Sociology of health and illness 2025 - 2026
CHAPTER 1 – DISEASE & ILLNESS MODELS
ORIGINS OF HEALTH / MEDICAL SOCIOLOGY:
First half of 20th century:
‣ Medicine and sociology as separate disciplines
‣ Physicians & biological sciences: attention to health issues
‣ Durkheim, Weber, Marx: limited attention to the role of medicine and health in society
After WWII:
‣ Increasing cooperation: both disciplines needed each other
‣ Sociology in medicine:
o Sociological research that serves the needs and interest of medicine
o Goal: provide solution to medically defined problems
o Aim: serving the interest of medicine
o E.g. improving physician-patient relationships, detecting social causes of disease …
o E.g. in public health
‣ Sociology of medicine:
o Sociological study of health, illness and institutions of healthcare
o Goal: understanding society and social life in general
o Theory of the sick role (Parsons)
DEFINITIONS:
Defining health / medical sociology:
‣ “A theory-oriented research field, committed to the study of social structure and culture and
social change and their consequences for behavior, social interaction and social relations in
the field of illness and health” (Straus, 1975)
‣ Sociology in medicine: observe that health problems are prevalent in society
→ study what social causes are
‣ Health and medical sociology: starts from structure (e.g. social stratification mechanisms like
structural racism, expansion of higher education, …) → then asks questions about what the
consequences of these broader structures are for health and illness
Defining health, disease, illness and sickness:
Health = the absence of disease
Biomedical
‧ Narrow view on health
model
‧ Binary view: either healthy or either have a disease
Health = a state of complete physical, mental and social wellbeing
‧ Perspectives of loneliness, good social relations, sleep patterns, energy
WHO
levels, …
‧ Broader view
Health = the capacity to carry out daily activities
‧ Broadest view
‧ Varies from person to person: different people interpretate health on
Lay beliefs
different ways
‧ Health is multidimensional & varies throughout the life course: varies
with gender, class, ethnicity, …
1
,Sociology of health and illness 2025 - 2026
‣ Syndrome = meaningful cluster of symptoms (e.g. cluster of headache, nausea, …)
‣ Disease = abnormality within the body or the mind which can cause disfunction to the person
or to a person who comes into contact with said person → bodily abnormality!
o Syndrome is considered the expression of an underlying disease
o Relation between syndrome and disease: in order to diagnose with a disease, there has
to be empirical evidence of the syndrome
o Essential role in the biomedical model
o “Een ziekte”
‣ Illness = an experience
o Can exist whether you have a disease or not (e.g. not feeling well, but you don’t have
a specific disease linked to the syndrome) → but you experienced a illness experience
o What if you are having a illness experience but you don’t match a certain disease (e.g.
chronic illness, fibromyalgia, …)
o “Zich ziek voelen”
‣ Sickness = the social categorisation
o More used in theoretical contexts
o Can exist whether you have a disease or not, and whether you have an illness
experience (e.g. someone in a manic state → does not match a bodily disease, person
doesn’t feel ill in a manic state → but will still be seen als ‘sick’)
o “Ziek gevonden worden”
‣ When experiencing an illness AND having a disease biomedical model legitimizes the
experience of the illness
‣ When experiencing an illness but not having a disease/diagnosis biomedical model does
not legitimize the illness…
5 MODELS OF HEALTH AND ILLNESS:
1) Biomedical model
2) Biopsychosocial model
3) Evolutionary / Darwinian model
4) Sociological model: Parsons
5) Sociological model: ecological, population health model
Why do we need to study the different models of health and illness?
‣ How physicians approach patients and the problems they present is very much influenced by
the conceptual models in relationship to which their knowledge and experience are organized!
2
,Sociology of health and illness 2025 - 2026
BIOMEDICAL MODEL:
‣ Disease-centered model
‣ What you see in hospitals: division of specialties according to:
o Location of disease (e.g. cardiology, neurology, …)
o Disease type (e.g. oncology)
‣ Dominant paradigm in western society (e.g. Covid-vaccines: successes in “battle with
disease”)
‣ Focus on the pathogen/pathology rather than the person!
Core assumptions:
1. All illnesses arise from an underlying abnormality within the body, referred to as a disease
→ abnormality in the body
2. All diseases give rise to symptoms (→ relation between syndrome/symptoms and disease)
(e.g. lesions inside the body whose presence can be detected via symptoms)
3. The removal or attenuation of the disease, using medical procedures, will result in a return to
health (purely physical)
Implications for treatment:
1. Mechanical metaphor: the body as a machine, and physicians as engineers
2. Technological imperative: emphasizes the merits of technological interventions (vaccines,
drugs, …)
3. Drugs as “magic bullets” that can be shot into the body to cure or control afflictions
4. The patient is a victim of circumstances with little or no responsibility for the presence or
cause of the illness
5. The patient is a passive recipient of treatment, although cooperation with treatment is
expected → power relation between physician and patient
General implications of biomedical model:
‣ Health is the absence of disease: troubling binary
‣ Reductionism: all behavioural manifestations of disease can be reduced to a single/multiple
biological cause within the body
‣ Exlusionism: what cannot be explained by physiochemical principles, cannot be considered a
disease
o May lead to symptoms not being taken seriously
o Need for expansion of disease categories (e.g. alcohol use disorder, anorexia nervosa,
PTSD, HIV, shellshock, …) → otherwise: a lot of experiences that are not being taken
seriously → what do we do with everything related to the mind?
‣ Mind/body dualism: mind and body can be treated separately → mental phenomena are
taught to be non-physical and so irrelevant for the body
When/where does the biomedical model ‘work’?
‣ Relevant for many disease-based illnesses (e.g. acute appendicitis)
‣ Quick diagnosis and treatment (e.g. chest pains lead to a heart attack)
‣ Supported by a wealth of biological findings (e.g. covid vaccine: snel gevonden dat het virus
zeer hard leek op het Sars virus uit 2002 → snelle vaccins produceren)
‣ Is valuable and does work in certain contexts
3
, Sociology of health and illness 2025 - 2026
Kritieken op biomedical model:
‣ Some people with positive laboraty findings are told that they are in need of treatment when
they are feeling well (e.g. preventional mammograph for women > 50 → no illness
experience or empirical evidence) → first flaw in the biomedical model
‣ Some people are feeling sick but are assured that they are well (e.g. chronic fatigue
syndrome → they are having an illness experience but there is no empirical evidence)
‣ Biomedical model assume that symptoms can be mapped into disease in an one-to-one process
→ more ambiquity!
‣ Mental health care? → e.g. DSM focuses mostly on the biomedical model → explains high
use of antidepressant in Belgium
o 13% of the population in Belgium has at least once in their life taken antidepressants
o Think about the repercussions of these kinds of treatments
Conclusion:
‣ Biomedical model is good at understanding disease/pathogen
‣ But it will always focus on disease, rather than the person as a whole
BIOPSYCHOSOCIAL MODEL:
‣ Response to criticism on biomedical model: biological factors as
insufficient in explaining the emergence of disease as human
experience (illness)
‣ Biological factors play important role
‣ But: psychological and social factors have an impact as well
‣ Illness has to be viewed as a result of interacting mechanisms at
the molecule, cellular, tissue, organismic, nervous system,
personal, interpersonal and environmental levels
‣ George Engel:
o “By evaluating all the factors contributing to both illness, rather than giving primacy
to biological factors alone, a biopsychosocial model would make it possible to explain
why some individuals experience as “illness” conditions which others regard merely
as “problems of living”
Implications for treatment:
‣ Personal experience of the patient as an important source of clinical information
o Does not only determine a patient’s illness experiences
o But also whether the patient is deemed sick (e.g. exogenous vs. endogenous
depression)
‣ Treatments limited to the correction of bodily dysfunctions are not sufficient to heal most
illnesses
‣ Doctor-patient relationship is very important
4
CHAPTER 1 – DISEASE & ILLNESS MODELS
ORIGINS OF HEALTH / MEDICAL SOCIOLOGY:
First half of 20th century:
‣ Medicine and sociology as separate disciplines
‣ Physicians & biological sciences: attention to health issues
‣ Durkheim, Weber, Marx: limited attention to the role of medicine and health in society
After WWII:
‣ Increasing cooperation: both disciplines needed each other
‣ Sociology in medicine:
o Sociological research that serves the needs and interest of medicine
o Goal: provide solution to medically defined problems
o Aim: serving the interest of medicine
o E.g. improving physician-patient relationships, detecting social causes of disease …
o E.g. in public health
‣ Sociology of medicine:
o Sociological study of health, illness and institutions of healthcare
o Goal: understanding society and social life in general
o Theory of the sick role (Parsons)
DEFINITIONS:
Defining health / medical sociology:
‣ “A theory-oriented research field, committed to the study of social structure and culture and
social change and their consequences for behavior, social interaction and social relations in
the field of illness and health” (Straus, 1975)
‣ Sociology in medicine: observe that health problems are prevalent in society
→ study what social causes are
‣ Health and medical sociology: starts from structure (e.g. social stratification mechanisms like
structural racism, expansion of higher education, …) → then asks questions about what the
consequences of these broader structures are for health and illness
Defining health, disease, illness and sickness:
Health = the absence of disease
Biomedical
‧ Narrow view on health
model
‧ Binary view: either healthy or either have a disease
Health = a state of complete physical, mental and social wellbeing
‧ Perspectives of loneliness, good social relations, sleep patterns, energy
WHO
levels, …
‧ Broader view
Health = the capacity to carry out daily activities
‧ Broadest view
‧ Varies from person to person: different people interpretate health on
Lay beliefs
different ways
‧ Health is multidimensional & varies throughout the life course: varies
with gender, class, ethnicity, …
1
,Sociology of health and illness 2025 - 2026
‣ Syndrome = meaningful cluster of symptoms (e.g. cluster of headache, nausea, …)
‣ Disease = abnormality within the body or the mind which can cause disfunction to the person
or to a person who comes into contact with said person → bodily abnormality!
o Syndrome is considered the expression of an underlying disease
o Relation between syndrome and disease: in order to diagnose with a disease, there has
to be empirical evidence of the syndrome
o Essential role in the biomedical model
o “Een ziekte”
‣ Illness = an experience
o Can exist whether you have a disease or not (e.g. not feeling well, but you don’t have
a specific disease linked to the syndrome) → but you experienced a illness experience
o What if you are having a illness experience but you don’t match a certain disease (e.g.
chronic illness, fibromyalgia, …)
o “Zich ziek voelen”
‣ Sickness = the social categorisation
o More used in theoretical contexts
o Can exist whether you have a disease or not, and whether you have an illness
experience (e.g. someone in a manic state → does not match a bodily disease, person
doesn’t feel ill in a manic state → but will still be seen als ‘sick’)
o “Ziek gevonden worden”
‣ When experiencing an illness AND having a disease biomedical model legitimizes the
experience of the illness
‣ When experiencing an illness but not having a disease/diagnosis biomedical model does
not legitimize the illness…
5 MODELS OF HEALTH AND ILLNESS:
1) Biomedical model
2) Biopsychosocial model
3) Evolutionary / Darwinian model
4) Sociological model: Parsons
5) Sociological model: ecological, population health model
Why do we need to study the different models of health and illness?
‣ How physicians approach patients and the problems they present is very much influenced by
the conceptual models in relationship to which their knowledge and experience are organized!
2
,Sociology of health and illness 2025 - 2026
BIOMEDICAL MODEL:
‣ Disease-centered model
‣ What you see in hospitals: division of specialties according to:
o Location of disease (e.g. cardiology, neurology, …)
o Disease type (e.g. oncology)
‣ Dominant paradigm in western society (e.g. Covid-vaccines: successes in “battle with
disease”)
‣ Focus on the pathogen/pathology rather than the person!
Core assumptions:
1. All illnesses arise from an underlying abnormality within the body, referred to as a disease
→ abnormality in the body
2. All diseases give rise to symptoms (→ relation between syndrome/symptoms and disease)
(e.g. lesions inside the body whose presence can be detected via symptoms)
3. The removal or attenuation of the disease, using medical procedures, will result in a return to
health (purely physical)
Implications for treatment:
1. Mechanical metaphor: the body as a machine, and physicians as engineers
2. Technological imperative: emphasizes the merits of technological interventions (vaccines,
drugs, …)
3. Drugs as “magic bullets” that can be shot into the body to cure or control afflictions
4. The patient is a victim of circumstances with little or no responsibility for the presence or
cause of the illness
5. The patient is a passive recipient of treatment, although cooperation with treatment is
expected → power relation between physician and patient
General implications of biomedical model:
‣ Health is the absence of disease: troubling binary
‣ Reductionism: all behavioural manifestations of disease can be reduced to a single/multiple
biological cause within the body
‣ Exlusionism: what cannot be explained by physiochemical principles, cannot be considered a
disease
o May lead to symptoms not being taken seriously
o Need for expansion of disease categories (e.g. alcohol use disorder, anorexia nervosa,
PTSD, HIV, shellshock, …) → otherwise: a lot of experiences that are not being taken
seriously → what do we do with everything related to the mind?
‣ Mind/body dualism: mind and body can be treated separately → mental phenomena are
taught to be non-physical and so irrelevant for the body
When/where does the biomedical model ‘work’?
‣ Relevant for many disease-based illnesses (e.g. acute appendicitis)
‣ Quick diagnosis and treatment (e.g. chest pains lead to a heart attack)
‣ Supported by a wealth of biological findings (e.g. covid vaccine: snel gevonden dat het virus
zeer hard leek op het Sars virus uit 2002 → snelle vaccins produceren)
‣ Is valuable and does work in certain contexts
3
, Sociology of health and illness 2025 - 2026
Kritieken op biomedical model:
‣ Some people with positive laboraty findings are told that they are in need of treatment when
they are feeling well (e.g. preventional mammograph for women > 50 → no illness
experience or empirical evidence) → first flaw in the biomedical model
‣ Some people are feeling sick but are assured that they are well (e.g. chronic fatigue
syndrome → they are having an illness experience but there is no empirical evidence)
‣ Biomedical model assume that symptoms can be mapped into disease in an one-to-one process
→ more ambiquity!
‣ Mental health care? → e.g. DSM focuses mostly on the biomedical model → explains high
use of antidepressant in Belgium
o 13% of the population in Belgium has at least once in their life taken antidepressants
o Think about the repercussions of these kinds of treatments
Conclusion:
‣ Biomedical model is good at understanding disease/pathogen
‣ But it will always focus on disease, rather than the person as a whole
BIOPSYCHOSOCIAL MODEL:
‣ Response to criticism on biomedical model: biological factors as
insufficient in explaining the emergence of disease as human
experience (illness)
‣ Biological factors play important role
‣ But: psychological and social factors have an impact as well
‣ Illness has to be viewed as a result of interacting mechanisms at
the molecule, cellular, tissue, organismic, nervous system,
personal, interpersonal and environmental levels
‣ George Engel:
o “By evaluating all the factors contributing to both illness, rather than giving primacy
to biological factors alone, a biopsychosocial model would make it possible to explain
why some individuals experience as “illness” conditions which others regard merely
as “problems of living”
Implications for treatment:
‣ Personal experience of the patient as an important source of clinical information
o Does not only determine a patient’s illness experiences
o But also whether the patient is deemed sick (e.g. exogenous vs. endogenous
depression)
‣ Treatments limited to the correction of bodily dysfunctions are not sufficient to heal most
illnesses
‣ Doctor-patient relationship is very important
4
