This the sixth 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.
The posts I have written so far in this series have drawn on sociological concepts and perspectives which focus on large scale, macro level processes. In this piece I will introduce an approach which looks at small scale, micro level processes, in particular, the ways in which meaning is generated through interactions between people. This approach is often called interpretive sociology or symbolic interactionism and is primarily focused on experiences, interpretations and meanings rather than big social structures.
One of the main insights of this strand of sociology is the that our “sense of self” (or understanding of who we are) is largely the result of our interactions with those around us. The sociologist Charles Cooley suggested that we have a “looking glass self”. By this he meant that society acts like a mirror. We look at other people’s reactions to our behaviour and use these reactions to construct our sense of self. So, to oversimplify, if people respond to me with smiles and nice gestures I will consider myself to be a friendly person so I will continue acting in a way which generates these positive responses.
Another key insight in this tradition of sociology comes from Erving Goffman who proposed that in most contexts in our lives we are playing “roles” (in a similar way to how actors play parts on TV or in plays). We play these roles depending on what we think other people expect of us. Crucially this shows how we construct our identities through performing to one another.
These sociological insights highlight two key things for us when thinking about health and illness. Firstly, that it is important to understand the experiences of people in particular situations in order to know why people act in the ways that they do. Secondly, that the ways in which people interpret situations will have an impact on how they behave.
This type of sociological analysis (which focuses on interpretations of everyday experience) has inspired a lot of research into the experiences of patients or people with illnesses. Some sociologists, such as Arthur Kleinman, have analysed “illness narratives” or the stories which people tell about their health. He defined these narratives as:
“A story the patient tells, and significant others retell, to give coherence to the distinctive events and long-term course of suffering… The personal narrative does not merely reflect illness experience, but rather contributes to the experience of symptoms and suffering” (Klenman, 1988: 49).
A great example of a one of these narratives can be seen in the recent research which Marian Peacock, Paul Bissell and Jenny Owen conducted into the ways in which people integrate neo-liberal discourses into interpretations of their own eating practices:
“Our childhood, obviously it moulds us … I know that, but I also know we become adults and we make choices because we know what’s right, what’s intrinsically right for us and what’s not right for us, and I make choices that are not healthy choices. I choose … I know that I should take more exercise but I don’t, I know that I should eat less fat, but I don’t. Do you know what I mean? I have weaknesses. I have cake, I know I shouldn’t eat cake because it’s not good for me and it’s not helping me feel better about myself [but] I’m still choosing to eat it. Only me can do it, so I am responsible aren’t I?” (Donna, 39, midwife, married mother of two girls) (Peacock, Bissell and Owen, 2014: 176)
These narratives show the ways in which people make sense of illness (or health) and what they consider to be significant causes of their situation (these might not be the same as what the doctors think). By getting an understanding of, for instance, the reasons why someone thinks they became overweight (dealing with stress at work or a relationship breakdown, lack of availability of healthy food, lack of opportunity to exercise, etc.) then these things can perhaps be tackled.
In the next post in this series I will address sociological analyses of gender and their application to health and illness.
Kleinman, A. (1988) The Illness Narratives: Suffering, Healing and the Human Condition. New York: Basic Books.
Peacock, M., Bissell, P. and Owen, J. (2014) ‘Dependency denied: Health inequalities in the neo-liberal era’ Social Science & Medicine 118: 173-180.