing the analytic potency of social constructionism for explaining a key cultural and historical trend of our time: medicalization (Clarke et al. 2003; Conrad 2007). It includes a detailed discussion of contested illnesses— illnesses where patients and their advocates struggle to have their medically unexplainable symptoms recognized in orthodox biomedical terms—and suggests that lay practices and knowledge , and the consumer demands they engender, are increasingly crucial in advancing medicalization in the twenty-first century. Sociology of Knowledge and the Social Construction of Illness Social constructionism is a diverse set of theories of knowledge developed and used by social scientists , historians, and cultural studies scholars. From a constructionist perspective, a social construct is an idea that appears to refer to some obvious , inevitable, or naturally given phenomenon, when in fact the phenomenon has been (in full or part) created by a particular society at a particular time. Pointing to the socially constructed character of an idea challenges its taken-for-granted nature and the social practices premised on it. As a case in point, feminists claim that gender is a social construction, meaning that our current ideas 148 Handbook of Medical Sociology have demonstrated the relationship between our ideas and our social locations in race, class, and gender hierarchies of power, and have built on Foucauldian views of knowledge as a type of discourse that arbitrarily gives some groups power over others (Collins 1991; Smith 1987). Finally, sociologists contributing to the interdisciplinary field of science studies claim that scientific knowledge , like other ideas, is the outcome of concrete social practices rather than of individual discoveries of truth that “carve nature at its joints” (Knorr Cetina 1997; Latour 1987; Timmerman 2007). This long and venerable tradition—often called the “sociology of knowledge”—studies ideas not as true or false expressions of the world per se, but as the realized expression of particular social interests within particular social systems and contexts (Merton 1973). In other words, from a sociology of knowledge perspective, our ideas are social constructions (Berger and Luckmann 1967). Sociologists study the social construction of many different ideas, but of interest to us here are sociologists who study ideas about illness. Although perhaps not immediately obvious, the use of social constructionism in medical sociology can be traced to Talcott Parsons’s (1951) concept of the sick role. The sick role describes illness as a form of medically sanctioned deviant behavior, and specifies the rights and obligations given a sick person to ensure that an episode of sickness doesn’t disrupt social order and stability. Despite Parsons’s social conservatism, his theoretical claims were premised on the conceptual distinction between the biophysical nature of disease and the social experience of sickness. Over the last fifty-plus years, medical sociologists have built on this distinction to make more radical and far-reaching claims concerning the social construction of illness and disease (Brumberg 2009; Conrad and Schneider 1992; Freidson 1971; Lorber and Moore 2002). Social...

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