Making Sense of Illness: The Social Psychology of Health and Disease

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Alan Radley

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    Acknowledgements

    I have been fortunate to have had the advice of several colleagues at various stages of this book's preparation. Wendy Stainton Rogers and Doug Carroll were encouraging about the original book proposal, for which I thank them. Particular thanks go to those who took time to read draft chapters, correcting errors in the manuscript and advising upon changes of emphasis – Ellen Annandale, Paul Bennett, Mildred Blaxter, Mike Bury, Robert Dingwall, Mark Levine and Kristian Pollock. Any remaining shortcomings in the text are, of course, my sole responsibility.

    I am also grateful to the following publishers for permission to reproduce figures and tables that appear in the text: to the Office of Population Censuses and Surveys for extracts from tables in the General Household Survey 1992; to the World Health Organization for material from Demographic Trends in the European Region, 1984; to Macmillan Ltd and to St Martin's Press Incorporated for a figure from Kane, 1991, Women's Health; to the British Medical Journal Publishing Group for material from Moser et al., BMJ, 1988; to Elsevier Science Ltd for a table from Nathanson, which appeared in Social Science and Medicine, 1980, and for allowing me to reproduce the ‘Social Readjustment Rating Scale’ from an article by Holmes and Rahe in the Journal of Psychosomatic Research, 1967.

    Preface

    This book is an introduction to the topic of ‘health and illness’, as viewed from both a social and a psychological perspective. It reviews some of the more important research that has been carried out in recent years, mainly by medical sociologists, health psychologists and medical anthropologists. The reasons for drawing upon a wide range of work is, quite simply, that the efforts of these different disciplines often overlap. This overlap occurs because questions of how people fall ill, and how they stay well, have a human significance that no discipline can overlook. Of course, this significance is not restricted to the inquiries of academics. Most people are interested in illness and its treatment – first, perhaps, from a distance, and then later in a personal way.

    What often grasps our interest is not the disease itself, not the germs or the symptoms, but the way that becoming ill faces people with all kinds of personal choices and moral dilemmas. Once we begin to look into it, this is a topic that seems to touch all other aspects of life. Perhaps that, too, is what makes it interesting to so many people. When we try to make sense of illness we find that we are, often unintentionally, also making sense of these other aspects of life, and perhaps of ourselves as well.

    For social scientists of whatever hue, these questions make ‘health and illness’ more than just another topic to be investigated. It promises something more in the way of telling us about ourselves, about our society and the way that we live within it. One other reason for this interest is that it concerns something which social scientists find difficult to analyse, but (eventually) impossible to ignore – the body. Health and illness are not just abstract states, but also physical ones. Our bodies matter to us, and how they matter is surely something for any sociologist, psychologist or anthropologist to want to explain.

    If the book has any single approach, it is to look at illness in this way – as something that we have to ‘make sensible’, if our own lives are to ‘make sense’. This is a task not just for individual sufferers, but for others around them, for medical staff, and for society as a whole. It invites questions about how people think about health; how they conduct themselves when ill; the part played by family, friends and strangers; relationships with doctors and nurses; and the place of the sick in the social world. In my terms, this makes for a ‘social psychological’ approach to these questions, and this is the perspective that I have adopted in the text.

    In the pages to follow I have tried, wherever possible, to relate the argument to everyday life. Therefore, the book follows a path that leads from health – when illness appears a distant prospect – through diagnosis and treatment, to the experience of having a chronic, and perhaps serious, disease. Although it is not essential that readers start with Chapter 1 and proceed onwards, many of the later arguments build upon ideas presented earlier on in the text.

    There are, inevitably, several omissions in a book of this length. There is no discussion of mental illness, even though many points raised in the text are relevant to this question. Also, the reader will find little here about the hospital experience, and nothing concerning terminal care, dying or specialist services such as dentistry. Instead, much of the coverage concerns what might be called ‘everyday illness’, and how this is managed by medical staff and by laypeople in their turn. For that reason, I hope the reader will bring to bear on the text his or her own experience, thus not only making sense of it, but making sense with it as well.

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    Author Index


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