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This paper reviews the author's experience in becoming a medical sociologist before the field had become formalized. The contributions to medical sociology of sociologist Selden D. Bacon and physician and medical educator William R. Willard are described. The relationship of medical sociology to medical behavioral science, as experienced at the University of Kentucky, is discussed. Finally, the thesis of the author's 1957 paper on the nature and status of medical sociology is re-examined. [ABSTRACT FROM AUTHOR]

This paper addresses current contentions that medical sociology is handicapped as both a scholarly and a policy science by its subordinate relationship to the more powerful field of medicine. An analysis of all research articles published in the JOURNAL OF HEALTH AND SOCIAL BEHAVIOR which focus upon patients reveals the following: (1) the presence, in the majority, of implicit and explicit medical value assumptions influencing all stages of the research process, from the definition of problems and variables through the application of findings to health policy; (2) a tendency for cases of "medical bias" to be associated with collaborative research in which the sociologist is wholly or partly dependent upon medical sponsorship and definition of the research situation. Consequences of this situation for the human subjects of research as well as for the field are discussed. A conclusion is that both our subjects' interests and the theoretic and political integrity of the field are best served by maximizing professional autonomy vis-à-vis medicine. A proposal for studying the structure of working arrangements concludes the paper. [ABSTRACT FROM AUTHOR]

This paper examines the social construction of diagnosis and illness in several ways. First, I discuss the centrality of social construction in medical sociology. Next I discuss the major role of diagnosis in social construction, leading to the need for a sociology of diagnosis. I emphasize controversial and conflictual diagnoses, as a first step toward a more general sociology of diagnosis. Then I put forth a typology of social construction, involving four combinations based on whether a condition is generally accepted and whether a biomedical definition is applied. Next I detail a series of stages in the social construction of a condition. In that process, my primary concern is the initial social discovery, which is essentially a matter of diagnosis, with a secondary emphasis on illness experience. This is followed by stages of treatment and outcome, which recursively affect social construction. I conclude by noting the health policy implications of the social constructionist perspective. [ABSTRACT FROM AUTHOR]

This paper is a revision of the address given by Professor Bloom in connection with his receipt of the Leo G. Reeder Award for distinguished scholarship in medical sociology. The address was given August 12, 1989 to the Medical Sociology Section of the American Sociological Association during its annual meeting, held in San Francis. co. [ABSTRACT FROM AUTHOR]

This paper is a revision of the address given upon receipt of the Leo G. Reeder Award for distinguished Scholarship in Medical Sociology. It was presented on August 19, 1987 to the Medical Sociology Section of the American Sociological Association during its annual meeting held in Chicago. [ABSTRACT FROM AUTHOR]

This paper is a revision of the address given upon receipt of the Leo G. Reeder Award for Distinguished Scholarship in Medical Sociology. It was presented on September 1, 1986 to the Medical Sociology Section of the American Sociological Association during its annual meetings, held in New York City. [ABSTRACT FROM AUTHOR]

Recently interest has shifted from the fact of a relationship between social stressors and health outcomes to factors that may buffer the impact of social stressors. Many forms of the stress-resource-adaptation model are possible. This paper argues that there is not one, but at least two distinct versions of the stress-buffering argument. Statistical models corresponding to each of these versions are developed with an emphasis on the interpretive logic of each model. Three other models described are not consistent with the notion of stress-buffering, but are sometimes thought to be. If more than one form of stress-buffering exists, then it ix possible that some coping resources play a "dual" buffering role. An illustration of how dual stress-buffering works suggests the importance of searching for such resources. Criteria for delimiting and distinguishing cases of stress-buffering from non-cases are discussed in the final section. [ABSTRACT FROM AUTHOR]

This paper is a revision of the address given by Professor Fox in connection with her receipt of the Leo G. Reeder Award for distinguished scholarship in medical sociology. The address was given August 29, 1984, to the Medical Sociology Section of the American Sociological Association during its annual meeting, held in San Antonio. [ABSTRACT FROM AUTHOR]

In this thoughtful paper, Mechanic discusses the differences between quantitative and qualitative researchers, focusing on health-related issues. It should, of course, be evident to readers that the issues he discusses have applicability far beyond medical sociology. The same issues arise in all kinds of social research and the excellent examples he gives can be expanded easily to examples in areas including education, criminology, industrial relations, social stratification, and others. In my reading of his paper, Mechanic discusses both differences between methods at a single point in time and differences in measuring process across time. As a quantitative survey researcher, I will comment on my perceptions of the similarities and differences between observational and survey methods for cross-sectional research. I then discuss some methods for bridging the gap that do not involve diaries. Finally, I discuss procedures for measuring process using observational and diary methods. [ABSTRACT FROM AUTHOR]

When biomedical knowledge and technology create the capacity for humans to avoid disease and circumvent early death, sociological factors become more, not less important for population health. The transformation of disease causation from cruel fate, accident, and bad luck to circumstances that are under some degree of human control facilitates a powerful social shaping of disease and death. When humans have control, it is their policies, their knowledge, and their behaviors that shape the consequences of biomedical accomplishments, and thereby extant patterns of disease and death. I propose a "social shaping approach" that can frame our understanding of these processes and allow us to take action to optimize population health. Support for this approach is garnered from evidence of dramatic improvements in population health and in the uneven distribution of those improvements across persons, places, and times. Health improvements suggest that humans have gained control of disease whereas the uneven and very slow spread of such improvements underscores the critical importance of social factors. But the evidence presented represents a stick figure at best, one that needs to be filled in by a well-supported "epidemiological sociology" that uses a wide range of sociological concepts and theories to elucidate the social shaping of disease and death. Absent a robust societal investment in epidemiological sociology, population health will reside below its optimal level and the maldistribution of health-enhancing innovations will continue to create health disparities. [ABSTRACT FROM AUTHOR]

The medical research institution is analyzed within a sociology of science framework and from a social psychological perspective. As an exemplar, a published study by Bierman (1976) concerning a treatment for genital herpes is explored in detail. Despite serious methodological flaws and ambiguities in the Bierman study, there has been widespread acceptance of the findings within both the medical and lay communities. Societal, medical, and personal implications of such practices arc discussed. [ABSTRACT FROM AUTHOR]

Calls have been issued for understanding the "contexts" or "environment" shaping the causes and consequences of health and health care. Existing efforts raise concerns about how a panorama of influences can be considered simultaneously. Sociology's view of contexts as social network structures that shape and are shaped in social interaction offers one key to resolving this dilemma. Because social networks have become central in the social, natural, and physical sciences, this perspective provides a common platform for bringing in sociology's rich theoretical and methodological insights. Yet, to do this well, three conditions must shape our response. First, all levels relevant to health and health care must be considered, separated out, and linked by network mechanisms. The genetic-biological level, perhaps the most foreign level to sociologists, represents the greatest need and best prospect for advancing a sociologically based solution. Second, room must be made to tailor models to populations, whether defined socially or medically. Third, sociologists must find a voice within "big science " to address problems from social construction to social causation that contribute to basic social processes as well as health. I trace developments in the Network-Episode Model as one theoretical starting point. [ABSTRACT FROM AUTHOR]

The attempt to assess the impact of medical sociology on health policy encounters operational difficulties regarding what should be counted. After reviewing these difficulties, we argue that there is potential interest among policymakers for sociological contributions to policy debates, but that policy impact has been limited by sociologists' ambivalence, academic career considerations, and by health research becoming a distinct field of research. Suggestions for increasing sociologists' policy impact include attending to policy relevance in both the design of studies and the dissemination of results and by sociologists' becoming more oriented to the field of health policy research. [ABSTRACT FROM AUTHOR]

Over the past 40 years, the mental health care system has been radically transformed from one focused on institutionalized care to one centered on treatment in community settings. While medical sociology has played a prominent role in the study of psychiatric hospitalization and the deinstitutionalization process, the systematic exploration of the sociological dimensions of community-based mental health care is only just beginning. This essay reflects on past disciplinary contributions and explores some important empirical and theoretical directions in the field of mental illness research that could benefit from more extensive sociological analysis. The central argument is that the shift to a community-based mental health system has increased the need for the sociological perspective and that medical sociologists, in particular, have the theoretical and analytical perspective essential for developing a more complete understanding of the current conditions impacting the lives of people with severe mental disorders. Drawing on recent work in medical sociology, we illustrate some important topical areas at the center of controversies over treatment, social change, and public policy regarding severe mental illness. We conclude with a discussion of the barriers to this type of sociological research and suggestions for ways medical sociologists might contribute to the study of severe mental disorders in the future. [ABSTRACT FROM AUTHOR]

The current situation in health care organizations, among providers and for people, dramatically challenges the "business as usual" roles of medicine, government, insurance companies, the community, and the university. Health care reform marks the first attempt in a century to consider a reconstruction of the social contract between society and medicine. While sociology stands as one of the earliest social sciences to systematically study the health care arena and create a health-focused subfield, there is a perception, not without support, of a desertion of identity from within, an encroachment by other areas from without, and abandonment by the parent discipline. We argue that these situations in medical arenas and in research fields require serious rethinking. The key lies in understanding how these phenomena are related to each other and to larger social forces, and how they offer opportunities, rather than signal limitations, to medical sociologists. We turn to the theoretical tools of sociology to help unravel the complicated challenges that face both policymakers and researchers. After framing these issues in a sociology of knowledge perspective, we use the case of "utilization theory" to illustrate the connections between society and systems of care (as well as studies of them) and to create a future agenda. We end by raising three basic questions: (1) Why is a sociological perspective critical to the understanding of change and reform in health care? (2) Why is medical sociology critical to the survival of the general sociological enterprise? and (3) Why is general sociology critical to the research agenda in medical sociology? [ABSTRACT FROM AUTHOR]

Why is it that quantitative and qualitative researchers on health issues often have divergent findings and conclusions? Exploration of such differences can be a useful way of bringing separate intellectual enclaves in medical sociology together and also can stimulate future inquiries. Some differences can be resolved by more precise definitions, by comparable frequency and timing of measurement, and by careful evaluation of meaning contexts. The triangulation of methods, using diaries as a bridge between surveys and qualitative measurement, offers particular promise. Improved theory on the relationships of method to data, and more attention to behavioral sequences and the social context of measurement, can serve as a stimulant to innovative solutions. [ABSTRACT FROM AUTHOR]

The emphasis of this analysis is on the social institutional history of medical sociology. This subfield is described as (1) closely connected with the patterns of development in its current discipline, (2) as containing a dual thrust between applied and basic science, and (3) as struggling with "insider-outsider" ambiguity involving the work of subgroups working either in medicine or from roles external to medicine but studying the sociology of medicine. Tracing a detailed historical fragment from the decade following World War II, it is predicted that the continuity of an accepted position for medical sociology is assured even though the style and quality of its professional life are full of uncertainty. [ABSTRACT FROM AUTHOR]

What patients understand from medical consultations and the processes by which they understand are of considerable clinical and theoretical interest. Empirical research about patients' understanding has been restricted, however, by measures which are inadequate when compared with the depth and complexity of sociological and social anthropological theories of medical consultations. One consequence has been that sociological and social anthropological ideas have been considered largely inappropriate for practical application. A "third party" method of defining the information universe which patients might be expected to grasp from the consultation and of assessing three levels of patient "understanding" is proposed. The method involves judgments about the content of what doctors actually say to patients and what it might mean. Such methods inevitably involve specifying values and therefore make apparent problems of validity which are only implicit in methods where such judgments appear to be avoided. Evidence is presented to show the approach can be reliably conducted. Moreover, the measures described discriminate groups of patients in interesting and predictable ways and help to deepen our ideas about the determinants of cognitive outcomes in medical consultations. [ABSTRACT FROM AUTHOR]

The article discusses the author's plans as incoming editor of the "Journal of Health and Social Behavior". To prepare for upcoming editorial duties, the author tried to determine whether, within recent years, the periodical has had desirable breadth. Using a category system for mapping the field, a tally of issues since 1978 was conducted. From the survey, two conclusions were made. The first conclusion is that every important corner of the field has been covered. There have been articles on social factors in mental illness, the health effects of stress and multiple roles, health professional education and many other topics. The second conclusion is that there ahave been some strongly accented categories and others which, through present, are heard in a fainter voice. The author also highlighted the importance of medical sociologists in various parts of the field to the continuing soundness of the periodical.