THE SELF IN SICKNESS AND IN HEALTH Clara Valverde RN BSc Aquo Training Team

The interruption of one’s biography  While healthy, one takes for granted one’s body  And what else?  What changes with illness?  How would one be seen differently? (social meanings)  How would it affect one’s idea of “success”?  How would it interrupt one’s biography?

Medicalization of society  How does it feel to be a patient?  How does the health care system see the patient?  Gender differences.  How does the patient see the health care system?

Medicalization of society  What does the doctor want to talk about?  What does the patient want to talk about?

Medicalization of society  Medicalization is a social process in which bodies and social circumstances are defined from a biomedical perspective requiring biomedical intervention.

Today it is not the stethescope nor the scalpel that does the fundamental work of medicine; it is the ideas conveyed in words that persuade us that what is done is right and good. Trish Greenhalgh Under the Medical Gaze

Medicalization of society  The “battle of narratives” in the doctor’s office  (Arthur Kleinman, Arthur Frank, Abel and Browner, Rita Charon, T. Greenhalgh, C.Mattingly, L.Garro)

The doctor hides his doubts and fears behind a shield of invincibility and he forgets that it is only a shield. Eric J.Cassell The Healer’s Art

Medicalization of the self  How does the doctor take power?  How does the patient give the doctor power?  Possible problems with this situation?

Science’s job now-a-days is not so much to tell The Truth, but to tell a truth and then make it look like The Truth. David Locke Science as Writing

Medicalization of the self  Embodied knowledge: what one feels in one’s body.  Empathic knowledge: another’s experience that one identifies with. (Abel and Browner 1998)

Scientists make things that are only probably true seem definitely true. David Locke

Truth claims  What are some “truth claims” that doctors make that are reproduced in society?  How are they reproduced?

Expected Illness Behaviours  What does society expect the ill person to do, not to do, to be like, not to be like, to look like, not to look like?  What does society expect the ill person to think, hope for?  Are some behaviours seen as “better” than others?

To always be looking for a cure is not an adaptative behaviour. M.J. Montbriand

Expected Illness Behaviours  How does society see slowness, weakness, confusion, vulnerability?  Could they be accepted values, just as accepted as the “can-do” attitude?

I wake up with it. I feel like I’ve done something wrong. I have this horrible feeling, like I’m really bad, like I should make up to someone, even get forgiveness. I often can’t shake it till I’m on my way to work. Sometimes at night I dread going to sleep ‘cause I know I will wake up with it. Moira, legal assistant, lives with lupus Sick and Tired of Feeling Sick and Tired: Living with Invisible Chronic Illness (Donoghue and Siegel 2000)

Expected Illness Behaviours Guilt:  How does “blaming the victim” work?  Why does it work?  Who does it?

Medical encounters tend to convey ideologic messages supportive of the current social order. Howard Waitzkin

Invisible Chronic Illnesses or Disabilities  How does it affect one’s self having an illness or disability that is invisible?  Advantages and disadvantages of the fact that it is invisible

 Three types of invisibility in the new chronic illnesses such as Chronic Fatigue Syndrome-Myalgic Encephalitis (CFS-ME), Multiple Chemical Sensitivities (MCS), Fibromyalgia (FMS), Gulf War Syndrome (GWS), etc:  1. The person is not seen because s/he is at housebound  2. S/he has no outer signs of the illness (“but…you don’t look sick”)  3. When s/he says s/he has CFS, MCS, FMS or GWS, people do not believe him/her Juliene Lipson PhD UCSF

Diagnosis or Definition?  What are the advantages of having the diagnosis?  What are the disadvantages of having the diagnosis?

Reclaiming the Self  What would help the ill person find his own definition of what it is to have that illness, to find meaning to his or her new life?  What would hinder?

I have changed. Like you. But in a different way. Paul Verlaine

Thank you!