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Michael BuryThe sociology of chronic illness: a review
ofresearch and prospects
Abstract This paper provides a review of research and debate in
the heldof chronic illness, it lirstoutlincs some gerscral features
of ast)cit>logicai approach, and then goes on to use recent
empiricalstudies of chronic illness to illustrate sotnc of the main
stagesinvolved. These include: onset and the problems ot
explanationand legitimation, the impact of treatment, and the
developmentof adaptive responses. An attempt is made todisttngutsh
the useof the terms 'copmg'. 'strategy' and 'style' in
describingadaptation. The paper argues that a sociological approach
needsto recognise the positive actions people take, as well as
theproblems they face. In this way. diversity iti managing
chromeillness, and the continuing need for a person-baseti approaeh
tosociological work, are underlined
Introduction
Some years ago the Anierican soeioiogist. Herberl Blumer. made
thecomment, often repeated since, that sociological interest in
soeial problemsfollows in the wake of soeietal definitions. What he
might have added isthat sociologists also tetid to be more
interested tn problems than inpeople's responses to tackling them.
In the field of ehronic illness, thedoeumentation of problems faced
by patients, and !i) a lesser extent theirfamilies, has usually
dominated the research agenda, including sociologicalresearch,
fiighlighting the hidden burden of work and social
relationships(Blaxter 1976) for example, or the extent of poverty
associated withdisabling illness (Townsend U?79) has. of course,
been an importantcorrective to a narrow medical view preoccupied by
disease and its elinical(or, at best, functional) sequelae,
flowever, the emphasis on suehdiffieulties and disadvantages has
been at the ex|K-nse of studying theresponses and positive actions
of those aftectcd.
Alongside descriptions of the burden of chronic illness,
however,research iindings have alstt appeared documenting the steps
people take to
Soctology of Health Si Illness Voi /.? No. 4 1991 ISS,\ ONI -
98S9
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452 Michael Bur\
manage, mitigate, or iuhipt to it, am) the meanings attached to
theseactions. Part of this change in emphasis has ct)ftie about
through thedevelopment and application of more theoretically
inforiiiecl approaches tochronic illness. Interpretive soci(i!ogy,
in particular, has tieveliipett a viewof people as agents, rathei
than being nserely ihe products of the contextsin which they live,
interaetionist and phenonienological models of illnesshave been
explicated, as a tiieans of understanding belter the social basis
ot"the meanings of symptoms, and the negotiated reality actors
fashion inresponse to them (Gerhardt \'-W>).
Moreover, a series of empirical stutlies has emerged, more or
lessexplicitly employing such approaches. Larlier disquiet about
the wisdomof, or justilication Tor. sociologists studying specific
medical complaints,has given way to an aceumulali
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T h e s o c i o l o g ) ot chri>nic i l lness i5^
dtsruption ot illness, then going on to the processes of
explanation andlegitimation, before turning to tieatment and
adaj)tation.
Disrupted biographies
As is now widely recognised, the onset of chronic illness
represents anassault not only on the person's physical self, but
also on fhe person's senseof identity, calling into doubt the
person's self-worth (Charma/ l'*83). Lossof confidence in the body
leads lo loss of eontidence in socia! interaetion.More broadly, I
have described this experience, of the onset of chronicillness, as
"biographical disruption' (Bury 1982). hollowing Strauss
andCilaser's pioneering work (Strauss and (ilaser 1475. l'IH4) Ihis
idea bringsinto focus the tneaning of illness as well as the
settnig m which it occurs,ineluding in the latter ease, the
lesources available to the individual. Thenoiion of biography
suggests that meaning and context in chronic illnesscannot easily
be separated. 11iis may be espeeially relevant within modernculture
vvith its dualistic emphasis on the 'affirmation ol ordinary
life'(I 'aylor 1WJ), as well as on l i lc planning' (Bergcr ei al
1M74). Corbin andStrauss (i'*S8) speak of "iUU.."s',
bit>graphical bodv conceptions, which tietogether ihe subjective
evpencnee of self in daily lilc and the relationshipthis has to the
body across the life course.
In a later paper (Burv I'-JHN) I distinguished two tvpes of
"meaning' inchronic illness. In tlie first place the "meaning' of
illness lies in itsconseipwnces for ihc individual. The effects of
the t)nset of disruptivesvmptoms on everyday life at home or at
work, including, ft)r example,giving time to managing symptoms or
regimens (Locker 19S3) may beuppermost. Ativice about svniptoni
management ntav be sfuight. togetherwith a search for information,
tioni other sufferers, self help grcuips oraequaintanees. as (o fhe
best methods of managing altered daily life,mobilising and
compensating foi loss t)f resources, in the cailv period of
aconditii)t}. practical management b \ individuals niuy be
tentative anduncertain, as trade-offs between the effects of
svmptoms. and efforts tominimise them, arc undertaken.
Second, the meaning of chronic illness \x\\\\ be seen in terms
ot itssii^inficafice. !iy this ! mean that different conditions
carry with themdifferent connotations ami iniagerv, I'hesc
diftefences may have aprofound inlluenee on how individuals regard
themselves, and how theytiiink others see them. ( 'hronic
conditions v;iry itiai kedlv m terms o!" theirsymbolic significance
within segments of the cultural order, and these arcbound to affect
adaptation. Whilst these may eoale'sce into sjcreofypes (egof
'epilepfics' or "arthrihcs'), meanings surrounding illness often
change asthey interact with different stages of ihe life eiunse.
T!ic iminiet of suchcategories on individuals and social
inleraction !iiay not always be atcfleefion of neszativc
associations. Disuuisinsz and ilisclosnm diagnosis and
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454 Michael Bury
symptoms, for example, depends not only on their physical
intrusivenesswithin soeial contexts, buf also on their posifive and
negative meaningswithin a spccifie set of social relationships,
C'hanges in symptoms over timemay affect social responses, and
these in turn will intluence experience.This interactive process
can also be seen in the changing perceptions ofdisease in
historical time; the complex interaction between disease and
thesocial meanings which surround, or 'frame' it (Rosenberg
1989),
In everyday lite, chronic illness also creates what I have
termed (afterSahlins 1985) a situation ot "meanings at risk'(Bury
1988). In responding tochronic illness, individuals constantly test
the meanings attached to theiraltered situation against the reality
of everyday experience. It is a situationof risk because mdividuals
cannot be sure that their own developingperceptions and detinitton
of the situation' will be shared by others.whether in the informal
setting or in interactions with professional care-givers. Calls for
help may turn out to produce unwanted dependence andcalls for
sympathy run the risk of rejection. Only fhe passage oi time
andtrial and error can provide guidelines as to the nature of the
risks involvedin living with a patticular condition, though a
degtee of unpredictabilitywill always remain. Robinson (1988) tor
example, shows that patients withmultiple sclerosis report being at
risk of having their symptoms misunder-stood as signs of mental
illness, malingering or even being drunk by thosenot in the know.
Hven with those in the know, "any claims which allowpeople social
exemptions are likely to be scrutinised by others" (Robinson1988:
113).
It is understandable, from this viewpoint, that studies such as
Robinson'sshould emphasise uncertainty as a key aspect of
disruptive experience,especially around the emergence and onset of
the condition. Symptoms ofchronic illness, in their early stages
often overlap with a range of normalbehaviours, making the problem
of early diagnosis particularly difficult.Interactions and
negotiations with others abcmt the illness will be tentative,with
the person being unsure of the reality of the condition and yet
beingpressed into seeking help by the growing insistence i>f
symptoms, or as aresult of, or pressures from, significant others
(Bury 1982. !988). in otherconditions onset might be more
dramatieally disruptive, throwing extantmeanings sharply into
relief. As Scamhier (1989) shows, in his study ofepilepsy.
symptt)ms may appear trightemngly 'out of the blue', eausing
theindividual not only to have to tace a changed situation, but
also thepotentially stigmatising reactions of others. In other
cases, such as renalfailure, onset may be either rapid or prolonged
(J. Morgan 19K8).
These studies illustrate the range of "biographical disruption'
occasionedby the onset and early development of chronic illness.
Experiences are notonly intlucnced by the social context in which
tlie person lives, but by thenature of the symptoms, and their
perception by self and others.Conditions which have stigmatising
consequences (whether these are 'felt'or enacted') such as epilepsy
(Scambler 1989) or cancer (Macdonald 1988.
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The soeiology of chrome illness 455
Kelly 1986) may create an urgent need to reduce any possible
negativeimpact of the diagnosis. Kelly, for example, calls for the
physician torecognise the element of grief involved in cancer
diagnosis and curativesurgery, and for communication with the
patient around such feelings,Bardiey (1988} suggests that doctors
should adopt a strategy of working foimpart a sense of strength U)
eancer patients. !n other eonditions. such asrheumatoid arthritis.
(Bury 19S2) and multiple sclerosis {Robinson l'->88)the early
recognition and naming of the condition may. albeit
temporarily,help to clear the air' and reduce uncertainty. Initial
diagtiosis may thusboth enable and eonstrain responses, (or
example, helping some negotiationswithin the family, hindermg
others. However, as a condition develops, anew set of issues to do
with explanation and legitimation presentthemselves.
Explanation and legitimation
Onec the initial onset and impact of a condition have (tecurred.
individualsbegin to face the longer-term implications of their
altered circumstances.Information about a medieal condition may be
gatherccL in terms of bothits aetiology and its progn(sis, in order
to answer tlic questions of why me.why now? Frequently, of course,
the answers arc less than whollysatisfactory, so that more realist
or fatalist response of "well, why not me',''may ensue. Whilst
medical knowledge may be important to patients intheir management
of symptoms, several studies have shown that its"explanatory
coverage' is often less than satisfactory. In his study
ofrheumatoid arthritis Williams found that medieal explanations of
thecondition may be supplemented by "narrative reconstructions"
whichattempt to place such inft)rmation within a more meaningful
biographicalcontext (G. Williams 1984). Following Blaxter (1976).
Seambler (1989)emphasises the tendency towards rationalisation, as
individuals withepilepsy try to bring into line limited medical
knowledge about, andexplanations of. aetiology and their paitieular
experiences, Robinson(1990) distinguishes the 'personal narratives'
or stories individuals maycome to construct and communicate around
their experience of ilhiess.from biomedicat knowledge about the
unfolding character of the diseasefrom whieh they are sulfering.
Similarly, in a study of childhood leukemia,Comaroff and Maguire
(1981) found that parents went beyond theexplanations on offer
within the medical eneounter (o establish a widerpicture of the
condition and its possible aetiology, Hazards in theenvironment,
including, most notably, the possible role of nuclear energy,have
continued to figure in the lives of patients and parents living
with thiscondition.
Part of what is going on here concerns the questitni of
legitimation.Individuals not onlv wish to nain a measure oi control
over their condition
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45(1 Michael Eiuryby finding explanations that make sense in
terms of their lite circumstancesand biographies, but they also
wish to establish a proper sense ofperspective about the condition,
and re-establish credibility in the face ofthe assault on scit-hood
which is involved. The term 'legitimation', here,refers to the
process ol attemptmg to repair disruption, and establish
anacceptable and legitimate place for the condition within the
pcrst)n's life.in the wider sociological literature the temi
"legitimation' is used to denotethe processes through which
authority is made credible. In the presentcontext the term retains
these associations, but in a much more focusedmanner, pointing to
the individual's attempt to maintain a sense ofpersonal integrity,
and reduce the threat to social status, in the face ofradically
altered circumstances.
Robinsctn (1988) reports lor example, that people may use the
diagnosisof multiple sclerosis to overcome the feelings of being
regarded asdepressive or mentally ill. A diagnosis may represent an
official validationof the condition. Yet, it is also clear that
knowledge about the diseasedoes not guarantee success ui trying to
legitimate change, and maycontinue to elash with others'
perceptions in everyday settmgs. Personalgoals tiiay also differ
eonsiderabty from medical ones even in the healtheare setting, when
doctor and patient are ostensibly communicating aboutthe same
problem. Sufferers may disagree about the significance ofsymptoms,
for example by being resistant to the permanent use of awheelchair
long after the appropriate point on the 'medical trajectorv'
hasbeen reached (Robinson 1990, see also Zola 1MS2). Here,
again,negotiations will be necessary, in order to produce
stabiliiy.
The visibility of symptoms has long been noted as important m
thiscontext. The disjunction beiweeii 'definitions tif the
situation' held by selfand others may be sharp in conditions where
physical deterioration orimpairment is becoming obvious, but where
no explanation can be offered.Other conditions, however, itiay
produce sympt
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TIR' soemlogv of chronic illness 457
of legilimation may not ttnl\ be a feature o i symptoms and
their perceptionby self and others, but the\ may also arise front
longer-term consequencesoi eonditions occurring long after onset.
For example Kellv (19S9) andMacdonald (1988) show in their studies
of ulecrative colitis and cancer.that 'minor medieal matters' that
arise irom treatment, even whensueeessful, pose particular
dilliculties fi"ir communicaiion. For example, ifsurgery has been
suecessfuL doctors ma\ be relativeK uninterested in theproblems of
sfoma care, minor sknt ilistHxIeis and ihe like which arise
afterthe event. Patients may have considerable difficuhy
establishing thaf theseare significant, or causes for concern, in
both formal and informal socialsettings. A new "crisis of
credibility" may (teeur if the individual continuesto repon
problems after their "share' of attention has been used up. orwhen
they have been placed m a category (eg 'siicccsslul tperation')
whichcloses off avenues of support and informatitm. Under these
circumstancesihe improved situation niav m lact be as diflicuh to
manage as whendealing with Ihe condition itscif. At tiic same time,
such studies underlinethe point thaf medical advice and
informafion. when it is tailored to theparticular e(tntiguration'
of the individual's condition and treaiment. mayplay a positive
role in the legitimatifui of the conditKin in everyday life(Burv
1988).
Iht' impact of treatmenl rt-giniens
The issue oi treatment, and its place m the experience of
chronic illness,has only recently begun lo receive the atteniion it
dcsetves. though Straussand (ilaser (1975) drew attention to it in
their earlier w
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4^K Michael Bury
remission emerges. Parents therefore inform themselves about
treatmentsand their possible cffeets, and place eonsiderable hope
in specialist care.However, modern treatments may still be limited
m whaf they can achievein altering the fundatnental course of the
disease, and may cause in theirwake unpleasant side effects,
leading to a new set of problems, to whichresponses have to be
fashioned. Parents may go back over theirexperiences, feeling that
indecisiveness, poor communication and lack otinformation,
especially by the general practitioner at an earlier stage, areto
blame. Mope and frustration alternate. Interactions with fellow
parentsare equally risky, as these may reveal the character of
different trajectoriesindividual children are following.
Comparisons with others may be asource of comfort, but they may
also be a source of worry if the resultingcontrasts in managing the
effects of treatment regmiens prove unfavourable.
More positively, in a condition stich as multiple sclerosis, or
arthritis,considerable initial difficulties in communicating about
symptoms and theirimplications may diminish when the merry-go-round
slows down, fheritual of consultation, of the individual often
repeating versions of theirstory to different doctors, may be
accompanied by a growing confidenceabout the nature of the
condition and its treatment. Patients may becomeexpert, for
example, about the drug therapies on offer. Whilst, say,steroids,
or anti-intlammatory drugs offer the possibility of reducing
thelength and severity of altacks of MS, or rheumatoid arthritis,
patientsbecome knowledgeable, not only about their immediate
effects but alsoabout the differing medical views of their
long-term usage. Patients weighup in their own minds, as do
doctors, from a medical viewpoint, the costsand benefits of such
treatments. Both participants may have difficulty atany one time
knowing what the effects really arc, but patients may pursue
a'careful pattern of experimentation" and eome to isolate what they
thinkare the actual benefits of treatment (Robinson 1988: 86,
Scambler 1989:35).
It is clear, from a number of studies, that expectations of
treatmentchange at different points in an illness trajectory. For
example. In a studyof patient views of chronic low back pain and
its treatment, groups ofsufferers were identitied at different
stages of their biography and patient'career', with different views
of what they expected and wanted from aspecialist clinic
(Fit/patrick et id 19S7). Though many of the respondentshad long
been travelling on the medical merry-go-round, they had
differentoutlooks on what they wanted. Younger patients with milder
levels ofdisability were looking for a more instrumental' style of
intervention, andfor information about tests and treatments. Older,
more severely affectedpatients, on the other hand, were more
concerned to communicate withthe doctor about their personal and
family circumstances, and the widerimpact of their condition.
Whatever the combination of instrumental and affective needs
theperson may have, making sense of the effects of treatment and
medical
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'1 he socioU>|.;\ ot chritnic illness 459adviee may not
always he a straightforward matter. As indicated, costs andhenelits
cannot always be simply and rationally assessed. As ,Iobling
pointsout in his insightful essay on the treatment of psoriasis [
I9S8) "the processof making sense of treatment may be at times as
much a matter of intuitionas much as intellect' (p 229). In his
study, ,lobling illustrates that ireatmentsmay become a part of the
problem as well as the solution, and may place anadded burden on
the individual and family, .lobling argues that the effectsof
living with treatments as well as with the psoriasis are ignored or
illunderstood by many dcrmatologisis. As a sufferer huiiself,
Jobling foundthat doctors "showed tiltle interest in the
complexities of the process . . .the psychological and social
consctjucnces of living with a potentiallystigmatising condition
seemed beyond their protessional concern' (Jobling1990). A sense of
"disgrace' or "punishment' associatcil with the condition,may be
heightened by the use ot ointment-basetl trealments, many ofwhich
demand arduous etfort In the patient without any clear-cut
rewards.
Patients are often caught Jn what Jobling (19S8) calls the
"sysyphussyndrome'. Like Sysyphus who was condcnincil hv the gods
to roll aboulder up to the top of the hill, only to see it roll
back down again, sopatients ijo through many rituals of treatment
regimens, onl\ to find thatthe condition has changetl very litilc.
Periods in hospital may involveconsiderable physical "work' ot this
kind accompanied by considerableemotional 'work' arountl their
condition. In many cases patients come toask over time "what does
it all mean'.'" rather than 'why me'.'", and tind thatdoctors'
comments require careful decoding, frequcntiy. patients will
usenurses m order to try lo work i)ut \vhat the latest change or
development oftreatment engineered by dt)ctors means, 'fhus,
recourse to the clinic orhospital involves both instrumental and
affective "work' by patients(Strauss et ul 1982a,b). fhe
implications of these aspects of chronic illnessfor the
organisation of liospital treatment have onlv just begun to
beconsidered in any depth (Strauss and C'orbin 1988, Field hW
J^).
I-"rom this viewpoint the traditional medical beliet in
"rational" com-munication of information and coinpliance in
following treatment regimensneeds re-thinking. F'.videncc tioni
many studies of chronic illness. Includingmost of those cited
above, show how far patients are torccd to makedecisions about
iheir treatments in terms of the social impact they have ondaily
life, and hmited medical knowledge, 'fhe trade-otf between,
forexample, adhering to a regimen for controlling diabetes, by
controllingweight, may clash not only with other goals held by the
patient (forexample the desire to remain sociable) but also with
social and culturalpressures from without (Kelleher 1988).
Similarly, recixicihng the need forrest with the desire to remain
active or at work, in living with arthritis, mayset up considerable
conflicts about what should be said and to whom andwhat dictates
should be complied with (Locker 19H3, ( i . Williams andWood
1988),
Indeed, ihe term "compiiance' is of limited use m the context of
chronic
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460 Michael Burvillness. As we have seen, neither the doctor or
the patient has completeknowledge or answers, whereas "compliance"
suggests that an objective isclear and can be met if the patient
does what the doctor orders. Rather, asRobinson suggests, the
situation in ehromc illness is such that 'a pooling oftheir
respective and complementary expertise may facilitate the
achievementof some of their goals' (Robinson 1988. 84-5).
Negotiatmg over theappropriate use and effeets of treatment
regimens as well as thesiiinilicance of symptoms enhances
adaptation to a disrupted biography, orat least achieving a measure
of stability.
Adapting to chronic illness: coping, strategy and style
Recent sociological work on chronic illness has done more than
simplydocument the problems of uncertainty, doctor-patient
conflicts anddifticulties in managing symptoms and their treatment.
Important thoughthese issues are, an interpretive approach to
illness brings Into view changesover time and the positive actions
people adopt to counter fhe effects ofsymptoms and treatment,
fhough firmly wedded to a person orientedapproaeh, this approach
also recognises the range of resources drawn uponin ad.iptation.
including medical resources, in order to improve the qualityof
life.
In considering long term adaptation to chronic illness, i would
like tosuggest that the terms "copinii*. 'strategy' and 'style' be
distinguished moredearly, at least for analytic purposes, even
though they may be illfficult todistinguish empirically, "fhe
problem is that these terms are sometimesused synonymously, and at
other times they are used In a combined form.For example, "coping'
may be used to refer to the overall process ofadaptation, or as a
way of describing particular practices, as in "copingstrategies'.
Whilst this overlap ui usage is perhaps Inevitable. I would liketo
suggest that the terms be used, where possible, to direct our
attention todifferent dimensions
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fhe socu'k^gy ot chronic illness 461
"normalisation' may also mean trcatmg the illtiess. or treatment
regimen,as 'normal", and incorporating it more fully into the
person's identity andpublie self (Kelleher 1988). Predictability in
the relationship between selfand others may therefore be enhanced.
Kelly (1989) reports different waysof coping with ulcerative
colitis and the effects ot an ileostomw along theselines.
Similarly, Schneider and Conrad (1981. 1983) document the
'interpretiveprocedures' adopted to minimise the disruption of
epilcj'^tic seizures.Building on their distinction between
'adjusted' and 'unadjusted' modes ofadaptation, Scamhier (19S8)
discusses the various methods of coping foundin his siudy of
epilepsy. Where seizures are frequent the need tocommunieate and
have the condition recognised within the family may givethe
condition particular salience, but vvherc seizures are inlre(]uent
or canbe hidden from view there is less need to communicate wiih
others, andthus the condition can play a far less important role in
disrupting theperson's identity, Jn sum, coping itivolves
maintaining a sense of value andmeaning in life, in spite ot
symptoms and their effects.
'Various factors may be adduced to explain these variations in
coping, forexample the impact of social class position in producing
considerableadvantage in COAD (Williams and iiury 1'-I89b), or
gender In denial andnormalisation in diabetes, where women may be
rrmre likely to sufferanxiety in managing their condition, as a
result of worrv (Kelleher 1988b:152). Interestingly, howe\er.
Kelleher reports elsewhere that male valuessurrounding health may
have more negative effects in other aspects ofmanaging diabetes
(Kelleher 1988: 65). In addition, (>f course, the severityand
nature of symptoms, as well as ihe values held by the individual
andthe resp(tnses of others, help deicrmlne whaf it is that people
must copewith. Kelly's study of colitis has shown that coping can
often comprise acomplex mixture of individual \alues, outlook antl
s(icia! citcumstance(Kelly 1989).
The term "strategy', m contrast to 'c(*ping', directs attention
t
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462 Michael Bury
actions taken to mobilise resources and maximise favourable
outcomes. Indefence of the use of the term, responses to the
disruptive effects ofchronic illness may bring about a greater
degree of consciousness andcalculation in everyday life, whether at
home or at work, than is normallyexperienced. The use of 'strategy'
or "strategic management', in thiscontext, might he preferable to
the rather ctinfusing use of such terms as"coping strategies' or
"social coping' to be found In the literature.
Ihc strategic management of Illness, from the person's
viewpoint, meansnot only the skilful manipulation of social
settings and appearances tominimise the impact of Illness on
interaction (Wiener 1975) but also theattempt to mobilise resources
to advantage (Locker 1983), and fhe settingof realistic goals In
order to maintain everyday life, fhe use of the term'strategy'
suggests the need for a dynamic view of choice and constraint,
aspeople attempt to weigh up alternative forms of action. However,
aperspective which emphasises that choices are made within material
andcultural contexts can sometimes miss the point that contexts
themselvesmight partly be chosen (Crow 1989). People may withdraw
from somewider activities and social commitments, in order to
concentrate onmaintaining the viability of key relationships, for
example, in the home.
This last point is important when one recognises the importance
ofchanges over time. Strategics ma\ be akercd, involving shifts in
the way inwhich people interact with others, together with changes
in c
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The soci(>loi;\ oi chronic illness 463
The use ot the term "style' in managing chronic illness h;is
been givenparticular attention recently by Radley (1988, 1489) in
his study of chronicheart disease, Ditlerent forms ot s
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464 Michael Bury
placing them in 'inuminating conncciion with experience-distant
concepts"(Geertz i9S_i: 58). It is with this mm thai 1 have
employed terms sueh asbiographical disruptmn and legitimation, and
distinguished betweeneoping, siratcgy and styie.
Future research will nol only need, however, to pursue
greatereonceptuai eonsistency and methodologieal rigour. It will
also h;ive totaekic the eharge. often levelled againsi Ihe
interpretive approaeh, that iteoneenlrates too much on meanings,
and not enough on wider slrueturalfactors. Concentrating on the
positive achons people take, need not heeounterposed to
e(.)nsidering the inipael of the soeia! position and resourcesof
the individual on ehronic illness.
The need to consider the wider context is important at a time of
rapidchange in the health held. For example, ehanges in the eulture
surroundinghealth, may have important implications for our
understanding- As Blaxter{1990) has recently pomted out the eurrent
emphasis on 'healtliy lifestyles'may have a negative effeet in
chronic illness, where symptoms ean limittheir adoption. While such
changes ni the eultural eiimate may beattractive t
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fhe sdcioluiivof chiniiic illness 4fi5
Acknowledgement
I would particularly like io fhank Jon (-.ihc tor hi^ l idptu!
'l) Health atul Ijii'Mvic London- Roullcdge.Bourdicu. P. (i '>M)
Dtsumtmn. a Social C'ltujiu- of 'he liulx^cmcnt of laste.
London: Koutlcdge and Kegan Paul.Bury. M. k. (!9S2Khronic
illness :,s hiomapiiicaUiisri(piion, >.'< i^ 'A'.^ v o/
Health
anil Illness, 4, l(v- S2.Biuv, M. R. (P'SS) Mcannies at risk
llic experience o| arUirilis. in Anders,.n A\U\
Burv (P).. \t'S 9^.ConuiroiL .f and Matjnnc, P, (L 'S l )
Amhiguitv .uu\ the s.arcii tor nicaninb. n 5 - 2 . v
Corbni , .L M. and Strauss. A. (l''HS) (^nendmg Work ami i arc
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