Goffman: contribuições para a Sociologia da Saúde / Goffman: contributions to health sociology

Com uma obra que trouxe inegáveis contribuições, Goffman inovou a pesquisa etnográfica nos estudos socioantropológicos. Esta marca pode ser observada desde os seus primeiros trabalhos nos quais aborda a apresentação do self na vida diária, os manicômios, o estigma e são, por sinal, aqueles que mais referências receberam nos estudos sociais sobre a doença, instituições e práticas de saúde. Neste artigo são analisadas essas contribuições e a importância que tiveram para a construção da sociologia da saúde. O texto destaca alguns conceitos que se tornaram fundamentais para os estudos sociológicos da doença e do paciente, como carreira do paciente, instituição total, interação estratégica e organizações formais instrumentais.

Author of a work with undeniable contributions, Goffman brought innovation to ethnographic research in socio-anthropological studies. This characteristic may be already observed in his first works - where he approaches the presentation of 'self' in daily life, asylums, and stigma -, which are those more cited in social studies about the disease, institutions and health practices. This study analyzes these contributions and their importance for the development of the field of health sociology. The text highlights some concepts considered fundamental for sociological studies on the disease and the patient, such as the patient's career, the whole institution, the strategic interaction, and instrumental formal organizations.

Ethical considerations at the end of life in the intensive care unit.

Intensive care units (ICUs) confront the healthcare system with end-of-life situations and ethical dilemmas surrounding death. It is necessary for all providers who treat dying patients to have a working knowledge of the philosophical principles that are fundamental to biomedical ethics. Those principles, however, are insufficient for compassionate care. To function well in the intensive care unit, one also must appreciate the behaviors that surround mortality. Human conduct is not predicated solely on rules; complex, unpredictable interactions are the norm. Palliative care, moving forward as a discipline, will become the perfect complement to intensive medical care, rather than being seen as an embodiment of its failures. We need to be as aggressive about respecting patient dignity as we are about using the technology that is central to health care. This article will outline end-of-life ethical principles, explore the sociology that influences human interactions in intensive care units, and show how palliative care should guide behaviors to improve how we deal with death.

The politics of pathology: how obesity became an epidemic disease.

Americans' recent weight gains have been widely described as an "obesity epidemic." Such a characterization, however, has many problems: the average American weight gain has been relatively low (eight to 12 pounds over the last 20 years), and the causal linkages between adiposity, morbidity, and mortality are unclear. Nevertheless, the media and numerous health officials continue to sound dire warnings that obesity has become an epidemic disease. In this article, I examine how and why America's growing weight became an "obesity epidemic." I find the disease characterization has less to do with the health consequences of excess weight and more with the various financial and political incentives of the weight loss industry, medical profession, and public health bureaucracy. This epidemic image was also assisted by the method of displaying information about weight gain with maps in PowerPoint slides. Such characterizations, I argue, are problematic. Given the inconclusive scientific evidence and the absence of a safe and effective weight loss regimen, calling America's growing weight an epidemic disease is likely to cause more harm than good.

La construcción social de la enfermedad / Disease as a social construction

En la naturaleza, la enfermedad no existe como tal sino como un fenómeno biológico que sólo puede distinguirse porque rompe cierta secuencia de eventos que son parte de un proceso continuo. Si no está el ojo testigo del ser humano, ese fenómeno no adquiere sentido. Es el individuo y la sociedad los que otorgan el rótulo de enfermedad a determinado evento. Este rótulo es el resultado de una construcción social y como tal se describe en este artículo desde una mirada sociológica. La enfermedad se construye a través de un vínculo médico-paciente en el que se generan roles y expectativas de cumplimiento mutuo. La medicina es una respuesta de la cultura para legitimar la condición de enfermo en alguien que no puede continuar cumpliendo sus roles habituales. Hay escuelas que consideran la enfermedad como una desviación legítima en cuanto se asuma que el paciente no es responsable de su propia dolencia; si se asume responsabilidad, esa enfermedad pasa a considerarse una desviación ilegítima con una fuerte condición moral peyorativa. La enfermedad, a su vez, puede tener una significación diferente según la clase social del individuo que la padece. El médico debe ser consciente del significado social que tienen las enfermedades, ya que este conocimiento puede contribuir a que cumpla con el mayor desafío de la medicina que es ayudar al otro considerándolo, no un objeto de conocimiento, sino esencialmente un semejante.