Matches in DBpedia 2014 for { <http://dbpedia.org/resource/Medical_sociology> ?p ?o. }
Showing items 1 to 40 of
40
with 100 items per page.
- Medical_sociology abstract "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).HISTORICAL ROOTS''Medical sociology can trace its intellectual lineage to the late 1800s. In the waning decades of the nineteenth century, two nascent disciplines, sociology and allopathic medicine,began to cross paths in small but significant ways. For allopathicmedicine, this time period witnessed the beginningsof medicine’s ongoing attempts to consolidate its professionalpowers and social legitimacy. Meanwhile, sociology(the term being first coined by Auguste Comte in 1838) wasbeginning to emerge as a distinct discipline.In the UnitedStates, for example, Herbert Spencer’s The Principles ofSociology (three volumes, 1876–1896) was a seminal33MEDICAL SOCIOLOGYFREDERIC W. HAFFERTYUniversity of Minnesota, DuluthBRIAN CASTELLANIKent State University331Bryant-45099 Part VII.qxd 10/18/2006 7:22 PM Page 331publication, along with the establishment of the firstAmerican sociology course (“Elements of Sociology” atthe University of Kansas, Lawrence, in 1890), and thefounding of the first department of sociology (at theUniversity of Chicago in 1892 by Albion Small—who threeyears later also would launch the first sociology journal,American Journal of Sociology [AJS], in 1895).Examples of work from this time period that formallylink “medicine” and “sociology” include two articles byCharles McIntire (1915, 1991) (“The Importance of theStudy of Medical Sociology”—first published in 1894 andreprinted in Sociological Practice—and “The Expanseof Sociologic Medicine”) along with two key books, thefirst by Elizabeth Blackwell (1902) (Essays in MedicalSociology) and the second by James P. Warbasse (1909)(Medical Sociology: A Series of Observations TouchingUpon the Sociology of Health and the Relations ofMedicine). The second McIntire article is of particularinterest because of where it appeared—in the Journal ofSociologic Medicine, which was published not by a sociologyassociation but by the American Academy of Medicine.This journal, with its distinctive sociological title andmedical “residence,” existed for a scant four years(1915–1919) before both the parent and the journal disappearedfrom view. The American Public HealthAssociation hosted a similar sociologic offspring—its“Section of Sociology”—for a slightly longer period oftime (1909–1921), but with a similar demise (Bloom2002).It would take another quarter century before thenext medical sociology journal (Journal of Health andHuman Behavior—see below) appeared.The initial timing and brief duration of these linksbetween medicine and sociology reflected a much broadertransformation taking place within allopathic medicine andbetween medicine and society, as both rushed to affirm the“scientific side” of medicine (Starr 1982; Stevens 1971).As medicine grew in clinical effectiveness and organizationalcomplexity, however, the social-psychological andbehavioral sides of medicine began to atrophy—withinstruction, research, and principles relegated to “secondorder”medical fields such as psychiatry and public health.While scattered “sociology of medicine” articles wouldcontinue to appear (albeit infrequently) in medical journalsbetween 1920 and 1950 (Lawrence J. Henderson’s [1935]“Physician and patient as a social system” being a notableexample), the few that did surface would have a far greaterimpact on sociology than on medicine (one famous “benefactor”of the Henderson article, for example, was TalcottParsons). In 1960, E. Gartly Jaco published what wouldbecome the first substantive disciplinary journal in medicalsociology, the Journal of Health & Human Behavior(JHHB).In the spring of 1967, the American SociologicalAssociation (ASA) took JHHB under its organizationalwing where it was renamed the Journal of Health andSocial Behavior (JHSB). Eliot Freidson was the first editor.This same year also marked the first issue of SocialScience & Medicine (SS&M), with its distinctivelyinternational and multidisciplinary social science focus.By the early 1970s, the medical sociology section of theBritish Sociological Association had established its ownorganizational footprint, and in 1979 published its own“medical sociology” journal (Sociology of Health &Illness). Like SS&M, it too would have an internationaland multidisciplinary focus (Jobling 1979).During the 1950s and 1960s, the field of medical sociologyunderwent an explosive period of growth—beforepeaking in the early 1970s (Bloom 2002; Day 1981).During these two decades, the field enjoyed considerableacademic excitement and success, including what todaymight be considered a lavish amount of grant support, bothfrom private foundations and the federal government. Atits peak in the early 1970s, for example, the NationalInstitute of Mental Health subcommittee for social sciencetraining was awarding 1,500 graduate student stipends peryear—80 percent of which went to sociology departments.The number of stipends was well in excess of what wasneeded to support medical sociology graduate students—and thus the entire field of sociology benefited from thisphilanthropic and federal largess (Bloom 2002). Even thefounding of the medical sociology section itself and theASA’s decision to adopt the JHSB were underwritten byoutside funding.Membership in the new ASA section (established in1959) was mercurial. In less than a year, the medical sociologysection grew to 561 members. By 1964, membershiphad soared to nearly 900 (which, not incidentally, is closeto the section’s membership today). In less than a halfdozen years, the field went from publishing introductionsto the field (Anderson 1952; Hall 1951) to summativereviews (one notable example is Eliot Freidson’s [1961]“The Sociology of Medicine: A Trend Report andBibliography,” published as a special issue in CurrentSociology).By the mid-1970s, however, there were signs of trouble(Bloom 2002; Day 1981). Established funding streams haddried up and were not replaced by alternative resources.Section membership had plateaued and coverage ofmedical/health issues in flagship sociology journals, suchas the AJS and the American Sociological Review, becamemore infrequent. Meanwhile, colleges and universitieswere undergoing their own upheavals. Faced with considerablefinancial pressures, schools looked to trimprograms, and sociology was high on a number of lists.As one small but indicative example, Yale University’sDepartment of Sociology, which housed the first medicalsociology program in the United States, decided in the1990s to eliminate that program.The 1980s and 1990s were a difficult time for allopathicmedicine as well. The rise of managed care, the commodificationof medical services, and the discovery of medicineby Wall Street and corporate America during the“go-go” years between 1985 and 1997 had earth-shatteringimplications for the future of medicine as an autonomousprofession.332–•–SOCIAL INSTITUTIONSBryant-45099 Part VII.qxd 10/18/2006 7:22 PM Page 332The 1970s through early 1990s also were a time of vigorousdebates within academic sociology about the fateand future of allopathic medicine as a profession (Haffertyand Light 1995; Hafferty and Wolinsky 1991). Beginningwith Eliot Freidson’s (1970a, 1970b) transformativeProfession of Medicine and Professional Dominance, anumber of distinguished medical sociologists in the UnitedStates (Mark Field, David Frankford, Marie Haug, EliotKrause, Donald Light, John McKinlay, Fredric Wolinsky)and elsewhere (David Coburn, Julio Frenk, Rudolf Klein,Magali Larson, Gerald Larkin, Elianne Riska, Evan Willis)began to debate the changing fortunes of organizedmedicine’s status as a profession (Hafferty and McKinlay1993). Once again medicine and sociology crossed paths.It is worth noting, however, that by the time organizedmedicine began to mount a campaign to reestablish its professionalstatus and stature, sociologists had moved on toother debates (Castellani and Hafferty 2006).Issues of Identity and IdentificationFrom its very conception as an academic entity, medicalsociology has been plagued by issues of identity (self) andof identification (others). On the one hand, the study ofmedical and health issues offered sociology great challengesand opportunities (Fox 1985). On the other hand,these same opportunities had the potential to strip sociologyof its unique perspective (Bloom 1986). One hallmarkof this tension is the now 50-year-old debate about whetherthe ASA’s section should be named “medical sociology” orwhether 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 a sociology of and asociology in medicine. The problem is one of placementand perspective. The former (of ) reflects situations wheresociologists maintain their disciplinary base (an academicsociology department for example) and train their sociologicallens on fields of inquiry (such as medicine) for thepurpose of answering sociological questions. The latter(in) connotes a state of affairs where sociologists work, forexample, in a medical setting and employ sociologicalconcepts and perspectives to solve problems that aredefined as such by medicine. Sociology of medicine thusbecame considered (by academically based sociologists)as more in keeping with the sociological tradition, with thepresumption being that those operating from a sociology inmedicine ran the risk of being co-opted or at least corruptedby the medical perspective. More recently, therehave been efforts to “retire” this distinction by insistingthat sociology has passed through its of/in phase and hasgraduated into a sociology with medicine (Levine 1987).This is wishful thinking. Organized medicine remainsone of the most powerful social institutions in moderntimes—forces of deprofessionalization notwithstanding.Furthermore, medicine has little incentive (then ornow) to welcome sociology to its table unless it feels thatsociology can help solve issues or problems—as definedby medicine (and not sociology). Under such circumstances(andexpectations),anyworkingrelationshipbetweensociology and medicine involves considerable potential forsociology to undergo disciplinary co-option. Sociologistswho work in medical settings must be particularly sensitiveto these issues. Often they function betwixt andbetween, receiving little respect from physicians or fromtheir academically based peers who consider their “wayward”colleges to be too “applied.” Whatever the particulars,organized medicine retains considerable institutionalpower 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 ofthings, and this is what makes the medical perspective sopotentially corrupting.Medical Sociology and Medical Education'The move to introduce medical sociology into the medicalschool and nursing curriculum played an importantrole in the discipline’s evolution as an institutional entity.The first beachhead came in 1959, when Robert Strausfounded the first Department of Behavioral Science at theUniversity of Kentucky. Straus also helped to found, in1970, the discipline’s first professional association(Association for the Behavioral Sciences and MedicalEducation). For Straus, “behavioral science” (note the singularform) reflected the intersection of medical sociology,medical anthropology, and medical psychology—andtherefore represented a unique and transcending socialscience discipline. The field quickly established a presencewithin a number (but not all) of medical schools during the1960s and 1970s, particularly in those 40+ communitymedical schools that were being founded during the 1970sand 1980s. Nonetheless, the field’s fundamental identitywithin the basic science and clinical arms of the medicalschool was—and would remain—marginal and suspect.As departments and programs of behavioral science(s)began to grow in number and size, once supportive alliessuch as psychiatry and community medicine began to mountcounteroffensives to reestablish control over domains ofmedical knowledge and instruction that once had been theirexclusive jurisdiction. Today, there are only three formallylabeled “Departments of Behavioral Science(s)” in theUnited States: the University of Kentucky College ofMedicine, the University of Minnesota Medical School–Duluth Campus, and Northeastern Ohio UniversitiesCollege of Medicine (NEOUCOM).Another indicator that points to the rather persistentmarginal status for the behavioral sciences (including medicalsociology) within medicine and medical education isreflected across the numerous national committees, commissions,and reports (dating back to the 1920s) that haveemphasized the necessary role of the social sciences inmedical education (Christakis 1995)—yet with littlechange over these decades in actual institutional andMedical Sociology–•–333Bryant-45099 Part VII.qxd 10/18/2006 7:22 PM Page 333instructional practices by medical schools. Bloom (1986)famously likened this ongoing state of affairs to “reformwithout change.” Straus’s sociology of and in medicinealso raises the question of whether there are two (or more)medical sociologies. One way to answer this question is toask whether the medical sociology taught/presented tomedical and/or other health science students, for example,is the same medical sociology presented to undergraduateand graduate medical sociology majors. Although we donot pretend to answer the question here, there is a sufficientlylarge body of relevant material to at least raise thequestion and suggest that there are, indeed, differences.Books by Thomas (2003) and Taylor and Field (2003),along with articles written for medical journals depictingsociology (Bilkey 1996; Chard, Lilford, and Gardiner1999; Chard, Lilford, and Court 1997; Chaska 1977;Petersdorf and Feinstein 1981; Ruderman 1981) are a goodplace to begin any such inquiry.Finally, we note that for some sociologists and sociologyprograms, the label applied is something to be courted, notcondemned. There is a vigorous movement within organizedmedical sociology (and sociology in general) to makesociology training more explicitly “applied” and or “clinical”in focus—with the goal to make students more “jobready” or employable postgraduation (Dolch 1990;Gabelko and McBride 1991; Haney, Zahn, and Howard1983; Hoppe and Barr 1990; Sengstock 2001).Medical Sociology as Sociology:Or,What Makes Medical Sociology Sociological?Any new or emergent subfield must draw on its parentdiscipline for theoretical, conceptual, and methodologicalsustenance. Thus, when Talcott Parsons (1951) began tocraft his now famous Chapter 10 of The Social System(“Social Structure and Dynamic Process: The Case ofModern Medical Practice”), he drew on core aspects ofsociological theory (e.g., the sociology of deviance, roletheory, etc.) to reframe issues of health and sickness froma functionalist perspective. Similarly, Eliot Freidson(1970a, 1970b) drew on the sociology of knowledge andthe framing of social order as the product of ongoinghuman production (Berger and Luckman, 1966) to helpshape his analytical approach to medical work, language,and knowledge. As a final example, two of the mostfamous early studies of medical education, Robert Merton,Leo Reeder, and Patricia Kendall’s (1957) The StudentPhysician and Howard Becker et al.’s (1961) Boys in Whitewere less studies of medical education per se than theywere efforts to test competing theories of social action,including adult socialization. The Merton camp advocateda structural functionalist perspective and the Becker campa symbolic interactionist perspective. In short, the coreissue was sociological theory, not occupational training,and therefore both studies were a sociology of rather thana sociology in. Medical education was “simply” the backdropor battlefield (Hafferty 2000).It seems reasonably self-evident that “medical sociology”must involve the application of sociological knowledgeand concepts to issues of health and illness. It isdistinct in its approach because it considers the import thatsocial and structural factors have on the disease and illnessprocesses as well as on the organization and delivery ofhealth care. This includes factors such as culture (e.g.,values, beliefs, normative expectations), organizationalprocesses (e.g., the bureaucracy of hospitals), politics (e.g.,health care policy, political ideology), economics (e.g.,capitalism, the stock market, the costs of health care), andmicrolevel processes such as socialization, identity formation,and group process.All of this conceptual blocking notwithstanding, whatwe have remains too limiting a definition. It is not enoughthat someone labeled a “sociologist” employs sociologicalconcepts to answer questions if the questions themselvesare defined/framed in a nonsociological manner. Askingsociologists to help solve the “problem of patient compliance”proposes that the sociologist take on a medical definitionof the situation (where any deviation from “doctor’sorders” is considered the responsibility and fault of thepatient). Lost in the shuffle of who gets to define the topicsand terms is the fact that physicians and patients interactwithin a highly complex system involving medicineand society, along with broader social issues such as therole of experts in society or the social management of risk.There is another question here as well. Where and howdoes medical sociology contribute to the greater sociologicalenterprise? More specifically, where do we findevidence that medical sociologists/sociology directlycontributes to the advancement of sociological theory ormethods? The question is not rhetorical. Much of AnselmStrauss’s early work on grounded theory (Glaser andStrauss 1967) came via research on the topics of death anddying (Glaser and Strauss 1965, 1968; Strauss and Glaser1970). On the other hand, while it is clear that ErvingGoffman’s (1986) work on stigma has been widelyemployed within medical/health sociology, and while it isequally clear that the concept has great applicability to thesociology of chronic illness and the sociology of disability/disability studies, it is less clear how studies in these areashave contributed to the conceptual development of stigmaas a sociological concept and therefore as a tool that can beapplied by social scientists studying issues other than medicine.Finally, we have a third question related to the multiplemedical sociology question raised above. It is not alwaysself-evident how the work of medical sociology differsfrom that of medical anthropology, medical economics,health policy, medical epidemiology, and public health. Assuch, is medical sociology itself a unique and singular perspective?Asked in a more sociological manner, Can wedisentangle “medical sociology” from the broader socialcontext in which it functions? To answer this question, wewill briefly explore differences between U.S. and Britishmedical sociology.334–•–SOCIAL INSTITUTIONSBryant-45099 Part VII.qxd 10/18/2006 7:22 PM Page 334THE CASE OF BRITISH MEDICAL SOCIOLOGYIn addition to the possibility that medical (nursing, healthscience, etc.) students receive a different medical sociologythan what is taught to sociology graduate students,there appears to be considerable (and important) differencesbetween British and American medical sociology.We begin by noting that the parent disciplines (British andAmerican sociology) themselves harbor key differences(Abbott 2000). British sociology is more theoreticallyinclined, more accepting of qualitative research strategies,and more critical of “abstract empiricism” (not only withrespect to data analysis but also with respect to the verydefinition of data itself). There also are differences in theoreticalconstructs. British sociology, for example, has astrong tradition focusing on the “sociology of the body”(e.g., “constructing the body” or “gender, sexuality, andthe body”) (Shilling 2004; Turner 1992, 1996)—somethingmuch less visible in U.S. sociology. There also aredifferences in the use of analytic concepts—the British useof social class and the American use of socioeconomic statusbeing one example (Halsey 2004; Reid 1979; Staceyand Homans 1978). Finally, we can point to significant differencesbetween the U.S. and British health care systems.The American system is more capitalistic and “market oriented,”while the British have a national health systemorganized and controlled by the state. Indeed, there arethose who believe that while the British have a coherentand organized health care “system,” the American arrangementof competing capital interest is, at best, a “nonsystemsystem.”All these differences are reflected in the focus and toneof British versus American medical/health sociology.Comparisons between White (2002) and U.S. textbookssuch as Conrad (2005) and/or Weitz (2003) show differencesin content and context. Chapter titles in White (e.g.,“Foucault and the Sociology of Medical Knowledge,”“Postmodernity, Epidemiology and Neo-Liberalism,” and“Materialist Approaches to the Sociology of Health”) haveno parallel in Conrad or Weitz.We continue to see these same differences in themedical/health sociology taught to British medical versusAmerican medical students. One major difference is theuse of medical/health sociology textbooks. Not only isthere a market for such textbooks within British medical(and/or other health science) education, but the volumesthemselves are formally identified as health and/ormedical sociology text (Scambler 2003; Taylor andField 2003; Thomas 2003). There are no such textbooksin the United States. Furthermore, in the rare instancewhen textbooks are used in the United States, theoperative label used is “behavioral science” (Sahler andCarr 2003). Even here, most “behavioral science” textbookssold in the United States are “board review”(Fadem 2001) or biostatistics (Gravetter and Wallnau2003) books.Similar differences can be found with other types ofmedical curriculum materials (Cook 2004; Iphofen andPoland 1997; Kitto 2004; Turner 1990). The article byCook (2004), for example, describes course materials forhealth professional students built around “the concepts ofdifferentiation, commodification, and rationalization(associated with the work of Émile Durkheim, Karl Marx,and Max Weber, respectively),” with these materials providing“a useful conceptual ‘launching pad’ for understandingkey changes to medicine and doctor-patientrelationships since pre-modern times” (p. 87). Similarly,the article by Kitto (2004) describes a new “health, knowledge,and society” curriculum for medicine, nursing, andhealth sciences students built around “aspects of C. WrightMills’ sociological imagination to teach 1st year medicalstudents the importance of analysing the social aspectsof health and illness in medical practice” (p. 74). Coursematerials with titles or rationales such as these simply donot exist within U.S. medical education. In the UnitedStates, behavioral sciences faculty are urged by students(via course evaluations) and administration (also driven bystudent evaluations) to be “relevant,” “applied,” “practical,”“case based,” and/or “patient centered”—all antonyms forthe dreaded terms “theory” or “theoretical” (which areinterpreted by U.S. medical students as having little to noapplicability to issues of patient care). Moreover, even ifwe were to sweep away the stigmatizing presence of theoreticalmaterials, the fact remains that medical students(along with many basic science faculty) consider the entirefield of behavioral/social science to be “soft” and “subjective”when compared with the remaining basic sciences(pathology, pharmacology, molecular and cell biology,etc.) and clinical coursework. Within U.S. medical educationcircles, data demonstrating that U.S. medical studentslearn better when course materials are “patient oriented”rather than “theoretically oriented” (Leigh and Reiser1986) have great face validity.'Theoretical Passages through Medical Sociology'As William Cockerham (2001) explains in his essay“Medical Sociology and Sociological Theory,” becausemedical sociology is an applied field of study, there is atendency to think that it lacks a theoretical rationale for thevarious topics it studies. Such conclusions are false. As weexplained above, the general aim of medical sociology(whether the sociologist be Talcott Parsons or a newlyhired junior faculty person or research associate) is toapply sociological theory and concepts to the topics ofhealth and health care. This is true of both the sociology ofand in medicine (Bloom 2002; Gerhardt 1989).Obviously, an important part of what medical sociologists“know”—independent of what they study—is sociologicaltheory. As each cohort of medical sociologists istrained, they learn not only the older canon of sociologicaltheory—what has gone on before them—but also the latestMedical Sociology–•–335Bryant-45099 Part VII.qxd 10/18/2006 7:22 PM Page 335theoretical advances. One hallmark of any academic disciplineis how each new cohort of scientists goes aboutapplying this “new-found” theoretical knowledge to whatthey seek to examine and understand. This, in turn,advances the field. A survey of the medical sociology literaturesuggests just this process to be the case (Gerhardt1989).While such an unfolding of the field certainly representsadvancement, this progression, for medical sociology,has not been linear, nor has it been entirelycumulative. There also is much debate within medicalsociology about the validity of applying various sociologicaltheories to the fields of medicine and health care—one such example being the case of postmodernism(Cockerham 2001). Moreover, there are a variety of rifts inthe field over the epistemological assumptions behindmany of these theories. These rifts concern, for example,the validity of deductive reasoning and the linear model ofstatistics, the reliability of qualitative methodology andscientific representation, the appropriateness of varioussociological units of analysis—micro, meso, macro—andthe authority of medical and sociological knowledge(Annandale 1998; Levine 1995; Link 2003; Williams2001). Finally, it appears that while different theories areuseful in some areas, are less appropriate in others.Postmodernism, for example, is a useful way to critiquethe power of medical knowledge. It is, however, not muchhelp in studying social stress or the social distribution ofhealth and illness.Despite the complexity and nuances of thesedifferences—yet in many ways because of them—medical sociology is a theoretically rich and diverse fieldof study. Our purpose in this section is to provide a quickoverview of this richness by surveying some of the moreimportant sociological theories that have been employedby medical sociologists over the past 50 years. While nostrict chronology is implied in our review, it is historicallyaccurate to label the first four theoretical orientationsas “classical” sociological theory, while theremaining three are more recent in both origin and applicationwithin the field.The first major theoretical passage through medicalsociology is structural functionalism. Grounded in thework of Talcott Parsons (1951), this theory takes a systemsview of health and illness, focusing on the functionalrole that social institutions such as medicine playin maintaining the well-being of society. Despite thecontroversy that ensued during the 1960s and 1970sregarding the legitimacy of this perspective, it retainsconsiderable influence and relevance (Williams 2005).Not only did the presence of Parsons (as probablythe most famous sociologist of his time) and theutility of structural functionalism help to establish thestudy of health and illness as a worthy sociologicalendeavor, this lineague and apparent applicability alsohelped to develop several of the field’s most importantareas of research: the patient-physician relationship, thesick role (which later became known as illnessbehavior), the medicalization of deviance, and medicalprofessionalismThe second major theoretical passage is symbolic interactionism.Unlike strucutural functionalism, this perspectivefocuses more on the “microlevel” social processes ofhealth and health care and the important role that patientsand health care providers play in the creation, development,and transformation of the larger health care systemsof which they are a part. Through the work of AnselmStrauss, Erving Goffman, Howard Becker, NormanDenzin, and Kathy Charmaz (to name a few), this perspectivehas examined such important topics as how medicalschools socialize physicians, how patients learn the role ofbeing chronically or mentally ill, how physicians andnurses use the tools of medicine and the medical model toimpose on patients the normative expectations of society,how patients and their families manage the emotional laborof “illness,” and how patients and health care providersnegotiate the “politics” of daily medical encounters(Charmaz and Paterniti 1999; Gerhardt 1989). Like structuralfunctionalism, symbolic interaction theory predatesthe origins of modern-day medical sociology. For example,and as noted above, the two most famous studies of medicalstudent socialization, the Merton and Becker studies,built their respective investigations around this theoreticaldivide.The third major theoretical passage is conflict theory.Building on the work of Karl Marx and Max Weber andrepresented by more contemporary conflict theorists suchas Randall Collins (Collins and Makowsky 2004), thisperspective demonstrates how a society’s health andhealth care system is the result of a complex network ofconflicting and competing aims and interests based on differencesin income, gender, ethnicity, occupation, education,political affiliation, and so on (Navarro 2002).Conflict theory has been an important addition to the fieldof medical sociology because it has provided a muchneededtheoretical framework for the sociology of medicine,which has enabled medical sociologists to studysuch important topics as the social distribution of healthand illness, inequalities in the health care delivery system,the politics of health care policy, the economics of healthinsurance, and the failures of medicine to meet the healthcare needs of society (Gerhardt 1989; Henderson et al.1997; Navarro 2002).The fourth major theoretical perspective is feminism(Annandale 2003; Bury 1995; Clarke and Olesen 1999;Harkess 2000). Drawing on a variety of theories withinsociology, including symbolic interaction and conflicttheory, this perspective is concerned with the role thatpatriarchy, sexism, and gender play in the health and wellbeingof women. This perspective has examined importantissues such as the medicalization of the female body, thequality of health care women receive, and the role thatpatriarchy has played in the construction of medicalknowledge.336–•–SOCIAL INSTITUTIONSBryant-45099 Part VII.qxd 10/18/2006 7:22 PM Page 336The fifth major theoretical framework is poststructuralism.Based on the work of the French philosopher andhistorian Michel Foucault, this perspective examineshow people use the discourses of medicine, psychiatry, andscience to care for and control themselves and others(Petersen and Bunton 1997). Like Parsons before him,Foucault (1980, 1987, 1988) examined many of the keytopics in medical sociology, such as the history ofmadness, the medicalization of deviance, the birth of themodern medical clinic, and the various ways in whichhealth care providers and everyday people use medicalknowledge—think of, for example, the self-help literature,medical diets, and plastic surgery—to master and controlthe body.The sixth major theoretical passage is postmodernism.Building on the work of Lyotard, Baudrillard, andDerrida (Best and Kellner 1991, 2001; Fox 1994), thisperspective makes two radical assertions. First, it assertsthat medicine and biomedical science are nothing morethan discourses; powerful textual strategies that use avariety of binaries to control such important issues as (a)who is a medical expert (physicians versus traditionalhealers), (b) what constitutes valid medical knowledge(biology versus sociology), and (c) what sits outside“normal” ideas about health and health care (allopathicmedicine versus alternative medicine). Second, it assertsthat the dominating discourses of medicine and biomedicalscience need to be deconstructed and re-created toform new ways of thinking about health and health care,ways that are better able to address the postindustrial,globally interdependent, culturally fragmented, and nonlinearworld in which we now live.While postmodernism has provided an effective critiqueof modern medicine, critics point out that its wholesaledismissal of medicine and science as little more than normativeways of thinking oftentimes appears to “throw thebaby out with the bathwater.” While modern medicine andbiomedical science are hierarchically ordered and stilldecidedly patriarchal, it hardly seems reasonable to issue ablanket dismissal of biomedicine as little more than dominatingtextual strategies, given its role in improving thehealth of populations throughout the world. It is for thisreason that postmodernism has had a limited presence,impact, and utility in medical sociology.The seventh major theoretical passage is multiculturalism(Lupton 2003; White 2002). Drawing on the theoreticalperspectives of symbolic interactionism, conflict,feminism, poststructuralism, and postmodernism, this perspectivehas three major foci. The first is to examine thenegative impact that racism, sexism, homophobia, ethnocentrism,and cultural intolerance have on the health andwell-being of people. The second is to examine the ways inwhich culture affects the practice of medicine and biomedicalscience. The third examines the ways in which cultureaffects the health behaviors of different populations and,in turn, their use of contemporary Western health care(Lupton 2003; White 2002).TWO SUBSTANTIVE THEORIESTwo important substantive theories have played amajor role in medical sociology: (1) stress and coping(Cockerham 2004; Mirowsky and Ross 2003) and (2) professionalism(Hafferty and Light 1995; Hafferty andMcKinlay 1993). Stress and coping is situated at the intersectionof sociological traditions such as symbolic interactionism,conflict theory, and the sociology of work. Thesociological study on stress and coping itself has two foci:(1) the role that certain social factors (e.g., chronic poverty,lifestyle, health behaviors, occupation, gender, etc.) play inthe creation and exacerbation of stress and conversely,(2) the role that other social factors (e.g., marital status,strength of kinship networks, financial stability) play inassuaging stress.The sociological study of professions has a longer andmore storied history. While the sociological study of professionsand occupations date back to the turn of thecentury (Carr-Saunders and Wilson 1928), modern-day discussionsof medical professionalism are linked to Parsonsand his conception of medical dominance and autonomy asnecessary/functional for the well-being of both patients andsociety. Since Parsons, medical sociology has been engagedin an extended (and critical) examination of American medicine’sclaim to be a profession and the extent to whichmedicine has been able to maintain and live up to thisclaim. More specifically, medical sociology has examinedthe impact that medicine’s professional status has on thelives of physicians and patients, as well as also on the entireissue of how work is organized relative to free marketand bureaucratic organizational forms (Freidson 2001).According to the sociological analysis of medicine as a profession,medicine has gone through four major transformations:professional reform and rise (1890s–1930s),professional dominance (1940s–1960s), deprofessionalization(1970s–1990s), and organized medicine’s efforts toreclaim and redefine its professional status (1990s–present)(Castellani and Hafferty 2006). As an aside, both traditionaland modern-day medical sociology have strong disciplinaryties to the sociological study of profession. For example,the germination of medical sociology at Columbia, includingThe Student Physician study, arose out of a seminarorganized by Robert Merton and William J. Goode on professions(“University Seminar on the Professions inModern Society”).EMERGING THEMESWe see two emergent lines of sociological investigation aswe move to examine the future of medical sociology—each related to the other. The first is globalization. It is clearthat the world in which we live is going through majortransformation. This is particularly true of health and healthcare. We now live in a world where the spread of disease isglobal and where the poor health of one country affects theMedical Sociology–•–337Bryant-45099 Part VII.qxd 10/18/2006 7:22 PM Page 337well-being of others. Global financial markets and economiccompetition are challenging the ability of businessand governments to provide affordable health care. As such,we can expect that as globalization increases, so will itsimportance as a major theme in medical sociology (Bury2005). There are an increasing number of studies examiningissues of health and illness in countries other than theUnited States or Britain—far more than can be listed here.Resources such as Mechanic and Rochefort’s (1996)“Comparative Medical Systems” and Cockerham’s (2004)The Blackwell Companion to Medical Sociology (with its17 chapters on the United States, Canada, Mexico, Brazil,the United Kingdom, France, Germany, Sweden, Russia,Poland, the Czech Republic, South Africa, the Arab world,Israel, Australia, Japan, and the People’s Republic ofChina) provide an excellent beginning.The second and related theme is “complexity science.”As argued by a growing list of scholars, and due to keyfactors such as the information revolution and globalization,anj emerging theme within twentieth-first-centuryscience is complexity (Capra 1996, 2002). One exampleis the study of complex health networks (Freeman 2004;Scott 2000). While this perspective has been an importantpart of medical sociology since the 1970s, primarily interms of explaining the role that social support and kinshipnetworks play in promoting health and well-being, the latestadvances in the study of complex networks (e.g., smallworlds, scale-free networks) are providing new insightsinto the processes by which diseases spread and the waysthat health care providers can improve the health andwell-being of large populations (Watts 2004).As these two new themes suggest, the theoretical frameworkof medical sociology continues to change to meetthe new and contextually grounded needs of health careproviders and patients. Medical sociology is—andremains—a theoretically rich area of study.CONCLUSIONMedical sociology is a rich and diverse field that has, inits short history, gone through an appreciable amount ofinstitutional and intellectual development. Some of thesechanges have been good, as in the case of the continuingapplication of sociological theory to the field. Others, suchas the continued institutional difficulties medical sociologyhas had in finding a home in both sociology and medicaleducation, continue to plague the field, both in terms of itslegitimacy and the impact of its ideas. Despite these struggles,medical sociology remains an important part of thesociological family and the field of health care. This isparticularly evident given the increasing relevance thathealth and health care issues have—along with a “sociologicalunderstanding” of these issues—to the globalworld in which we now live. Following a tradition thatemphasizes theoretical relevance, the current generation ofmedical sociologists are once again embracing the latesttheoretical advancements in sociology (e.g., networkanalysis, complexity science, globalization) and advancingthem to help us better understand (as a global society) theevolving patterns of social relationship we call health andhealth care.".
- Medical_sociology wikiPageExternalLink Medsoc+Origin.htm.
- Medical_sociology wikiPageID "258952".
- Medical_sociology wikiPageRevisionID "604971334".
- Medical_sociology date "April 2014".
- Medical_sociology hasPhotoCollection Medical_sociology.
- Medical_sociology reason "the article is full of incorrect capitalization and formatting errors".
- Medical_sociology subject Category:Branches_of_sociology_(interdisciplinary).
- Medical_sociology subject Category:Medical_sociology.
- Medical_sociology subject Category:Public_health.
- Medical_sociology subject Category:Sociology_index.
- Medical_sociology type Abstraction100002137.
- Medical_sociology type AdministrativeUnit108077292.
- Medical_sociology type Branch108401248.
- Medical_sociology type BranchesOfSociology(interdisciplinary).
- Medical_sociology type Division108220714.
- Medical_sociology type Group100031264.
- Medical_sociology type Organization108008335.
- Medical_sociology type SocialGroup107950920.
- Medical_sociology type Unit108189659.
- Medical_sociology type YagoLegalActor.
- Medical_sociology type YagoLegalActorGeo.
- Medical_sociology type YagoPermanentlyLocatedEntity.
- Medical_sociology comment "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_sociology label "Medical sociology".
- Medical_sociology label "Medizinsoziologie".
- Medical_sociology label "Sociologia médica".
- Medical_sociology label "Социология медицины".
- Medical_sociology label "علم الاجتماع الطبي".
- Medical_sociology label "医療社会学".
- Medical_sociology sameAs Medizinsoziologie.
- Medical_sociology sameAs Sosiologi_medis.
- Medical_sociology sameAs 医療社会学.
- Medical_sociology sameAs Sociologia_médica.
- Medical_sociology sameAs m.01m4rs.
- Medical_sociology sameAs Q1916660.
- Medical_sociology sameAs Q1916660.
- Medical_sociology sameAs Medical_sociology.
- Medical_sociology wasDerivedFrom Medical_sociology?oldid=604971334.
- Medical_sociology isPrimaryTopicOf Medical_sociology.