This is the fifth in a series of posts which I have written alongside a module I will be teaching which is intended to help non-sociology students to gain an understanding of the sociology of health and illness. While these posts are primarily intended for that audience and are therefore intentionally introductory there might be something of interest to a more general audience. For that reason I have decided to put them on my blog in amongst more specific and specialist writings.

In this post I will introduce the sociological concept of rationalization and explore its relevance to health. Firstly, it is important to be clear that rationalization is a process of becoming more rational, that is, an increasingly great emphasis is placed on:

  • Empirical (observable, scientific) facts
  • Cause and effect
  • Profit and loss

Rationalization is a process which is most prominently associated with the sociologist Max Weber. In particular he was interested in the move away from religious, superstitious or value-laden thinking towards rational thinking. This is a process about which he thought there were negatives as well as positives. But he considered rationalization to be a particularly important phenomenon because he believed that it was this process which had enabled capitalism to develop in many societies.

The process of rationalization is important for understanding health because the dominant ways of understanding health tend to come from one of the most rational of all institutions; medicine. Sociologists have suggested that at its core medicine has a particular view of health, illness and the body which is referred to as the “biomedical model”. The key assumptions of the biomedical model are that:

  • Health = absence of disease
  • Diseases are uniform
  • Diseases have particular, isolated causes
  • Illnesses should be treated individually

Of course the medical model has been highly a highly effective basis for the treatment of many diseases but some people have argued it has also had negative impacts. For instance, Ivan Illich has proposed that the dominance of the medical model has pushed out other ways of dealing with disease. He used the concept of iatrogenesis to describe the process of rationalization which has taken place with regards to medicine.

Illich claimed that there are three levels to iatrogenesis:

  • Clinical
    • Harm to patients through error, lack of safety measures, etc.
  • Social
    • Medicalization increases our dependence on institutional care
  • Cultural
    • Damage to traditional ways of dealing with and defining illness
    • Decrease in autonomy and coping skills

The final aspect of iatrogensis, the cultural, is similar to the notion of medicalization I discussed in my previous post. The result of this process of medical dominance is that we become more dependent on medicine and professionals and therefore we lose the autonomy to look after ourselves. Illich claimed that this then would lead to an increase of stress from worrying about illness and a lack of control over our own lives and ultimately makes us sicker.

In the next post I will discuss the impact of sociological approaches to health which prioritise the experience of illness.