Читать книгу The Wiley Blackwell Companion to Medical Sociology - Группа авторов - Страница 13

TERRENCE D. HILL, WILLIAM C. COCKERHAM, JANE D. MCLEOD, AND FREDERIC W. HAFFERTY

The sociological study of health, illness, and healing systems in the US has expanded substantively and deepened theoretically over the past half century. While work in this area once fit under the single moniker of “Medical Sociology,” we now use a range of alternative labels (e.g. Sociology of Medicine, Sociology of Health and Illness, Sociology of Health, Illness, and Healing, Sociology of Health, Health Sociology) and definitions to describe the field. Some definitions highlight topic areas:

“Medical sociology is the study of health care as it is institutionalized in a society, and of health, or illness, and its relationship to social factors” (Ruderman 1981: 927).

“The sociology of health and illness studies such issues as how social and cultural factors influence health and people’s perceptions of health and healing, and how healing is done in different societies” (Freund et al. 2003: 2)

“Medical sociology focuses on the social causes and consequences of health and illness” (Cockerham 2017: 4).

Others emphasize different aspects of the sociological perspective:

“Medical Sociology is the subfield which applies the perspectives, conceptualizations, theories, and methodologies of sociology to phenomena having to do with human health and disease. As a specialization, medical sociology encompasses a body of knowledge which places health and disease in a social, cultural, and behavioral context” (Committee on Certification in Medical Sociology 1986).

“The most important tasks of medical sociology are to demonstrate and emphasize the important influence of cultural, social-structural, and institutional forces on health, healing, and illness…” (Weiss and Lonnquist 2016: 11).

“An approach that emphasizes using the area of health, illness, and health care to answer research questions of interest to sociologists in general. This approach often requires researchers to raise questions that could challenge medical views of the world and power relationships within the health care world” (Weitz 2017: 346).

The many labels and definitions that have been offered suggest a lack of consensus on defining medical sociology’s substantive scope and its most significant contributions to knowledge. Some suggest that it is “hard to find a comprehensible statement of what… medical sociology is” (Chaiklin 2011: 585). Others describe the field as a “loosely connected network of disparate subgroups” (Veenstra 2002: 748). This state of the field raises several fundamental questions. How can we characterize our field in a general and consistent manner? What are our contemporary disciplinary boundaries? What are our major subfields? In other words, who are we now, and what do we do?

In this chapter, we propose a disciplinary structure for medical sociology that attempts to answer these questions. By “disciplinary structure,” we mean a representative model of our major subfields as defined by topic areas, theoretical orientations, and significant contributions to the study of health. All sciences invariably reflect on these important issues and, in doing so, define their scientific orientation and boundaries in relation to other sciences, including, for example, medical sociology (Bloom 1986; Gold 1977; Petersdorf and Feinstein 1980; Straus 1957), medical anthropology (Saillant and Genest 2007), health psychology (Baum et al. 2011), and health economics (Pauly et al. 2012). Explicit disciplinary structures are one way to set disciplinary boundaries, mark accomplishments, and direct future efforts toward a cumulative science. Substantive topics and concepts alone are too granular to signify a field’s major organizing principles. As Zerubavel (1991) once pointed out, things become meaningful only when placed into categories, and the “islands of meaning” that are created in this process explain what matters to a particular social world (or in this case, medical sociology) and help to determine the nature of its social order (or field of knowledge). In short, it is through the process of classification that we establish our boundaries and identity and, by extension, distinguish ourselves from other fields within sociology and other disciplines concerned with health.

The identification of a disciplinary structure was once integral to the development of the field, as evidenced in Straus’s (1957) classic distinction between the sociology of medicine and sociology in medicine. Six decades have passed since Straus offered his structure, and we believe it is time to consider a more contemporary scheme that acknowledges the expansion of our subject matter, the broadening of theoretical influences, and the resultant complexity. Our primary aim here is to stimulate a forward-looking conversation among medical sociologists by reviewing previous conceptualizations and proposing a new model to serve as a basis for discussion. Our model classifies medical sociology in terms of its major subfields as defined by substantive topics, theoretical orientations, and scientific contributions. We review the unique contributions of each subfield while recognizing an underlying unity driven by common training in sociological theory and methods. We end with several recommendations for a more refined and directed conceptualization of the field.

There are several reasons why we should be having these discussions. When we define our major subfields and contributions to the study of health, we (1) claim our independence from other health sciences (e.g. medicine), (2) maintain our status in the marketplace of health research (e.g. as health psychologists and public health researchers publish more and more on socioeconomic inequalities), and (3) develop as a cumulative science through a formal recognition of the expansion of our field’s purview. Before Straus (1957), for example, some questioned whether sociology should be considered a “third branch to medicine” (Boulton 2017: 242). When we stop reflecting and leave our subfields undefined, we lose track of our major contributions across generations of medical sociologists and in the broader interdisciplinary field of health research, leaving scholars from other health sciences (e.g. public health) unable to identify them. We also create intellectual vacuums for less fruitful discussions. For example, when we stopped discussing subfields in the late 1980s, we began the great “moniker debate” over whether to continue using the term “medical sociology” or to rename ourselves something else to be more inclusive of work related more to health than medicine. Instead of taking up that debate, we intend to redirect the conversation to how best to represent our disciplinary structure. Ultimately, we believe that focusing more on our major subfields and contributions to sociology and the broader study of health will support more productive and substantive conversations about what medical sociology has to offer.