Medical Sociology Research Articles

Complicity in sociology and community-based participatory research with Marshallese.

Complicity with colonialism can be reflected in a particular approach to research, whose interests it serves, and who has power or ownership over the research process. It can also be reflected in neglect, inaction or methodological erasure of groups historically subjected to domination by colonial empires. Social scientists have often failed to account for colonialism's role or the complicit role they have played. We provide a brief historical overview of colonialism in the Marshall Islands and the role social scientists-and their methodological and epistemological approaches-played in the US empire's expansion into the region. We discuss the tenets of Community Based Participatory Research (CBPR), setting the research agenda, co-direction of the research process, research team membership, collaboration challenges, and the action and outputs which have come from our team's health disparities research among the largest Marshallese population in the continental US. We argue CBPR is a promising but imperfect approach to guarding against complicity within medical sociology and situate our methodological approach within ongoing debates regarding objectivity and advocacy within sociology. We reflect on successes and shortcomings of our CBPR efforts to address health disparities among Marshallese, as well as how those successes and shortcomings overlap with questions of complicity.

Embodying disabled liminality: A matter of mal/adjustment to dis/ableism.

This article combines the line of work that links disability and liminality with feminist dis/ability studies to analyse how the 'disabled body-subject' is produced and subjectified during hospitalisation and post-hospitalisation. This analysis is based on six bodily itineraries conducted with three men and three women with a spinal cord injury (five with tetraplegia and one with paraplegia) acquired during their adolescence. First, we interpret hospitalisation as a phase of 'acute liminality' in which the disabled body-subject starts being produced as suspicious, expropriated and de/gendered. Secondly, we illustrate how discharge and the 'return' to the community entail the formation of several bodily assemblages that embody mal/adjustment. This leaves the subject in a state of 'sustained liminality' plagued with paradoxes and ambivalence. We argue that both liminalities lead disabled subjects to do an emotional work consisting of adjusting to situations of affective disablism while also opening up spaces of resistance regarding heterosexist and ableist mandates. We conclude by pointing out the potentialities of a two-way dialogue between medical sociology and dis/ability studies.

The resistance to mainstream assumptions about retribution in Job and Tobit as theologically positive deviance

This article uses material from organizational studies and medical anthropology and sociology to address the value of the idea that bodily dysfunction or illness depart from a norm of health. It argues that examples of positive deviance can be found in the books of Tobit and in Job. Positive deviance describes behavior that notably departs from expected norms, albeit in a direction that a referent group finds positive. In much of the Hebrew Bible, there is a tight connection between the ideas of wrongdoing, bodily suffering, and retribution. However, the books of Tobit and Job are examples of a departure away from this norm. In Job and Tobit the portrayal of circumstances in the text depart from expected norms with a view to encouraging the referent group (i.e., audiences) towards a positive assessment of the departure. The character Tobit, in line with dominant thought about retribution assumes his blindness is a result of some inadvertent or inherited sinfulness. However, Tobit’s characterisation and dramatic irony prevents audiences agreeing with Tobit’s assessment of circumstances. Similarly, the advice of Job’s friends betrays their assumption that his physical condition must be retribution for wrongdoing. However, Job’s characterisation and dramatic irony prevents audiences agreeing with his friends. More shockingly, the character Yahweh departs from the expected role and becomes a deviant actor. Through resisting simplistic assessments of somatic distress as caused by retribution for wrongdoing, both books are examples of positive deviance that encourage audiences towards more positive norms.

American Medical Sociology and Health Problems in the Global South

COVID-19 has focused global attention on disease spread across borders. But how has research on infectious and noncommunicable disease figured into the sociological imagination historically, and to what degree has American medical sociology examined health problems beyond U.S. borders? Our 35-year content analysis of 2,588 presentations in the American Sociological Association’s (ASA) Section on Medical Sociology and 922 articles within the section’s official journal finds less than 15 percent of total research examined contexts outside the United States. Research on three infectious diseases in the top eight causes of death in low-income countries (diarrheal disease, malaria, and tuberculosis [TB]) and emerging diseases—Ebola, Middle East Respiratory Syndrome (MERS), and Severe Acute Respiratory Syndrome (SARS)—was nearly absent, as was research on major noncommunicable diseases. Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) received much more focus, although world regions hit hardest received scant attention. Interviews suggest a number of factors shape geographic foci of research, but this epistemic parochialism may ultimately impoverish sociological understanding of illness and disease.

Stress perception: A pathway from socio-economic status to health

Stress research is an important area in medical sociology. Psychosocial stress accounts for negative health outcomes across various physiological systems and can have far-reaching consequences for the organism’s health. Socio-economic status, in its turn, influences the likelihood of stress exposure and how its consequences will be addressed. All in all, there is ample systematic evidence in support of complex associations between socio-economic status, stress and health outcomes. Following a series of discoveries in the biomedical sphere, our understanding of stress became considerably more complex, and the causal mechanisms of this process have become more prominent in research literature over the last few decades. Integration of this new data from biology, genetics and medicine into sociological, anthropological and socio-epidemiological research of stress has changed not only how this research niche conceptualizes and measures stress but also how the role that the society and social structures play in patterned distribution of disease, aging and mortality is understood. Although the link between stress and health is well studied, the mechanisms linking socio-economic status, the stress process and health outcomes have received rather less attention. An online quantitative study (n = 902) carried out in Kyiv during 2020–2021 focused on the question of the SES–stress link in the context of health outcomes. Specifically, the study tested the following propositions: (a) stress affects self-rated health and wellness of individuals; (b) current SES affects individual self-rated health and wellness; (c) individuals from low SES categories face higher current perceived stress levels compared to individuals from higher SES categories; (d) individuals who report having low SES in childhood have higher perceived stress levels during the COVID-19 pandemic compared to their counterparts whose familial socio-economic status was higher when they were children; and (e) having chronic conditions exacerbates individual stress levels.

Evolution and effectiveness of therapeutic patient education for obesity and diabetes

Therapeutic patient education (TPE) aims to help patients acquire or maintain the skills they need to best manage their lives with a chronic disease. Through a scientometric analysis of the literature, we identified the most influential bibliographic data related to TPE research that have strengthened the field and increased its effectiveness. These were studies from the fields of education, philosophy, psychology, anthropology and medical sociology. We have conducted a meta-analysis that has demonstrated the effectiveness of TPE for the management of obesity and diabetes on biological and psychological parameters. It allowed patients to improve their knowledge, their therapeutic adherence and their sense of self-efficacy.

Surveillance, Medical Sociology and COVID-19

Surveillance, Medical Sociology and COVID-19

Patient Agency: Manifestations of Individual Agency Among People With Health Problems

This paper conducts a critical review of qualitative studies of the life experiences of people with health problems and proposes the notion of patient agency. It highlights that discontinuous continuity in life is the key category of life experiences around which individuals reveal agency. In particular, the paper first discovers multiple dimensions of life that individuals with illness engage in. It subsequently identifies four different manners in which discontinuous continuity in life is manifested along the multiple dimensions, such as single-dimensional rescaling, multi-dimensional shift, multi-dimensional embedding, and submission. These achievements and the remaining limitations in the medical sociology of patient agency are on a par with those in general sociological theories of individual agency. The paper proposes a set of future research agendas to expand these limits. This theory of patient agency is expected to renew approaches to how people lead their life in illness. It also suggests that patience should be a valid category of agency for general sociological imagination.

The Nexus of Physical and Psychological Pain: Consequences for Mortality and Implications for Medical Sociology.

Although physical pain lies at the intersection of biology and social conditions, a sociology of pain is still in its infancy. We seek to show how physical and psychological pain are jointly parts of a common expression of despair, particularly in relation to mortality. Using the 2002-2014 National Health Interview Survey Linked Mortality Files (N = 228,098), we explore sociodemographic differences in the intersection of physical and psychological pain (referred to as the "pain-distress nexus") and its relationship to mortality among adults ages 25 to 64. Results from regression and event history models reveal that differences are large for the combination of the two, pointing to an overlooked aspect of health disparities. The combination of both high distress and high pain is most prevalent and most strongly predictive of mortality among socioeconomically disadvantaged, non-Hispanic whites. These patterns have several implications that medical sociology is well positioned to address.

Public intent profile towards medical facility visualisation systems in russian federation: a one-stage sociological survey

Background. Medical facility visualisation systems comprise navigation, information panels and visual operation control elements. Visual perception surveys in medical institutions are of great value in medical sociology. Knowing the today’s visitor intent towards visual content inside healthcare facilities will allow a better formulation of most comfortable arrangement of medical services and improvement of healthcare delivery to various visitor categories. Objectives . An assessment of modern public intent towards medical visualisation systems in the Russian Federation. Methods. A total of 7,356 citizens across 85 country subjects contributed to a sociological survey. Data of a formalised multistage stratified territorial random sampling survey were taken as main information source. The Kano model was used to organise intent towards attributes of medical visualisation systems. Depending on two parameters (functionality and satisfaction), the attributes were assigned between the categories of attractive, linear, obligatory, indifferent or undesirable. Results. The highest approval level among the visualisation attributes was found towards accuracy of the information panel content. The high-level of respondent approval were external navigation, compliance to the Russian language style and rules, good-making of the element, content structuring and use of modern information technologies. The lowest approval level was in a visually unified medical institution design. The most contentious respondent intent was observed in relation to colour-coding of visualisation objects. Conclusion. The survey recovered a generally similar public intent profile towards main visualisation system attributes in the Russian Federation. The mandatory included two attributes, “compliance to the Russian language style and rules” and “good-making of visualisation element”. Mandatory attributes are baseline to medical visualisation systems. They do not improve the visitor’s satisfaction, but their absence negatively impacts perception of healthcare visualisation systems.

The vicious cycle of distrust: Access, quality, and efficiency within a post-communist mental health system

Trust –a critical mechanism to manage vulnerability amidst uncertainty– may greatly influence healthcare practices, and consequently, its objectives. Building upon the work of Jürgen Habermas and the framework of trust chains, the aim of this article is to unpack how trust dynamics between the state, the provider, and the service user shape the functioning of mental healthcare in one of the former Soviet states –Lithuania. The case is of interest to medical sociology due to the region's historical and contemporary context. By drawing on in-depth interviews with healthcare providers and users, I demonstrate how the chains of reciprocal distrust underpin the workings of the mental health system and how the actors in turn employ a range of responses to such distrust. The instances of trusting relations nevertheless demonstrate how trust might facilitate the strive for mental healthcare that is more accessible, efficient, and of higher quality.

“Парадокс здоров’я” та іммігранти з колишнього CРСР: інтегрована теоретична модель

This study examines the critical mechanisms explaining the health outcomes of such understudied social group as immigrants from the former Soviet Union (FSU), including Ukraine, Russia, and Belarus, among other countries. Literature on the ‘health paradox’ suggests that immigrants from various countries enjoy better health than their native-born counterparts. Importantly, however, this trend does not seem to exist among FSU immigrants, especially those residing in the United States. In addition, while research studies find that socioeconomic status (SES) is the fundamental cause of health and illness among native-born individuals, higher SES does not appear to be the health-protective factor among the FSU group, likely due to their unique experiences and beliefs. Consequently, a new model is necessary to provide a more nuanced explanation of health outcomes of immigrants from FSU countries. Drawing on medical sociology and epidemiology literature, first, this paper outlines unique factors that explain health of FSU immigrants and argues that particular attention should be paid to acculturation, its sources, and the mechanisms through which it affects health. Specifically, differential levels of acculturation shape the degree to which FSU immigrants engage in risky behaviours, hold unique beliefs, access health care, and cope with stressors, which, in turn, influences their physical and mental health. Second, hypotheses are proposed based on the new model to be tested by future studies and third, unique interactive effects on health outcomes are discussed including such factors as SES, gender, country of origin, and other social structural factors. Overall, this paper contributes theoretically to medical sociology, epidemiology, social psychology, and global studies by outlining the novel model conceptualizing immigration and health relationships among one of the fastest-growing immigrant groups in contemporary society.

Making sense of experiences in suicide helpline calls: Offering empathy without endorsing suicidal ideation.

The question of how people make sense of experiences in relation to health is central to medical sociology and lies at the heart of suicide helpline practice. This article draws on a corpus of 900 audio-recorded suicide helpline calls to examine how call-takers respond to the challenge of reframing callers' suicidal ideation while still treating their experiences as legitimate. Conversation analysis of a subselection of calls revealed two call-taker practices, involving the framing of the caller's suicidal ideation as (1) being ambivalent or (2) having legitimate feelings in a difficult situation. While callers resisted the former, 'feeling formulations' laid the interactional foundations for exploring alternatives to suicide. This may be because call-takers' empathy increased their rights to subtly negotiate callers' experiences. By focusing on recipients' contributions in these critical interactional moments, the article widens the sociological approach to examining sense-making of health experiences as a thoroughly social process.

Enacting evidence-based medicine in fertility care: Tensions between commercialisation and knowledge standardisation.

In this article we explore the recent enactment of evidence-based medicine (EBM) in the field of fertility care. We aim to contribute to the medical sociology literature through an analysis of how evidence is produced, interpreted and institutionalised in a relatively new medical field such as in vitro fertilisation (IVF), characterised by high uncertainty due to limited knowledge and high levels of commercialisation. Drawing on extensive ethnographic research conducted in England, this article explores the challenges IVF professionals encounter in producing credible data on the effectiveness of additional treatments, offering novel insights on the tensions between commercialisation and standardisation in the enactment of EBM. Extant medical sociology and Science and Technology Studies literature has shown the hidden professional work required to enact randomised control trials in practice. Our analysis shows that this hidden work is not enough when there is a broader lack of standardisation in both clinical and research practices, as producing 'good quality' evidence requires high levels of standardisation of knowledge production.

Legal and Social Status of Eunuchs Islam and Pakistan

Media interest on eunuch and their problems has blossomed over the past decade. Stories about eunuchs have been the focus of dozens of books, movies, television dramas, and documentaries. Similarly, eunuchs now has moved from being a relatively obscure topic, Examined in a handful of medical journals, to becoming the central topic of numerous books and articles in a variety of disciplines, including psychology, history, anthropology, and medical ethics. Eunuchs now a day has also become a hot topic in legal circles. In the past ten years, more than a hundred legal articles and books have included a discussion on eunuchs and their problems. Most of these publications do not focus on the issues that have a direct effect on the lives of eunuchs.
 Understanding how the issues that are critical to people with such condition can be conflated with the issues affecting other people who challenge sex and gender norms requires a basic understanding of the nature of intersexuality. The meaning of the term eunuch has varied and the issue is still a topic of sometimes heated discussion. Although doctors and activists debate exactly what conditions qualify as to be called eunuch I am using the term in its broadest sense to include anyone with a congenital condition whose sex chromosomes, gonads, or internal or external sexual anatomy do not fit clearly into the binary male/female norm.
 Activists working to enhance the rights of eunuch’s advocate of eliminating harmful practices based on sex and gender stereotypes. In addition, both groups seek to enhance the right to sexual self-determination. The primary focus of each group differs, however. The primary goal of the eunuch’s movement is to eliminate or decrease the number of medically unnecessary genital surgeries being performed on children with an intersex condition. Intersex advocates believe that these medical interventions often result in physical and emotional trauma. Thus, they believe that these surgeries should not be performed on children and should only be undertaken with the informed consent of patient’s parents when they reach an age at which they can fully understand the risks and can decide for themselves whether they want to undergo genital surgery. The eunuch’s activist movement is still in its infancy and is in the process of developing its advocacy strategies.
 Although scholars in a variety of disciplines, including medical ethics, history, psychology, sociology, and anthropology, have published books on eunuchs, none has examined the role that the law can play in enhancing the lives of people with an intersex condition. The legal frameworks used by social justice movements that have effectively brought challenges to discriminatory practices and explores whether the eunuchs movement can form mutually beneficial alliances with these other movements and use similar legal strategies.

A legacy of silence: the intersections of medical sociology and disability studies

Disability remains on the margins of the social sciences. Even where disability is foregrounded as a category of analysis, accounts regularly emerge in silos, with little interdisciplinary dialogue acknowledging the...

Uncertain and under Quarantine: Toward a Sociology of Medical Ignorance.

At the center of the COVID-19 pandemic lies a ubiquitous feature of medicine. Medicine is permeated with ignorance. Seizing this moment to assess the current state of medical sociology, this article articulates a sociology of medical ignorance. We join insights from earlier medical sociological scholarship on uncertainty with emerging research in the sociology of ignorance to help make sense of the omnipresent but sometimes invisible dynamics related to the unknowns in medicine. Then we examine two streams of inquiry with a focus on uncertainty and ignorance-(1) research on the interconnections between technology, medical authority, and ignorance and (2) research on lay expertise within the context of ever-present uncertainties. For decades, and to good effect, medical sociologists have asked, "What does medicine know, and what are the consequences of such knowing?" Going forward, we encourage medical sociologists to examine the unknown in medicine and the consequences of not knowing.

Physician dominance in the 21st century: Examining the rise of non-physician autonomy through prevailing theoretical lenses.

Theories of physician dominance are a foundational contribution of medical sociology to the study of health care, but must be revisited in the light of ongoing changes in medicine. As non-physician specialists like nurse practitioners grow in number and acquire more autonomy, increasing medical profession differentiation presents a challenge for traditional physician dominance theories. After evaluating potential theoretical explanations for subordinate occupations' autonomy gains, we conduct a state-level quantitative analysis of variation in nursing policies across U.S. states. We construct our dependent variable, nursing autonomy, using seven state-level advanced practice nursing policies adopted from 2001-2017. Using an ordered scale, we code nurse practitioner, nurse anaesthetist, nurse midwife and clinical-nurse-specialist practice and prescription polices according to each policy's autonomy level. We then use time-series regression to examine theory-driven propositions regarding nursing autonomy change. Nursing autonomy has increased over time, signalling a general erosion of physician dominance. However, we find differential patterns of policy adoption, indicating that erosion is not uniform. Physicians have maintained dominance in relatively prestigious specialties (e.g. anaesthesiology) while dominance declined in others (e.g. obstetrician). Factors external to the profession, such as consumer power, continue to influence within-profession dynamics. Examining ongoing professional differentiation in medicine illustrates how physician dominance depends on shifting social and professional contexts.

Knowledge, boundaries, and bodies: Social construction between medical sociology and science and technology studies

AbstractMedical sociology and science and technology studies (STS) emerged from different positions, but often closely related concerns, within the broad discipline of sociology. Their interface and areas of overlap have mostly been shaped by theoretical positions broadly considered “social constructionist.” Taken together, these perspectives provide empirical and theoretical tools to analyze important questions about how social inequalities, forms of scientific knowledge, and patterns of human health come to be produced and feedback into one another. Examining their intersection enables sociological questions such as: How is medical and public health scientific knowledge produced, stabilized, and taken as fact? How are scientific facts about health and illness used, experienced, and challenged? What is the relationship between health inequalities and public health or medical knowledge? This article seeks to briefly trace the important contributions that social constructionist research has made at the interstices of medical sociology and STS, further clarifying the history, points of intersection, and areas of diversion between them. The current COVID‐19 pandemic has unveiled the political struggles that constitute public health scientific knowledge and circulation. The interface between STS and medical sociology can help us to make sense of the interrelationships between politics, power inequalities, and public health scientific knowledge.

Rudolf Virchow, poverty and global health: from “politics as medicine on a grand scale” to “health in all policies”

The German pathologist and politician Rudolf Virchow proposed the concept of sociomedical causation, emphasising the role of social and environmental factors in the aetiology and prevention of diseases. Virchow's achievements are threefold: he was a founder of scientific biomedicine, he characterised medicine as a social science as much as a biological science and he promoted and improved public health. In his landmark report of a typhus epidemic in mid-19th century Germany, Virchow drew a connection between the epidemic and poverty and living conditions. He proposed radical social reform and stated that, “medicine is social science and politics nothing but medicine on a grand scale”. The task of medicine was therefore not merely to treat disease but also to contribute to the health of the entire population. Virchow realised that, in order to improve the health of the public, medicine must attend to both its biological and social underpinnings. His work has had far-reaching consequences for the development of public health and medical sociology. As in Virchow's times, poverty, deprived living conditions, malnutrition, crowding and economic insecurity determine to a high degree the prevalence of disease and life expectancy in low- and middle-income countries today. Sociomedical causation is not limited to infectious diseases but also extends to the contemporary pandemics of non-communicable diseases. Obesity and other non-communicable diseases cannot be addressed effectively without considering and acting on the social determinants of health. The concept of “health in all policies” has emerged with the goal of promoting political action addressing the social determinants of health. This concept concerns prevention of disease, promotion of a healthy lifestyle and improvement of factors potentially harmful to the health of entire populations. The current “health-in-all-policies” reforms in China may advance the global evidence base for the prevention of chronic disease in low-, middle- and high-income countries.