Syllabi: Health, Society and Disease

INSTITUTION: University of Illinois at Urbana-Champaign

Niranjan S. Karnik, M.A.

Department of Sociology, Medical Scholars Program and

Program in Arms Control, Disarmament and International Security

Email: n-karni@uiuc.edu

ENROLLMENT: undergraduates

SEMESTER: Spring 1997

Monday, Wednesday and Friday, 8:00-8:50 am

COURSE DESCRIPTION:

This social problems course is a multifaceted look at health and disease, and their interconnections to society. As part of this analysis we will cover several major topics including HIV/AIDS, tuberculosis, refugees and war victims, cancer, genetics, trauma and violence, and several others. The somewhat eclectic topics transverse many regions of the world including India, Rwanda, South Africa, China, France and the United States. Throughout this examination we will be searching for connections which bind these regions together and looking for factors which separate them.

REQUIRED READINGS:

Required Books:

Paul Farmer, Margaret Connors and Janie Simmons, eds., Women, AIDS and Poverty: Sex, Drugs and Structural Violence, (1996, Monroe, Maine: Common Courage Press).

Albert Camus, The Plague, (1991[1948]), New York: Vintage).

Arthur Kleinman, The Illness Narratives: Suffering, Healing and the Human Condition, (1988, New York: Basic Books).

Kay Redfield Jamison, An Unquiet Mind: A Memoir of Moods and Madness, (1995, New York: Knopf).

Reynolds Price, A Whole New Life: An Illness and A Healing, (1994, New York: Atheneum).

FirstClass Electronic Conferencing System:

This class is one a small number of campus classes which uses the FirstClass Electronic Discussion System. It is administered through the Sloan Center for Asynchronous Learning Environments (SCALE). URL: http://www.scale.uiuc.edu) The system is accessible through most campus computer sites and you can easily download the necessary software to run the program through your personal computer as long as you have a modem or a direct connection to the campus network. We will go through a brief demonstration in class on how to use the system.

Each week members of the class (determined by sign-up at the beginning of the semester) will read ahead in the syllabus and post a summary of the readings along with questions for discussion in class by 12noon of the preceding Friday. Other members of the class should read the assigned readings and post their responses on FirstClass by 12 noon of the preceding Sunday Students should then log on at some point between 12noon Sunday and the beginning of Monday's class session. We will review and discuss the questions and responses by using the network connection available to us in our classroom.

Departmental Film Series:

This class is one of a small number that participates in the Sociology Department Film Series. Run in conjunction with Professor William Martin's Africa Course, these films are all worthwhile and interesting. A complete schedule will be handed out in class to alert you to the relevant dates, times and locations for the films. There will be approximately 3 films during the semester that link to this course. Attendance is not required but if you attend, watch the film and write up a one page analysis linking the film to the course, you will earn extra-credit points (up to 2% added to your final class average per film depending on the quality of your write-up).

COURSE REQUIREMENTS:

1. Use of FirstClass and Participation (25%)

Using the FirstClass and actively participating in classroom discussions form the basis of this portion of your grade. In this way, this class will run like a seminar requiring each student to participate in making the class discussions vibrant. Reading, posting regularly on FirstClass and actively talking in class will all be required to be successful. Should the class show signs of not keeping up with the readings, I may have to institute pop reading quizzes. Hopefully we won't have to go down that road...keep reading.

2. Written Papers (60%, 15% per paper)

All papers are due on the indicated date during class time. Papers for this class are built progressively through the semester. All papers should be double-space typed on white paper with 1 inch margins in 12 point Times font. Alternative formatting will result in loss of points. Do not include a cover page and your references (according to some established format - Chicago, MLA, APA) should take up no more than half a page...don't skimp on the writing - its only 5 pages. Each student will have to a pick a disease that they "have" for the semester. After clearing the disease with the instructor, students will be required to research and investigate the disease from different perspectives for each paper as follows...

Paper 1 (5 pages): Narrative Due Date: Feb. 7

Find a descriptive narrative of your disease (either a book or feature length film). Preferably, this narrative will be a first person one but other forms may be acceptable - if you have concerns check with the instructor. Using this narrative analyze and summarize in the context of the course the disease as described by this individual.

Paper 2 (5 Pages): Medical Journals Due Date: Feb. 28

Go to the Health Sciences Library (located in the Medical Sciences Building on Mathews) and find at least three articles on your disease preferably from mainstream medical journals (JAMA, New England Journal of Medicine, Lancet). Using these articles, discuss how the medical practitioners portray the disease and how this compares and contrasts with the ways in which your narrative portrays the disease. Please attach copies of the articles that you cite as an appendix to your paper.

Paper 3 (5 Pages): Society's Response Due Date: April 11

Obtain some type of mass media or popular depiction of your disease (i.e. an educational pamphlet, informational guide from McKinley, newspaper or magazine article. As you did for the last paper, build a discussion of how this response/depiction of the disease compares and contrasts from your previous ones. Once again, include a copy of the article you use at the end of your paper.

Paper 4 (5 Pages): Alternative Vision Due Date: Varies

Using what you have learned through the investigation of your disease, imagine a world where you could define how doctors, nurses, insurance companies, and society more generally would respond to your disease. What would this world look like and how would people treat and address the disease? Remember that you cannot get rid of the disease you can only respond to it. How would doctors treat these people? What steps would society take to care for them? What changes do you see needed?

3. Oral Presentation (15%)

During the last weeks of class, each member of the class will be required to give an oral presentation summarizing their series of reports and their experience with their disease. This will include the material for your final paper which will be due in class at the time of your presentation. You will also need to develop an outline or handout for the class to follow. Detailed guidelines on the length and format of your presentation will be handed out in class.

COURSE SCHEDULE

Jan. 22-24: Introduction

Sociology and the study of Social Problems

The structure of knowledge in Sociology

A brief history of sociology and its origins

Basic Social Theories: Race/Ethnicity, Gender, Stratification

Medical Sociology and its origins

Approaches to studying health and illness: interdisciplinarity

Narratives and their discontents

Social suffering and the study of pain

Social Constructivism and Its Varieties

Advanced Social Theories: Postcolonialism, Postmodernism,

Globalization, Political Economy, Feminism, Cultural Studies

Jan. 27-31: Cancer and Chronic Illness

Here we will begin our examination of illness and disease in society by taking a closer look at the ways in which cancer and society intersect. In looking at this disease, we want to better understand how we can use personal narratives to examine broader social phenomena. This reading is light and easy to move through so do not be intimidated by its length. Price is a well known fiction author but we are reading his autobiography.

Reading: Reynolds Price, A Whole New Life: An Illness and A Healing

Film: "The Littlest Heroes" ABC News Turning Point

Feb. 3-7: Society, Suffering and Medicine I

Here we enter the core of our course by beginning to read Arthur Kleinman's book. Kleinman is a psychiatrist-anthropologist based at Harvard University. He is well known for his work comparing different medical system (especially Traditional Chinese Medicine and Western Biomedicine). In this first selection of readings, we will begin explorations on using narratives to study disease and illness, the meaning (and lack of meaning) of pain, the social construction of pain and finally cross-cultural understandings of depression. Kleinman is not difficult to read but he is academic and therefore, you will need to set aside approximately 4 to 6 hours to read this selection (depending on your reading speed).

Reading: Arthur Kleinman, The Illness Narratives, pp.3-120.

Feb. 10-14: Society, Suffering and Medicine II

Continuing with Kleinman's book we will now consider topic such as conflicting medical systems, chronic illness, death, time, and the social positions of health care practitioners.

Reading: Arthur Kleinman, The Illness Narratives, pp.121-267.

Feb. 17-21: HIV/AIDS Part I

This week's readings bring us into a close examination of one of the world's most serious and socially significant diseases. It has been studied and examined from a variety of directions and here we select a few to look at closely. The book by Paul Farmer et al is a product of the Institute for Health and Social Justice. Farmer is a physician-anthropologist who studied the first cases of HIV/AIDS in rural Haiti and has come to focus on the relationship between poverty and infectious disease. The second reading by Paula Treichler (who is on the faculty of UIUC) gives us a powerful framework from which to look at the ways in which the media portrays disease. The Farmer reading moves quickly but is packed with information. Part 1 which we read for this week contains background information and a detailed analysis of the global dimensions of HIV/AIDS. The Treichler piece is dense and you will do best to read it quickly trying to pick up the main points (return to it if you have time).

Reading: Paul Farmer, Margaret Connors and Janie Simmons, eds., Women, AIDS and Poverty: Sex, Drugs and Structural Violence, Part 1

Paula Treichler, "AIDS and HIV Infection in the Third World: A First World Chronicle" (CP)

Film: "A Country Doctor" Nightline 2-Part Special

Feb. 24-28: HIV/AIDS Part II

Continuing with the Farmer book, we will now read Part 2 which critically analyzes the existing social science, public health and medical literature on HIV/AIDS. This will be particularly helpful for all of you in writing your second paper. Farmer and his colleagues' techniques is powerful and we will discuss the similarities/differences between HIV/AIDS and the diseases that you are studying individually. For this section, move through the Farmer reading quickly picking up his main points and then pausing to consider any issues that you consider important.

Reading: Paul Farmer, Margaret Connors and Janie Simmons, eds., Women, AIDS and Poverty: Sex, Drugs and Structural Violence, Part 2

Mar. 3-7: HIV/AIDS Part III

The final section of Farmer's book is only two short chapters long and can be skimmed rather quickly. Then we move on to the Treichler piece (long, entertaining and complicated) to consider in conjunction with Farmer's book how to approach solutions to the HIV/AIDS epidemic.

Reading: Paul Farmer, Margaret Connors and Janie Simmons, eds., Women, AIDS and Poverty: Sex, Drugs and Structural Violence, Part 3

Paula Treichler, "How to Use a Condom: Bedtime Stories for the Transcendental Signifier" (CP)

Mar. 10-14: Epidemics: Old and New

This week's reading is Albert Camus' The Plague. Camus is best known as part of the existentialist school. He was a member of the French resistance during World War II and was a key intellectual in France throughout his life. We want to read his book and view it in relation to modern HIV/AIDS epidemic. Find a nice comfy chair and a cup of tea and enjoy reading the Camus book. Dan McGee is an M.D./Ph.D. student in Anthropology here at UIUC. His piece is a one page analysis of our modern response to epidemic diseases and their popular depictions.

Reading: Albert Camus, The Plague

Dan McGee, "Virulent Fear" JAMA

Film: "In the Danger Zone" 48 Hours

Mar. 17-21: Tuberculosis in Society and Literature

This week picks up a topic that may at first glance be very distant for most members of our class. There was a time early in the 1980s when tuberculosis (TB) was misdiagnosed in American hospitals because so few physicians had ever seen a case. HIV/AIDS changed this rapidly and TB is now on the rebound. The IHSJ paper tackles this issue directly. It is a short paper and quick to read. Geoffrey Bowker and Susan Leigh Star's (who are both professors at UIUC) paper takes up the issue of the ways in which TB patients become "classified" as diseased entities and the ways that time factors into this process. Finally, Susan Sontag (a cultural critic) examines the ways in which TB is constructed in our minds through literary metaphors.

Reading: IHSJ Discussion Paper, "The Consumption of the Poor" (CP)

Geoffrey Bowker and Susan Leigh Star, "Of Lungs and Lungers: The Classified Story of Tuberculosis" (CP)

Susan Sontag, Illness as Metaphor (CP)

Mar. 24-28: SPRING BREAK

Mar. 31- Apr. 4: Psychiatry and Manic Depression

This book should provide interesting reading for you over the Spring Break (take it to the beach or home, wherever you go it will prove interesting). Kay Redfield Jamison is a professor of psychiatry and a research psychologist at Johns Hopkins University. She in addition to being a scholar of Manic Depression is also a sufferer of the disease. Her account shows the multiple dimensions and complexities of living with this disease. In the course of our discussions we want to look at the social world around the manic depressive. We will pick up elements of Kleinman's book during the course of this discussion and weave them into our analysis.

Reading: Kay Redfield Jamison, An Unquiet Mind: A Memoir of Moods and Madness

Apr. 7-11: Genetics and Its Controversies

This week begins an analysis of a very pressing socio-medical issue - genetic testing. We will examine this issue in part through the eyes of UIUC professor Michael Bérubé and the birth of his son who was diagnosed with Down Syndrome. This will form the basis for a day of debate, in class and hopefully online, about the benefits and risks of genetic testing and the nature of the compact between the state and the individual. The reading is lengthy but worthwhile and easy to read.

Reading: Michael Bérubé, excerpts from his book Life As We Know It (CP)

Film: "Marked For Life" Nightline Episode

Apr. 14-18: Refugees, Trauma and Memory

This week begins to study of topics not traditionally included in courses if this type. The topic we will explore is the nexus of a modern political phenomena and its effects on the health of individuals. Using Kleinman's paper, we can begin to see how violence affects individuals on personal and political levels. We will use his framework to understand the Human Rights Watch report on sexual violence during the Rwandan genocide and the Royte article on surviving genocidal rape. Finally, we will combine this with an examination of the ways in which forensic medicine (as shown in the Nightline video) serves to provide evidence and a sense of memory.

Reading: Arthur Kleinman, "Violence, Culture and the Politics of Trauma" (CP)

Human Rights Watch, "Shattered Lives: Sexual Violence during the Rwandan

Genocide and its Aftermath" (CP)

Elizabeth Royte, "The Outcasts," New York Times Magazine (CP)

Film: "All That Remains" Nightline Episode

Apr. 21-25: Violence: Institutional and Social

Much of my interest in these topics originates out of my own research. Nancy Scheper-Hughes is a medical anthropologist at Berkeley. Her essay takes close look at race related violence in Cape Town, South Africa. We will follow this social violence with an example of institutional violence through the eyes of Veena Das. She is a sociologist at the Delhi School of Economics in India. Her paper tries to give voice to the survivors and victims of one of the world's worst industrial disasters in Bhopal, India. In reading these two very different essays, we are looking for the connections that bind them within the sociology of health and suffering. The Scheper-Hughes story reads like an interesting and complex piece of journalism while the Das piece is more difficult to read but valuable and insightful.

Reading: Nancy Scheper-Hughes, "The Last White Christmas: The Heidelberg Pub Massacre" (CP)

Veena Das, "Suffering, Legitimacy and Healing: The Bhopal Case" (CP)

Apr. 28-May 5: Individual Presentations

May 7: Conclusions and Wrap Up