Sociology of Health and Illness Test 2
Terms in this set (113)
Kleinman's concept of "social suffering"
The interpersonal experience of suffering, experience of chronic illness
Pain and suffering caused by social forces: Global and local economics, politics, social institutions, social relationships, culture, e.g. structural violence
argues that to improve health, we must reduce suffering and "structural violence"
Social structure, or pattered social arrangements, put individuals and populations in harm's way
• The arrangements are structural because they are embedded in the political and economic organization of our social world
• They are violent because they cause injury to people
• Those most who are most vulnerable in our societies
• And, typically, not those responsible for perpetuating such inequalities
that committed by identifiable people on particular victims
that which often comes from subtle, gradual,
systematized, normally accepted actions of particular social structures or institutions where responsibility is blurred
Determines who gets heard, who gets devalued and who gets resources
Understanding Social Structure
social structure both shapes individuals' actions, and is shaped by them.
To properly understand structural violence, we therefore need to:
-Examine the role of human agency in creating and sustaining it
-Examine how it constrains individuals' human agency in ways that put them at risk of violence
illegal immigration status (Willen)
puts individuals at special risk because
-Lack not only rights but also, and more fundamentally, the right to have rights in
the first instance - no right to stake political claims or act decisively in the political sphere
-Constructed as undeserving and excluded from the moral community of people whose lives, bodies, illnesses, and injuries are deemed worthy of attention, investment, or concern
Suffering of this type tends to go uncounted, and even when counted is not effectively conveyed by statistics or graphs
-Hard to capture complex causal mechanisms, tendency to focus on individual, not structural factors
-Role of individual agency in shaping social structure is ignored
-"Othering" and conflation with cultural difference
Norms, rights, entitlements, obligations, responsibilities and duties that shape our sense of justice and guide our behavior with others
Those we value inside our "scope of justice", family, friends, compatriots and coreligionists "US"
Strangers outside our scope of justice and enemies
The Social Determinants of Health (SDH) Model
Does recognize that individual behaviours and
biological factors influence health
But emphasizes that:
-Individuals do not exist in a social vacuum
-Meso- and macro-level factors shape individual
-Behaviours and may interact with biological factors
-Social conditions and contexts are uniquely
amenable to policy interventions
Our health is primarily determined by
by social and contextual factors, rather than simply
individual biology or behaviour...
-Social inequities translate into health
-People with higher social status (education,
income, race, etc.) are more likely to have
After NHS was implemented, health in the UK improved overall, but inequalities in health were not eliminated
-In fact the "health gap" between the rich and the poor was widening
-Identified gap as stemming from social and economic conditions
-Lower social classes engaged in more risky behaviours, but this was traced back to poverty
Found step-wise social gradient in health
-Health improved in line with increases in seniority/occupational status
-Socio-economic differences in health
occur at all levels of society
have the largest impact on life expectancy and
quality of life
-Yet, most resources spent on health are
dedicated to medical services and health behaviours
are not just about lack of access to health care or poor individual choices
-are mostly the result of policy designs that systematically disadvantage some populations over others
-Esp. people with low income and/or low levels of
education, racial minorities, LGBTQ, etc.
Proximate Causes of Disease
Diet, cholesterol, hypertension, electromagnetic fields, lack of exercise, etc.
• Thought to be controllable through
distal causes of disease
Social economic status (SES), Gender, Race, etc.
• Addressing these requires social structural
Fundamental Causes Theory (FCT)
Seeks to explain the strong and
persistent association between SES and
health over time, despite changes in
proximal factors linking SES to health
outcomes and improvements in overall
-Link and Phelan have elaborated four key
features of FCT that explain how SES acts
as a fundamental social cause of health
Principles of Fundamental Causes Theory
1. SES influences multiple disease outcomes
2. This process takes place via SES' effect on
a multitude of risk factors
3. The association between fundamental cause and health is reproduced overtime via the replacement of intervening mechanisms
4. This effect is made possible because people of different SES have varying levels of access to flexible resources that can be used to reduce the risks and consequences of disease
-Influence what people know about, have access
to, can afford and whether they are support in their efforts to engage in health-enhancing behaviours
-Shape access to broad contexts associated with
different profiles of health risks and protections
lack of sanitation- unequal exposure to infectious disease-public amenities
unequal access to health care- unequal health outcomes- public health care
Three interlinked approaches to health inequalities
1. Targeting worst off
2. Closing the gap
3. Reducing the gradient
Individualist Approach to health inequities
Based on belief that health inequalities are the result of how INDIVIDUALS choose to lead their lives
-Focus on what they think are differences in health habits between different social classes
-People of lower social class seem to: smoke and drink alcohol more often, exercise less and have less healthy diets
-Idea is that people should be largely responsible for monitoring own health
-Government action should centre on high-profile health advertising campaigns etc.
Collectivist Approach to health inequities
Based on the view that differences in health are beyond the ability of the individual to change
-Sees differences in health as due to major economic and social problems in society (eg. poor housing stock, unemployment, inflation)
-Understand these problems affect different people in different ways - but poorer social classes suffer most
-Feel that improvements will only come by concerted government action centered on anti-poverty strategies
Social Determinants of Health
can be understood as the conditions in which people are born, grow, live, work and age, which are shaped by and in turn shape the distribution of money, power and resources at global, national and local levels, and are largely responsible for health inequities through their influence on exposure to health risks and protections.
Race, gender, and sexual orientation as SDH's
are important in that they function as "Master
Statuses" shaping our identities, interactions,
expected roles and the social and physical contexts we are exposed to
-Statuses can be ascribed or achieved
-The ascribed statuses can have greater significance for health in that they're often
understood as fixed
Gender, race and sexual orientation (along with
other axis of inequality) should be understood
-Relational and mutually constituted
◦ Embedded social structure and cultural representation
◦ Socially constructed in power differences
Inequalities grounded in
◦ Racism, slavery and colonialism
◦ Sexism and patriarchy
◦ Heterosexism and homophobia
While there are some similarities in the types of health inequalities experiences across different axes of inequality, their precise nature is unique to their particular trajectories
Racial Disparities in Health
African Americans have higher death rates than
Whites for 12 of the 15 leading causes of death.
-Blacks and American Indians have higher age- specific death rates than Whites from birth through the retirement years.
-Minorities get sick sooner, have more severe illness and die sooner than Whites
-Hispanics have higher death rates than whites for
diabetes, hypertension, liver cirrhosis & homicide
-When it comes to mental health, racialized
group experience more distress... but have
lower levels of disorders
Gender Disparities in Health
Women have higher life expectancies than men, but they also experience higher rates of morbidity and psychological distress
◦ Causes of morbidity also differ by gender
-Men are more likely to commit suicides, women are twice as likely to be depressed and anxious, and their depression and anxiety last longer.
-Women are more likely to report conditions such as allergies, headaches, arthritis. Men are more likely to report heart conditions, back pain, limb problems.
-Women more likely to experience sexual violence and domestic abuse. Men more likely to experience interpersonal violence
◦ Women are more likely to go to the doctor regularly, but are also more likely to be hospitalized
Disparities in Health by Sexual Orientation
LGBTQ populations experience significantly higher rates of:
◦ Mental health problems and suicides (completed
◦ Sexual abuse and physical abuse
◦ Higher rates of negative coping behaviours
(smoking, drinking, drug use)
◦ Exposure to STIs and HIV/AIDS
◦ Obesity (among lesbian) and eating disorders (Gay & Bi men)
Consequences of Structural Vulnerability
◦ Racial differences in socioeconomic status
◦ Marginalization of residents and communities
◦ Housing discrimination
◦ Limited educational and employment opportunities
◦ Fewer economic and social resources (lower tax base, out migration/avoidance of neighborhood by businesses and social institutions, food deserts)
◦ Neighborhood disorder and violence
◦ Concentrated poverty
◦ Health disparities
structural vulnerabilities tied to
health disparities in:
Infectious disease and TB
Exposure to environmental toxins
Infant mortality and poor birth outcomes
Death from homicide
Social and economic inequality produce
negative health outcomes and poor health status for women
◦ Male socialization and lifestyles expose men to riskier, aggressive, and dangerous behavior
◦ The often demanding and contradictory social roles of women produce negative health outcomes
◦ Women more likely to live in poverty, have lower incomes
Two perspectives that explain gender differences in psychological health:
◦ differential exposure theory
◦ differential vulnerability theory
The former emphasizes the extent to which men and women are exposed to particular stressors, whereas the latter focuses on men's and women's responses to those stressors
Race and Health
-Institutional discrimination can restrict socioeconomic attainment and group differences in SES and health.
-Segregation can create pathogenic residential conditions.
-Discrimination can lead to reduced access to desirable goods and services.
-Internalized racism (acceptance of society's negative characterization) can adversely affect health.
-Racism can create conditions that increase exposure to traditional stressors (e.g. unemployment).
-Experiences of discrimination may be a neglected
Gender and Health
◦ Gendered effects of health vary
◦ Norms of masculinity shown to be harmful in term of unwillingness to show vulnerability (tied to lower preventative care, less regular check-ups, etc)
◦ Power imbalance between men and women reduce women's ability to negotiate health-related decisions in relationships (paying for treatments, health behaviours such as condom use)
◦ Harmful effects of sexism, sexual harrassment and longterm stress of double duty
◦ Women also internalize of lower social worth (reflected in self-esteem, eating disorders, self-harm)
Sexual Orientation and Health
In Canada LGBTQ youth experience significantly
higher rates of physical, verbal and sexual
victimization. This is specifically tied to sexuality.
-Internalized homophobia is likely to be acute
during the coming out process, but is unlikely to
abate completely even when the person accepts
that they are a sexual minority. This has been
shown to affect self-esteem, induce self-doubt or
Michel Foucault (1980) developed this theory arguing that in the 18th & 19th century the way
humans related to their bodies changed
-Organizing social life now included "the administration of bodies and the calculated management of life"
-While before management of the body was ignored by authorities, in late modernity authorities increasingly treated managing life and bodies as a means to improve population efficiency, health, learning, skill, etc.
- Politics and social policy became increasing concerned with managing bodies and populations (no longer private)
-There was increased emphasis on norms not as moral rules of correctness, but about calculated averages that define statistically normative behavior (Ewald, 1990)
-Those deviating from the norm were deemed problematic, in need of management, fixing, "discipline"
-This was reflected in politics, medicine, and individuals' relationships to their own bodies
This gave rise to a new kind of "medicalized deviance"
-With this we see increasing medicalization of disability, as outside the norms of a "healthy" body
-In the 19th century, doctors, scientists and politicians became concerned with rehabilitating/restoring "disabled" bodies through medical, technological, therapeutic, and educational interventions
-As technology progressed, efforts to gain control over the body have also. Now see more emphasis on molecular interventions (i.e. at the genetic or bio-chemical level)
body in opposition to, transformed by
self and society
Control of the body at the political/societal level, was also accompanied by increasing concern about monitoring, controlling and improving bodies at an individual level
-Giddens (1991) discusses how late / high modernity is characterised by a process of continual questioning and reflexivity that is intimately bound up with questions of self
-We see a growing importance of the body as constitutive of self identity
-body as self
-body as something to be worked on
-By working on body, you are working on yourself
Increasing investment of self-identity in our bodies
-The body is increasingly viewed as an entity in the
process of becoming; it can be accomplished reflexively as part of an individual's self-identity
-Appearance, size, shape, content / constitution seen as always potentially open to (re)construction in line with the desires, plans and purposes of their "owners"
-Bodies are treated as malleable; moulded as a trait of personality; honed through vigilance and hard work
Reflexive body techniques
the body as subject (we are bodies) and the body as object (we have bodies)
-Recognizing that we can objectify ourselves and
distinguish between these two, but this distinction is always reflexive and not substantive
-Encourages us to identify the 'mindful' and social aspects of embodied activity
-Ensembles of RBTs (sets of techniques) may be practised together for a common social purpose
e.g. getting dressed, doing make-up, brushing hair
Some techniques may mark group boundaries and serve to cultivate bodily markers of collective identity
Crossley Reflective Body Techniques
draws on Mauss' (1979) definition of
body techniques as "ways in which from society to society men [sic] know how to use their bodies"
-Except, he argues that this def. implies humans and their bodies are separate things
-Defines RBTs as: body techniques whose primary purpose is to work back upon the body, so as to modify, maintain or thematize it in some way in relation to the self
-Can be a body worked upon by others, or by the self RBTs vary across social groups in response to different social norms/pressures/availability of resources
Gimlin on cosmetic plastic surgery:
Why do people abstain from or choose to engage
in certain types of body management that may be
"normative" but are viewed as socially
What social forces that contribute to this?
How are women's understanding of their body
shaped by cultural context and individual
(surgery as not harming others financially or
depleting public resources)
(surgery as necessary to overcome pain, distress,
Metaphor of the ledger
(Surgery as self-indulgent, but balanced by self-sacrifice, valuation of non-physical qualities)
Refusals of criticism
(Surgery as non-problematic)
(Surgery as self-indulgence, something to be
(surgery as a result of pressure from others, esp. men)
Cultural Variations in Accounts (UK)
View of healthcare as a social right, not something to buy or be earned. More conservative approach to interventions.
-More likely to frame pre-surgical body in terms of medical need or social exclusion, and deny "excessive" interest in appearance
Cultural Variations in Accounts (US)
Market-based approach to healthcare (inds. with more
resources can have greater access to care)
More likely to emphasize financial sacrifice/physical effort
Informed by cultural values linking morality to work ethic
Charmaz (1995) explores how chronic illness undermines the unity between body and self and forces identity changes
-Explores "adaptation" as one mode of living with
impairment (among many)
-Recognizes that modes of living with impairment are embedded in social definitions of "appropriate" attitudes, actions, and activity levels,
-Negative definitions and judgements of deviance result when others view ill people as failing to reveal "correct" feelings or to take the "right" approach
3 Stages of Adaptation (Embodied Illness)
1. Experiencing an altered body, defining impairment/loss, and in turn making reassessments
2. After reassessing one's altered body, appearance to self and others, and the context of life, changes are make to one's future identity (identify trade-offs, re-definitions)
3. Surrendering to the sick body means the end of the quest for control over illness. People open themselves to experiencing their illness; define body and self through it.
Experiences of an altered body
Different embodied experiences of illness (alienation, break down (body as machine), betrayal (bodies out of control)
-Struggling with/against body: differing abilities to separate body and mind, to prevent illness from affecting feelings about self-body
-Objectifying body and embracing the subject vs. (limited) unification body and self
Identify trade-offs and surrendering to the sick body
Identity goals as emerging and changing through
mediation of subjective and social meanings
-As people shift their identity goals laterally or downward they may relinquish what others view as a more socially valued identity, and assess the costs-benefits of doing so
-In order to frame trade-offs positively, they are forced to integrate self and illness (identity loss as identity gain)
Surrendering to the body
Relinquishing quest for control over body
Giving up notions of victory over illness
Affirming self as tied to body (even if more than)
Surrender as new unity between body and self
Surrendering to illness as transforming the self (illness merges with subjectivity)
War on fat
Fatness/obesity seen as a lifestyle issue
-Emphasis on individual responsibility
-Measured by Waist to Hips Ratio/BMI
Appearing fit & fitness behaviours
Sign of healthiness
-Sign of good citizenship
-Responsibility, discipline, morality
A system of governmentality that links with neoliberal expectations that individuals
should mediate risk through an ongoing construction of individual biographies narrated
by the correct 'choices.'
-"Individualism": deeply rooted beliefs that all [people], regardless of gender, class, race, etc.
can overcome adversity through hard work (Firth 2012)
-Works as a legitimising and regulatory discourse that shapes girls' physical activity participation
-Simultaneously contributes to a moral hierarchy of bodies through which the girls can position both themselves and others
surveillance of self and others
held to a higher standard of slimness
o Men associated with mind, women
o Worrying about weight is an
element of normative femininity
o Weight loss interventions
o Women tend to be blamed for
the fatness of others
Health Behaviours & Subjectivities are shaped by social location:
Gimlin 2007 finds women's experiences in slimming groups differ by age:
-Age affects the meanings of body size in different contexts
-Older women were able to account for failure more easily than younger women
-Older women had more realistic weight loss goals
****Health beliefs/behaviours not just individual, shaped by dominant norms and institutional factors
Experiences of fitness vary by race/religion
Women of colour more likely to be
-Bodies of white women as more easily
regulated and disciplined (vs. bodies of
colour out of control)
-Black women more likely to have higher
-Racism & stress can lead to weight gain
-Clark (2006): clash between fitness norms and girls ethnic/religious identities
5 Pillars for Action (White House Task Force on Childhood Obesity's Report)
1) Early Childhood
2) Empowering Parents and Caregivers
3) Healthy Food in Schools
4) Access to Healthy, Affordable Food
5) Increasing Physical Activity
¡ Encourage healthy pre-natal weight in mothers
¡ Increase breastfeeding
¡ Reduce chemical exposure
¡ Reduce screen time
¡ Encourage physical activity and health eating in early care & education
Foetal Protectionism vs. Maternal Culpability
Empowering parents and caregivers
Make nutritional information widely available
¡ Ensure food labels are easy to understand
¡ Encourage responsible food marketing (industry self-regulation)
¡ Increase BMI screenings as increase preventative health
¡ Increase role of dentists and oral health providers
¡ Increase medical counselling for all parents and caregivers
-Failure to consider gender norms/division of labour/triple-shift
-Emphasis on choice, personal responsibility
-Good health = productive citizen contributing to the economy
Access to Healthy, Affordable Food
¡ Increase physical access to healthy food by eliminating food deserts
¡ Increase production of fruits, vegetables and whole grains
¡ Evaluate the effect of subsidies and sales taxes
¡ Encourage food/restaurant industry to develop healthy foods for young people
¡ Address links of hunger and obesity by increasing participation rates in
nutritional assistance programs such as school lunches and food stamps
v Food deserts, unequal access as an issue of racism, poverty, inequality
v Food insecurity leading to weight gain
Individual level intervention
Educating individuals about risks and recommendations
¡ Promoting healthy behaviours / practices
¡ Increasing availability of social support
System level intervention
Reducing social inequalities and addressing environmental factors
¡ Improving housing conditions, controlling safety and making the streets safe for
walking or cycling
¡ Promoting and improving access to sport and leisure facilities
¡ Subsidizing healthy foods and further regulating/taxing unhealthy foods
the patterned social arrangements in society that are both emergent from and determinant of the actions of the individuals
the unjust and avoidable differences in people's health across the population and between specific population groups
hard to define since the reality of it for each person is different
Two leading causes of death among adults Haiti
AIDS and political violence
required to explain Acephie and Chouchou's stories, provide context to their suffering
can help us untangle the complicated relationship between universalizing juridical arguments about health rights, on one hand, and situationally specific, vernacular moral arguments about health-related deservingness, on the other
do not reveal suffering
political, social structural forces in Haiti
lead to structured risk for suffering from AIDS, hunger etc
-Haiti has political violence, worst poverty in hemisphere
-Haiti has high human suffering index, only three countries judged to be more extreme
-life expectancy less than 50 years
-suffering as a result of human agency
health related deservingness
who is and is not deserving of health-related attention, investment, and care are highly contentious, particularly against the backdrop of today's global recession, retreating welfare states, and skyrocketing health care costs - not to mention the deeper, and deepening, infrastructures of inequality that divide the world's rich and poor.
distinct from formal assertions of entitlement, which typically are anchored in legal or policy commitments.
-must be distinguished from practical questions of health care access.
however socially constructed and ideologically loaded, has health consequences
associated with a wide variety of health risks, and it interacts with other factors - political, economic, sociological and epidemiological - to leave unauthorized migrants and their families vulnerable to health adversity
- These health implications affect not only migrants themselves, but also a wide array of other stakeholders including clinicians, public health professionals, health care administrators, policymakers, migrant advocates, politicians, and citizens.
often forces unauthorized migrants to forego or delay care-seeking for ailments that could easily be prevented
- vulnerabilities often become embodied.
the health effects of illegalization
parallel other forms of social exclusion that are grounded in racial-ethnic background, socioeconomic status, mental health status, lack of permanent residence, dependence on addictive substances, or history of incarceration, among other factors
Constructed as undeserving and denied political voice, unauthorized migrants face yet another form of exclusion; they are excluded not only from the political community, but also from the moral community of people whose lives, bodies, illnesses, and injuries are deemed worthy of attention, investment, or concern
refers to the complex, multilevel processes through which human bodies literally incorporate aspects of our environments - social, political, and biological - in ways that can be "read" on our biology
approach access to health care and the social determinants of health from three angles
(1) the juridical (rights, policies, and other kinds of formal entitlement), (2) the moral (deservingness), and (3) the empirical (access in practice).
social determinants of health
the economic and social conditions that influence the health of individuals, communities and jurisdictions as a whole
determine whether individuals stay healthy or become ill, also the extent to which a person possesses the physical, social and personal resources to identify and achieve personal aspirations, satisfy needs, and cope with the environment.
-about the quantity and quality of a variety of resources that a society makes available to its members.
conditions of childhood, income, availability of food, housing, employment and working conditions, health and social services.
societal conditions as determinants of health
in contrast against traditional biomedical model
-attention to economic and social policies as a means of improving health
2 key problems in the study of social determinants of health
1. what are the societal factors (eg income, education, employment conditions, etc) that lead to health inequalities?
2. what are the societal forces (eg economic, social and political policies, etc) that shape the quality of these societal factors?
prerequisites for health (Ottawa charter for health promotion)
peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity
determinants of health (health Canada)
income, social status, social support networks, education, employment and working conditions, physical and social environments, biology and genetic endowment, personal health practices and coping skills, healthy child development, health services, gender, and culture
Four criteria used to identify social determinants of health
1. Social determinant be consistent with most existing formulations of the social determinants of health and associated with an existing empirical literature as to its relevance to health. (all these social determinants of health are important to the health of Canadians)
2. The social determinant of health be consistent with lay/public understandings of the factors that influence health and well-being. (Understandable to Canadians)
3. The social determinant of health be aligned with existing government structures and policy frameworks (clear policy relevance to Canadian decision-makers and citizens)
4. The social determinant of health be an area of either active governmental policy activity or policy inactivity that have provoked sustained criticism (especially timely and relevant)
Four themes within the study of social determinants of health
a) empirical evidence concerning the social determinants of health
b) mechanisms and pathways by which social determinants of health influence health
c) the importance of a life course perspective
d) the role of policy environments in determining the quality of the social determinants of health within jurisdictions.
the materialist/structuralist explanation
emphasises the material conditions under which people live their lives. These conditions: availability of resources to access the amenities of life, working conditions, and quality of available food and housing
individual's behavioural choices (tobacco and alcohol use, diet, physical activity, etc) were responsible for their developing and dying from diseases.
the neo-materialist view
directs attention to both the effects of living conditions on individual's health but also the societal factors that determine the quality of these social determinants of health. Directs attention to how a society's decisions on how to distribute resources affects the quality of various social determinants of health, thereby influencing the health of Canadians.
The social comparison explanation
argues that health inequalities in developed nations such as Canada are not primarily due to material deprivation, but to citizen's interpretations of their standings in the social hierarchy.
the individual level
the perception and experience of hierarchy in unequal socieities lead to stress and poor health.
the communal level
the widening and strengthening of hierarchy weakens social cohesion- a determinant of health
the McKeown thesis
states that the enormous improvements in health experienced over the past two centuries owe more to changes in broad economic and social conditions than to specific medical advances.
risk factor epidemiology
focuses attention on individually based biological and behavioral risks for ill health...has downplayed social conditions as important causes of ill health.
shape access to a broad range of circumstances that affect health.
Four essential components of the theory of fundamental causes of morbidity and mortality
1. Such causes influence multiple disease outcomes
2. Such causes operate through multiple risk factors
3. New intervening mechanisms reproduce the association between fundamental causes and mortality over time
4. The essential feature of fundamental social causes is that they involve access to resources that can be used to avoid risks or to minimize the consequences of diease once it occurs.
3 policy recommendations
1. Create contextually based health interventions that automatically benefit individuals irrespective of their own resources or behaviors.
2. Prioritize interventions that are potentially available and beneficial to people at all socioeconomic levels and target the special needs of resource-poor groups who may face barriers in implementing those interventions
3. Promote policies that increase the SES related resources available to resource-poor groups
The fundamental-cause idea
tells us that resource-rich persons will be far more effective in gaining access to and employing health-enhancing initiatives focused on individuals than people who are resource-poor. Stipulates that people use their knowledge, money, power, prestige and social connections to gain a health advantage.
Two critical issues (fundamental cause idea)
1. whether we promote initiatives that people with fewer resources may not be able to access.
2. understanding why people with fewer resources do not always act on information or adopt health-enhancing ways of life.
altering life and self to accommodate to bodily losses and limits and resolving the lost unity between body and self. It means struggling with rather than against illness
three major stages of adapting
(1) experiencing and defining impairment,
(2) making bodily assessments and, subsequently, identity trade-offs, as ill people weigh their losses and gains and revise their identity goals, and
(3) surrendering to the sick self by relinquishing control over illness and by flowing with the experience of it.
goals that people assume, desire, hope, or plan for. The concept of identity goals assumes that human beings create meanings and act purposefully as they interpret their experience and interact within the world
ways of living with illness
ignoring it, minimizing it, struggling against it, reconciling self to it, and embracing