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

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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-