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The APA is offering the Cultural Formulation Interview (including the Informant
Version) and the Supplementary Modules to the Core Cultural Formulation
Interview for further research and clinical evaluation. They should be used in
research and clinical settings as potentially useful tools to enhance clinical
understanding and decision-making and not as the sole basis for making a
clinical diagnosis. Additional information can be found in DSM-5 in the Section
III chapter “Cultural Formulation.” The APA requests that clinicians and
researchers provide further data on the usefulness of these cultural formulation
interviews at http://www.dsm5.org/Pages/Feedback-Form.aspx.
Measure: Cultural Formulation Interview (CFI)
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researchers and by clinicians for use with their patients.
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Cultural Formulation Interview (CFI)
Supplementary modules used to expand each CFI subtopic are noted in parentheses.
GUIDE TO INTERVIEWER
INSTRUCTIONS TO THE INTERVIEWER ARE ITALICIZED.
The following questions aim to clarify key aspects of the
presenting clinical problem from the point of view of
the individual and other members of the individual’s
social network (i.e., family, friends, or others involved
in current problem). This includes the problem’s
meaning, potential sources of help, and expectations
for services.
INTRODUCTION FOR THE INDIVIDUAL:
I would like to understand the problems that bring you here so that I can
help you more effectively. I want to know about your experience and
ideas. I will ask some questions about what is going on and how you
are dealing with it. Please remember there are no right or wrong answers.
CULTURAL DEFINITION OF THE PROBLEM
CULTURAL DEFINITION OF THE PROBLEM
(Explanatory Model, Level of Functioning)
Elicit the individual’s view of core problems and key
concerns.
Focus on the individual’s own way of understanding the
problem.
Use the term, expression, or brief description elicited in
question 1 to identify the problem in subsequent
questions (e.g., “your conflict with your son”).
1. What brings you here today?
IF INDIVIDUAL GIVES FEW DETAILS OR ONLY MENTIONS
SYMPTOMS OR A MEDICAL DIAGNOSIS, PROBE:
People often understand their problems in their own way, which may
be similar to or different from how doctors describe the problem. How
would you describe your problem?
Ask how individual frames the problem for members of
the social network.
2. Sometimes people have different ways of describing their problem to
their family, friends, or others in their community. How would you
describe your problem to them?
Focus on the aspects of the problem that matter most to
the individual.
3. What troubles you most about your problem?
CULTURAL PERCEPTIONS OF CAUSE, CONTEXT, AND SUPPORT
CAUSES
(Explanatory Model, Social Network, Older Adults)
This question indicates the meaning of the condition for
the individual, which may be relevant for clinical care.
4. Why do you think this is happening to you? What do you think are the
causes of your [PROBLEM]?
Note that individuals may identify multiple causes, depending on the facet of the problem they are considering.
PROMPT FURTHER IF REQUIRED:
Some people may explain their problem as the result of bad things
that happen in their life, problems with others, a physical illness, a
spiritual reason, or many other causes.
Focus on the views of members of the individual’s social
network. These may be diverse and vary from the individual’s.
5. What do others in your family, your friends, or others in your community think is causing your [PROBLEM]?
Page 1 of 3
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This material can be reproduced without permission by researchers and by clinicians for use with their patients.
Cultural Formulation Interview (CFI)
STRESSORS AND SUPPORTS
(Social Network, Caregivers, Psychosocial Stressors, Religion and Spirituality, Immigrants and Refugees, Cultural Identity, Older
Adults, Coping and Help Seeking)
Elicit information on the individual’s life context, focusing
on resources, social supports, and resilience. May
also probe other supports (e.g., from co-workers, from
participation in religion or spirituality).
6. Are there any kinds of support that make your [PROBLEM] better,
such as support from family, friends, or others?
Focus on stressful aspects of the individual’s environment. Can also probe, e.g., relationship problems,
difficulties at work or school, or discrimination.
7. Are there any kinds of stresses that make your [PROBLEM] worse,
such as difficulties with money, or family problems?
ROLE OF CULTURAL IDENTITY
(Cultural Identity, Psychosocial Stressors, Religion and Spirituality, Immigrants and Refugees, Older Adults, Children and Adolescents)
Sometimes, aspects of people’s background or identity can make
their [PROBLEM] better or worse. By background or identity, I
mean, for example, the communities you belong to, the languages
you speak, where you or your family are from, your race or ethnic
background, your gender or sexual orientation, or your faith or religion.
Ask the individual to reflect on the most salient elements
of his or her cultural identity. Use this information to
tailor questions 9–10 as needed.
8. For you, what are the most important aspects of your background or
identity?
Elicit aspects of identity that make the problem better or
worse.
Probe as needed (e.g., clinical worsening as a result of
discrimination due to migration status, race/ethnicity,
or sexual orientation).
9. Are there any aspects of your background or identity that make a
difference to your [PROBLEM]?
Probe as needed (e.g., migration-related problems;
conflict across generations or due to gender roles).
10. Are there any aspects of your background or identity that are causing
other concerns or difficulties for you?
CULTURAL FACTORS AFFECTING SELF-COPING AND PAST HELP SEEKING
SELF-COPING
(Coping and Help Seeking, Religion and Spirituality, Older Adults, Caregivers, Psychosocial Stressors)
Clarify self-coping for the problem.
11. Sometimes people have various ways of dealing with problems like
[PROBLEM]. What have you done on your own to cope with your
[PROBLEM]?
Page 2 of 3
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Cultural Formulation Interview (CFI)
PAST HELP SEEKING
(Coping and Help Seeking, Religion and Spirituality, Older Adults, Caregivers, Psychosocial Stressors, Immigrants and Refugees,
Social Network, Clinician-Patient Relationship)
Elicit various sources of help (e.g., medical care, mental
health treatment, support groups, work-based counseling, folk healing, religious or spiritual counseling,
other forms of traditional or alternative healing).
Probe as needed (e.g., “What other sources of help
have you used?”).
Clarify the individual’s experience and regard for previous help.
12. Often, people look for help from many different sources, including
different kinds of doctors, helpers, or healers. In the past, what kinds
of treatment, help, advice, or healing have you sought for your
[PROBLEM]?
PROBE IF DOES NOT DESCRIBE USEFULNESS OF HELP RECEIVED:
What types of help or treatment were most useful? Not useful?
BARRIERS
(Coping and Help Seeking, Religion and Spirituality, Older Adults, Psychosocial Stressors, Immigrants and Refugees, Social Network, Clinician-Patient Relationship)
Clarify the role of social barriers to help seeking, access
to care, and problems engaging in previous treatment.
Probe details as needed (e.g., “What got in the way?”).
13. Has anything prevented you from getting the help you need?
PROBE AS NEEDED:
For example, money, work or family commitments, stigma or discrimination, or lack of services that understand your language or
background?
CULTURAL FACTORS AFFECTING CURRENT HELP SEEKING
PREFERENCES
(Social Network, Caregivers, Religion and Spirituality, Older Adults, Coping and Help Seeking)
Clarify individual’s current perceived needs and expectations of help, broadly defined.
Probe if individual lists only one source of help (e.g.,
“What other kinds of help would be useful to you at this
time?”).
Now let’s talk some more about the help you need.
14. What kinds of help do you think would be most useful to you at this
time for your [PROBLEM]?
Focus on the views of the social network regarding help
seeking.
15. Are there other kinds of help that your family, friends, or other people
have suggested would be helpful for you now?
CLINICIAN-PATIENT RELATIONSHIP
(Clinician-Patient Relationship, Older Adults)
Elicit possible concerns about the clinic or the clinician-patient relationship, including perceived racism,
language barriers, or cultural differences that may
undermine goodwill, communication, or care delivery.
Probe details as needed (e.g., “In what way?”).
Address possible barriers to care or concerns about the
clinic and the clinician-patient relationship raised previously.
Sometimes doctors and patients misunderstand each other because
they come from different backgrounds or have different expectations.
16. Have you been concerned about this and is there anything that we
can do to provide you with the care you need?
Page 3 of 3
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Social Science & Medicine 73 (2011) 939e943
Contents lists available at ScienceDirect
Social Science & Medicine
journal homepage: www.elsevier.com/locate/socscimed
From diagnosis to social diagnosis
Phil Brown*, Mercedes Lyson, Tania Jenkins
Department of Sociology, Brown University, Box 1916, Providence, RI 02912-1916, United States
a r t i c l e i n f o
a b s t r a c t
Article history:
Available online 12 June 2011
In the past two decades, research on the sociology of diagnosis has attained considerable influence
within medical sociology. Analyzing the process and factors that contribute to making a diagnosis amidst
uncertainty and contestation, as well as the diagnostic encounter itself, are topics rich for sociological
investigation. This paper provides a reformulation of the sociology of diagnosis by proposing the concept
of ‘social diagnosis’ which helps us recognize the interplay between larger social structures and individual or community illness manifestations. By outlining a conceptual frame, exploring how social
scientists, medical professionals and laypeople contribute to social diagnosis, and providing a case study
of how the North American Mohawk Akwesasne reservation dealt with rising obesity prevalence to
further illustrate the social diagnosis idea, we embark on developing a cohesive and updated framework
for a sociology of diagnosis. This approach is useful not just for sociological research, but has direct
implications for the fields of medicine and public health. Approaching diagnosis from this integrated
perspective potentially provides a broader context for practitioners and researchers to understand extramedical factors, which in turn has consequences for patient care and health outcomes.
Ó 2011 Elsevier Ltd. All rights reserved.
Keywords:
Diagnosis
Risk
Social movements
Environment
Public health
USA
Canada
Reservations
Introduction
Sociological analysis of diagnosis has achieved considerable
influence in the last two decades, providing important insight into
how we understand health, disease, and illness. It has also
expanded how we view the social and cultural influences that
shape our knowledge and practice on health and illness.
This includes studies of diagnosis that have gone beyond the
interaction between physician and patient, to take into account the
larger social, structural, and temporal forces that shape diagnosis
(see, for example, the categorization of homosexuality as a mental
disorder and the role of gay rights activists in the American
Psychiatric Association’s deliberations) (Cooksey & Brown, 1998).
Recently we have also seen the emergence of diseases whose
etiologies, symptoms, and, therefore, diagnoses, are often contested
or uncertain. This combination of medical and social uncertainty
leads us to propose a reformulation of the concept social diagnosis as
a new way of thinking about the sociology of diagnosis. This paper
explores social diagnosis by first, outlining a conceptual framework
of social diagnosis; second, discussing the different actors who
contribute to social diagnoses; and third, providing a case study of
* Corresponding author.
E-mail address: Phil_Brown@brown.edu (P. Brown).
0277-9536/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.socscimed.2011.05.031
how to apply our social diagnosis approach. Lastly, we conclude
with implications for sociology, medicine, and public health.
Introducing social diagnosis
Social diagnosis is ‘social’ for two reasons: First, it connects an
illness or the act of diagnosing that illness to a set of political,
economic, cultural and social conditions or factors. Second, social
diagnosis is conducted by different social actors, and the actions of
one group of stakeholders often spill over to affect the actions of
other actors. As we will see, social diagnosis is done by sociologists
who study diagnosis, as a way for researchers of social medicine and
the social determinants of health to look at the process, outcomes,
and consequences of diagnosis. It is also done by the lay public visà-vis social movements that expand what goes into the diagnosing
process. In this more comprehensive, public version of uncovering
the social determinants of health, a condition is diagnosed by
a social groupdfor example, the politicized collective illness identity that arises over a contested disease like Gulf War Illness
(Zavestoski, Brown, Linder, McCormick, & Mayer, 2002). Lastly,
social diagnosis is a way to expand the lens of the public health and
medical establishment in identifying what mechanisms and factors
are consequential for individual and community health. Social
diagnosis therefore provides a broader context for health practitioners, medical researchers, and social scientists to understand the
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P. Brown et al. / Social Science & Medicine 73 (2011) 939e943
extent of extra-medical factors in health and illness. With that
approach, neighborhood and community environments (which are
themselves determined by larger structural forces) can be included
in approaches to wellness, highlighting the intersection between
individuals and the larger social forces that structure their lives.
A genealogy of social diagnosticians
Social scientists
The roots of this approach are deep. The term “social diagnosis”
was coined in Richmond’s (1917) book, Social Diagnosis, considered
to be the classic textbook laying a professional foundation for social
work, and which focused on examining a wide array of social
conditions causing poverty and disease. This was a period when
sociology and social work shared many common interests in documenting and alleviating poverty, with the reformist Chicago
School sociologists categorizing and analyzing urban social problems that they traced to social structures rather than inborn
characteristics.
Even in the early 20th century, sociology focused on the social
determinants of health and illness, as in Faris and Dunham’s (1939)
work on mental illness. Decades later, Navarro (1976) and Waitzkin
(2000), both MD/PhD sociologists, led the charge of other political
economy scholars who sought to rekindle social medicine, found as
early as Rudolf Virchow’s work in mid-19th century Europe, and
more recently in Chile during Allende’s Popular Unity Government
in the early 1970s.
A committed approach to health inequalities, rooted in England,
worked its way into the literature starting in the 1990s. A leading
medical sociologist, Sol Levine, and a prominent social medicine
physician, Alvin Tarlov, nurtured this endeavor in their Health and
Society group, publicizing well-known British work such as Michael
Marmot’s Whitehall Study, bringing key health inequalities
researchers such as Richard Wilkinson to the US as visiting scholars,
and providing a research setting to nurture new health inequalities
researchers (Amick, Levine, Tarlov, & Walsh, 1995). A young generation of US-based scholars brought health inequalities work to the
fore, emphasizing race, class, sex, ethnic, and neighborhood differences (Kawachi, Kennedy, & Wilkinson, 1999; LaVeist, 2002;
Williams, 1994). These scholars’ work helped push the National
Institutes of Health to develop a strong program in health inequalities, though usually termed “health disparities,” a more neutralsounding phrase. From being only a National Center on Minority
Health and Health Disparities, in 2010, NIH transformed the center
into a full institute, the National Institute on Minority Health and
Health Disparities, signifying a major acceptance of this work.
Public health and medical professionals
Medical professionals and public health scholars in the US share
an important tradition of taking into account social factors in their
work. For an example of 1960s social medicine that exemplifies
social diagnosis performed by a physician, we can remember the
work of Dr. Jack Geiger, a founding member of the Congress of Racial
Equality (CORE) in 1943, a leader in efforts to end racial discrimination in hospital care and medical schools admission and a 1960s
founding member and National Program Chairman of the Medical
Committee for Human Rights which protected and provided medical
care for civil rights workers. Geiger was famous for diagnosing
poverty, racism, and hunger, and writing prescriptions for food to
give to poor children, which he and colleagues did to garner public
attention. More practically, the community health centers developed in that era diagnosed disease as stemming from a multitude of
social conditions. For example, staff would act on these diagnoses by
seeking improvements in neighborhood parks and fighting for lead
removal and blood lead testing (Lefkowitz, 2007).
While the public health field in the US continued a strong
commitment to examining social factors in disease, medicine often
trailed after it. Occupational health, environmental health, nutrition, and community health training still remain marginalized in
medical education and practice. Federal research, largely conducted
through the National Institute of Health, emphasizes treatment
over prevention. For example, the prestigious, well-funded
National Cancer Institute provides few resources for researching
environmental causation, leaving that to the much smaller National
Institute of Environmental Health Sciences whose budget is 6.5
times smaller (Brown, 2007) Sociologists have played a role in
examining social factors in disease, working alongside public
health scholars and community activists in pursuing multi-causal
approaches to understanding disease and developing multipronged solutions (Brody et al., 2009).
Public participation/social movements
Diagnosis is simultaneously a site of compromise and contestation because it is a relational process. When there is a disconnect
between the patient and the medical explanatory model, the
individual may be unsatisfied with treatment goals, and collectively
work to politicize the illness through social movements. This would
be the case especially if people were not given a diagnosis for
something which they expected to, or when they received
a psychiatric diagnosis for something they believe is physical.
The greater the symptom severity or the disconnect between lay
and professional perspectives on diagnosis, the greater the likelihood of contestation.
In contesting diseases and conditions, people often seek to
reshape or overturn a shared set of entrenched beliefs and practices
about diagnosis, causation, and treatment that is embedded within
a network of institutions, including medicine, law, science,
government, health charities/voluntaries, and the media. This
network is the “dominant epidemiological paradigm” for a given
disease. Activists challenge the dominant epidemiological paradigm by shifting the modes of scientific inquiry, and by refocusing
regulatory and policy attention (Brown, 2007). Scientists may be
asked to weigh in on questions that are virtually impossible to
answer scientifically, either because data do not exist or because
studies required to answer the question at hand are not feasible.
Scientists may frame political, moral, or ethical questions in
scientific terms thus limiting lay participation. This scientization
protects the illusion of medical omnipotence and delegitimizes
questions that cannot be framed in scientific terms (Morello-Frosch
et al., 2006). Health social movements may respond to these situations by marshaling resources to conduct their own research and
produce scientific knowledge in a process known as “popular
epidemiology” (Brown, 2007). In doing so, they democratize the
production of scientific knowledge and then use that transformed
science as the basis for demands for improved research on disease
etiology, treatment, prevention, and stricter regulation.
These concerns may extend into the legal realm when diagnoses
are a classification of what the individual’s health status could be in
the future. Exposed people may seek redress through medical
monitoring torts in advance of injury, in an attempt to offset the
costs associated with periodic testing in order to ascertain whether
a given exposure has led to changes in health status (Maskin,
Cailteux, & McLaren, 2001). Even US law now recognizes that
disease is no longer a unique collection of symptoms equaling
a given condition, but rather a constellation of current symptoms,
previous exposures, and future potential manifestations, all of
which make the art of diagnosis even more precarious.
P. Brown et al. / Social Science & Medicine 73 (2011) 939e943
The democratization of medicine and science we have
mentioned above is made possible by bringing the discussion of
diagnosis out into the open, rather than keeping it restricted to
professionals. Krimsky (2002) notes that the endocrine disrupter
hypothesis (that argues for the central role of endocrine-disrupting
chemicals in many diseases) was discussed quite extensively in the
public light, far beyond the shelter of academic journals and
government funding agencies. His notion of a “public hypothesis”
helps us see that increasingly, challenges to scientific orthodoxy are
shaped by public discussion in the media, social movement organizations, virtual communities, and other accessible formats
(e.g. homosexuality, post-traumatic stress disorder). When people
view their diagnosis as stemming from a particular toxic exposure,
they are rarely satisfied with the simple act of diagnosis. Rather,
they seek evidence of causation in order to seek redress in various
forms: medical coverage, medical monitoring, relocation,
compensation, assignment of blame, and (less commonly) the
incalculable but valuable apology from responsible parties.
As discussed earlier, in the absence of a specific diagnosis, people
with a shared environmental exposure sometimes file suits for
medical monitoring, to ensure that they have lifetime checkups to
diagnose a disease process as early as possible.
Yet despite a rich history of social diagnosis exercised by various
actors, including sociologists, public health officials and the public,
the above-mentioned strands have not yet been well-connected,
nor woven into a social diagnosis framework. Below, we discuss
several elements of a social diagnosis model.
1) A social diagnosis approach is more comprehensive than
a political economy/health inequalities outlook that accounts
for how larger social structures affect diagnostic processes. In
social diagnosis, we also must “socially diagnose” those structures themselves. In this light, we would argue that the injured
foot of a ballet dancer is not merely an injury caused by a pointe
shoe. It includes the larger setting of the balletic art form e its
teachers, theaters, dance companies, dance critics e as socially
iatrogenic. It includes gender roles that force-fit women into
many uncomfortable clothes and shoes, and anorexogenic
notions of beauty that limit the art form. Our diagnosis would
be of an unhealthy foot in an unhealthy art form in an
unhealthy culture. Treatment and prevention goes beyond the
individual, seeking to restructure power, capacity, and
community in the surrounding society.
2) Traditionally, diagnosis dealt with diseases and symptoms in
the past and present, with future orientation toward only
treatment and prognosis. Indeed, even attempts at incorporating social factors into diagnosis (either by healthcare
professionals or sociologists) do not adequately account for
a third dimension of time; that is, the future. Today, potentiality
is an important concept, where a biomarker may or may not
indicate future diseases. This potentiality introduces new
contestations and foci; preventive medicine now goes beyond
generic health advice, to consider borderline categories:
pre-diabetes, pre-high cholesterol, pre-hypertension. Further,
patients are increasingly prescribed pharmaceuticals to regulate these borderline conditions (Welch, Schwartz, & Woloshin,
2011). Therefore, a social diagnosis approach must contend not
only with past and present conditions, but explicitly consider
the potentiality of future conditions, specifically because they
may have social causes and consequences.
3) The process of diagnosis is carried out by multiple social actors,
including medical professionals, researchers, government
agencies, private corporations, social movements, and legal
institutions. For example, we can understand the role of public
health agencies in new forms of surveillance geared to
941
population exposure measurement and to the diagnosis of
pre-disease. Combined with increased academic and advocacy
research in this area, biomonitoring and household exposure
has opened vast new realms of seeing potential disease causes
at microscopic levels. Therefore, in a social diagnosis framework, not only are social factors considered in the diagnosis,
but a variety of social actors are contributing to the creation of
that diagnosis. In doing so, they diagnose not only individuals
but societiesda practice which is growing ever more important
in light of increasing biomedical uncertainty.
To further elaborate on and exemplify this idea of social diagnosis, we will use the case of obesity and diabetes in Akwesasne,
a Mohawk reservation straddling New York and Canada. This situation demonstrates how diagnosis has moved from the individual
to society, and is being performed by more than just doctors.
The multiple layers of diagnosis in obesity and diabetes: A
case study of social diagnosis in action
Obesity and diabetes have become a major concern of both
environmental justice and health groups in the 2000s. There is
broad understanding that, in addition to individual and lifestyle
factors, obesity is caused by numerous social phenomena:
increased consumption of processed foods (especially high fructose
corn syrup), food deserts, poor school lunch programs, a decline in
school physical education, and unsafe recreation spaces. Social
diagnosis looks here at an unhealthy body within an unhealthy
community, itself situated in an unhealthy food system.
Hoover’s (2010) medical anthropological study of local food
production and community illness narratives in the Akwesasne
Mohawk community found diabetes to be a central concern. Rising
prevalence indicated a rate higher than both the state and national
averages, and lay awareness of this led to a complex set of diagnoses. Residents in this highly contaminated area (primarily due to
PCBs and fluoride from local industry) believed that there were two
potential pathways through which contamination increased
diabetes risk. The direct pathway was based on recent science
linking exposure to endocrine-disrupting chemicals, to obesity
(Baillie-Hamilton, 2002; Newbold, Padilla-Banks, Snyder, Phillips,
& Jefferson, 2007). The indirect pathway was based on fear of
contamination, including fish advisories and concerns over soil
contamination, leading people to abandon traditional local foods
for less healthy processed foods, and hence also getting less exercise since they were not gardening and fishing. This second
pathway, rooted in a risk society perception, also led to changes in
the traditions and cultures of the community, leading to a broader
social illness.
We do not imply here that the discovery of contamination led to
obesity. Rather, the discovery of the toxicants set off a cascade of
events that meshed with other reservation developments, which
then involved dietary and agricultural changes. Such changes have
occurred in other communities, sometimes because of contamination discovery and sometimes for different reasons such as urban
decline. This then leads to the departure of groceries with fresh
produce or to the immigration of people from more self-sufficient
food regimes to urban locales flooded with fast-food restaurants
and completely lacking any resources to continue traditional
practices.
Using Chaufan’s (2004, 2008) work, Hoover argues that
the medicalized approach to diabetes individualizes and depoliticizes
the problem. Alternatively, a political ecology framework emphasizes
social, economic, and political institutions of human environments
where diabetes is emerging. Hoover adapts Scheper-Hughes and
Lock’s (1987) model of three bodies e the individual body, the
942
P. Brown et al. / Social Science & Medicine 73 (2011) 939e943
social body and the body politic. As Hoover points out, in addition to
losing the nutrition from fishing and gardening, people also lost the
physical and cultural activity involved in that food production. This
led to fewer burned calories, affecting the individual body, but also to
broader losses affecting the social body e the failure to connect with
ancestral ways and to pass traditions onto youth. Eating is an
important social experience, and the sharing of food is an integral
part of Mohawk culture, full of morals around cooperation and
proper behavior. This larger unity of the body politic is especially
important at present, when the community is less united due to
overlapping tribal, US, and Canadian governing bodies. Akwesasne
environmental health activists used their mobilization around
contamination as a way to achieve general social unification and
harmony. When people seek to take control of individual and social
levels of obesogenic and diabetogenic conditions, this crisis that
originates in massive contamination has the capacity to provide new
unity.
In effect, we see that what might appear as a straightforward
diagnosis of a metabolic disease is in fact much more complex.
Hoover’s analysis of the social diagnosis of this condition builds on
the community-based participatory research by the laypeople and
traditional healers of Akwesasne, in alliance with university
scholars and environmental health scientists, and implicates individual, social and cultural, and body-politic disease contributors.
Such analysis informs us that by the time it reaches the body politic,
biological disease goes to the core of the social fabric, and warrants
an overall restructuring of power, capacity, and community.
Further, we see that struggles over diagnosis are simultaneously
struggles over causation. In this light, we can understand the multitemporality of diagnosis: it is not only about the present, where
people seek knowledge about the symptoms they experience. It is
also about the past, whereby people seek the causes of problems
that led to a current diagnosis. As well, it is about the future, where
the medical and social sequelae of the diagnosis reside along with
the treatment and prognosis.
Conclusion
Studying diagnosis provides a window into many components
of health and illness, and presents an organizing configuration and
master frame. Our expansion into understanding and elaborating
on social diagnosis makes this broader framework more applicable
to an even greater number of research arenas. The act of diagnosing
an illness is important on multiple levels. It is about an individual’s
relationship to the illne