Sociology Of Medicine Research Articles

The emergence and implications of a mental health ethos in juvenile justice

Study of the interaction of mental health and justice systems tends to focus on the ways that the respective realms inadvertently ‘capture’ each other's target populations. There has been little research into a system-level analysis that can answer questions about how styles, organising principles and institutional values of one system relate to and are sometimes incorporated by the other. This paper reconsiders juvenile de-institutionalisation in Massachusetts to document the emergence of a mental health ethos in the state's juvenile justice system of community-based treatment. The emergence of this ethos superficially bears out an influential thesis in the sociology of punishment that penal practice has now become charactised by an amoral actuarialism. A more sophisticated criminological awareness of developments in mental health and the sociology of medicine would show how a mental health ethos might instead be understood to challenge the actuarial thesis, by providing a framework that reconciles the traditional aims of retribution and rehabilitation in punishment.

Positivism resurgent: the epistemological foundations of evidence-based medicine

The aim of evidence-based medicine (EBM) is to introduce scientific coherence into what clinical epidemiologists characterise as the unscientific practice of medicine and, in particular, variations in diagnoses, treatment and prescribing. This paper lays out the claims of EBM—its concept of scientific knowledge, its model of disease and its construction of the role of epidemiology in medicine—and analyses them in the framework of a sociology of medical knowledge. It argues that rather than a paradigmatic restructuring of medicine, EBM is an appeal to positivistic canons of scientificity which have been systematically challenged by both the philosophy and the sociology of medicine. The paper concludes by providing a brief account of sociological explanations of practice and diagnostic variation in modern medicine. Taking these sociological explanations into account would much improve the delivery of medicine.

Recertification for neurologists.

In 1994, the American Board of Psychiatry and Neurology, Inc. (ABPN) issued its last lifetime certificates. All diplomates certified after 1994 are required to pass a recertification examination before December 31st of the 10th year after the original certificate was issued in order to maintain certification. To many physicians, recertification may seem a new idea that has emerged from recent changes in the politics, economics, and sociology of medicine. At the meeting of its advisory board in 1936, however, the American Board of Medical Specialties (ABMS), the umbrella organization for (currently) 24 specialty boards, including the ABPN, discussed an agenda item entitled “Re-registration at Stipulated Intervals.” Additionally, in 1940, the Commission on Graduate Medicine published a statement entitled “Time Limit on Certification,” a portion of which reads: Many persons argue that certification of a specialist indicates that he is up-to-date and competent at the time of examination but that this does not prove that he continues indefinitely thereafter to be competent and aware of all important new knowledge in his field. This is obviously true and, as the certifying Boards become established and as they complete the examination of the large group of physicians already practicing the specialties, they may find it desirable to issue certificates that are valid …

What’s all the fuss about Ritalin?

with an equation describing a chemical equilibrium reaction, the presence of an extremely effective treatment (or of readily available reimbursement for a treatment of unproven efficacy) will not unexpectedly contribute both to an increase in the use of that treatment and possibly to more accurate diagnosis. Although not every child who qualifies for a diagnosis of an attention disorder needs a trial of medication, the prescription rate would need to significantly exceed the 10% level before it can be interpreted as prima facie evidence of overuse. Several decades ago, there was an “epidemic” of learning disabilities, and more recently, there has been a “pandemic” of autistic spectrum disorders. For the most part, these increases do not reflect faddish overdiagnosis but rather a recognition of cases that were previously misdiagnosed or just plain missed. Although Goldman et al 10 found little evidence of any “widespread overdiagnosis or misdiagnosis of ADHD or of widespread overprescription of methylphenidate,” Angold et al 11 uncovered some confusing discrepancies between prescription practices and accurate diagnoses in a community setting. Commenting on the latter article, Jensen 12 interpreted this mismatch as not inconsistent with undertreatment as the primary phenomenon.

Manfred Waserman and Samuel S Kottek (eds), Health and disease in the Holy Land: studies in the history and sociology of medicine from ancient times to the present, Lewiston, NY, and Lampeter, Wales, The Edwin Mellen Press, 1996, pp. xii, 489, $109.95 (0-7734-8764-6).

Manfred Waserman and Samuel S Kottek (eds), Health and disease in the Holy Land: studies in the history and sociology of medicine from ancient times to the present, Lewiston, NY, and Lampeter, Wales, The Edwin Mellen Press, 1996, pp. xii, 489, $109.95 (0-7734-8764-6).

The body and the digital archive: the Visible Human Project and the computerization of medicine

This paper addresses itself to some biopolitical issues raised by the computerization of medicine. It is now widely accepted in cultural studies and the sociology of medicine that the computer offers a conceptual model to medicine for the organization of human bodies, and that bodies are increasingly understood as forms of digital archive. However this paper uses one recent development in medical computer imaging, the Visible Human Project, to argue that the computerization of medicine also involves a material reorganization of at least some bodies, a reorganization which reveals a biopolitical hierarchy of more and less valuable bodies within the framework of high-technology medicine.

Existential and clinical uncertainty in the medical encounter: an idiographic account of an illness trajectory defined by Inflammatory Bowel Disease and Avascular Necrosis

AbstractUncertainty has been a central theme in the sociology of medicine. Scholars have focused on the existential uncertainty which is an aspect of the illness experience, and on the clinical uncertainty which marks the diagnosis and treatment of disease. However, there are few intensive examinations of how existential and clinical forms of uncertainty mutually affect each other. This essay draws on a personal experience of illness with inflammatory bowel disease (IBD) and a vascular necrosis (AVN), and on the clinical record of how these diseases were diagnosed and treated, in order to demonstrate that these two forms of uncertainty, by continuously playing to and playing off each other, mutually shape the nature of the medical encounter.

A Diagnosis for Our Times: Alternative Health's Submerged Networks and the Transformation of Identities

In this article we examine an understudied social movement-alternative health. In fact, alternative health is rarely conceptualized as a social movement but is more often studied as a marginal branch of the sociology of medicine or as part of the New Age religious "cult." Instead, we examine alternative health as a "new social movement" (NSM) (Cohen 1985; Eder 1982; Larafia, Johnston, and Gusfield 1994). We explore the creation of oppositional identities and meanings and argue that the larger significance of this movement is as a site in which diverse communities and discourses challenge a leading expression of what Jilrgen Habermas has called the "colonization of the lifeworld." We draw on the work of Habermas (1981; 1987), who has argued that the source of new social movements is the resistance to the "colonization of the lifeworld" by the media of money and power (for a critique of Habermas's lifeworld model, see Fraser 1989). Habermas argues that modernity has differentiated three value spheres that had been undifferentiated in premodern societies:-the cognitive-instrumental sphere, morality and law, and art and aesthetics. But the "developmental logic" of modern societies has created an imbalance. Science and technology in alliance with state administration and the economy or "the system" have colonized and marginalized the communicative structures of everyday life. Everyday life or

Disease and class: tuberculosis and the shaping of modern North American society

Until a decade ago, the conquest of tuberculosis seemed one of the great triumphs of modern medicine. The resurgence of TB in the wake of AIDS has to be understood, Georgina Feldberg argues, in the context of decisions the U.S. Public Health Service made, beginning in the 1930s, to prevent TB through improved hygiene and long-term treatment with medications, rather than program of BCG vaccination that Canada and many other countries adopted. Feldberg's aim is not to judge which was the right choice, but to explain why the U.S. rejected the vaccine and the consequences of that choice. To American physicians, TB, the conditions that fostered it, and the kind of people who got it were a direct threat to their own middle-class values, institutions, and prosperity. They prescribed vigorous social reform, and by the 1960s, they were convinced the strategy had worked. But, as the country's commitment to strong social welfare programs waned, the bacteriological reality of TB reasserted itself. Feldberg challenges us to recognize that the interplay of disease, class, and the practice of medicine can have unexpected consequences for the health of nations. The book is essential reading for students and professionals in public health, medicine, and the history and sociology of medicine. Georgina D. Feldberg is director of the York University Centre for Health Studies in North York, Ontario. She is coauthor of Take Care: Warning Signals for Canada's Health System.

The Effects of Hospital Characteristics and Radical Organizational Change on the Relative Standing of Health Care Professions

This paper examines the effects of hospital characteristics and radical organizational change on the relative representation of health care professions in hospitals over the period of the 1980s. Health care organizations, and hospitals in particular, represent organizations where multiple professional groups make competing claims of expertise that often conflict. The question our research seeks to answer is whether different constellations of organizational characteristics and organizational changes affect the outcome of these professional conflicts. Using the annual census of hospitals compiled by the American Hospital Association, we examine the effects of several characteristics of community hospitals on the relative representation of specific professional groups. We find that hospital mergers favor physicians at the expense of administrators, and multihospital system affiliation favors technical core occupations at the expense of administrators. Measures of organizational growth and decline increase the relative representation of physicians and administrators compared to nurses, and increase the probability that hospitals will employ physicians' assistants and nurse practitioners. Our results are evaluated in light of recent developments in the sociology of medicine and research on the relative standing of occupations in other industries.

The Dialectics of Depression

This article attempts to illuminate the phenomenology of clinical depression by making it sociologically intelligible. It proceeds from the fundamental premise of the sociology of medicine that there is a dialectical relationship between illness and social experience. Throughout, it explores the paradox that depressed persons greatly desire connection while they are simultaneously deprived of the ability to realize it. In‐depth interview data from 35 persons diagnosed and treated for clinical depression suggest that four factors interact synergistically to deepen depression's isolation: (1) the intrinsic character of the emotional experience of depression, (2) the failure of individuals to have a clear vocabulary for understanding their own predicament, (3) the incomprehensibility of depression to “normals,” and (4) the stigma attached to “going public” with one's problem. The article concludes by outlining a research agenda that links the incidence of depression to structural factors diminishing social connection.

Invalid women: figuring feminine illness in American fiction and culture, 1840-1940

fine example of politically engaged literary criticism.-- Belles Lettres Price Herndl's compelling individual readings of works by major writers (Harriet Beecher Stowe, Hawthorne, Wharton, James, Fitzgerald) and minor ones complement her examination of germ theory, psychic and somatic cures, medicine's place in the rise of capitalism, and the cultural forms in which men and women used the trope of female illness.-- Choice A rich and provocative study of female illnesses and their textual representations...A major contribution to the feminist agenda of literature and medicine.--Medical Humanities Review [An] important book.-- Nineteenth-Century Literature [This] sophisticated new study ...brings the best current strategies of a thoroughly historicized feminist literary criticism to bear on textual representations of female invalidism.-- Feminist Studies An outstanding study of the representation of female invalidism in American culture and literature. There emerges from this work a striking sense of the changing meanings of female invalidism even as the conjunction of these terms has remained a constant in American cultural history...Moreover, Invalid Women provides fascinating readings of female illness in a variety of texts. --Gillian Brown, University of Utah A provocative study based on imaginative historical research and very fine close readings. The book provides a useful American complement to Helena Michie's The Flesh Made Word and Margaret Homans's Bearing the World . It should prove enlightening and otherwise useful not just to scholars of American literature, but also to those engaged in American studies, feminist criticism and theory, women's studies, the sociology of medicine and illness, and the history of science and medicine.--Cynthia S. Jordan, Indiana University

Mother-Infant Bonding: A Scientific Fiction

This book uses the issue of maternal-infant bonding to illustrate what is now a truism in the sociology of medicine, but one that cannot be repeated enough: often ideology is more critical than data in both popular and scientific acceptance of certain research findings. A decade ago Stephen Jay Gould offered a thorough and compelling historical demonstration of this point in<i>The Mismeasure of Man</i>. Diane Eyer's book is a welcome attempt to explore the realworld implications of this academic theory. It is a theory that is also relevant to other areas of medicine, such as the acceptance of "new diseases" or nutritional doctrines. Studies and assertions that correspond to societal prejudices, values, or wishes are accepted as scientific truth even in the absence of valid and reliable evidence. Eyer, a psychology teacher at the University of Pennsylvania's Graduate School of Education, maintains in this book that widespread acceptance of

Consent, autonomy and the infantilised patient.

In this article we examine a particular aspect of the doctor-patient relationship — that of consent to treatment procedures — from three perspectives: ethics, sociology of medicine, and the Common Law. The legal deliberation and judgments are considered within the first two perspectives. Ethics provide us with ideal standards such as personal autonomy or the sanctity of life, whereas the sociological perspective focuses on the actuality of the doctor-patient relationship in terms of knowledge and mystification or power and dependence. In our analysis of the cases, including a spate of recent decisions, we note how the rhetoric of patient autonomy in the leading House of Lords cases has not followed through into the later crisis-handling judgments. We argue that the practical model for these decisions is not the rhetoric of autonomy but the prerogative jurisdiction of wardship: the infantilised patient. We argue that there is an aspect of professional collusion here between lawyers and doctors, which exemplifies much of the sociological literature as well as the individual constituted as subject, rather than citizen, in English jurisprudence. We suggest a number of reforms for the situation we have criticised.

Unresolved Questions of German Medicine and Medical History in the Past and Present

While in recent years a great deal has been written to clarify Germany's medical past, the picture is not yet complete in several important respects. In the realm of the sociology of medicine, for example, we still do not know enough about physicianpatient relationships from, say, the founding of the Second Empire to the present. On the assumption, based on the meager evidence available, that this relationship had an authoritarian structure from the physician on downward, did it have anything to do with the shape of German medicine in the Weimar Republic and, later, the Third Reich? Another relative unknown is the role of Jews in the development of medicine as a profession in Germany. Surely volumes could be written on the significant influence Jews have exerted on medicine in its post-Wilhelmian stages, as well as the irreversible victim status Jewish doctors were forced to assume after Hitler's ascension to power

The Sociology of Medicine: A Participant Observer's View.

The Sociology of Medicine: A Participant Observer's View.

Readings in Medical Sociology/ The Sociology of Medicine, a participant observer's view (Book).

Readings in Medical Sociology/ The Sociology of Medicine, a participant observer's view (Book).

Doctors and rules: a sociology of professional values

Doctors and Rules is a unique and immensely scholarly book. It draws on material which has informed our civilization, including many of the social sciences-history, sociology, and psychology, as well as law. The author accesses the current importance of the Hippocratic tradition within medicine, and puts forward various models of its practice. He seeks to expose the often inarticulated foundation of contemporary debates about the law, medicine, and health, and to question some common assumptions of the functionsand structures of social and legal order. The book challenges the idea that legal rules should be respected merely because they exist and because they play a part in centralizing the organization of society. It rejects the notion that the courts always, or even often, offer useful mechanisms for defining and settling disputes. On the contrary, the author sees in their formalism many things which hinder the common cause of humanity. Only a skeptic trained in law but also deeply concerned by our fate and circumstances could have produced it. It also contributes both to the sociology of law and the sociology of medicine. Out of a reassertion of old ways, this book presents a new blueprint for future professional conduct. It is rich in questions and ideas for researchers, teachers, and professionals in the fields of law, medical sociology, and medicine and generally for those concerned with the place of professional conduct.

The sociology of medicine: a participant observer's view

Provides a social, cross-cultural and interdisciplinary perspective on health, illness, and medicine. Analyzes first-hand, participant observer-based, qualitative studies in the field.

Henry E. Sigerist: From the Social Production of Disease to Medical Management and Scientific Socialism

^H w ENRY E. SIGERIST DID MORE THAN ANY OTHER individual to establish, promote, and popularize the history of medicine in America. He made the history of medicine relevant to contemporary concerns and greatly broadened its appeal beyond the small company of scholars, collectors, and amateur gentlemen physicians who had been interested in the field (Miller 1980). As professor of the history of medicine at Johns Hopkins, he made the history of medicine comprehensive, more comprehensible, more significant in human and social terms (Stevenson 1958). Here, I will be concerned with Sigerist's analysis of the social production of disease and its relation to his proposals for the reform of medical care. Sigerist's work on the history of disease has more radical implications than much of his more overtly political writing on the sociology of medicine and medical care organization. Sigerist articulated two, largely distinct, positions in relation to the politics of health and disease. On the one hand, his work on the history of disease suggested that the incidence of disease was generated by social and economic conditions, and therefore had to be addressed by social and economic reorganization, promoted in part by a people's war for health; on the other hand, much of Sigerist's active political and sociological work concentrated on the more limited (if still ambitious) goal of changing the organization, delivery, and financing of health services. Sigerist's dual vision of the physician's role-as participant