Tim, here is my effort to reply to your question.
A red, swollen, about to burst, etc appendix is a
social construction in that all the ways we have of
knowing about this appendix are mediated through human
language, communication, theories and the possible
actions that we find we can take, made possible by
social arrangements including distribution of medical
training, access to drugs and operating theatres, etc.
To make a diagnosis of appendicitis, we have to learn
to pay attention to the redness, the swelling, and to
distinguish these from other kinds of redness or
swelling. None of this is self-evident. New diagnostic
tests might add new adjectives to our description of
the signs of appendicitis - so how to diagnose
appendicitis is surely something that is in flux,
never absolutely fixed, but changing. If we are good
at emergency surgery but not good at dealing with
peritonitis, appendicitis is constructed as something
indicating the patient should be rushed to the
operating theatre, but couldn't there be a discovery
of a very satisfactory miracle cure for peritonitis
which we find to be safer than surgery, and so
appendicitis would be constructed as something to be
monitored and treated with drugs. (Sorry for my lack
of medical knowledge, but I hope the example serves
its purpose). If we lived in a society that had
absolutely no experience or means of preventing
patient death following the signs of appendicitis, the
signs would be constructed, not as an emergency
treatable illness, but perhaps as a tragic,
family-focused process calling for grieving and
goodbyes. As John says, the key point is that it could
be conceived of differently, and is changing,
according to what our social arrangements enable us to
do about it.
In my view, the big problem for the concept of 'social
construction' is when the term is prefaced by 'just'
and when it is assumed that 'social construction'
means 'not real and so not worth taking seriously'.
That a diagnosis of appendicitis is a social
construction does not mean that it is not a
tremendously useful and effective construction.
Luckily for many patients, this particular social
construction enables all kinds of effective action on
the part of GPs, and surgeons and others.
What is the point, then, of calling a diagnosis a
'social construction' if I agree that it is a useful
one? For me, it is to emphasise that the definition is
open-ended and changing, not fixed, and to remind us
that it could be otherwise. This is especially
important when we think about the
unequally-distributed power to establish and
legitimise various constructions and what kinds of
actions and personhood the constructions make
possible. Perhaps the diagnosis of appendicitis is
less oppressive than other diagnoses, but I think it
is still worth treating the concept as malleable and
changeable.
--- Tim Anstiss <[log in to unmask]> wrote:
> Sorry, can you answer my question?
>
> Tim
>
> Sent using BlackBerry® from Orange
>
> -----Original Message-----
> From: John Cromby <[log in to unmask]>
>
> Date: Thu, 28 Feb 2008 10:38:42
> To:[log in to unmask]
> Subject: Re: Anti depressants 'of little use'
>
>
> All diagnoses are social constructions. This doesn't
> mean they don't
> contain material, embodied elements. It does mean
> that those elements
> can be configured and put together in a variety of
> ways, and therefore
> that their meaning might vary according to how they
> are constructed. So
> hearing voices might be a symptom of
> 'schizophrenia'; a single symptom
> in its own right, amenable to cognitive treatment; a
> feature of many
> people's experience that isn't necessarily
> pathological; a communication
> from god or whatever other deity you favour; a sign
> that the voice
> hearer is possessed, or a witch; and so on.
>
> For an excellent study of how asthma is socially
> constructed that makes
> these issues crystal clear see the opening chapter
> of:
> The Problem of Medical Knowledge: Examining the
> Social Construction of
> Medicine. by Peter Wright, Andrew Treacher (1982)
>
> J.
>
>
>
> Tim Anstiss wrote:
> > I only understood every second word of the below,
> at a push, which probably says more about me than
> the author.
> >
> > But help me out here (being a simple doctor), in
> what way is a red, inflamed, swollen, painful, about
> to burst and cause peritonitis and possibly death
> appendix (aka appendicitis) a social construction?
> >
> > I understand appendicitis is a label, and I
> understand it is shorthand - is this what you mean
> by "social construction"? - or do you mean something
> else above and beyond this?
> >
> > Tim
> >
> >
> >
> > David Fryer <[log in to unmask]> wrote:
> >
> >
> > Hi Craig,
> > I think the phrase “the conditions
> problematically diagnosed as depression" is useful
> because it avoids the over-simplification and
> depoliticisation of the position you appear to take
> in this email. The phrase leaves room to acknowledge
> that depression is diagnosed i.e. is socially
> constructed with all the involvement of interest
> groups that implies, that it is problematic as a
> diagnosis (in the narrow sense that it is quite
> different from e.g. a diagnosis of appendicitis –
> though that is also a social construction too of
> course) and problematic in the wider sense to which
> Carl Walker alerts us that depression may be a
> phenomenological and embodied manifestation of
> societal and political phenomena but it is still
> dreadful, destructive and very ‘real’ for people
> manifesting it and not in any useful sense just
> ‘part of the human condition’ (a positioning which
> naturalises it and makes it seem inevitable) but a
> direct consequence of oppressive forms of political,
> economic
>
> > and social organization which are not inevitable
> and could be changed by collective decision.
> > David
> >
> >
> >
> >___________________________________
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> >
>
> --
>
********************************************************
> John Cromby
> Department of Human Sciences
> Loughborough University
> Loughborough, Leics
> LE11 3TU England
> Tel: 01509 223000
> Email: [log in to unmask]
> Personal webpage:
> http://www-staff.lboro.ac.uk/~hujc4/
> Co-Editor, "Subjectivity":
> www.palgrave-journals.com/sub
>
********************************************************
>
> ___________________________________
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