The Palgrave Handbook of Social Theory in Health, Illness and Medicine

F. Collyer

• Publisher: Palgrave Macmillan
• Year: 2015
• ISBN:
  9781137355621
• Topic: Ciencias sociales
• Subtopic: Sociología

This wide-reaching handbook offers a new perspective on the sociology of health, illness and medicine by stressing the importance of social theory. Examining a range of classic and contemporary female and male theorists from across the globe, it explores various issues including chronic illness, counselling and the rising problems of obesity.

Chapter 1

The Sociology of Health, Illness and Medicine: Institutional Progress and Theoretical Frameworks

Fran Collyer and Graham Scambler

As we write in the twenty-first century, the sociology of health and medicine sits as a distinct and growing speciality field of research and university teaching, found on all continents and within many countries, including the United States, eastern and western Europe, Australia, Britain, Japan, China, Brazil, South Africa and Mexico.

The sociology of health and medicine formed historically within the intellectual tradition of its parent discipline of sociology and was initially a Western, European and North American product. Assisted by generational change, vast social and political changes, as well as the development of new communications technologies; it is expected that in the twenty-first century, sociology – and the sociology of health and medicine – as fields of social practice and knowledge-making, will be increasingly diverse, as newer national sociologies strengthen and overcome the many structural impediments to contribute to these expanding global domains of knowledge production.

Organisations, associations, journals and the curricula

If we look closely at this history, the sociology of health and medicine began to take on an institutional form in the twentieth century with the establishment of the modern university system. The speciality field began its process of institutionalisation – that is, becoming concentrated, structured, formalised and broadly accepted as a legitimate and valuable scholarly activity – from about 1950. This coincided with the dominating presence of biomedicine and medical, professional power. As such, medical sociology can be seen to have developed in response to, and as a critique of, the biomedical paradigm (Nettleton 2006), and an argument can well be made that sociology itself – the parent discipline – had its institutional origins intimately tied to the professionalisation of medicine in the early decades of the twentieth century (see Collyer 2010). That said, the timing of the process of institutionalisation for the sociology of health and medicine was specific to each country. For instance, studies of the social aspects of health did not appear until the late 1960s in France, and the field has still to become institutionalised, in large part because its practitioners, unlike those in Britain, Australia or the United States, are full-time researchers rather than academic teachers and thus not required to produce curricula or textbooks (Herzlich 1985:121).

The processes of institutionalisation have also varied globally. In the United States for example, the field benefitted enormously from the ‘lavish’ amount of grant support from influential private foundations and the federal government between 1950 and 1970. This stimulated growth in the sociology departments and the Medical Sociology Section of the American Sociological Association (ASA) (Bloom 2000:27; Hafferty and Castellani 2007:332). It also encouraged an intense interaction between sociology and medicine (as well as the other health sciences), and Cockerham (2000) argues that it was the support from these disciplines that was critical to the growth of medical sociology, rather than from sociology itself, providing the fledgling medical sociologists with the ‘early recognition, funds and jobs … that were not forthcoming elsewhere’. Thus in the United States, much of the stimulus for medical sociology, and much of the activity of medical sociologists, occurred outside the sociology departments, ensuring that initially at least research addressed the concerns of medicine, public health and health administration rather than the central questions of sociology (Zimmerman 2000:1814). Nevertheless the field developed within the parent discipline of sociology, with external funding encouraging sociologists to remain within the sociology departments, and grow the departments, while working on projects with medicine. In Britain, the ‘impetus’ for the formation of the field of medical sociology was also external to the sociology departments. Many of the original members of the nascent Medical Sociology Group did not work in universities in the 1950s and 1960s, and the group was decidedly multi- or interdisciplinary (Collyer 2012a:102–3). As Margaret Stacey and Hilary Homans (1978:282) noted at the time, there was little ‘recognition on the part of mainstream sociologists that it is important to understand healthcare institutions if the society as a whole is to be understood’. Like their American counterparts, the early British medical sociologists largely pursued the interests of medicine, building a programme of sociology in medicine rather than of medicine (for a more detailed discussion of the debate over sociology in, rather than of, medicine, see Straus 1957; Cockerham 1983; Light 1992; Murcott 2001). Nevertheless, as Margot Jefferys (1986:52) points out, it was in the 1960s, in this interactive environment, that the ‘medical model’ (as it was later to be called) first came under scrutiny and criticism. In the Australian case, while the early networks of the 1950s were composed of individuals from many disciplines (particularly psychiatry), with an enthusiasm for the social aspects of illness, by the 1960s there were sufficient sociologists (and universities) for the formation of a Medical Sociology Section of The Australian Sociological Association (then known as the Sociological Association of Australia and New Zealand) (Collyer 2012a:125). Here the process of institutionalisation differed from those of both the United States and Britain, primarily because there was a close connection between the mainstream academic sociologists and the medical sociologists throughout the formative period. As occurred in the British case, there were many social psychiatrists and medical doctors participating in the annual Australian sociological conferences and seminars, making it relatively easy for sociologists to access the medical arena. Unlike the British and Americans, however, specialisation as a medical sociologist was not the norm in Australia until much later in the century (if at all), with many mainstream academic sociologists showing an interest in health or medicine at some time in their careers, and most importantly, there was an early and widespread acceptance of the subject as an appropriate focus for sociological investigation (Collyer 2012a:124,127). These three cases suggest the possibility for significant variation in the institutionalisation of the field, and as more is learned about disciplinary and sub-disciplinary formation in the Asian and African contexts, further lessons will no doubt be learned.

In the academic context, three of the major features of the institutionalisation of a discipline (or sub-discipline) are the formation of formal networks and associations, the establishment of academic journals and the production of academic textbooks. With regard to the latter, the French example above indicates the importance of academic textbooks to institutionalisation and, moreover, the way that the timing of such publications can indicate the relative development of the field from one country to the next. With the expansion of the university sectors of many countries in the nation-rebuilding programmes after the Second World War, textbooks became an important vehicle for distilling the essential concepts and subject matter of the disciplines, constructing and maintaining disciplinary identities and assisting with the socialisation of a new generation of intellectual workers. Taken as historical markers, textbooks point to the relevant level of institutionalisation of the disciplinary fields. In the case of the sociology of health and medicine, there were earlier books produced in the United States in the first half of the twentieth century, notably perhaps Elizabeth Blackwell’s (1902) volume about medical sociology; one from James Warbasse (1909); and another from Henry Sigerist, called American Medicine (1934). Such books were, however, quite rare until the post-Second World War period, when the first modern textbook for medical sociology in the United States was produced in 1958 by Norman Hawkin, called Medical Sociology, followed in the same year by E. Gartly Jaco’s edited collection, Patients, Physicians and Illness. In Germany, important first books included a sociology of the hospital from Juergen Rohde (1962), though the first textbook was from Johannes Siegrist in 1974 (Cockerham 2000). In Britain the first one came in 1962 with Mervyn Susser and William Watson’s Sociology in Medicine; in Australia, Athol Congalton and Jackob Najman broke new ground with their (1971) Nurse and Patient: A Sociological View; and in Iran it was with Manuchehr Mohseni’s (1974) publication of Medical Sociology of Medicine and Health. In many of the developing countries, the first medical sociology textbooks appeared from the 1970s and 1980s. Initially, these were translations of American or British texts, but they have increasingly been authored by locals with greater local content and relevance.

A second marker of institutionalisation is the establishment of special interest groups within national professional associations. In many of the sociological associations, medicine and health were the focus of the earliest groups to form. These have tended to be much larger than other special interest groups and have had a sustained presence in the associations. The earliest such group appears to have been that of the Medical Section within the ASA. This originated in 1930, not long after the association itself began in 1905, though with various organisational and legal changes to the definition of a ‘section’ and the rules of operation, the Section wasn’t formalised as an organisational body until 1955 and was reformulated again in 1962. The International Sociological Association (ISA) – which has divisions called ‘research committees’ rather than sections – began to host a Health and Medical Committee from 1963. Not long afterwards, The Australian Sociological Association (TASA) recognised a Medical Sociology Section in 1967; the British Sociological Association (BSA) followed in 1969 (Collyer 2012a:103); and the German Sociological Association in 1972 (Gerhardt 1989). There have also been independent societies, such as the German Society for Medical Sociology (formed in 1972); the Society for Study of Health and Medical Sociology in Japan (in 1974); and the European Society of Medical Sociology (in 1983). These ‘sections’ or research committees function in a similar way to the parent association, providing members with a research or teaching network, opportunities for collaboration and publishing, and assist with the building and maintenance of a professional identity.

A third marker of institutionalisation can be found in the formation of scholarly journals. Sociological associations often sponsor, auspice or own several academic journals, adding credibility and legitimacy to the scholarship of their members. The Journal of Health and Social Behavior, first published in the United States from 1960 as the Journal of Health and Human Behavior, was started as a private journal by E. Gartly Jaco as both editor and publisher. After some fierce negotiation over the under-writing of its costs, it became, in 1966, one of the ASA’s official journals with the assistance of the Milbank Memorial Fund (Bloom 2000:24–5; Collyer 2012a:85). Section members of the BSA and TASA also produced their own health sociology journals. In Britain, the Sociology of Health and Illness began in 1979, and in Australia the Annual Review of the Health Social Sciences (now known as the Health Sociology Review) started publication in 1991. In neither case is ownership in the hands of the professional associations, though there is close collaboration between the various bodies (Collyer 2012a:108). A similar arrangement is in place for the journal Social Theory and Health, which began in 2003 and is affiliated with the European Society for Health and Medical Sociology.

These three markers tell us that the field began to institutionalise from the 1950s and was complete in several key countries, and at the international level, by the end of the 1980s. With the completion of the process of institutionalisation of a scholarly field, individuals no longer have to rely on individual resources and capacities when they enter public debates about the value of good healthcare, nor need demonstrate the strengths or shortcomings of a given health policy or programme. Although all steps in the institutionalisation process are a matter of negotiation and political struggle at the local, national and even perhaps the international level, institutionalisation marks the point at which material and cultural resources have become available to members of the field; public recognition and support have been won; and formal means of communication and interaction firmly established (Collyer 2012b:118). Thus by the 1990s, the sociology of health and medicine had achieved broad acceptance within the university sector, with many institutions recognising the worth of individuals specialising in the field and providing resources for undergraduate and (post)graduate teaching.

Commonality and divergence across the field

The institutionalisation of any scholarly field also marks the point at which a certain level of coherence or commonality of practice has been reached. In the current context, there appears to be some consensus about the main themes or questions of the sociology of health and medicine. For instance, it is said to offer an alternative to the limitations of the biomedical model of illness and to challenge medicine’s claims of effectiveness (Nettleton 2006); demonstrate the patterning of health and illness according to social and economic conditions and explain this relationship (Fitzpatrick 2008; Freese and Lutfey 2011:67); investigate healthcare organisations and institutions, the provision of healthcare services and the social behaviour of healthcare providers and consumers of care (Cockerham 2000); study the Sick Role and the illness experience (Bird et al. 2000:2); and demonstrate the social shaping of medical knowledge (White 2009).

Despite the apparent consensus, there continues to be interesting global differences in the way the sociology of health and medicine is practised, researched and taught. Some hint of this is given in the different names for the field, for it is known as medical sociology in the United States and Britain, the sociology of health in Australia and both the sociology of health and medical sociology in Canada. Yet even these names do not always cleanly match the main trends in the field, and may instead reflect past developments (such as a well-known book title) or the preferences of a person of some influence who had been instrumental in establishing the local society, section or research committee. Medical sociologists with long experience in the field are often aware of national differences in the speciality field. For instance, Hafferty and Castellani (2007:335) point to the more theoretical inclinations of British medical sociologists in comparison to their American counterparts, the former’s acceptance of qualitative methods and their preference for studying social class rather than socio-economic status. Other pointers to national differences can be found in empirical studies, such as those using content analysis to examine and compare the publications of sociologists of health and medicine. There have been several comparative analyses of the field applying this method, though the focus has generally been limited to American and British publications (for example, Clair et al. 2007; Seale 2008) with somewhat fewer studies inclusive of other countries such as Australia (Willis and Broom 2004; Collyer 2012a) or New Zealand (Collyer 2013a).

Such analyses can throw a spotlight on the shared concerns of sociologists of health and medicine which are not always apparent from one’s personal experience in the field. For instance, in an examination of the research interests of sociologists of health and medicine from Britain, the United States and Australia, significant levels of shared interest are demonstrated across all three countries on th...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• List of Figures and Tables
• Preface
• Acknowledgements
• Notes on Contributors
• 1. The Sociology of Health, Illness and Medicine: Institutional Progress and Theoretical Frameworks
• Part I: The Nineteenth-Century Theorists
• Part II: The Early Twentieth-Century Theorists
• Part III: The Mid-Twentieth-Century Theorists
• Part IV: The Late Twentieth Century and Theorists of the Present
• Index