HEALTH, ILLNESS, AND DYING
Fall 2009 -- MWF 11-11:50 a.m.
Schindler Ed Center 116
Instructor: Kent Sandstrom, Ph.D.
Office: Baker Hall
356
Office Hrs: MW 9:00-10:30 or by appointment
Phone: 273-2769 or 2786
(main office)
Course Goals:
This course will examine the concepts of health, illness, and dying from a sociological perspective, drawing on both sociological theories and methods. The seminar format of the course requires students to take an active role in shaping class sessions. We will focus primary attention on the social organization of the health care system and the social psychological factors that shape the experiences of health, illness, and dying, particularly in the United States. Through discussion of course readings, we will address the following questions:
1. What is health? What is illness? How do doctors,
scientists, and laypeople distinguish between these two concepts? How are they
influenced in this process by larger social, political, economic, and
technological forces?
2. How and why can illnesses be seen as social
constructions? What social conditions foster various types of illnesses? Which
illnesses tend to acquire threatening moral and political meanings? How and why
do they acquire such meanings? What implications does this have for those who
experience these illnesses and for their communities?
3. How do social factors such as race, class, gender,
and sexuality become salient in the social construction of illness? Also, how do
these factors shape the personal experience of illness?
4. How and why has medicine become such a powerful
instrument of social control in the 21st century, particularly in Western
industrial societies? Why is it increasingly serving this function in
contemporary America? What implications does this have for our own
understandings of illness, morality, deviance, and health?
5. What is happening to health care in the U.S. today? Why is the health care system set up for acute illness when chronic conditions are so prevalent?
6. What does experiencing a serious illness mean to those who have them? How does it affect their lives and the lives of those around them? How should U.S. draw lines between individual and social responsibility for health?
7. What will health, illness, and medicine look like as
the 21st century unfolds? What “diseases” and health threats will be most
prominent? Why? How will these “diseases” be publicly defined and addressed?
What related dilemmas in medical care, prevention, and/or education will arise?
What impact will this have upon our social and political relationships?
8. What is death? What are its key causes in our
society? How has the nature and experience of death changed in recent decades?
What are the central features of the dying process? What are the problems and
limitations of popular models of this process? What forms of identity work do
people engage in as they cope with dying? For instance, how and why do they
construct and embrace post-mortal identities?
Course Objectives and Learning Outcomes:
By the end of the semester, you should be able to:
1. Use sociological concepts and principles to explain the definition, distribution, and experience of health, illness, and dying.
2. Identify and critique issues in the American health care system.
3. Apply a sociological lens to make sense of your own health-related actions, identities, experiences, and interactions.
4. Identify and use sociological methods, such as ethnographic interviewing, to write up a study of illness and build
sociological knowledge.
5. Describe and apply the ethical principles that should guide sociological research.
6. Present your ideas verbally and participate meaningfully in seminar discussions.
7. Identify and evaluate arguments based on their theses, assumptions, and supportive evidence.
8. Develop improved skills in writing, analysis, critical thinking, and oral expression.
Course Requirements:
Your course will grade
will be based upon the following:
A. A reflective essay delineating your understandings of
illness and health.
B. Quizzes and/or "reaction papers" that assess your understanding of course readings. In your reaction papers, you will need to draw upon assigned readings and address pertinent questions posed by facilitators.
C. A literature review (5 page paper) that discusses the nature and demographics of the illness you will write about in your final paper. This review of the literature will serve as the introduction to your final paper.
D. A final project paper in which you discuss the social
construction and lived experience of a particular illness or disability. This
paper will be based on an interview with a person experiencing an illness (e.g.,
cancer or depression) and it will need to draw upon relevant course readings and
concepts.
You will need to turn in your project papers during the class period on the
specified due date. No late papers will be accepted unless you have made prior arrangements
with me.
In addition to the above project papers, you will be asked to take occasional quizzes to assess your understanding of course
readings. You will also be required to facilitate at least one class session. As
a facilitator, you will need to (1) briefly summarize readings pertinent to one
of the course topics, (2) write reflective questions to be handed out to class
members prior to the class, and (3) promote and guide discussion. I will assist
you in facilitating the discussion as it unfolds.
I believe that people learn best through INTERACTION and DISCUSSION. I will
therefore try to involve you in some way during each class session. Since each
session will be discussion-oriented in format, it will be CRUCIAL for you to
keep up with course readings and to attend class regularly. Your success in this
course will depend upon your attendance at class meetings and your ACTIVE
PARTICIPATION in class activities and discussions.
Grading Summary:
Your grade for the course will be based on the following:
1. Project A: 25 points
2. Quizzes/Reaction Papers: 100 points
3. Literature Review: 50 points
4. Class Facilitation: 25 points
5. Final Project Paper 100 points
6. Participation: 50 points
TOTAL = 350 points
KEY POLICIES REGARDING PARTICIPATION AND GRADING
1. No late assignments will be accepted without my
explicit agreement. Any assignment turned in more than 72 hours after the due
date will lose at least one letter grade. No assignment will be accepted more
than ten days after the original due date.
2. Excellence in class participation includes active
involvement in small group exercises and larger class discussions, evidence of
having read class materials, insightful and critical examination of course
concepts and materials, and demonstrated ability to apply relevant concepts when
discussing topics. Any student who has more than three unexcused absences will
lose at least 35 points from his/her participation grade. This translates into a
deduction of at least one grade on their final course grade. Absences from class
are excused when they occur because of a death in the family, serious illness,
or involvement in a university-approved event (e.g., official UNI athletic
contests). To receive an excused absence, you must provide me with WRITTEN
DOCUMENTATION (e.g., a physician’s excuse, a funeral notice, or a letter from a
coach) that clearly indicates why you had to miss a class.
3. If you miss class, be sure to find out whether you
missed any important announcements. You are responsible for knowing about all
announcements made in class. Please do not ask me if you “missed anything
important” when you miss a class. Every class session is important.
4. No incompletes will be given for this course unless
you have a prior written agreement with me. Incomplete course work results in
hassles for both students and instructors. I expect you to do everything in your
power to avoid this situation.
I would like you to have a rewarding and successful learning experience in this
class. Please contact me if you are having difficulties in the course. If you
have a “disability,” you should be aware of the following policy:
The Americans with Disabilities Act of 1990 (ADA) provides protection from
illegal discrimination for qualified individuals with disabilities. Students
requesting instructional accommodations due to disabilities should arrange for
such accommodations through the Office of Disability Services. This office is
located at 213 Student Services Center and its phone number is 273-2676.
Texts And Readings:
Phil Brown, Perspectives in Medical Sociology. 4th ed. (Long Grove, IL: Waveland Press, 2008).
Harriet Washington, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York: Doubleday, 2006).
David Karp, Speaking of Sadness: Depression, Disconnection, and the Meanings of Illness. (New York: Oxford University Press, 1993).
Recommended Book
Kathy Charmaz, Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. (Beverly Hills, CA: Sage Publications, 2006).
Other Readings:
The following course readings will be handed out in class:
Thomas Szasz, “What Counts as Disease? CMAJ 135, October 15, 1986, pp. 859-860 and “Should the FDA Ban Water?” Inquiry, April 2, 1979, pp. 5-6.
Charles Edgley and Dennis Brissett, “Health Nazis and the Cult of the Perfect Body: Some Polemical Observations” in Symbolic Interaction 13 (2): 257-279, 1990.
Rose Weitz, “HIV Disease and the Moral Status of Illness,” Pp. 34-51 in Life with AIDS. (New Brunswick, NJ: Rutgers Press, 1991).
Barbara Ehrenreich and Deirdre English, “The Sexual Politics of Sickness.” Pp. 101-140 in For Her Own Good. (New York: Anchor Books, 1978).
Robert Jay Lifton, “Nazi Doctors at Auschwitz,” pp. 280-287 in S. Cahill, ed. Inside Social Life. 3rd ed. (Los Angeles, CA: Roxbury, 2001).
Adam, Barry and Alan Sears. "In the Beginning," pp. 1-28 in Experiencing HIV: Personal, Family, and Work Relationships. (New York: Columbia University Press, 1996).
Kent Sandstrom, “Redefining Sex and Intimacy: The Sexual Self-Images, Relationships, and Outlooks of Gay Men Living with AIDS,“ R. Heasley and B. Crane, eds. Sexual Lives: A Reader in the Theories and Realities of Human Sexuality. Boston, MA: McGraw Hill, 2003), pp. 345-360.
Kent Sandstrom, “Preserving a Vital and Valued Self in the Face of AIDS,” Sociological Inquiry 68 (3): 354-371.
Daniel Chambliss, “Protecting the Routine from Chaos,” from Beyond Caring: Hospitals, Nurses, and the Social Organization of Ethics. (Chicago: University of Chicago Press, 1996.)
Boston Women’s Health Collective, “The Politics of Women and Medical Care," Pp. 719-744 in Our Bodies, Our Selves: A New Edition for a New Era. (New York: Simon & Schuster, 2005).
“Interview: Thomas S. Szasz, M.D,” Pp. 394-404 in G. Stone and H. Farberman, eds. Social Psychology through Symbolic Interaction (New York: Wiley and Sons, 1981).
David Rosenhan, “On Being Sane in Insane Places,” Pp. 284-294 in James Henslin. ed. Down to Earth Sociology 8th ed. New York: Free Press, 1995).
Kim Chernin, “The Tyranny of Slenderness” in Obsession (NY: HarperCollins, 1981).
Abra F. Chernik, “The Body Politic,” Pp. 75-84 in Barbara Findlen. ed. Listen Up: Voices from the Next Feminist Generation. (Seattle, WA: Seal Press, 1995).
Monika Ardelt, “Physican-Assisted Death,” Pp. 424-432 in Cliff Bryant et al., eds. Handbook of Death and Dying. (Thousand Oaks, CA: Sage Press, 2003).
Kent L. Sandstrom, “On Coming to Terms with Death and Dying,” Pp. 468-474 in Cliff Bryant, Charles Edgley, Mark Leming, Dennis Peck, and Kent Sandstrom, eds. Handbook of Death and Dying. Thousand Oaks, CA: Sage Press, 2003.
Cliff Bryant, Kent Sandstrom, et al., “Death in The Future: Prospects and Prognosis,” Pp. 1029-1040 in C. Bryant et al., eds. Handbook of Death and Dying.(Thousand Oaks, CA: Sage, 2003).
Graves Enck, “The Dying Process,” Pp. 457-466 in Cliff Bryant et al. Handbook of Death and Dying. (Thousand Oaks, CA: Sage, 2003)
PROSPECTIVE SCHEDULE OF TOPICS AND READINGS
8/24-8/28 Introduction to the Course: What Is Illness Anyway?
Read: *Szasz, “What Counts as Disease?”and “Should the FDA BanWater?”
Brown, “Introduction,” in Brown, pp. ix-xiii.
*Edgley & Brissett, “Health Nazis and the Cult of the Perfect Body.”
8/31 & 9/2 The Moral Meanings of Illness
FIRST PAPER DUE on Mon., 8/31
Read: *Weitz, “HIV Disease and the Moral Status of Illness”
Conrad, “The Shifting Engines of Medicalization,” in Brown, pp. 104-115
9/4 Femininity as “Disease”: Medicine and Gender in 19th Century America
Read: *Ehrenreich and English, “The Sexual Politics of Sickness”
Ethnicity and Infirmity as “Disease”: Medicine and Racism
9/9 & 11 A. The Nazis’ Biomedical Vision
Read: *Lifton, “German Doctors and the Final Solution” and “Nazi Doctors at Auschwitz”
9/14 & 16 B. Race, Racism, and Illness in the U.S.
Read: Washington, Introduction and Chs. 1, 2, 6 and 7
9/18 & 21 C. Race, Medicine, and Medical Experimentation in the U.S.
Read: Washington, Chs. 8, 10, and Epilogue
Sexuality and Disease: Medicine, Morality, & AIDS in America
9/23 A. The Onset and Social Construction of the AIDS Epidemic
Read: Adam and Sears, “In the Beginning”
9/25 &28 B. The Lived Experience of HIV/AIDS (and Chronic Illness)
Read: Ciambrone, “Illness and Other Assaults on Self,” in Brown, pp. 243-257
*Sandstrom, “Preserving a Vital and Valued Self in the Face of AIDS”
9/30 & 10/2 C. The Social and Sexual Consequences of AIDS and Illness
Read: *Sandstrom, “Redefining Sex and Intimacy”
Charmaz, Ch. 2 (re: Interview Guide and Final Paper Project)
Social and Cultural Factors Shaping Illness and Health Care
10/5 &7 A. The Social Organization of Health Care
Read: * “Protecting the Routine from Chaos”
* “The Politics of Women’s Health”
***INTERVIEW GUIDE DUE on 10/14***
10/9 & 12 B. The Demographics of Health and Illness: Gender and Sexism
Read: Lorber, “Women Get Sicker and Men Die Quicker,” in Brown, pp.
41-60.
10/14 C. The Demographics of Health and Illness: Race and Class
Read: Williams, “Race, SES, and Health,” in Brown, pp. 24-37
McCally et al., “Poverty and Ill Health,” in Brown, pp. 5-19.
10/16 D. Health, Illness, and Social Support
Read: Pearlin and Aneshensel, “Stress, Coping, and Social Supports” in Brown, pp. 146-153.
*** LIT REVIEW DUE on 10/23***
10/19 & 21 E. Health Care Experiences and Treatment Philosophies
Read: Zola, “Pathways to the Doctor” in Brown, pp. 176-189.
Goldstein, “The Emergence of Alternative Medicine” in Brown, pp. 261-268.
10/23- 30 Mental and Emotional “Illness”: The Manufacture of Madness
10/23 A. Mental Illness: Myth or Reality?
Read: *“Interview: Thomas Szasz”
*Rosenhan, “On Being Sane in Insane Places”
10/26 & 28 B. Gender and Mental “Illness”: Women, Fat, and Eating Disorders
Read: *Chernin, “The Tyranny of Slenderness”
*Chernik, “Body Politic”
The “Dis-ease” of Postmodernity: An Epidemic of Depression?
10/30-11/4 A. The Social Construction of Depression
Read: Karp, Chs. 1 (skim), 2, and 7
11/7 & 9 B. The Personal Meanings and Implications of Depression
Read: Karp, Chs. 3, 4 (skim), 5 and 6
The Future of Health, Illness, and Dying in the U.S.
11//11 & 13 A. Bioethical Issues
Read: *Ardelt, “Physician-Assisted Death”
Fox & Swazey, “Transplantation & the Medical Commons, in Brown.
Charmaz, Ch. 3 (re: Final Paper Project)
11/16-20 B. Improving Health Care and Health Policy
Read: Quadagno, "Why the U.S. Has No National Health Insurance," in Brown,
pp. 400-410.
Busfield, "Pills, Power, People," pp. 411-425.
11/23-27 ***NO CLASS – THANKSGIVING BREAK***
Read: Charmaz, Ch. 4 (re: Final Paper Project)
11/30-12/4 C. Death, Dying, and the Future
Read: Enck, “The Dying Process”
Sandstrom, “Coming to Terms with Death and Dying”
Bryant et al., “Death in The Future: Prospects and Prognosis.”
12/7-11 Presentations and Course Wrap-Up
**FINAL PAPER DUE by Friday, 12/11**
12/15 Final Exam – Tue., 10-11:50 a.m.