SOC 146 Medicalization Midterm Study Guide

GQ: What are some of the differences between sociology in medicine and sociology of medicine?

Sociology in Medicine:

• sociologist works in collaboration with medical institutions

• research problems are defined by physicians or other medical professionals

Sociology of Medicine:

• sociologist studies medicine as an institution of behavior system as an “outside”

• less collaborative

• critical evaluation of medical categories, knowledge, actors, and institutions

GQ: What are some of the questions of topics of focus at the macro-peso, and micro-levels in medical sociology?

At the macro level, medical sociology examines how large-scale social forces like inequality, policy, and culture shape population health. At the meso level, it focuses on how institutions like hospitals and medical schools create and manage definitions of illness, while the micro level looks at individuals’ experiences, meanings, and interactions related to health and illness.

GQ: What is a fundamental social cause of health inequality, and how does it make health interventions difficult?

A fundamental social cause of health inequality is socioeconomic status (SES) because it provides access to flexible resources like money, knowledge, and social connections that protect health. It makes interventions difficult because when one risk pathway is reduced, people with more resources can use new advantages, so inequalities persist over time.

GQ: What is the biomedical model and some of its key assumptions?

The biomedical model is the dominant Western approach to medicine that views disease as a problem of biological malfunction within the body. It assumes a mind–body separation, that illnesses have specific physical causes, and that scientific and technological interventions are the primary solutions.

GQ: How are illness, disease, and sickness related to each other, and what role do social relations play in each?

Illness is a person’s subjective experience of symptoms, disease is the medical classification of a biological or psychological dysfunction, and sickness refers to the social meanings and expectations attached to those conditions. Social relations shape how symptoms are interpreted, whether they are recognized as disease, and how others respond to someone seen as sick.

GQ: What are some of the defining features of the “sick role” and how useful is it for understanding health and illness?

The sick role describes how a sick person is excused from normal responsibilities, is not blamed for their condition, must want to get better, and is expected to seek medical help. It is useful for showing how illness is socially regulated, but it is limited because it assumes short-term illness, patient compliance, and equal access to medical care.

GQ: What is medicalization and how does it relate to the politics of definition?

Medicalization is the process by which behaviors, traits, or life experiences become defined and treated as medical problems. It connects to the politics of definition because different groups compete to decide whether something is labeled as sin, crime, or sickness, which determines who has authority and how the issue is managed.

GQ: What factors gave rise to the professionalization of medicine and rise of medical authority in the United States?

The professionalization of medicine and rise of medical authority in the U.S. came from efforts to standardize training and exclude competitors, especially through organizations like the American Medical Association, state licensing laws, and the reforms following the Flexner Report. Scientific advancements and alliances with institutions like hospitals and government agencies also increased medicine’s legitimacy and social power.

GQ: What is the relationship between cultural authority, social authority, and legitimacy?

Cultural authority is medicine’s power to define what is normal, real, or pathological, while social authority is the ability to influence or direct people’s actions. Both depend on legitimacy, meaning society accepts medical knowledge and expertise as valid and trustworthy.

GQ: How might we think about medical authority in today’s culture and institutional landscape?

Today, medical authority operates not just through individual doctors but through large institutions, professional guidelines, technologies, and public health systems that shape how we understand and manage health. It is reinforced by cultural trust in scientific expertise but also challenged by alternative health movements, patient advocacy, and unequal access to care.

GQ: How did the Flexner Report impact medical training in the United States, and what were some of the consequences?

The Flexner Report reshaped medical training by promoting scientific, laboratory-based education and raising standards for medical schools. Its consequences included the closure of many schools, higher costs and barriers to entry, and reduced racial, gender, and class diversity in the medical profession.

GQ: How does medical training encourage particular forms of patient-doctor interactions?

Medical training socializes doctors to focus on diagnosis, efficiency, and technical expertise, often encouraging emotional distance and viewing the body as an object of treatment. Through role modeling and workplace culture, students learn specific ways of speaking, behaving, and managing impressions in interactions with patients.

How does the nature of the work done by nurses differ from doctors, and what unique challenges does this create for their status as professionals?

Nurses’ work centers on ongoing, hands-on care, emotional support, and seeing patients as whole people, while doctors’ work is more focused on diagnosis and technical treatment. Because nursing is associated with caring labor, which is feminized and often invisible, nurses face challenges gaining the same authority, autonomy, and status as physicians despite being highly skilled professionals.

GQ: What does it mean to call stigma a process, and what are its defining features?

Calling stigma a process means it is not just an attitude but a series of linked social actions that unfold over time. Its defining features are labeling human differences, stereotyping those differences, separating “us” from “them,” status loss and discrimination, and the exercise of power.

GQ: How does stigma relate to (modified) labeling theory?

Stigma is central to labeling theory because being labeled as deviant can change how others treat a person and how they see themselves, sometimes leading to secondary deviance. Modified labeling theory adds that even awareness of stereotypes and possible rejection can cause stress, secrecy, and withdrawal, affecting people’s lives whether or not they fully internalize the label.

GQ: What are the different functions and consequences of stigma?

Stigma functions to keep people down (supporting domination and exploitation), keep people in (enforcing conformity and social control), and keep people away (encouraging avoidance of those seen as “contagious” or different). Its consequences include status loss, discrimination, reduced access to resources like healthcare and housing, and negative effects on identity and well-being.

GQ: What is the relationship between stigma, courtesy stigma, and medicalization?

Medicalization can reduce blame by framing a condition as medical, but it can also increase perceptions of difference, permanence, and dangerousness, which can reinforce stigma. Courtesy stigma occurs when stigma extends to people associated with the stigmatized individual (like family members), showing how medical labels can affect not just patients but their social networks.

GQ: How does surveillance medicine differ from other “medical cosmologies”?

Surveillance medicine differs from earlier models by focusing on monitoring risk and detecting potential disease in people without symptoms, rather than treating visible illness. Instead of a clear divide between healthy and sick, it views everyone as existing along a spectrum of risk and in need of ongoing medical oversight.

GQ: What are the consequences of medical technologies and the notion of being “at risk”?

Medical technologies expand the ability to detect risk before symptoms appear, turning more people into “patients-in-waiting” who are monitored and managed over time. Being labeled “at risk” can shape identity, create anxiety and family tensions, and influence access to resources and medical decisions even in the absence of disease.

Micro/ Individual Level (bottom)

perceptions and experiences of health and illness (ex) if you go in the cold you will get sick

Meso/ Social Level (middle)

social construction of disease categories and medical knowledge within organizers

• how do we determine if someone is healthy?

Macro/ Societal Level (upper)

political, economic, and cultural contexts that shape national and global health outcomes

Fundermental Causes

resources that can help protect health and reduce both morbidity and mortality

• involve resources that are flexible and are useful across time and place

Socioeconomic Status (SES) as a Fundamental Cause

Low SES —→ Higher exposure to risk factors (ex. unsanitary conditions, access to healthy food) and lower access and utilization of resources once disease occurs (ex. diet and exercise, sources of support) ——→ higher risk of diabetes, cancer, and heart disease

• when one mechanism is blocked, it will be replaced by another mechanism

What are the four features of a fundamental cause?

1. Associated with multiple disease outcomes

2. Affects these outcomes through multiple risk factors

3. Involves access to resources that help avoid risks or minimize consequences once a disease manifests

4. The association is reproduced over time

Illness

a persons experience and perception of their physical and/or mental state

Sickness

social and cultural beliefs and responses to illness and disease

Disease

illness identified and chatagorized through lens of physiological or psychological dysfunction

Talcott Parson’s “The Sick Role”

based on a structural functionalist framework that people need to work and be in sync and healthy in order for society to function

Sickness is a form of _______.

deviance

Assumptions of the Sick Role

1. Medicine is based on scientific and subjective knowledge

2. Doctor is competent and unbiased in applying that knowledge

3. The role of physician and patient are distinct

A “Sick” Person ______.

1. Is exempt from normal social role responsibilities and obligations

2. Cannot get better through an act of decision or sheer will

3. Is obligated to get well and desires to do so

4. Is obligated to seek technically competent help

Politics of Definition

involves groups competing to legitimate their categorization and control of deviance

What are the three major deviance paradigms?

1. Sin (Morality)

2. Crime (Criminalization

3. Sickness (Medicalization)

Medicalization

the process through which behaviors, traits, and experiences are identified, described, and/or responded to through a medical perspective

• Ivan Illich (1976) described the “medicalization of life”

Ho (2023)

Studied what percent of Americans take prescription medication on a regular basis

• in 2019: 52.2% of men and 62% of women

• Americans born after 2019 are predicted to spend more than half of their lives taking prescription medication

Levin and Bradshaw’s (2024) 10 Different Health Related Measures

10 different health-related measures:

• smoking, drinking, exercise, sleep, body mass index (BMI), blood pressure, resting pulse rate, fasting blood glucose, and cholesterol

1906 Pure Food and Drug Act

opposed advertising medicine to the public

American Medical Association (AMA)

established and introduced its own Code of Ethics

• large corporate entities threatened independent professionals

• cheaper malpractice insurance

• access to hospitals and other institutional resources

• social capital and referrals

Post Flexner Report Impacts

• racial, class and rural, and gender impacts

• significant reduction in the number of medical schools

• increased competition and cost of tuition

• decreased diversity

Post Flexner Report Gender Impacts

Flexner argued the decline in women medical students prior to his report was a sign they simply lacked interest in medicine

• many coeducational medical schools were shut down after the report

Bell Commission of 1987

Formed after the death of Libby Zion

• recommended attending physicians should always be present

• limit on work and education hours for residents

Impression Management

Medical training that involves learning the “right way” to play the role of a doctor

• example: crude jokes and “gallows humor” with peers

• a coping strategy or form of stress relief

• reinforce distinction between patient and doctor

Chambliss (1998)

Nurses demonstrate care through:

• face to face work with patients

• seeing patient as a whole person

• taking on further duties/filling in the gaps left by others (family members, physicians, etc.)

Care Work

nurses often find themselves in a challenging position

• their knowledge is seen as less than by doctors

• care work is feminized and devalued

Stigma

Goffman describes stigma as “an attribute that is deeply discrediting”

• has the power to spoil a persons social identity

Goffman’s Three Forms of Stigma

1. Physical and Body

2. Character

3. Group (ex) religion, race, nationality

Discredited Stigma

Stigmatized attribute tis immediately apparent or difficult to conceal

Discrediting Stigma

Stigmatized attribute is not immediately apparent or can be concealed

• invisible disabilities fall under this category

Stigma involves the co-occurance of:

1. Labeling human differences

2. stereotyping those differences

3. Separating “them” from “us”

4. Status loss and discrimination

5. POWER

Labeling Theory and Deviance

Stigma can be _______.

1, Experienced/ Enacted: has actually been stigmatized

2. Anticipated/ Felt: has the fear or thinks they will be stigmatized

3. Internalized: believe or reject feelings or stigmatizing

4. 4. Perceived: what we think society is going to stigmatize

Attribution Theory

medicalization may perception of blame and increases positive emotions and sentiment (ex) sympathy and anger

Essentialist Perspective

medicalization may increase perceptions of differentness, dangerousness, and permanence of a problem

Courtesy Stigma

those who interact with members of stigmatized groups can experience feeling stigma

Bedside Medicine

symptoms are the illness

Surveillance Medicine

replaced hospital medicine

• tests or assessments are applied to an asymptomatic population

• the population is grouped into those who are unlikely to have or develop a disease

• we are all “patients in waiting”

Four Vital Signs of Being at Risk

body temperature, pulse rate, respiration rate, blood pressure

Diagnostic Uncertainty

it is unclear if symptoms constitute a disease classification

• whether a disease is present even without symptoms

Pseudoaddition

when opioid dosage is too low, patients experiencing pain may exhibit similar behaviors to individuals with ‘true’ addiction

Sociology of Medicine: How does medicine as an institution impact social control?

Is sociology of medicine a social or biological issue?

Features of a Profession

1. Specialized knowledge and lengthy training

2. Altruistic (doing it for the public good)

3. Self policing and autonomous

4. Monopoly over practice