1. INTRODUCTION: THEORIES AND PERSPECTIVES zA. HOW DO YOU KNOW WHEN YOU ARE ILL?  1. SYMPTOM ORIENTATION  2. CAPACITY ORIENTATION  3. FEELING STATE ORIENTATION

2.  B. HEALTH IN RELATION TO SOMETHING: CONSTANT COMPARISON  1. NORMATIVE NATURE OF HEALTH AND ILLNESS a. HOW TO FEEL, BEHAVE OR BE

3. b. ILLNESS PROTOTYPES (1) SIGNS AND SYMPTOMS (2) LABEL (3) CAUSE (4) SEQUELA (5) TREATMENT (6) CONSEQUENCES

4. c. SOURCE (1 ) CULTURE: ZOBROWSKI (2) PARENT AND FAMILY (3) PERSONAL (4) MEDICAL PROVIDERS (5) MEDICAL MEDIA d. BODILY BACKGROUND EXPECTATIONS

5. x2. HEALTH EVALUATIONS ARE SITUATED a. EVALUATIONS ARE NORMATIVE AND SITUATIONALLY SPECIFIC b. DRIFT AND HEALTH EVALUATIONS: MATZA

6.  3. HEALTH, SITUATIONS AND INSTABILITY a. HEALTH AND ILLNESS AS EXPRESSION OF RELATIONSHIP TO ENVIRONMENT

7. b. EPIDEMIOLOGY TELLS WHO IS AT RISK OF MAINTAINING GOOD OR POOR RELATIONSHIP c. WHO’S CRITERIA DO WE USE AS TO GOOD OR POOR RELATIONSHIPS?

8.  C. TWO MAJOR PERSPECTIVES  1. REALISTS, ABSOLUTISTS OR POSITIVIST a. DISEASE IS EMPIRICAL, OBSERVABLE AND MEASURABLE (1 ) IT HAS A BIOPHYSICAL BASIS

9. (2 ) TRADITIONAL MEDICAL MODEL (a ) DISEASE IS THOUGHT TO STAND FOR ITSELF; COMES WITH LABELS; REALISTS POSITION

10. b ) DISEASE INDEPNDENTOF INTERPRETATION OR EVALUATION; OBJECTIVE

11. (c ) MEDICINE REVEALS BIOPHYSICAL REALITY; REVEAL “NATURAL DESIGN” (d ) REALITY FROM: ANATOMY, PATHOLOGY, PHYSIOLOGICAL CHEMISTRY, GENETICS, CELLULAR BIOLOGY

12. (e ) CRITERIA: PATHOLOGICAL, STATISTICAL, POSITIVE [WHO] CAPACITY AND DEVELOPMENTAL (f ) MEDICINE AS AN “OPEN” VS “CLOSED” DISCIPLINE

13. (3 ) KOSA & ROBERTSON SUGGEST: (a ) GERM THEORY: DISEASE AGENTS AND MAGIC BULLETS (b ) EPIDEMIOLOGICAL THEORY: HOST, AGENT AND ENVIRONMENT; PUBLIC HEALTH

14. (c ) CELLULAR & GENETIC CONCEPTIONS: CELL CHANGES AND CHRONIC DEGENERATIVE DISEASES (d ) MECHANISTIC CONCEPTIONS: DEFECTIVE PARTS REQUIRE SURGICAL INTERVENTION

15. x 2. CONSTRUCTIONISTS, INTERACTIONISTS, IDEATIONAL PERSPECTIVE: SUBJECTIVE INTERPRETATIONS a ) ILLNESS AS SUBJECTIVE b ) SUBJECTIVE SIGNS AND SYMPTOMS

17. c ) ASSUMPTIONS: (1 ) DISEASE IS SUBJECTIVE, ONLY ILLNESS EXISTS (2) DISEASE INDEPENDENT OF OBSERVATIONS?

18. (3 ) EASILY SEEN IN: MENTAL ILLNESS, ALCOHOLISM AND OTHER STIGMATIC DISEASES; CAN YOU LOBBY? (4 ) ALL DISEASES ARE SOCIAL PROBLEMS: OBJECTIVE CONDITION AND SUBJECTIVE INTERPRETATION

19. (5 ) MEDICINE GIVEN BODY, RELIGION GIVEN DEITY RELATIONS, AND LAW GIVEN RELATIONS OF MEN WITHIN IN FRAME-WORK OF LAWS (6 ) MEDICINE AS SOCIAL AND MORAL ENTERPRISE

20. (7 ) WE CREATE, SUSTAIN AND TRANSFORM DEFINITIONS OF HEALTH AND ILLNESS (8 ) DISEASE AND ILLNESS VARY INDEPENDENTLY, BUT NOT TOO INDEPENDENTLY; CONSISTENCY AND COLLAPSE

21. (9 ) STUDY CONSEQUENCES OF LABELING SOMETHING AS DISEASE OR ILLNESS (10 ) WHAT IS DEFINED AS DISEASE IS NOT ALWAYS BIOPHYSICAL, BUT THE RESPONSE [ILLNESS BEHAVIOR] IS ALWAYS SOCIAL, PSYCHOLOGICAL AND CULTURAL

22. z d. MEDICAL MODEL AND EPIDEMIOLOGY DISENTANGLE ETIOLOGY BY CONSTRUCTING THEORY. CONSTRUCTIONIST LOOK AT THE INTERACTION OF INDIVIDUAL AND ENVIRONMENT AND THE CONSEQUENCES OF LABELING

23.  E. DUBOS: “IN ESSENCE HEALTH AND ILLNESS OR DISEASE ARE AN EXPRESSION OF A RELATIONSHIP WHICH WE ARE MAINTAINING WITH OUR ENVIRONMENT AND NOT A PHYSICAL ATTRIBUTE INDICATED BY AN ABNORMAL PART OF US OR PROCESS IN US.”

24. 1. BUT ENVIRONMENTS ARE ALWAYS CHANGING, BECOMING AND EMERGING 2. ADAPTION AND EQUILIBRIUM OR PERFECT HEALTH IS NEVER MAINTAINED 3. PARABIOLOGICAL NEEDS AND VALUES; URGES AND STRIVINGS NOTHING TO DO WITH SPECIES SURVIVAL

25.  4. SACRIFICE BIOLOGICAL FOR HIGHER FORMS OF LIFE “CONCEIVED IN THE SOUL RATHER THAN EXPERIENCED IN THE FLESH;” CULTURE EVOLVES FASTER THAN ABILITY TO ADAPT BIOPHYSICALLY 5. MIRAGE OF HEALTH F. SUMMARY