Updated: May 4, 2019
Before you read this, if you haven't read the Sociology for Nurses post, do that first. The following will make a lot more sense.
Like most other conceptions of the human experience, health is a social construct.
I already know the questions (read: objections) people will have about this. "But health is based in science! Science is as real as you can get! You can’t make up molecules!” That’s true, and you know what? Science is a social construct, too. (Who developed the Scientific Method? Who's doing the studying? Can't do science without humans!)
Health is a social construct because the concept didn’t exist until humans realized we could get sick. It’s just the way you were, until it wasn’t anymore. Health only became meaningful to people once we were met with its antithesis, Illness -- just like Life wasn’t meaningful until we realized it could end. Until the first person witnessed a living thing die, living was just the way of existence.
Think about it: when you've been feeling healthy for a while, you don’t wake up saying, “I feel so healthy today!” But you sure are aware of how healthy you felt yesterday when it’s 3 am, and you’re up revisiting last night’s all-you-can-eat sushi.
What we consider to be 'Healthy' or 'Ill' varies throughout time and place.
Health and Illness are experienced by people and defined by people. What we consider to be 'Healthy' or 'Ill' is not stagnant; these definitions vary throughout time and place. Today, we would not label a pregnant woman 'Ill' (though her hospital bill might claim otherwise). However, this was certainly not always the case.
Sociologists distinguish between the medical term "Disease" and the sociological term "Illness". Disease describes the medical community's consensus on a collection of biological symptoms and processes; it is a condition. Illness is the social meaning and experience of being 'Diseased'.
The Illness Experience refers to how a person who is assigned a 'disease' incorporates the new label of 'Ill' into their identity, and subsequently interacts with society. In this construct, we recognize how biomedical knowledge and cultural context meet.
A patient came into the Emergency Department complaining of sudden onset chills, generalized weakness, and difficulty breathing during my shift yesterday. The patient was roomed in my section, and I assigned myself to him. As I introduced myself and began my assessment of the patient, I noticed the patient had a cough and flu-like symptoms. Per our protocol, I washed my hands, left the room, wheeled the Isolation Cart in front of his doorway, put up the Droplet Precautions sign outside his door, and came back in wearing a mask.
I picked up our conversation where we'd left off, but the man's demeanor had changed. He gave me short, just-a-few-words answers. He apologized after he coughed. We were both uncomfortable. I'm not too humble to say that as a nurse, I'm good at winning patients over. I explained what the mask was for, made a few jokes, asked him about his pets, and he loosened up. Sure enough, he tested Positive for Influenza A, got some Tamiflu, and went home to rest (in a mask).
By putting on a mask and placing a sign outside his door, I had literally labeled this man 'Ill'.
But that interaction stood out to me even after I had seen 30 more patients by the end of the day. By putting on a mask and placing a sign outside his door, I had literally labeled this man 'Ill' - and a threat to Health. This public designation affected this man emotionally - and our patient-nurse relationship. If a face mask and a transient flu diagnosis can cause that reaction, how do patients with a chronic illness cope?
There is an entire branch of sociology called Sociology of Health and Illness. I took a course with this title in college, and it's what made me want to be a nurse. There's also an academic journal dedicated to publishing articles examining areas of health and healthcare with a sociological lens. Even just reading the article titles is fascinating. There is much more to our healthcare system than meets the eye, and people are studying and writing about it! Let's not let that knowledge and discovery go to waste.
An entire global industry exists because of how humans conceptualize Health and Illness.
As nurses, we need to be familiar with the theory of social constructionism because the constructs of Health and Illness are the smallest denominators of our healthcare system. An entire global industry, including all of our jobs, our callings as healthcare professionals, exists because of how humans conceptualize Health and Illness.
The healthcare system functions the way it does because that’s how humans designed it. If we understand the power humans had to construct the world around us, then we can understand the power we have to change it. It seems big and impossible to change now. But if we built it, we can tear it down.
And re-build, obviously. Not advocating total anarchy here.
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