A Brief Introduction to the Sociology of Health, Healing, and Illness & The Development of Scientific Medicine
Chapter 1: A Brief Introduction to the Sociology of Health, Healing, and Illness
Definitions of Medical Sociology
Ruderman (1981:927): Defines medical sociology as "the study of health care as it is institutionalized in a society, and of health, or illness, and its relationship to social factors."
American Sociological Association (ASA) (1986): States that medical sociology "provides an analytical framework for understanding the social contexts of health, illness and health care."
Why Study Medical Sociology?
Modern medicine has significantly improved life expectancy and disease treatment.
Despite these achievements, medicine is increasingly viewed with suspicion and ambivalence.
Medical sociology offers an analysis of medical discourse.
Its promotion of social models of health and illness has influenced the development of healthcare policy and practice.
Historical Development of Medical Sociology
Setting the Foundation: The Importance of Social Factors on Health and Illness
Many ancient physicians recognized a crucial interrelationship among social and economic conditions, lifestyle, and health and illness.
The Turn of the Century: Development of Social Medicine
The Industrial Revolution and rapid urbanization created a significant health crisis.
Grotjahn documented how social factors contributed to disease and illness.
The term "social medicine" was coined to describe efforts to improve public health.
Despite the focus on social medicine, germ theory primarily emphasized the biological aspects of illness.
The Early- to Mid-Twentieth Century: More Studies on Health and Medicine
Social surveys became a vital research technique during this period.
Parsons (1939): Conducted work focusing on medical professionals.
Rosen (1944): Studied specialization within medicine.
Hall (1946): Focused on informal medical practice.
The 1950s and 1960s: The Formal Sub-discipline Emerges due to Changes in Health, Healing, and Illness
Changing patterns of morbidity and mortality:
The primary causes of sickness and death shifted from acute, infectious diseases (e.g., influenza, tuberculosis) to chronic, degenerative diseases (e.g., heart disease, cancer).
The impact of preventive medicine and public health:
As the 20th century progressed, it became clear that protecting public health required considering social factors in addition to biological ones.
The impact of modern psychiatry:
The rise of psychiatry led to increased interest in the psycho-physiological basis of many diseases and illnesses.
The impact of administrative medicine:
Sociologists' skills in analyzing organizations and structures, identifying beneficiaries and those harmed, and examining consequences of alternative techniques proved valuable in complex organizational environments.
External Recognition and Legitimation
Two key events in the 1950s and 1960s contributed to the recognition of medical sociology:
Medical schools began hiring sociologists for their faculty.
Government and private foundations started providing funding for medical sociology research.
Institutionalization of Medical Sociology
Two additional important events solidified medical sociology:
In 1959, the ASA formally accepted medical sociology as a recognized section.
The ASA adopted a dedicated medical sociology journal, the Journal of Health and Social Behavior.
Foundational and Emerging Areas of Interest
Interest is rapidly expanding in two main topics:
Issues related to medical ethics:
This involves studying values, attitudes, and behaviors concerning ethical medical issues.
It also addresses social policy questions arising from these ethical considerations.
Issues related to managed care and health care reform:
Concerns about the high costs of healthcare and millions of Americans lacking access to quality healthcare have driven health care reform efforts in the United States.
Key issues include the challenges faced by the uninsured versus the underinsured.
Major Topics in Medical Sociology
Relationship between the social environment and health & illness:
Social epidemiology
Social stress
Health and illness Behavior:
Health behavior
Experiencing illness and disability
Health care practitioners and their relationship with patients:
Physicians and the profession of medicine
Medical education and the socialization of physicians
Nurses, mid-level health care practitioners, and allied health workers
Alternative and complementary healing practices
Physician-Patient relationship
The health care system:
Health care delivery
Social effects of health care technology
Comparative health care systems
Sociology’s Contribution to Understanding Health, Healing, and Illness
Sociology is defined as "the scientific study of social life, social change, and the social causes and consequences of human behavior" (American Sociological Association, 2002: 1).
The Sociological Perspective
Sociology seeks to understand "individual behaviors" by placing them within a social context.
This involves looking for social patterns and examining the influence of social forces or circumstances on individual behavior.
The Scientific Foundation of the Discipline
Sociology is a social science.
Throughout its formative years, sociological researchers typically adhered to the same basic model of science and scientific research used by colleagues in the natural and physical sciences.
The Scientific Process (Wallace's Wheel)
This model illustrates the cyclical nature of scientific inquiry, moving between:
Theory: Broad explanations.
Review of the Literature: Examining existing research.
Deductive Logic: Used for generating hypotheses and rationalizing concepts.
Hypotheses: Testable statements.
Research Design: Includes concept definition, sampling, instrument design (e.g., statistical design, scaling, measurement).
Data Collection Techniques: Such as direct observation, indirect methods, surveys.
Generalizations: Findings from research.
Inductive Logic: Used for concept reformation and proposition rearrangement, leading back to theory.
Data-Collection Techniques
Survey research:
The most common technique.
Measures attitudes and beliefs.
Relies on self-reported data.
Requires the use of proper sampling techniques to ensure representativeness.
Experimental research:
Designed to identify cause-and-effect relationships.
An experimental group receives the independent variable (treatment or intervention).
Observational research:
Involves the systematic observation of people in their natural environment.
Use of Existing Statistics:
Researchers can examine pre-existing data such as birth/death records, medical charts, insurance forms, or compiled statistics on mortality, morbidity, medical resources, or other aspects of healthcare systems.
Getting at Socially Constructed Reality
Sociological perspectives help understand the "socially constructed" nature of belief systems concerning health, illness, and healing practices.
The Role of the Medical Sociologist in the Twenty-First Century
Demonstrate and emphasize: The influence of cultural, social-structural, and institutional forces on health and illness.
Maintain spirit: Of free and critical inquiry in research and analysis.
Seek: Interdisciplinary cooperation to address complex health issues.
Chapter 2: The Development of Scientific Medicine
A Brief History of Medicine
Shifting character: From supernatural explanations to scientific understanding.
Struggle for acceptance: Scientific medicine faced difficulty gaining acceptance and its impact on patient cure lagged initially.
Emergence of institutional processes: Government, church, and other institutions played roles in shaping medicine.
Disease as a social issue: Debates around its inevitability and the balance between social vs. self-care.
Early Humans
Supernatural Belief Systems: Disease was often attributed to supernatural forces.
Bloodletting: A practice to drain disease from the body.
Trephination: Drilling holes in the skull to release evil spirits.
The First Physicians: Shamans and "witch doctors" served as early medical practitioners.
The Egyptian Civilization
Egyptian medical practices are well-documented due to the civilization's reputation for health and abundant written records.
They had codified guidelines for practice.
Medical organization was often integrated within religious structures.
Greek and Roman Societies
Hippocrates – the "Father of Medicine"
Established the principle of natural, rather than supernatural, explanations for disease.
Developed the humoral theory of disease.
Proposed four body humors: blood, yellow bile, black bile, and phlegm.
Emphasized human compassion and ethical standards.
Credited with the Hippocratic Oath, an enduring ethical guide for physicians.
Roman Medicine
Greek physicians began to filter into Rome starting in the century B.C.
Ascieplades: Initiated a general increased regard for physicians in Rome.
Roman Contributions to Medicine
Significant advancements in public health concerns:
Clean water systems.
Public baths for hygiene.
Sanitation ordinances.
Development of a system of hospitals.
Galen
The most pivotal figure of this era, whose ideas dominated much of medicine for the next centuries.
Made extensive contributions to the understanding of anatomy.
Medieval Medicine
Monastic Medicine
Disease was sometimes seen as a beneficial test of faith and commitment.
The presence of disease was frequently attributed to God’s punishment, satanic possession, or witchcraft.
Arabic Medicine
Built famous teaching hospitals.
Private physicians held high prestige.
Served as a crucial link between Greek and Renaissance medicine.
Scholastic Medicine
Emerged in the second half of the Medieval Era.
The Council of Clermont forbade monks from practicing medicine, deeming it too disruptive to monastic life.
Medical practice subsequently became the province of secular clergy.
This period saw widespread leprosy epidemics and the devastating Bubonic Plague.
Medicine in the Renaissance
Andreas Vesalius: Advanced anatomical study; was discredited for heresy by some for his findings.
Paracelsus: Conducted early pharmacological studies, contributing to the understanding of medicines.
Medical Specialization
Medical specializations became more pronounced, leading to distinct roles such as:
Physicians
Surgeons
Barber surgeons
Apothecaries
Medicine from 1600 to 1900
The Seventeenth Century
William Harvey: Made groundbreaking discoveries regarding blood and the circulatory system.
Clinical Medicine: Saw the evolution of the physician-patient relationship and a greater appreciation for the self-healing capacity of the body.
The 18th Century
Development of Modern Concept of Pathology:
Morgagni contributed to the anatomical concept of disease, linking symptoms to specific organ lesions.
The Emergence of Public Health and Preventative Medicine:
Jenner's discovery of vaccination against smallpox was a pivotal event in the history of preventative medicine.
The 19th Century
Hospital Medicine: Emerged due to the concentration of patients in central locations, facilitating observation, study, and application of cures.
Laboratory Medicine: Focused on the examination and application of theoretical knowledge.
Discovery of the Cell: A fundamental breakthrough in biological understanding.
The Germ Theory of Disease: Transformed understanding of disease causation.
Progress in Surgery: Emphasized the critical importance of asepsis (surgical cleanliness) in preventing infections.
The Ascendency of Medical Authority in America
Early America
Native Americans often relied on supernatural explanations for disease.
Treatment of the sick was typically assigned to the "medicine man."
Early Colonists
Experienced difficult voyages followed by hardships upon arrival.
Epidemics and contagious diseases were the primary killers during the colonial years.
Colonists introduced several contagious diseases (measles, smallpox, mumps) that were unknown to Native Americans, decimating the native population.
Revolution to Mid-1800s
America's experience in the Revolutionary War highlighted the severe lack of accurate knowledge about disease causation and treatment.
There was a reluctance to test and experiment with new procedures, exemplified by the treatment and death of George Washington.
1850 Onward
Three key events combined to "professionalize" medicine:
The Civil War
Medical Advancements
The Organization of Professional Medicine
The Civil War
Resulted in deaths; one-third occurred in battle, while two-thirds were from disease.
One in seven of all wounded in battle died.
Led to the emergence of skilled nursing and ambulance corps.
Fueled a future focus on antiseptic care and treatment.
Medical Advancements
Pasteur's discovery that microorganisms cause disease is considered the single most important medical discovery.
The 1920s to 1940s were the peak years of pharmacological success.
These advancements motivated the organization of professional medicine and strengthened the emerging American Medical Association (AMA).
Ultimately led to the Great Trade of 1910.
The Organization of Professional Medicine
During the first half of the century, various localities and states formed professional medical societies.
Representatives of these societies met in 1847 to establish the American Medical Association (AMA).
Forces Stimulating Professionalism
Three pivotal events strengthened the position of the AMA in medicine:
The discovery of the germ theory of disease.
The implementation of medical licensure requirements.
The formal regulation of medical education, significantly influenced by the Flexner Report.
Great Trade of 1910
Impact of the Great Trade:
Led to the rise of medical authority.
Transformed medicine from a weak and poorly regulated field to one with professional power and prestige.
Spawned a concerted effort towards autonomy, with little or no government control over the medical profession.
Perspectives on the Ascendancy of Medical Authority
Paul Starr: Argued that the concentration on autonomy has led to the corporatization of medicine and its transformation into an economic model.
Vincente Navarro: Suggested that powerful social groups (government, wealthy elite, corporate structures) have been well-served by this transformation and have guided its evolution.