Medical sociology

Medical sociology is the sociological analysis of medical organizations and institutions; the production of knowledge and selection of methods, the actions and interactions of healthcare professionals, and the social or cultural (rather than clinical or bodily) effects of medical practice. The field commonly interacts with the sociology of knowledge, science and technology studies, and social epistemology. Medical sociologists are also interested in the qualitative experiences of patients, often working at the boundaries of public health, social work, demography and gerontology to explore phenomena at the intersection of the social and clinical sciences. Health disparities commonly relate to typical categories such as class and race. Objective sociological research findings quickly become a normative and political issue.

Early work in medical sociology was conducted by Lawrence J Henderson whose theoretical interests in the work of Vilfredo Pareto inspired Talcott Parsons interests in sociological systems theory. Parsons is one of the founding fathers of medical sociology, and applied social role theory to interactional relations between sick people and others. Key contributors to medical sociology since the 1950s include Howard S. Becker, Mike Bury, Peter Conrad, Jack Douglas, David Silverman, Phil Strong, Bernice Pescosolido, Carl May, Anne Rogers, Anselm Strauss, Renee Fox, and Joseph W. Schneider.

The field of medical sociology is usually taught as part of a wider sociology, clinical psychology or health studies degree course, or on dedicated master's degree courses where it is sometimes combined with the study of medical ethics/bioethics. In Britain, sociology was introduced into the medical curriculum following the Goodenough report in 1944: "In medicine, ‘social explanations’ of the aetiology of disease meant for some doctors a redirection of medical thought from the purely clinical and psychological criteria of illness. The introduction of ‘social’ factors into medical explanation was most strongly evidenced in branches of medicine closely related to the community — Social Medicine and, later, General Practice" (Reid 1976).

History

Medical sociology can trace its intellectual lineage to the late 1800s. In the nineteenth century, two nascent disciplines — sociology and allopathic medicine — began to cross paths. For allopathic medicine, this time period witnessed the beginnings of medicine’s ongoing attempts to consolidate its professional powers and social legitimacy. Meanwhile, sociology (the term being first coined by Auguste Comte in 1838) was beginning to emerge as a distinct discipline. The first publication which formally linked medicine and sociology was The Importance of the Study of Medical Sociology”, authored by Charles McIntire and first published in 1894. Two key books followed, Elizabeth Blackwell's (1902) "Essays in Medical Sociology" and the James P. Warbasse (1909) "Medical Sociology". The first journal to focus on medical sociology was the Journal of Sociologic Medicine, which was published by the American Academy of Medicine, and existing for four years between 1915 and 1919. The American Public Health Association hosted a similar “Section of Sociology” between 1909 and 1921. It took another quarter century before the next medical sociology journal (Journal of Health and Human Behavior) would appear.

The initial timing and brief duration of these links between medicine and sociology reflected a much broader transformation taking place within allopathic medicine and between medicine and society, as both rushed to affirm the validity of scientific medicine. As medicine grew in clinical effectiveness and organizational complexity, the social-psychological and behavioral sides of medicine began to lose attention, with instruction, research, and principles relegated to “second order” of medical fields such as psychiatry and public health. Scattered “sociology of medicine” articles would continue to appear infrequently in medical journals between 1920 and 1950.

In 1960, Austin Porterfield published what would become the first substantive disciplinary journal in medical sociology, the Journal of Health & Human Behavior (JHHB).[1][2] In the spring of 1967, the American Sociological Association (ASA) took JHHB under its organizational wing where it was renamed the Journal of Health and Social Behavior (JHSB). Eliot Freidson was the first editor. This same year also marked the first issue of Social Science & Medicine (SS&M), with its distinctively international and multidisciplinary social science focus.

By the early 1970s, the medical sociology section of the British Sociological Association had established its own organizational footprint, and in 1979 published its own “medical sociology” journal (Sociology of Health & Illness). During the 1950s and 1960s, the field of medical sociology underwent an explosive period of growth—before peaking in the early 1970s. During these two decades, the field enjoyed considerable academic excitement and success, including what today might be considered a lavish amount of grant support, both from private foundations and the federal government. At its peak in the early 1970s, for example, the National Institute of Mental Health subcommittee for social science training was awarding 1,500 graduate student stipends per year — 80% of which went to sociology departments. The number of stipends was well in excess of what was needed to support medical sociology graduate students, and the entire field of sociology benefited from this philanthropic and federal largess.

Even the founding of the medical sociology section itself and the ASA’s decision to adopt the JHSB were underwritten by outside funding. Membership in the new ASA section (established in 1959) was mercurial. In less than a year, the medical sociology section grew to 561 members. By 1964, membership had soared to nearly 900 (which, not incidentally, is close to the section’s membership today). In less than a half dozen years, the field went from publishing introductions to the field to summative reviews (one notable example is Eliot Freidson’s[1961] “The Sociology of Medicine: A Trend Report and Bibliography,” published as a special issue in Current Sociology).

By the mid-1970s, however, there were signs of trouble. Established funding streams had dried up and were not replaced by alternative resources. Section membership had plateaued and coverage of medical/health issues in flagship sociology journals, such as the AJS and the American Sociological Review, became more infrequent. Meanwhile, colleges and universities were undergoing their own upheavals. Faced with considerable financial pressures, schools looked to trim programs, and sociology was high on a number of lists. As one small but indicative example, Yale University’s Department of Sociology, which housed the first medical sociology program in the United States, decided in the 1990s to eliminate that program.

The 1980s and 1990s were a difficult time for allopathic medicine as well. The rise of managed care, the commodification of medical services, and the discovery of medicine by Wall Street and corporate America during 1985 and 1997 earth-shattering implications for the future of medicine as an autonomous profession. The 1970s through early 1990s also were a time of vigorous debates within academic sociology about the fate and future of allopathic medicine as a profession (Hafferty and Light 1995; Hafferty and Wolinsky 1991). Beginning with Eliot Freidson’s (1970a, 1970b) transformative Profession of Medicine and Professional Dominance, a number of distinguished medical sociologists in the United States (Mark Field, David Frankford, Marie Haug, Eliot Krause, Donald Light, John McKinlay, Fredric Wolinsky) and elsewhere (David Coburn, Julio Frenk, Rudolf Klein, Magali Larson, Gerald Larkin, ElianneRiska, Evan Willis) began to debate the changing fortunes of organized medicine’s status as a profession (Hafferty and McKinlay 1993). Once again medicine and sociology crossed paths. It is worth noting, however, that by the time organized medicine began to mount a campaign to reestablish its professional status and stature, sociologists had moved on to other debates (Castellani and Hafferty 2006).

Issues of Identity and Identification From its very conception as an academic entity, medical sociology has been plagued by issues of identity (self) and of identification (others). On the one hand, the study of medical and health issues offered sociology great challenges and opportunities. On the other hand, these same opportunities had the potential to strip sociology of its unique perspective. One hallmark of this tension is the now 50-year-old debate about whether the ASA’s section should be named “medical sociology” or whether it should sport some other marquee such as “health sociology” or the “sociology of health and illness.” Many of these tensions are reflected in Robert Straus’s (1957) famous distinction between sociology of and sociology in medicine.

The problem is one of placement and perspective. The former (of) reflects situations where sociologists maintain their disciplinary base (an academic sociology department for example) and train their sociological lens on fields of inquiry (such as medicine) for the purpose of answering sociological questions. The latter (in) connotes a state of affairs where sociologists work, for example, in a medical setting and employ sociological concepts and perspectives to solve problems that are defined as such by medicine. Sociology of medicine thus became considered (by academically based sociologists) as more in keeping with the sociological tradition, with the presumption being that those operating from a sociology in medicine ran the risk of being co-opted or at least corrupted by the medical perspective.

More recently, there have been efforts to “retire” this distinction by insisting that sociology has passed through its of/in phase and has graduated into a sociology with medicine (Levine 1987). Organized medicine remains one of the most powerful social institutions in modern times—forces of deprofessionalization not withstanding. Furthermore, medicine has little incentive (then or now) to welcome sociology to its table unless it feels that sociology can help solve issues or problems—as defined by medicine (and not sociology). Under such circumstances (and expectations), any working relationship between sociology and medicine involves considerable potential for sociology to undergo disciplinary co-option. Sociologists who work in medical settings must be particularly sensitive to these issues. Often they function betwixt and between, receiving little respect from physicians or from their academically based peers who consider their “wayward” colleges to be too “applied.” Whatever the particulars, organized medicine retains considerable institutional power and social legitimacy within today’s society. Medicine has been able to establish its knowledge, skills, and culture as the everyday, taken-for-granted order of things and this is what makes the medical perspective so potentially corrupting.

The move to introduce medical sociology into the medical school and nursing curriculum played an important role in the discipline’s evolution as an institutional entity. The first beachhead came in 1959, when Robert Straus founded the first Department of Behavioral Science at the University of Kentucky. Straus also helped to found, in 1970, the discipline’s first professional association (Association for the Behavioral Sciences and Medical Education). For Straus, “behavioral science” (note the singular form) reflected the intersection of medical sociology, medical anthropology, and medical psychology—and therefore represented a unique and transcending social science discipline. The field quickly established a presence within a number (but not all) of medical schools during the 1960s and 1970s, particularly in those 40+ community medical schools that were being founded during the 1970s and 1980s.

Key themes

We see two emergent lines of sociological investigation as we move to examine the future of medical sociology — each related to the other.

The first is globalization. It is clear that the world in which we live is going through major transformation. This is particularly true of health and health care. We now live in a world where the spread of disease is global and where the poor health of one country affects the well-being of others. Global financial markets and economic competition are challenging the ability of business and governments to provide affordable health care. As such, we can expect that as globalization increases, so will its importance as a major theme in medical sociology.[3] There are an increasing number of studies examining issues of health and illness in countries other than the United States or Britain.[4][5]

The second and related theme is “complexity science.” As argued by a growing list of scholars, and due to key factors such as the information revolution and globalization, and emerging theme within twentieth-first-century science is complexity.[6] One example is the study of complex health networks.[7][8] While this perspective has been an important part of medical sociology since the 1970s, primarily in terms of explaining the role that social support and kinship networks play in promoting health and well-being, the latest advances in the study of complex networks (e.g., small worlds, scale-free networks) are providing new insights into the processes by which diseases spread and the ways that health care providers can improve the health and well-being of large populations.[9]

As these two new themes suggest, the theoretical framework of medical sociology continues to change to meet the new and contextually grounded needs of health care providers and patients. Medical sociology is—and remains—a theoretically rich area of study.

See also

References

  1. ↑ Cain, Leonard. 2005. A Man's Grasp Should Exceed His Reach: A Biography of Sociologist Austin Larimore Porterfield. Lanham, MD: University Press of America.
  2. ↑ See Journal of Health and Human Behavior 1960 Volume 1, Issue 1. http://www.jstor.org/stable/2955591
  3. ↑ Bury 2005
  4. ↑ Comparative Medical Systems (Mechanic and Rochefort 1996)
  5. ↑ "The Blackwell Companion to Medical Sociology" (Cockerham 2004)
  6. ↑ Capra 1996, 2002
  7. ↑ Freeman 2004
  8. ↑ Scott 2000
  9. ↑ Watts 2004

Further reading

  • Bird, Chloe E.; Conrad, Peter; and, Fremont, Allen M. (2000). Handbook of Medical Sociology (5th ed.). Upper Saddle River, NJ: Prentice Hall. ISBN 978-0-13-014456-0. OCLC 42862076.  Cite uses deprecated parameter |coauthors= (help)
  • Bloom, Samuel William (2002). The Word as Scalpel: A History of Medical Sociology. New York, NY: Oxford University Press. ISBN 978-0-19-507232-7. OCLC 47056386. 
  • Brown, Phil (2008). Perspectives in Medical Sociology (4th ed.). Long Grove, IL: Waveland Press. ISBN 978-1-57766-518-2. OCLC 173976504. 
  • Cockerham, William C. (2001). The Blackwell Companion to Medical Sociology. Oxford, UK; Malden, MA: Blackwell. ISBN 978-0-631-21703-9. OCLC 44039611. 
  • Cockerham, William C.; Ritchey, Ferris Joseph (1997). Dictionary of Medical Sociology. Westport, CN: Greenwood Press. ISBN 978-0-313-29269-9. OCLC 35637576. 
  • Conrad, Peter (2007). The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders. Baltimore, MD: Johns Hopkins University Press. ISBN 978-0-8018-8584-6. OCLC 72774268. 
  • Helman, Cecil (2007). Culture, Health, and Illness (5th ed.). London, England: Hodder Arnold. ISBN 978-0-340-91450-2. OCLC 74966843. 
  • Law, Jacky (2006). Big Pharma: Exposing the Global Healthcare Agenda. New York, NY: Carroll & Graf. ISBN 978-0-7867-1783-5. OCLC 64590433. 
  • Levy, Judith A.; Pescosolido, Bernice A. (2002). Social Networks and Health (1st ed.). Amsterdam, The Netherlands; Boston, MA: JAI. ISBN 978-0-7623-0881-1. OCLC 50494394. 
  • Mechanic, David (1994). Inescapable Decisions: The Imperatives of Health Reform. New Brunswick, NJ: Transaction Publishers. ISBN 978-1-56000-121-8. OCLC 28029448. 
  • Rogers, Anne; Pilgrim, David (2005). A Sociology of Mental Health and Illness (3rd ed.). Maidenhead, England: Open University Press. ISBN 978-0-335-21584-3. OCLC 60320098. 
  • Scambler, Graham; Higgs, Paul (1998). Modernity, Medicine, and Health: Medical Sociology Towards 2000. London and New York: Routledge. ISBN 978-0-415-14938-9. OCLC 37573644. 
  • Turner, Bryan M. (2004). The New Medical Sociology: Social Forms of Health and Illness. New York, NY: W.W. Norton. ISBN 978-0-393-97505-5. OCLC 54692993. 
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