Thanks everybody - I will never think about an inflamed appendix the same way again.
Tim
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-----Original Message-----
From: Mark Burton <[log in to unmask]>
Date: Thu, 28 Feb 2008 12:42:58
To:[log in to unmask]
Subject: Re: Anti depressants 'of little use'
Wish I'd read this before posting my attempt - this is much more lucid!
Flora Cornish wrote:
> 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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