Medical Sociology Research Articles

Expanding Systems Thinking: Incorporating Tools from Medical Sociology into MFT Education and Research.

The field of marriage and family therapy has historically focused on dynamics within family systems, and at times the role of social and cultural factors external to the family. To date, however, little scholarship has examined how therapists themselves are embedded within a mental healthcare system. The purpose of this article is to demonstrate how structural components of the mental healthcare system shape the practice of therapy. We draw from the field of medical sociology to illustrate how three dominant structures-managed care, diagnosis, and evidence-based models-are intertwining and mutually reinforcing systems that have significant and long-term implications for systemic therapists and researchers. We recommend incorporating a sociological understanding of such structures into MFT education and research.

Contradicciones en Salud Mental: Estigma, Alfabetización en Salud Mental y Revelación (o no) del Diagnóstico de un Desorden Mental.

Las dolencias mentales afectan a un porcentaje de la población (25 %) que no se corresponde ni con los conocimientos que la población general tiene de ellas ni con los recursos (4% PIB) que invertimos en atenderlas en el sistema sanitario. Esta contradicción, o discrepancia, es evidente desde hace tiempo en la literatura de sociología médica. Analizamos en este artículo tres conceptos emparentados para comprender esa contradicción: son los de alfabetización en salud mental, estigma de las dolencias mentales y el de revelar o no el diagnóstico de una dolencia mental. Existe poca sino nula repercusión de estos tres conceptos en el ámbito de habla en castellano. Con este artículo intentamos solventar ausencia.

The complexity of non-sense making: a proposal of complex medical sociology of mental disorders.

The article describes social complexity of the biographical accounts of those connected with a mental disorder diagnosis in Galicia, a Northwest Spanish Autonomous Community. 147 biographies associated with Mental Disorders diagnosis (MD) have been collected and gathered in three groups differently linked to these conditions. Our first group has lived with a diagnosis of MD for at least 10 years (65 interviews and data from 300 people). Our second cluster of people shares their lives with those with a MD diagnosis mainly with a family relative bound (19 interviews and data from 300 families). Our third group, gathers Galician mental health medical professionals from three mental health units and other mental health facilities which medically and administratively manage people with a MD diagnosis and their relatives (63 biographies). Using data from these biographies, we have constructed three interconnected biographical profiles early published (Torres Cubeiro 2009b) using a social systems theory approach based in Niklas Luhmann sociology.

Living with a disease. Sociological (theoretical) approaches for studying the problem

Studying disease, the behavior of the ill person and of those with whom he communicates, the perceptions of and the reactions towards an acute or chronic disease is an important aspect of the field of medical sociology. The individual, as well as the social aspect of the disease and the behavior associated with it, are important for sociology. The present paper presents three classical sociological theoretical models - structural functionalism, symbolic interactionism and the conflict theory that provide opportunities for a systematic analysis when studying diseases from the sociological point of view.

Modified BG Prasads Socio-economic Classification-2018: The need of an update in the present scenario

Modified BG Prasad socioeconomic scale has been in use for determining the socio-economic status of study subjects in community-based health studies in India since 1961.It is an income-based scale and, therefore, constant update is required to take inflation and depreciation of rupee into account. For industrial workers (IW), the consumer price index (CPI) is used to calculate updated income categories at any given point of time, viz Jan 2018.These details of the calculations involved will help many researchers to calculate specific income categories for their ongoing and prospective research work in current calendar year. On the Department of Labour website (www.labourbureaunew.gov.in), state-specific CPI values are also available and should be used to determine more accurate income categories.The current exercise is a step towards increasing the validity of use of classification with relevance to the current price levels and enabling a real time update for a considerable time in the near future.The health behavior of an individual or a community is interdependent on their socio-economic status. The concept of socio-economic status is widely used in medical sociology. The social standing of an individual or a family in the society can be measured by it. Therefore, is an important factor affecting the health condition of an individual or a family. (1)Socio-economic status has been defined as “The position that an individual or family occupies with reference to the prevailing average standards of cultural and material possessions, income and participation in group activity of the community”. The social status may be inherited, but in modern society it is achieved on the basis of occupation, income, type of housing and neighborhood, membership of the certain associations and organizations, material, possessions, etc. (2)In India, several methods or scales have been developed for classifying different populations based on their socio-economic status, viz. Parikh scale 1964, Shirpurkar scale 1967, Jalota scale 1970, Kulsherestha scale 1972, Srivastava scale 1978, Bharadwaj scale 2001. (3-8)Modified BG Prasad’s classification that is used for both urban and rural areas. Modified Kuppuswamy classification is used in urban and peri urban areas which considers the education of the head of family, occupation of head of the family and per capita monthly income.(9,10) Another classification for rural areas is Uday Pareekh classification which takes into account following characteristics namely caste

Socioeconomic Status and Racism as Fundamental Causes of Street Criminality

The theory of fundamental causes in medical sociology identifies socioeconomic status and racism as fundamental causes of disease and health disparities. We draw on this theory to argue that socioeconomic status and racism are also fundamental causes of violent and property crime. In line with the theory, we argue that criminology should pay increased attention to socioeconomic status and racism for the most far-reaching reductions in street criminality to be achieved.

Beyond the binaries: reshaping pain communication through arts workshops

Pain is difficult to communicate and translate into language, yet most social research on pain experience uses questionnaires and semi-structured interviews that rely on words. In addition to the mind/body dualism prevalent in pain medicine in these studies pain communication is characterised by further value-laden binaries such as real/unreal, visible/invisible, and psychological/physical. Starting from the position that research methods play a role in constituting their object, this article examines the potential of participatory arts workshops for developing different versions of pain communication. Twenty-two participants were involved in workshops using drawing, digital photography, sound and physical theatre to explore pain communication. The use of arts materials made pain tangible. By manipulating pain-related objects, participants could consider alternative relationships to their pain. Pain's sociality was also explored, with relations with clinicians and others emerging as potentially cooperative rather than adversarial. Discussions considered whether pain felt internal or external, and whether it was possible to conceive of a self without pain. We argue that the socio-material context of participatory arts workshops enabled these alternative versions of pain. Such methods are a useful addition to medical sociology's heavy reliance on qualitative interviewing.

Thinking with care infrastructures: people, devices and the home in home blood pressure monitoring.

The growing consumer market in health monitoring devices means that technologies that were once the preserve of the clinic are moving into spaces such as homes and workplaces. We consider how one such device, blood pressure monitors, comes to be integrated into everyday life. We pursue the concept of 'care infrastructure', drawing on recent scholarship in STS and medical sociology, to illuminate the work and range of people, things and spaces involved in self-monitoring. Drawing on a UK study involving observations and interviews with 31 people who have used a consumer blood pressure monitor, we apply the concept beyond chronic illness, to practices involving consumer devices - and develop a critical account of its value. We conclude that the care infrastructure concept is useful to highlight the socio-material arrangements involved in self-monitoring, showing that even for ostensibly personal devices, monitoring may be a shared practice that expresses care for self and for others. The concept also helps draw attention to links between different objects and spaces that are integral to the practice, beyond the device alone. Care infrastructure draws attention to the material, but ensures that analytic attention engages with both material and social elements of practice and their connections.

The art and nature of health: a study of therapeutic practice in museums.

Drawing on ethnographic fieldwork and interviews at a major metropolitan art museum and botanic garden, this article considers the practical accomplishment of American museums' 'health turn' by tracing how museum staff develop therapeutic programmes for visitors with disabilities. In doing so, it considers one of medical sociology's fundamental theoretical questions - how ideologies of health order social life - in an unconventional empirical setting. Acknowledging contemporary arguments for both the relative merits and unintended consequences of this policy trend, I focus instead on the particular institutional arrangements, professional norms, and material cultures of art and nature that shape museums' therapeutic work, so as to reveal its effects. Data reveals ideological similarities, but practical differences, between museological and medical understandings of wellness. Extending a 'medical sociology of practice' to new contexts ultimately foregrounds the contingencies, and diversity, of therapeutic mechanisms and meanings, thereby broadening sociological research on healing and healthism.

Sociologie na poli medicíny a zdravotnictví – cizinec nebo vetřelec?

Medical sociology is a discipline that applies sociological perceptions, theoretical approaches and empirical methods to the study of healthcare issues. Modern medicine is one of the key symbols of modern society and its achievements in terms of human intervention in nature. A sociologist studying healthcare issues faces certain specific problems deriving from the socio-cultural framework of modern medicine and the natural sciences in general. By pursuing sociology in medicine he may lose his identity and autonomy, but by pursuing sociology of medicine he may tend to study issues perceived as irrelevant by healthcare experts. Being a „stranger“ in the field of medicine may, however, mean that a sociologist can contribute to the articulation of new problems as public matters or social problems. He may also be perceived as a representative of the lay perception of healthcare issues. Both quantitative and qualitative models are used in this field, mostly in a process of triangulation that gives a fuller and more truthful idea of reality from the perspectives of different actors. Although the natural sciences are the basis of medical knowledge and skills, medicine is also a symbolic world with its own culture, values and norms.

Medical and Familial Claims to Long-Term Care: Institutional Gaps and Shifting Jurisdictions

In light of the contemporary long-term care crisis, Sandra Levitsky's book Caring for Our Own examines why there has been no movement to secure state support for caregivers. Speaking to sociolegal and social movement audiences, Levitsky reveals how lack of collective identity, the power of family-based ideologies, and the separation of support organizations from political ones help to repress mobilization. In this essay I refract Levitsky's findings through the lens of organizational theory and medical sociology. I argue that the social problem of long-term care is caught in an institutional gap since it does not readily fall under the purview of either medicine or family. I also discuss the implications of lay caregivers' provision of sophisticated medical care for theories of professional jurisdictions and gatekeeping.

Some Pitfalls in Doing Medical Sociology

Some Pitfalls in Doing Medical Sociology

Teme iz medicinske sociologije na stranicama Sociološkog pregleda

The paper presents research results about the representation of medical sociology topics in the journal Sociološki pregled/Sociological Review from 1938 to 2017. It offers a classification of the thematic fields of published papers. Starting from the hypothesis that the situation in periodicals reflects the development level of an academic discipline and in view of the duration of the period considered here, the paper concludes that medical sociology remains an inadequately developed branch of sociology in Serbia, unlike one of its sub-disciplines - sociology of mental health, which is the result of traditional academic reasons and the difference in their representation at institutions of higher education in Serbia.

Model of decision-making in medical anthropology L. Garro

In recent years, within Russian medical anthropology and sociology there has been an increasing interest in the research direction “Medical Choice”. In this regard, the methodology of studying the treatment decision-making process suggested by the American anthropologist L. Garro is of particular value. This approach is based on theoretical provisions of cognitive anthropology. Using a broad empirical base, L. Garro develops a model for making patient decisions in the acute disease case by residents of a small Mexican village. It defines standards of treatment choice, which are typical for the studied community. The article describes theelements of the model, including selection criteria, their combinations, which establish the direction of choice, and alternative solutions. The value of L. Garro’s approach is determined by the unique combination of the theoretical harmony of the model and its proximity to real everyday life, as well as the ability to adapt it to the study of the patient’s medical choice in another socio-cultural context.

Death and the experience of dying in Magdalena Sokołowska’s research conceptions

One of the many research passions of Magdalena Sokołowska, regarded as the founder of Polish and cofounder of European medical sociology, was sociothanatological problems in the broad sense. Magdalena Sokołowska’s version of “socio-thanatology” presented at the end of the nineteen-seventies and the early eighties consisted first of all in sociodemographic considerations. The deontological and ethical-moral problems, as well as individual existential experiences associated with the process of dying, being disregarded during the period in question, appeared in M. Sokołowska’s research conceptions and papers in the nineteen-eighties. She was particularly concerned with the patterns of dying in medical institutions, conceptions of dying trajectories, processes of “waiting for death”, mechanisms of the institutionalization, commercialization and medicalization of dying, differences between the conditions and context of dying at home and in the hospital, consequences of “slow dying” for the range of social roles performed by the doctor and the nurse, the scope and character of changes in the function and structure of the family in the course of the process of dying and as a result of the death of one of its members, analysis of social behaviors after death in the institutional and noninstitutional context (hospital, hospice, home), etc. The analysis of Magdalena Sokołowska’s “socio-thanatological” achievements allows us to notice a clear evolution of her conception: from the “epidemiological-demographic” approach, oriented towards analysis of mortality, to a preference for “qualitative” interpretations based on the investigation of “subjective emotions” that accompany dying persons.

The feasibility of using remote data collection tools in field surveys

Background: The objectives of the study were to conduct a field survey to measure the prevalence of chronic diseases by taking history, to assess the feasibility of using remote data collection tools in field surveys and to create the map of the survey area using global positioning system (GPS). Methods: A community survey was carried out in two urban municipal wards by trainees with medical sociology back ground among those aged 35 years and above. There were a total of 563 participants from whom history of chronic diseases were collected and from those aged 60 years and above the presence of frailty was assessed using Canadian Study of Health and Ageing (CSHA) Clinical Frailty Scale. The data was collected using a remote data collection application named KoBo Toolbox, downloaded in their smart phones, which was sent directly to the main computer in the Clinical Epidemiological Unit, using mobile data or Wi-Fi hotspots. The co-ordinates of the households were marked using GPS which was also sent through the KoBo Toolbox to the main computer. At the centre the data was converted into excel sheets and various percentages were calculated. Results: In the survey the proportion affected with diabetes, hypertension, coronary artery disease and cerebrovascular accidents were 24%, 20.6%, 10.5% and 3.5% respectively. Among the older population 2.2% were found to be severely frail or worse requiring special care. The field map of the area surveyed was also generated using the co-ordinates marked using the GPS enabled phones. Conclusions: The remote data collection tool enabled us to conduct a survey on chronic diseases, effectively, within a limited period of time, creating a map of the area surveyed.

Laudation at the presentation of the Salomon Neumann Medal 2017 to Prof. Dr. med. med. Bernt-Peter Robra, MPH

The German Society for Social Medicine and Prevention (DGSMP) confers the Salomon Neumann Medal for outstanding merit in the field of Preventive and Social Medicine. The Salomon Neumann Medal 2017 was awarded to Bernt-Peter Robra, Institute for Social Medicine and Health Economics (ISMG) of the Otto von Guericke University Magdeburg. It honours an outstanding representative of social medicine, in whose person and Institute the essential problem areas of social medicine as well as the competencies of the 3 scientific bodies that gathered in Lübeck - epidemiology, medical sociology and social medicine - and the sociopolitical engagement of Salomon Neumann come together.

Human health and social-ecological systems change: Rethinking health in the Anthropocene

This review article considers how social-ecological systems change is transforming human health in the Anthropocene. From hunting and gathering bands through modern globalized societies, human health has been shaped by circular feedbacks between ecological processes, available energy sources, levels of social complexity, and cultural ontologies. As the environmental crises of the early Anthropocene (biodiversity loss, climate change, land use changes) push ecosystems across thresholds into new configurations, we are experiencing an equally profound transition for human health. Drawing on literatures from medical anthropology, sociology, complexity science, and ecological economics, this article argues that promising alternatives for health systems in the Anthropocene are emerging beyond the boundaries of the formal healthcare sector in community-based practices that can take root in a context of ecological limits, economic contraction, and growing networks of reciprocal care.

In BMI We Trust: Reframing the Body Mass Index as a Measure of Health.

Recent work in medical sociology has provided critical insights into distinguishing between obesity as a condition with severe individual- and population-level health consequences, and obesity as a socially undesirable, stigmatizing construct opposing thinness as the healthy ideal. Less often considered is the role of Body Mass Index (BMI) as the standard by which obesity and healthy weight are measured and defined. Addressing this issue, I begin by distinguishing between BMI as an empirical, objective measure of health, and BMI as an arbitrary, subjective label for categorizing the population. I further consider how BMI is empowered as a measurable quantity through the lens of medicalization and evidence-based medicine, and introduce the "performativity" of BMI as a superior framework for confronting the measure's conceptual limitations. Emphasizing key parallels between BMI and self-rated health as measures with high predictive validity, yet unspecified mechanisms of action, I propose an epistemological shift away from classifying BMI as a biomarker and toward a more flexible view of the measure as a holistic appraisal of health. In closing, I argue that researchers may continue to leverage BMI's ease of collection and interpretation, provided they are attuned to its definitional ambiguity across diverse research methods and contexts.

Revisiting Medicalization: A Critique of the Assumptions of What Counts As Medical Knowledge

The concept of medicalization is hugely influential and empirical studies have demonstrated that medicalization has largely been achieved through the work of medical professionals or scientists, but also increasingly through the efforts of patients or citizens seeking to legitimize their distress through defining it as a ‘medical’ problem. In this article, I argue that the concept of medicalization is still fundamentally important to the sub-discipline of medical sociology, but that there is a need to revisit and critique its conceptualization. I draw on reflexive arguments within the literature that we, as sociologists, have tended to reproduce the assumptions of the medical profession about what counts as medical knowledge and practice, and on literature that explores the complex and plural ways in which people seek to make sense of their illnesses. I argue that there have been few attempts to engage with the question of how ‘making things medical’ occurs in a global context of medical pluralism. By revisiting Conrad’s approach to defining medicalization, I argue for a separation between empirical observations of the dominance of biomedical knowledge, from theoretical observations about medical knowledge and definitions. I argue for a ‘knowledge-based’ approach to medicalization by opening up the definition of ‘making things medical’ to include all forms of medical knowledge in a global society. The concept of medicalization can then be replaced with medicalizations (plural). To argue this, I take two steps: first, I draw on hermeneutic philosophy to argue that there is a stable definition of medicine on which to base an argument that apparently diverse forms of medical practice can be grouped together and used within the concept of medicalization; second, I argue that medicalization is not unproblematically linked to medical social control. The ‘success’ or not of different attempts to define things as medical problems in part depends on the social and political context. This new approach allows sociologists to make sense theoretically of differences we see in comparative empirical research between whether ‘diseases’ are acknowledged in different national or cultural context. Finally, I provide the readers with guidance on the operationalization of this concept in empirical study.