Revision tool - just some notes and a few questions/pointers and only on a few topics. It is unlikely to make much sense if you have no previous knowledge

1. 
SSHM Exam Revision
1) Normal
and
Pathological
2)
Theoretical
Approaches
3) Risk
Discourses
4) Global
Health
5) Pointers
and
Questions

2. 
The Normal and Pathological
Canguilhem, Value Judgments,
Normal
The average –
quantifiable
What ought to be
Ambiguous – has
power
Descriptive but has
value judgment
Pathological
Not the opposite of
normal
Part of the same scale
as normal –
quantifiable
differences
Outside the average
not always
pathological (diversity)
Changing norms is part
of progress (Durkheim)
Canguilhem
Against medicine as a
Science – medicine is
an art
Aim to reopen
problems
Lots of influence over
1960s thinkers e.g.
Foucault
Other Thinkers
Broussais, Comte,
Bernard – health and
sickness not opposites
Renan – psychological
conditions available
through exaggerating
the normal
Leriche – disease must
be dehumanised in
order to be studied
Arguments
The repressed always
returns
The pathological is a
new form of life
There can be no
sickness without a sick
person

3. The Normal and the Pathological
Normal
 The average
 Quantifiable
 What ought to be
 Not stable – historical
changes
 Descriptive
 Value judgment – not
objective
Pathological
 Not the opposite of normal
 Pathological and normal on
the same scale
 Matter of degrees – e.g.
fever
 Outside average not always
pathological e.g. diversity
 Changing norms is part of
progress (Durkheim)

4. Canguilhem
 Body not a machine
 Medicine is an art
 Mixture of sciences, not a science in itself
 Aim to reopen problems
 Influenced many key thinkers of the 1960s including
Foucault

5. Other thinkers
Broussais, Comte, Bernard
 Pathological and normal are
the same apart from
quantifiable variations
 A matter of degree e.g. fever
 Made popular by Comte and
Bernard
Renan, Leriche
 Renan
 Psychological conditions
available through the
exaggeration of normal
 Normal can always become
pathological
 Links with risk
 Leriche
 Disease must be dehumanised
in order to be studied
 The sick can advance
knowledge of the normal
through their deficiencies
 Links with Positivism

6. Arguments
1. The repressed always returns
 Scales of normal and pathological have to be in relation to each
other – cannot be objective
 Terms have value judgments e.g. excess and deficiency
2. The pathological is a new form of life
 Change in the structure of an organ does not mean it should not be
brought back to the norm (hypertension)
 Infections change the human – they will have new antibodies etc.,
and therefore be a new/different
3. There can be no sickness without a sick person
 Difference between disease and illness – the subjective and
observable
 Pain is subjective – relies on the human – but

7. 
Theoretical Approaches
Ontology, Epistemology, Positivism, Social Construction, Comte, Geertz
Ontology and
Epistemology
Ontology – the
study of being –
what is reality?
Epistemology – the
study of knowledge
– how do we
know?
Positivism
Ontology – one
reality outside
human influence
Epistemology –
scientific study to
achieve objective
knowledge
Coined by Comte
and highly
influential
Problems with
methodology being
too reductive and
ability to be
objective
Social
Construction
Ontology – there is
no reality outside
human influence
Epistemology –
understanding
through
perspectives
Associated most
with Geertz
Problems with how
far this can go – is
there no truth?
Everything
constructed?

8. Ontology and Epistemology
Ontology
 The study of being
 What is there?
 What is reality?
 How can we understand
existence?
 What is it? E.g. what is a rock?
Epistemology
 The study of knowledge
 How do we know?
 What is valid knowledge?
 How can we obtain it?
 Why is it? E.g. why is that a rock?
How do we know that is a rock?

9. Positivism
 Linked with Enlightenment
thought and scientific
methology
 Ontology
 There is one reality
independent of humans
 Epistemology
 Through empirical scientific
study
 Reality can be known
objectively
 Coined by Comte
 Sociology was to be the
‘queen of the sciences’
 Assumes social facts can be
measured like natural science
facts
 It can produce value-free and
neutral understandings
 Often seeks to explain how and
why things happen
 Associated with quantitative
approaches

10. Problems with Positivism
 Methodology
 Social life considered more complex than biological life in
laboratories
 Experiences emerge from particular social, cultural,
political, economic and historical context which cannot be
easily quantified or separate
 Too reductive
 Objectivity
 Impossible to describe something without using language
which has value judgments attached
 Researchers bring their own ideas and understanding to
the research

11. Interpretivism/Social Construction
 Linked with Post-Enlightenment
thought in opposition to
Positivism
 Ontology
 There is no reality independent
of humans
 Reality is always socially
constructed
 Epistemology
 Understandings always
dependent on the person’s
perspective
 Always subjective to a degree
 Associated with Geertz
 People always attach meaning
to objects which then influence
experiences and behaviours
 Meanings are ‘intersubjective’ –
existing between the minds of
individuals
 Culture should be approached
in the literary approach to text
 Assumes subjectivity/partiality of
all knowledge
 Seeks to understand how and
why things happen
 Linked with qualitative
approaches

12. Problems with Social Construction
 Could be taken to far
 Nothing is real – everything is dependent of your
view and perspective
 There is no truth – only opinions

13. 
Risk Discourses
Beck, Normal/Pathological, Medicalisation, Protodiseases
• Anticipation of catastrophe
• Manufactured risks
• Responsibility to act and
manage risks
Beck
• Rose – mental health context,
risk blurring the boundaries
between normal and
pathological
• Hacking – risk tries to bring
certainty to the future
Other thinkers • Personalised medicine in
order to manage risks
• Preventative e.g. high blood
pressure, cholesterol, cancers
• Protodiseases (Rosenberg) –
medicialisation of risks into
diseases
Risk in
Medicine

14. Beck
 Anticipation of catastrophe – not what is happening
 Modernity – post-industrialisation, globalisation -
contexts
 Manufactured risks
 Known, unknown, and unknown-unknown risks
 Responsibility to act
 To manage and reduce the risk
 There is no such thing as zero risk

15. Other thinkers
Rose
 Mental health context
 ‘Risky individuals’
 Genomics and biomarkers as
risk assessments
 Risk blurs boundaries
between normal and
pathological
Hacking
 Trying to being certainty to
the future

16. Risk in Medicine
 Personalised medicine
 Treatment more personalised so not to increase
risks e.g. high risk of breast cancer and taking the pill
 Preventative medicine
 E.g. High blood pressure, cholesterol, cancers
 Medicalisation of risks, making them into
diseases/illnesses themselves
 ‘Protodiseases’ (Rosenberg)

17. 
Global Health
What is Global
Health
• Goal to improve
health inequity
worldwide
• Linked to public
health and
international
health
• Virchow - Health
has pathological
and political
elements
Inequality vs.
Inequity
• Health
inequality
• Differences in
health
experienced
and health
status
• Health inequity
• Differences in
health for a
significant
number of
people that is
preventable
and not a risk
freely chosen
Direct and Indirect
Interventions
• Upstream
• e.g. factory
polluting
water/river
• Downstream
• e.g. giving
technical
solutions to
clean water
for village
Approaches
• Technological
• Economic
• Sociological
• Bioethical
• Existential

18. What is Global Health?
 Linked to public health and international health
 Goal is to enhance health equity among nations and for all
people worldwide
 Health inequality
 Differences in health experienced and health status
 Health inequity
 Differences in health for a significant number of people that
is preventable and not a risk freely chosen
 Virchow
 All diseases have two causes: one pathological, the other
political

19. Institutions Involved
 Governments
 Bilateral organisations
 Multilateral organisations
 Global partnerships
 Private foundations
 Business/Corporate sector
 Individuals

20. Direct vs. Indirect Interventions
Direct interventions
 Downstream
 E.g. Access to medical care,
vaccinations,
equipment/technology to
improve water conditions
Indirect Interventions
 Upstream
 E.g. more equitable
economic system, stop
polluting rivers

21. Approaches to Interventions
 Technological
 Economic
 Sociological
 Bioethical
 Existential

22. 
Pointers and Questions
What is the
social?
Practice
Questions

23. Defining ‘the social’
 Make it really clear what is spoken about – political, social, economic,
cultural, historical – they are all different! Don’t just say ‘social’ to be all-
encompassing
 There is no one definition of the ’social’ but some schools of thought:
1. Social construction/interpretive – what meaning is given to actions.
Associated with Weber
2. Social is defined by the ‘conflict’ between people and institutions.
Associated with Marxist tradition
3. Social defined by ‘consensus’ – the creation of social norms and how
societies bind together. Associated with ‘functionalist’ thought with
Parsons and Habermas
4. ‘Hybrid’ social – binding psychology and biology. E.g. the environment
shapes psychological dispositions. Associated with Simmel

24. Questions
 What are the Normal and the Pathological? And What
do the Tell Us about the History of Medicine?
 With Reference to a Specific Case Study, Discuss how the
Experience of Illness is Shaped by Larger Social-Cultural
Contexts
 What can a Study of the Subjective Experience of Illness
tell us about Issues of Health, Disease and Medicine that
Other Approaches Cannot? Discuss.
 With Reference to a Specific Example, How Might the
Concept of ‘Risk’ be Useful in Critically Evaluating Issues
of Health and Disease in Modern Society?