282 Part V: Sociology and Your Life
The number of people who officially “retire” after multiple decades at one company (or in one career) is declining, so young people today don’t expect to “retire” as their grandparents did. One result of this is that they’re less likely, among other things, to save money for retirement.
A life course transition that’s becoming increasingly common, on the other hand, is cohabitation. Just a few decades ago, a couple who lived together before marriage was seen as exceptional, and “shacking up” was something you might not even talk openly about. In some circles, that’s still the case; but increasingly, cohabitation is a normal step in relationships that may or may not lead to marriage. In acknowledgement of this as well as of the
increasing prevalence of couples who openly live together in same-sex relationships, invitations to events are now more likely to say “partners invited” than “spouses invited.” Cohabitation is becoming a newly common transition in the ever-changing life course.
Taking Care: Health Care and Society
No matter what bad things happen to members of our family, my grandma has a single response: “At least you have your health!” Not just for her, but for many people, health is the fundamental concern in life: Without your health, it’s hard to enjoy anything else. Further, it’s a family concern: Your health can affect your employment, your mobility, your life expectancy, and many other aspects of your life that have a profound bearing on your family.
Sociologists have found, however, that “health” can mean different things to different people — and that providing health care is a matter of making hard decisions, both for individuals and society. In this section, I explain why.
Deciding what counts as “healthy”
It may seem absurd to think of health as something that’s socially constructed. After all, a broken arm is a broken arm, no matter what society you’re in. That’s of course true, but if you’re asked whether or not you’re “healthy,” you could answer that question in many ways, and in doing so you’ll consider what is normally considered healthy in your society.
Even if I make the question more specific and ask whether you need treatment for a health concern, your answer will vary depending on what treatment options are available to you and your family. Think about all these different examples of people seeking medical treatment:
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A 69-year-old woman has ovarian cancer and goes with her husband to a clinic to receive chemotherapy.
A 41-year-old man has an appointment with a counselor to talk about emotional problems he’s been having since the end of a relationship.
After starting a new relationship, a 26-year-old woman visits her gynecologist to request a prescription for birth control pills.
A 12-year-old boy has broken his collarbone skateboarding, and his mother takes him to the emergency room to have the bone set and a cast put on.
A 52-year-old man goes to his dentist to have a root canal performed.
A 37-year-old woman is having back pain after childbirth and receives acupuncture to relieve the pain.
Those are all legitimate health issues, but they would have been treated very differently — or possibly not at all — in different places and times. Why does the definition of what counts as “healthy” change over time and from place to place?
One obvious factor that changes is technology. As the ability to treat health issues grows, the bar for what counts as “healthy” goes up. Today, medical professionals have the ability to replace missing teeth, excise unwanted fat deposits, do full-body cancer scans, and perform thousands of other treatments that would have been impossible just a few decades ago. This means that the number of different health issues any given person can be treated for at any given time has grown significantly. That’s not to say any given family can necessarily afford to have those things treated or would choose to have them treated, but the possibilities are there.
Another aspect of health that varies, though, is a society’s — and a family’s — notion of what lifestyle and bodily state corresponds to the picture of “health.” Having conspicuously visible fat in the belly and elsewhere has been regarded in many societies as being especially healthy; in most societies today, it’s considered healthier to be on the thin side rather than the heavy side. This is a result of changes in:
Knowledge: Medical professionals today understand that being obese increases one’s risk of heart failure and other health problems.
Material circumstances: Because of changes in agriculture, transportation, and food-processing technology, it’s now more expensive to eat a healthy diet of vegetables than to eat a poor diet of junk food. Thus, being thinner is an indicator of greater wealth.
Culture: Prominent opinion-makers in the media and in social networks have promulgated the idea that thinness is attractive.
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Is ADHD socially constructed?
After decades of debate, psychologists have arrived at a definition of a disorder now called attention deficit hyperactivity disorder (ADHD), a condition in which individuals experience inattentiveness and/or impulsive behavior to an extent that interferes with their daily lives. Common treatments for ADHD include medications like Ritalin that often help increase attention span, concentration, and self-control.
ADHD has been diagnosed with increasing frequency in recent years, especially among children, and has become a matter of much debate among parents and educators. Some believe that many children diagnosed with ADHD are simply unusually active, and that medicating children for the condition is tantamount to drugging them into submission. Others — both children and adults — have found that taking medication has completely transformed their ability to get work done and has significantly enhanced their lives. When my friend’s doctor prescribed Ritalin for her, he explained that some of his patients liken it to putting on a pair of glasses: It brings clarity.
It’s hard to blame people for being suspicious of the medical establishment, which has not always worked well in the past (as recently as the 1950s, doctors were appearing in cigarette advertisements to tout their favorite brands). Still, most people find that professional associations like the American Psychological Association are generally trustworthy, and when they decide — as in this case — that a disorder is “real,” then it’s best to assume they’re right.
Definitions of health and sickness have always changed, and will always do so. Sociologists (and physicians) agree that the current medical consensus is by no means the final word on what diseases “actually” exist. Still, unless you’re ready to write off the medical establishment entirely — and some are! — the best you can do, in medicine as in sociology, is to find the most reliable data and interpret them as well as you are able. You can refine your views as more data become available. Right now, the best evidence suggests that, though it’s not for everyone, medication can be enormously helpful for many people who have ADHD.
Mental health is an area where attitudes particularly vary among societies. At the extreme, mental states like schizophrenia that may be regarded as dangerous or unhealthy in some societies may be regarded as special or blessed in others; short of that, though, opinions may vary widely from one society to the next about whether it’s desirable to seek treatment for depression, attention deficit disorder, learning disabilities, or anxiety. Even within a given society, different individuals may have strikingly different views on those matters. (See sidebar, “Is ADHD socially constructed?”)
When families are making decisions about health care, they are influenced by the attitudes in their society — and, if they have immigrated, in the society from which they came — as they decide whether to pursue preventative medicine, emergency medicine, traditional or holistic medicine, or nothing at all.
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The complex challenges faced by families in making health-care decisions are also challenges faced by governments, as they decide where, how, and when to devote resources to their citizens’ health care.
Organizing and distributing health care
Because health is so fundamentally important, there will always be debates over how health care is organized and distributed within societies. Everyone wants the best possible care for themselves and their loved ones, but the best possible care is extremely expensive.
Many governments and health care organizations aspire to guarantee adequate — ideally, far better than merely adequate — health care for all their citizens, but if every single person had unlimited access to all existing medical treatments and technology, the cost could be so high that a society would hardly be able to afford much else. If your family finances have ever been strained by the cost of health care, you understand the challenges that leaders in your government are facing.
What this means is that, one way or another, every society must somehow determine how and when various treatments will be provided — and how they’ll be paid for. Sociologists often study health care both to help improve it and because the medical establishment is a fascinating social institution.
A sociologist’s overall perspective on the health care establishment will depend on whether he or she leans more in the direction of Durkheimian functionalism or Marxism. (See Chapter 3 for more on those perspectives.)
A functionalist will likely pay attention to the overall norms — formal and informal — defining who is “sick” and how they’ll be treated. Talcott Parsons believed that “sick” is a particular role in society, a role that varies among societies of different sizes and at different stages of development. Just as there is always crime in society, there will always be the sick; but if a society defines too many people as sick, not enough work will get done and too much money will be spent on health care. If a society defines too few people as sick and fails to attend to basic health needs, it will suffer in the long run.
A Marxist will emphasize that different parties have different material stakes in health care. Providers and insurance companies want to provide as much care as possible providing they’re generously paid for it, but the patients want that care provided at low or no cost. The government could conceivably adjudicate between them, but is likely to be in control of the wealthy and thus to favor their interests.
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Of course, this isn’t just a black-or-white proposition: Most sociologists today don’t fall strongly in either of those camps but instead have a view akin to Weber’s: that different groups and individuals have real material interests, but that the conflicts among them play out on a field where the ground rules are set by cultural norms. For example, hospitals or insurance companies find themselves under siege when they deny lifesaving care to children; that care might be vastly expensive, and the children’s families may be unable
to pay the cost of that care, but there’s a strong social norm discouraging anyone from allowing a child to die if there’s anything that can be done to prevent it.
What all sociologists agree on is that health care organizations are exactly that — organizations — and they are apt to behave like all other complex organizations. I explain in Chapter 12 that organizational life is about much more than just “getting the job done,” it’s about managing the people in the organization as well as managing the organization’s relationship with its surroundings. This is just as true for hospitals and clinics as it is for coffee shops, despite the fact that the stakes are much higher.
Medical professions — especially the profession of physician — are deeply institutionalized: To become a doctor or a nurse, you have to go through long training that provides not just an education in how the human body works, but an education in how to be a doctor or a nurse. Members of those professions tend to go about various practices and procedures in certain ways; as with any profession, some of those traditional practices are wise and provide continuity and reliability whereas others may be bad habits that ought to be broken. Consider that when training to be a doctor, residents (young doctors learning the ropes) often work for shifts of over 24 hours. By the end of those shifts, they’re exhausted and, evidence suggests, more prone to make mistakes — but the current system is a longstanding tradition and has been resistant to change.
Doctors have more extensive training than do nurses, and have traditionally been the authorities in medical settings. Nurses, however, argue that their close day-to-day experience with patients (a doctor may see a given patient much less frequently than that patient’s nurses do) give them a valuable perspective that doctors too often neglect to consider, just because the doctors are “the experts.”
Medical professionals can be just as hesitant to believe evidence that contradicts their beliefs as everyone else is. A doctor may diagnose a patient based on a quick assessment or a hunch, and then may be slow to notice or accept subsequent evidence that they may have erred in their initial judgment.