Symptoms and illness : The cognitive organisation of disorder

The research reported here is largely concerned with the theoretical development and empirical elaboration of a sociological concept of illness and a theory of social action related to that concept which would contribute to the understanding of illness and illness behaviour. I took this to be of relevance since the concept of illness employed by medical sociologists has been inadequate and the study of illness behaviour characterised by an absence of explicit sociological theory. That is, by a general failure to specify and systematically apply a set of assumptions regarding the nature of social phenomena and social action. As I argued in 1975 (1), and as others have since argued (2), the social problem of why people do and do not use health services has been confused with the sociological problem posed by illness and illness behaviour. This confusion is rooted in the pragmatic origins of medical sociology, its patronage by medicine and its adoption of the epidemiological model of science.

The main theoretical assumption employed here is that illness is a social phenomenon constituted by the meanings actors construct in making sense of observed or experienced events. A related and equally important assumption is that the meanings imputed to these events have an influence on how they are subsequently managed. These ideas are derived from symbolic interactionism and labelling theory. For the most part, medical sociologists have ignored meanings; illness has been treated as an objective entity and causal explanations of illness behaviour offered whose implicit theories of action do not call for attention to meanings. The above assumptions have also been used to argue that disease and illness are distinct phenomena and must be studied in ways V which take account of their individual nature. While some medical sociologists have drawn this distinction between illness and disease, they have rarely followed up its implications in terms of theory or research. One reason for this is that the conceptual separation involved is usually asserted rather than having its origins in explicit propositions about the nature of social reality. The focus of the study reported here is on meanings. It aims to identify and describe some of the cognitive and interactional processes by means of which they are constructed. The methodological stance I adopt has been influenced by the sociological naturalists and the writings of the ethnomethodologists. Consequently, language, categorisation and social order are key and recurrent themes. It is then both sociology of illness and sociology of everyday life.