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. Later other sociologists such as Eliot Freidson have taken a conflict theory perspective, looking at how the medical profession secures its own interests. 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".

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.

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. ASSA's initial aim was policy reform on the basis of science. 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.

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. 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. 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 medicine's societal status.

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. Bloom argues that Sullivans work, and its focus on putative interpersonal causes and treatment of schizophrenia influenced ethnographic study of the hospital setting.

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.

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.

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. 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.

Medical Dominance
Writing the 1970s Eliot Freidson argued that medicine had reached a point of "Professional Dominance" over the content of their work, other health professions and their clients by convincing the public of medicine's effectiveness, gaining a legal monopoly over their work, and appropriating other "medical" knowledge through control of training. This concept of dominance was extended to professions as a whole in closure theory, where professions were seen as competing for scope of practice, for example in the work of Andrew Abbott. Coburn argued that the academic interest in medical dominance decreased over time due to the increased role of capitalism in healthcare in the US, challenges to the control of health policy by politicians, economists and planners, and increased agency of patients through their access to the internet. Kath M. Melia, sociologist nursing professor, argued that, so far as nurses were concerned the medical 'paternalistic' attitudes remained.

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.

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

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. 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. Illnesses vary in the degree to which their definition is socially constructed and some illnesses are straightforwardly biologically. 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.

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 myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia and Gulf War syndrome. For contested diseases can be studied as social constructs but there is no biomedical understanding. Some contested diseases, such as ME/CFS, are accepted by the institutions of biomedicine while others, such as environmental diseases, are not.

Sick role
The study of the social construction of illness within medical sociology can be traced to Talcott Parsons notion of the sick role. Talcott Parsons introduced the notion of the sick role in his book The Social System. 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.

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.

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. 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.

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.

Labelling theory separates the aspects of an individual's 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 individual's responsibilities.

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.

Mental health
An illness framework is the dominant framework for disease in psychiatry and diagnosis is considered worthwhile. Psychiatry has emphasizes the biological when considering mental illness. 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, who trained as psychiatrist, argued that mental health was a bad concept in his 1961 book, The Myth of Mental Illness, arguing that minds can only be ill metaphorically.

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.

A system of medical paternalism was prominent following the second world war through to the mid-1960s. Writing in the 1970s, Eliot Freidson 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 to them. Professional dominance is defined by three characteristics: practictioners having power over clients, for example through dependency, knowledge, or location asymmetry; control over juniors in the field, requiring juniors deference and submission; and control over other professions either by excluding them from practice, or placing them under control of the medical profession.

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.

Bioethics
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. 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.

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

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. 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. 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.

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. 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.

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. 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 argues that more interdisciplinary communication could improve both disciplines.