- •Introduction
- •242 Michael p. Kelly and David Field
- •1984) Or directly address the interactions between physical and social
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- •244 Michael p. Kelly and David Field
- •Variability, the interaction with the environment and the meanings
- •The body and illness
- •Into conceptions of self and are likely to become a basis for the imputation
- •1970, Garfinkel 1967). That the interaction between someone who is sick
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- •O Blackwell Publishers Ltd/Editorial Board 1996
- •256 Michael p. Kelly and David Field
- •Voysey, m. (1975) a Constant Burden: The Reconstitution of Eamily Life.
- •O BlackweU Publishers Ltd/Editorial Board 1996
Sociology of Health & Illness Vol. 18 No. 2 1996 ISSN 0141-9889. pp. 241-257
Medical sociology, chronic illness and the
hody
Michael P. Kelly^ and David Field^
^University of Greenwich ^University of Ulster
Abstract The sociological conceptualisation of chronic illness requires a
sociology which indicates the physicality of the body theoretically.
The aim of this paper is to demonstrate how the body
might be integrated into sociological accounts ofthe experience
of chronic illness in a way that acknowledges biological and
social facts. Central to our argument is the connection between
bodily aspects of self and identity. Self and identity are core
aspects of everyday experience and of the everyday experience
of illness. With the onset of illness bodily functioning alters
and self-conceptions and identity may also change. The body,
which in many social situations is a taken for granted aspect
of the person, ceases to be taken for granted once it malfunctions.
The bodily basis of chronic illness has to be attended to
because it limits or interferes with other physical and social
activities. The connection between biological and social facts is
explored using the concepts of self and identity.
Keywords: The body, chronic illness, self, identity, medical sociology
Introduction
The purpose of this paper is to raise questions and develop the debate
about how the body might be integrated into sociological accounts of the
experience of chronic illness in a way that acknowledges both biological
and social facts. Illness, like life itself, is a multi-phenomenal experience
and therefore a multi-layered object of analysis. From the perspective of
the person who has the illness and in whose body the physical or psychological
pathology exists, or is defined as existing, the illness will be felt in
a variety of ways. There may be intrusive symptoms such as pain or nausea.
There may be interruptions to usual physical and social routines.
There may be cognitive disorientation and confusion and the behaviour
pattems of self and others may take on new and particular forms. If the
pathology is asymptomatic, the phenomena may not have a subjective or
© BlackweU Publishers Ltd'Editorial Board 1996. Published by Blackwell Pubhshers, 108 Cowley Road,
Onford OX4 lJF, UK and 238 Mam Street, Cambndge. MA 02142, USA.
242 Michael p. Kelly and David Field
experiential dimension at all, and in the case of functional psychiatric disorders
there may be no lesion as such, but discomfort, distress and disruption
may be very real indeed. From the point of view of the sufferer
and of significant others - family or carers - the experience may be
described and labelled using various expert or lay languages. These provide
professionals, families and carers, as well as the sufferer, with various
bench-marks against which the experience may be evaluated. These
languages also provide explanations - scientific and lay - of what is happening.
These points are commonplace in medical sociology. Over several
decades sociologists have provided numerous accounts of these social and
biological processes. Thus the importance of the social construction and
definition of illness experiences (Freidson 1970, Scheff 1966), the kinds of
social structures which constrain human behaviour in the face of discomforts
and disruptions (Locker 1983, Navarro 1978), the means and the
mechanisms whereby the bearers of expert languages are able to define
the situation in various and sometimes self-serving ways (Hollingshead
and Redlich 1958, Mercer 1972, Scheff 1966, Scott 1969), the divergence
between expert and lay languages (Friedson 1970), the nature of the
power relationships between patients and professionals (Friedson 1970,
Kelly and May 1982, Jeffery 1979, Lorber 1975), and the contingent
nature of diagnosis (Dingwall 1976) have all been described sociologically.
Some authorities have written their sociology in ways which eloquently
express physical limitations and bodily difficulties (Strauss et al.
1984) Or directly address the interactions between physical and social
aspects of human life and their consequences for illness (Freund, 1982;
Freund and McGuire 1991, Lawler 1991). However, in most types of
sociological narrative about chronic illness, the body remains theoretically
elusive. Its existence is seldom explicitly denied, but its presence has a
kind of ethereal quality forever gliding out of analytic view.
The understatement of the body in medical sociology has been noted
by others (Turner 1992). Nevertheless, the point needs to be emphasised
that in chronic illness the obdurate nature of the physical reality of 'bad'
bodies is such an all-embracing aspect of the experience that an adequate
sociology of the physical experience would appear to be the sine qua non
for analysis (Moos and Tsu 1977, Anderson and Bury 1988, Radley
1993). Perhaps the omission is not very surprising. Sociological discourse,
with its foci on agency and structure, and its rejection of methodological
individualism, drives attention away from the body. Thus the physical
reality of illness tends mostly to be treated by sociologists in two broad
ways. First, as an a priori category which legitimately belongs to other
realms of discourse - medicine or biology (Friedson 1970). Second, as
something socially constructed and/or socially mediated, possibly of
doubtful ontological status, and therefore of little sociological interest
other than in terms of the forms of narrative and accounting which pro-