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.

Nurses protesting at the Nurses' Protest at Trafalgar Square, UK on Saturday 12 September 2020
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Medical sociology
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  • Talcott Parsons
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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. Later other sociologists such as Eliot Freidson have taken a conflict theory perspective, looking at how the medical profession secures its own interests.[1]: 291  Key contributors to medical sociology since the 1950s include Howard S. Becker, Mike Bury, Peter Conrad, Jack Douglas, Eliot Freidson, 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 and bioethics. In Britain, sociology was introduced into the medical curriculum following the Goodenough report in 1944: "In medicine, 'social explanations' of the etiology 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

Samuel W. Bloom argues that the study of medical sociology has a long history but tended to be done as one of advocacy in response to social events rather than a field of study. He cites the 1842 publication of the sanitary conditions of the labouring population of Great Britain as a good example of such research. This medical sociology included an element of social science, studying social structures as a cause or mediating factor in disease, such as for public health or social medicine.[2]: 11 

Bloom argues the development of medical sociology is linked to the development of sociology within American universities. He argues that the 1865 creation of the American Social Science Association (ASSA) was a key event in this development.[2]: 25  ASSA's initial aim was policy reform on the basis of science.[2]: 25  Bloom argues that over the next few decades the role of ASSA moved from advocacy to academic discipline, noting that a number of academic professional bodies broke away from the ASSA during this period, starting with the American Historical Association in 1884. The American Sociological Society formed in 1905.[2]: 26 

The Russell Sage Foundation, formed in 1907, was a large philanthropic organization which worked closely with the American Sociological Society, which had medical sociology as a primary focus of its suggested policy reform.[2]: 36  Bloom argues that the presidency of Donald R Young, a professor of sociology, that started in 1947 was significant in the development of medical sociology.[2]: 182  Young motivated by a desire to legitimize sociology, encouraged Esther Lucile Brown, an anthropologist who studied the professions, to focus her work on the medical professions due to medicines status[2]: 183 

Harry Stock Sullivan

Harry Stack Sullivan was a psychiatrist who investigated the treatment of schizophrenia using approaches of interpersonal psychotherapy working with sociologists and social scientists including Lawrence K. Frank, W. I. Thomas, Ruth Benedict, Harold Lasswell and Edward Sapir.[2]: 76  Bloom argues that Sullivans work, and its focus on putative interpersonal causes and treatment of schizophrenia influenced ethnographic study of the hospital setting.[2]: 76 

The Medical Profession

The profession of medicine has been studied by sociologists. Talcott Parsons looked at the profession from a functionalist perspective, focusing on medics roles as experts, their altruism, and how they support communities. Other sociologists have taken a conflict theory perspective, looking at how the medical profession secures its own interests. Of these, Marxist conflict theory perspective considers how the ruling classes can enact power through medicine, while other theories propose a more structural pluralist approach, exemplified by Eliot Freidson, looking at how the professions themselves secure influence.[1]: 291 

Medical Education

The study of medical education was a central part of the medical sociology since its emergence in the 1950s. The first publication onn the topic was Robert Merton's, The Student Physician. Other scholars who studied the field include Howard S. Becker, with his publication, Boys in white.[3]: 1 

The hidden curriculum is a concept in medical education that refers to a distinction between what is officially taught and what is learned by a medical student.[3]: 16  The concept was introduced by Philip W. Jackson in his book, Life in the classroom, but developed further by Benson Snyder. The concept have been criticised by Lakomski and there was considerable debate on the concepts within the educational community.[3]: 17 

Medicalization

Medicalization describe the process whereby an ever wider range of human experiences are understood is defined, experienced and treated as a medical condition. Examples of medicalization can be seen in deviance such as defining addiction or antisocial personality disorder as a medical condition. Feminist scholars have shown that the female body is prone to medicalization, arguing that the tendency of viewing the female body as the other has been a factor in this.[4]: 151 

Medicalization can obscure social factors by defining a condition as existing entirely within an individual, it can depoliticizing suggesting than an intervention should be medical when the best intervention is political, medicalization can give the profession of medicine undue influence.[4]: 152 

Social construction of illness

Social constructionists study the relationships between ideas about illness and expression, perception and understanding of illness by individuals, institutions and society.[4]: 148  Social constructionists study why diseases exist in one place and not another, or disappear from a particular area. For example, premenstrual syndrome, anorexia nervosa and susto appear to exist in some cultures but not others.

There are a broad range of social constructionist frameworks used in medical sociology that make different assumptions about the relationships between ideas, social processes and the material world.[4]: 149  Illnesses vary in the degree to which their definition is socially constructed and some illnesses are straightforwardly biologically.[4]: 150  For these straightforwardly biologically diseases it would not be meaningful to describe them a social construction, though it might be meaningful to study the social processes that resulted in the discovery of the disease.[4]: 150 

Some illnesses are contested when someone complains about a disease despite the medical community being unable to find a biological mechanism for disease. Examples of contested diseases include chronic fatigue syndrome, fibromyalgia and Gulf War syndrome. For contested diseases can be studied as social constructs but there is no biomedical understanding. Some contested diseases are accepted by the institutions of biomedicine such as chronic fatigue syndrome others are not such as environmental diseases.[4]: 153 

Sick role

The study of the social construction of illness within medical sociology can be traced to Talcott Parsons notion of the sick role.[4]: 148  Talcott Parsons introduced the notion of the sick role in his book The Social System.[5]: 211  Parsons argued that the sick role is a social role approved and enforced by social norms and institutional behaviours where an individual is viewed as showing certain behaviour because they are in need of support.[5]: 212 

Parsons argues that defining properties are that the sick person is exempt from normal social roles, that they are not "responsible" for their condition, that they should try to get well, and that they should seek technically competent people to help them.[5]: 213 

The concept of the sick role was critiqued by sociologists from a neo-marxist, phenomonological and social interactionist perspective, as well as by those with an anti-establishment viewpoint.[6]: 76  Burnham argues that part of this criticism was a rejection of functionalism due to its associations with conservatism. The sick role fell out of favour in the 1990s.[6]

Labelling theory

Labelling theory derived from work by Howard S. Becker who studied the sociology of marijuana use. He argued that norms and deviant behaviour are partly the result of the definitions applied by others. Eliot Freidson applied these concepts to illness.[5]: 226 

Labelling theory separates the aspects of an individuals behaviour that is caused by an illness, and that which is caused by the application of a label. Freidson distinguished labels based on legitimacy and the degree to which to this legitimacy affected an individuals responsibilities.[5]: 227 

Labelling theory has been criticized on the ground that it does not explain which behaviours are labelled as deviant and why people engage in behaviours which are labelled as deviant: labelling theory is not a complete theory of deviant behaviour.[5]: 228 

Mental health

An illness framework is the dominant framework for disease in psychiatry and diagnosis is considered worthwhile.[7]: 2  Psychiatry has emphasizes the biological when considering mental illness.[7]: 3  Some psychiatrists have criticized this model: some prefer biopsychosocial definitions, some prefer social constructionist models, others have argued that madness is an intelligent response if all circumstances are understood (Laing and Esterson). Thomas Szasz trained as psychiatrist argued that mental health was a myth in his 1961 book, The Myth of Mental Illness arguing that minds can only be ill metaphorically.[7]: 3 

The Doctor-Patient relationship

The doctor–patient relationship, the social interactions between healthcare providers and those who interact with them, is studied by medical sociology. There are different models for the interaction between a patient and doctor, which may have been more or less prevalent at different times. One such model is medical consumerism that has partly given way to patient consumerism.

Medical Paternalism

Medical paternalism is the perspective that doctors want what is best for the patient and must take decisions on behalf of the patient because the patient is not competent to make their own decisions. Parsons argued that though there was an asymmetry of knowledge and power in the doctor patient relationship the medical system provided sufficient safeguards to protect the patient justifying a paternalistic role by the doctor and medical system.[8]: 496 

A system of medical paternalism was prominent following the second world war through to the mid-1960s. Eliot Freidson writing in the 1970s referred to medicine as having "professional dominance" determining its work and defining a conceptualization of the problems that are brought to it and the best solutions.[8]: 497  Professional dominance is defined by three characteristics: having power over clients for example through dependency, knowledge asymmetry or location; control over juniors in the feel requiring deference and submission; and control over other professions either by excluding them from practice, or placing them under control of the medical profession.[7]: 161 

Yeyoung Oh Nelson argues that this system of paternalism was in part undermined by organizational change in the following decades in the US whereby insurance companies, managers and the pharmaceutical industry started competing for role of conceptualizing and delivering medical services, part of the motive being cost saving.[8]: 498 

Bioethics
Main article: Bioethics § Medical sociology

Bioethics studies ethical concern in medical treatment and research. Many scholars believe that bioethics arose due to a perceived lack of accountability of the medical profession, the field has been broadly adopted with most US hospitals offering some form of ethical consultation. The social effects of the field of bioethics have been studied by medical sociologists.[9]: 2  Informed consent, having its roots in biothetics, is the process by which a doctor and a patient agree to a particular intervention and has. Medical sociology study the social processes that influences and at times limit consent.[10]

Social medicine

Social medicine is a similar field to medical sociology in that it tries to conceptualize social interactions[11]: 241  in investigating how the study of social interactions can be used in medicine.[12]: 9  However, the two fields have different training, career paths, titles, funding and publication.[11]: 241 In the 2010s, Rose and Callard argued that this distinction may be arbitrary.[11]: 242 

In the 1950s, Strauss argued that it was important to maintain the independence of medical sociology from medicine so that there was a different perspective on sociology separate from the aims of medicine.[11]: 242  Strauss feared that if medical sociology started to adopt the goals expected by medicine it risked losing its focus on analysing society. These fears that have been echoed since by Reid, Gold and Timmermans.[11]: 248  Rosenfeld argues that the study of sociology focused solely on making recommendations for medicine has limited use for theory building and its findings cease to apply in different social situations.[11]: 249 

Richard Boulton argues that medical sociology and social medicine are "co-produced" in the sense that social medicine responds to the conceptualization of medical practices created by medical sociology and alters medical practice and medical understanding in response, and that the effects of these changes are then analyzed by medical sociology once again.[11]: 245  He argues that the tendency to view certain theories such as the scientific method (positivism) as the basis for all knowledge, and conversely the tendency to view all knowledge as associated with some activity both risk undermining the field of medical sociology.[11]: 250 

Medical anthropology

Peter Conrad notes that medical anthropology studies some of the same phenomena as medical sociology but argues that medical anthropology has different origins, originally studying medicine within non-western cultures and using different methodologies.[13]: 91–92  He argues that there was some convergence between the disciplines, as medical sociology started to adopt some of the methodologies of anthropology such as qualitative research and began to focus more on the patient, and medical anthropology started to focus on western medicine. He argued that more interdisciplinary communication could improve both disciplines.[13]: 97 

See also

References

Reid, Margaret (1976), "The Development of Medical Sociology in Britain", Discussion Papers in Social Research No 13, University of Glasgow, archived from the original on 2011-09-30, retrieved 2011-03-11

  1. Calnan, Michael (2015), Collyer, Fran (ed.), "Eliot Freidson: Sociological Narratives of Professionalism and Modern Medicine", The Palgrave Handbook of Social Theory in Health, Illness and Medicine, London: Palgrave Macmillan UK, pp. 287–305, doi:10.1057/9781137355621_19, ISBN 978-1-349-47022-8, retrieved 2021-11-06
  2. Bloom, Samuel William; Bloom, Samuel W. (2002). The Word as Scalpel: A History of Medical Sociology. Oxford University Press. ISBN 978-0-19-507232-7.
  3. Handbook of the sociology of medical education. Caragh Brosnan, Bryan S. Turner. London: Routledge. 2009. ISBN 978-0-203-87563-6. OCLC 442931243.{{cite book}}: CS1 maint: others (link)
  4. Bird, Chloe E.; Conrad, Peter; Fremont, Allen M.; Timmermans, Stefan (2010-11-29). Handbook of Medical Sociology, Sixth Edition. Vanderbilt University Press. ISBN 978-0-8265-1722-7.
  5. Cockerham, William C. (2017-04-21). Medical Sociology. Taylor & Francis. ISBN 978-1-317-21171-6.
  6. Burnham, John C. (2014-02-01). "Why sociologists abandoned the sick role concept". History of the Human Sciences. 27 (1): 70–87. doi:10.1177/0952695113507572. ISSN 0952-6951. S2CID 145639676.
  7. Rogers, Anne (2021). Sociology of mental health and illness / Anne Rogers and David Pilgrim. David Pilgrim (Sixth ed.). London, England. ISBN 978-0-335-24849-0. OCLC 1232510778.
  8. Cockerham, William C. (2021-03-22). The Wiley Blackwell Companion to Medical Sociology. John Wiley & Sons. ISBN 978-1-119-63375-4.
  9. Hauschildt, Katrina; Vries, Raymond De (2020). "Reinforcing medical authority: clinical ethics consultation and the resolution of conflicts in treatment decisions". Sociology of Health & Illness. 42 (2): 307–326. doi:10.1111/1467-9566.13003. ISSN 1467-9566. PMC 7012693. PMID 31565808.
  10. Corrigan, Oonagh (November 2003). "Empty ethics: the problem with informed consent". Sociology of Health and Illness. 25 (7): 768–792. doi:10.1046/j.1467-9566.2003.00369.x. ISSN 0141-9889. PMID 19780205.
  11. Boulton, Richard (August 2017). "Social medicine and sociology: the productiveness of antagonisms arising from maintaining disciplinary boundaries". Social Theory & Health. 15 (3): 241–260. doi:10.1057/s41285-016-0014-1. ISSN 1477-8211. S2CID 152247854.
  12. Čeledová, Libuše; Holčík, Jan (2019-05-01). Social Medicine: An Introduction to New Public Health. Charles University in Prague, Karolinum Press. ISBN 978-80-246-4276-5.
  13. Conrad, Peter (December 1997). "Parallel play in medical anthropology and medical sociology". The American Sociologist. 28 (4): 90–100. doi:10.1007/s12108-997-1021-4. ISSN 0003-1232. S2CID 144263774.

Further reading

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.; Ritchey, Ferris Joseph (1997). Dictionary of Medical Sociology. Westport, CT: 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 and 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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