Search

The article presents the response of the authors to the paper titled "The Legacy of Stress Research: The Course and the Impact of This Journal" which appeared in the September 1990 issue of the "Journal of Health and Social Behavior." The authors' principal concern has been to craft as effective and complete a statement as possible while remaining judicious stewards of the journal's scare page allocation. They made three brief comments on the general nature of the exchange and proceeded to commentary-specific responses.

The article responds to comments made by Catherine Schaefer from the Department of Biomedical and Environmental Health Sciences of the University of California on study of the mental and physical health consequences of job stress and social support by J. R. LaRocco, J. S. House and J. R. P. French, Jr that published in the September 1980 issue of the "Journal of Health & Social Behavior." The author appreciates Schaefer's comments regarding the theoretical contributions of the paper to the understanding of the concept of social support, and supports her call for improved conceptualization and empirical study of the processes of social support. The paper was concluded on a similar note and, in fact, speculated on the nature and substance of those processes. The article also welcomes her raising some statistical issues with which researchers have been concerned throughout their work. Researchers, perhaps mistakenly, decided not to raise these issues in their paper due to constraints of time and space, though they addressed some of them in other places. Some of those issues have been addressed in this article.

This section introduces several articles on the impact of race and ethnicity on mental health.

This commentary speaks to several issues that arise from the papers in this special issue. Two articles--Kessler (2002) and Mirowsky and Ross (2002)--focus on a major measurement issue: dimensional versus diagnostic-type assessments. One topic requires greater attention: the correspondence of these measures with the underlying states they supposedly measure--constructs in the psychometric tradition and empirically defined illnesses in the medical or psychiatric tradition. Conclusions about the nature of these unobserved states remain tentative at this time. Three articles--Keyes (2002), Schwartz (2002), and Umberson, Williams, and Anderson (2002)--address the expansion of mental health outcomes. The existing reliance on emotional distress is problematic for sociological research because a single disorder is not a good proxy for estimates of the overall mental health consequences of social arrangements. Although these papers present diverse and sometimes conflicting perspectives, collectively they demonstrate that no one approach to outcomes is best for all research questions. [ABSTRACT FROM AUTHOR]

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 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. [ABSTRACT FROM AUTHOR]

Cadaver stories are narratives describing "jokes" played by medical student protagonists on unsuspecting and emotionally vulnerable victims. In these stories, medical students physically (and thus symbolically) manipulate whole cadavers or certain cadaver parts-often extremities or sexual organs-for the dual purpose of shocking their intended victims and deriving humor from their victim's distress. The victims in cadaver stories are either lay people or what the narratives portray as emotionally vulnerable medical students. Cadaver stories circulate most freely among medical student aspirants and initiates, and are told as true accounts of actual events. They are also told with the expectation that peers will view their telling as a source of humor. in this paper, cadaver stories are viewed as part of the oral culture of medical training. Two questions are raised: Under what conditions do we find these stories being told (and thus what do these stories, and their telling, tell us about the experience of anatomy lab)? What functions are served by the telling of cadaver stories? A central focus of this paper is the role of cadaver stories in the emotional socialization of medical students. [ABSTRACT FROM AUTHOR]

The introduction to this special issue of the Journal expands the scope of research on "the sociology of medical education" to include studies of the institutions in which physicians are trained as well as studies of the socialization of the physician throughout the life cycle. Research since the 1960s is reviewed briefly and the papers in this issue are discussed. Studies of the macropolitics and micropolitics of academic medicine are called for as well as comparative analyses of the settings in which physicians are trained and research on the relative effects on physicians' attitudes and behavior of different sets of experiences, professional and nonprofessional, over the course of their life cycle-all in the context of massive changes in the organization of health care. [ABSTRACT FROM AUTHOR]

This paper proposes a symbolic interactionist basis for the identification of insanity. In contrast to the labeling model and the psychiatric model, the symbolic interactionist view holds that the defining feature of psychosis is the observer's inability to take the role of the actor or to make successful attributions. Psychotic behavior is thus not simply an objective feature of an individual but an interactional phenomenon whose fundamental characteristic is role-taking. It is shown that the same thought, mood, or behavior may be either sane or insane depending on role-taking success or failure. The only exception to this generalization is when the observer attributes the failure to take the role of the other to his or her own limitations. The paper then discusses several challenges to the symbolic interactionist approach. Finally, the labeling theory and symbolic interactionist approaches are compared. Although both focus on the societal reaction to insanity, it is shown that they differ in a number of fundamental ways. It is argued that symbolic interactionism provides a more correct understanding of the social definition of insanity. [ABSTRACT FROM AUTHOR]

This paper has two purposes. First, it provides a theoretical perspective for understanding the interrelationships among increasing equality of rights and greater equality of distribution and utilization of resources. It argues that increasing complexity, efficaciousness, and costs of technology lead to greater centralization in the delivery of services, which in turn leads to more equality of rights and to greater equality in the distribution and utilization of resources. Second, it confronts the question of whether the expanding equality of rights and the more equal distribution and utilization of resources over several generations bring about equality of results. Focusing on the structure of the British medical delivery system during the period between 1891 and 1971, the study concludes that increasing equality of access, of distribution of resources, and of utilization of services has not brought about more equality in levels of health across social classes. Since the British National Health Service has the most egalitarian service of any highly industrial society, the conclusions of the paper suggest that societies which wish to equalize levels of health across social classes might be more concerned with equalizing income and educational attainment. [ABSTRACT FROM AUTHOR]

It is important to examine the possibility that relationships between commonly studied status indicators and psychological distress indicators are due, in part or wholly, to differences in the impacts of comparable stressor events and situations on people in different status categories. This paper describes and illustrates a strategy for doing this and argues that the systematic existence of impact differentials helps explain the commonly observed relationships between certain social statuses and psychological distress. [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]

The inability to attract adequate numbers of psychiatrists has been a concern of community mental health (CMH) planners for some time. This paper considers whether normative or utilitarian (i.e., economic) inducements have more of an impact on their participation. Data are drawn from a survey of 946 New York area psychiatrists. These data suggest the likelihood of incremental growth among community psychiatrists because organizational involvement, high quality residency training, and "younger generation" status all are linked to normative commitments to CMH values. Moreover, since political orientation is the strongest single determinant of these values, commitments also can be deliberately stimulated through normative appeals. Yet, our principal finding is that severe utilitarian disincentives tend to undercut the effects of normative inducements and commitments. The paper concludes by examining the social policy implications for community mental health staffing of the primacy of utilitarian considerations among psychiatrists. [ABSTRACT FROM AUTHOR]

The primary objective of this paper is to review the past twenty years of research activity stimulated by Parsons' original formulation of the sick role concept. The paper also includes an assessment of the present status of this conceptual model and some implications for future research. This review suggests that many questions still remain unanswered. Consequently, an attempt is made to develop a paradigm intended to facilitate the integration of existing research evidence pertaining to sources of variance in the sick role and to provide a guide to a more comprehensive, systematic approach to the study of the sick role. [ABSTRACT FROM AUTHOR]

Over the last 25 years, national Health Maintenance Organization (HMO) and hospital firms attempted to enter local markets, either by acquiring formerly independent, locally based HMOs and hospitals or by directly entering local markets. While national HMOs have been relatively successful, national hospital firms have had much less success. This paper explores the reasons for this difference. It reviews changes in presence of national HMO and hospital firms in markets, discusses common conceptual lenses through which national entry into local markets typically has been viewed, and shows how social network theory can be used to develop a better understanding of why the entry experience of national HMO and hospital firms varies across markets. The paper concludes with a research agenda that addresses issues raised by social network theory and its application to national firm entry into local markets. [ABSTRACT FROM AUTHOR]

The sociology of mental health focuses on the epidemiology, etiology, correlates, and consequences of mental health (i.e., psychiatric disorder and symptoms, psychological distress, and subjective well-being) in an attempt to describe and explain how social structure influences an individual's psychological health. Critical race theory describes and explains iterative ways in which race is socially constructed across micro- and macro-levels, and how it determines life chances implicating the mundane and extraordinary in the continuance of racial stratification (i.e., racism). This paper invoked critical race theory to inform the sociology of mental health's approach to studying race and mental health by conceptualizing five hypothetical mental health problems that could exist because of racial stratification. These problems were: (1) nihilistic tendencies, (2) anti-self issues, (3) suppressed anger expression, (4) delusional denial tendencies, and (5) extreme racial paranoia. Mental health problems such as these and undocumented others can only be recognized given awareness of the social and personal implications of racial stratification. [ABSTRACT FROM AUTHOR]

Schizophrenia is diagnosed more frequently among African Americans while mood disorders are identified more often among whites. Such findings have raised serious questions about the accuracy of clinical judgment. This article analyzes data on 665 African American and white psychiatric inpatients using a semi-structured diagnostic instrument. The paper explores the relationship of patient race to schizophrenia, schizoaffective disorder, major depression, and bipolar disorder. The paper also explores the extent to which patient race is related to the manner in which clinicians link individual symptoms to diagnoses. Results indicate some significant race differences in diagnosis remain even when a semi-structured instrument and DSM criteria are used. whites, were more likely than African Americans to receive a diagnosis of bipolar disorder and less likely to be diagnosed with schizophrenia. There were no race differences in major depression. Some patterns of symptom attribution differed by race. The results are consistent with previous sociological research showing that patient race is related to diagnosis even when standardized diagnostic criteria are used. These findings underscore the importance of clinical judgment within the context of cross-race and cross-ethnic diagnosis. Clinical training programs must reduce ethnocentric bias by teaching the appropriate use of the socio-cultural information necessary to employ DSM-IV's Cultural Formulation. [ABSTRACT FROM AUTHOR]

This paper reviews the sociological controversy over using categorical versus dimensional assessments in the study of psychological distress. The preference of sociologists for dimensional assessments is traced to two assumptions: (1) that the associations of predictors with psychological distress syndromes are most accurately operationalized by using dimensional measures; and (2) that no true discrete mental illnesses can reasonably be inferred to exist that would justify the creation of dichotomous measures. Methods are described in this paper to test both assumptions. An argument is made that the first assumption is the critical one and that dimensional analysis is useful only when it can be demonstrated that the associations of predictors with dimensional scores are constant throughout the relevant dimensional severity range. The paper closes with an argument for the tandem use of categorical and dimensional assessments in future sociological research. [ABSTRACT FROM AUTHOR]

The article is a commentary on the portrayal of the impact of the "Journal of Health and Social Behavior" (JHSB) by Robert J. Johnson and Frederic D. Wolinsky relative to other sociology and social sciences journals in the period of 1977 to 1987. It is agreed that the journal is in high standing and regard within the social science community. The major lessons cited by Johnson and Wolinsky are different from the thesis. It is confirmed that their analysis elucidates the dangers of relying much on impression and too little on factual investigation. Their data show little change in the proportion of stress articles over the 1990s period. The evidence presented does not sustain the general perception regarding the impact status of three other sociological journals relative to JHSB. The argument that the course of the impact of JHSB due to its identification with stress research is questioned based on the data presented. The data given is not organized efficiently to test the hypothesis.

Drawing from an institutional-theory perspective on innovations in organizations, this paper examines the use of human immunodeficiency virus (HIV) prevention practices by the nation's outpatient substance abuse treatment units during a critical period from 1988 to 1995. An institutional perspective argues that organizations adopt new practices not only for technical reasons, but also because external actors actively promote or model the use of particular practices. We examine the extent to which treatment units use several practices to prevent HIV infection among their clients and among drug-users not in treatment. Results from random-effects regression analyses of national survey data show that treatment units significantly increased their use of HIV prevention practices from 1988 to 1995. Further, the results show that treatment units' use of prevention practices was related to clients' risk for HIV infection, unit resources available to support these practices, and organizational support for the practices. Implications are discussed for an institutional view of organizational innovation as well as for research on HIV prevention. [ABSTRACT FROM AUTHOR]

Does voluntary association reduce psychological distress and can these effects be distinguished from the more commonly recognized benefits of social support? This paper attempts to answer this question by reporting the results of an investigation, guided by the stress process model, into the effects of voluntary group membership on psychological distress. I conducted this research through a secondary analysis of a community sample of 850 persons residing in southwestern Ontario in 1984. I find that voluntary group membership results in a reduction in depressive symptoms for men and women ranging in age from 22-89. In addition, voluntary group members suffer lower levels of depressive symptoms in the presence of increasing stress burdens than do those who are not group members, indicating stress buffering effects. Controlling for individual psychosocial resources including mastery, self-esteem, and social support does not reduce these effects, thus leading to the conclusion that voluntary association membership itself makes a unique contribution to distress reduction. [ABSTRACT FROM AUTHOR]

Considerable evidence supports the premise that higher levels of education lead to enhanced health, including protective health behaviors. This paper focuses on how education affects one health behavior known to lead to enhanced health: the cessation of smoking. In particular, the authors examine the extent to which education influences the decision by middle-aged adults to quit smoking following a heart attack, a potentially life-threatening health event. We first hypothesize that middle-aged adults with more formal education will stop smoking more readily than people with less formal education following the experience of a heart attack. Second, we ask what other factors might underlie and explain that hypothesized effect. Using longitudinal data, the authors track changes in individual smoking behaviors after a heart attack among preretirement-age Americans. We control for documented correlates of smoking and heart attack plus other factors associated with education, heart attack, and smoking that may also influence whether a person quits smoking. In addition to confirming evidence on the education-health association as well as the documented connection between heart attack and smoking cessation, this study provides a surprising twist on those links: Our results show that the move to quit smoking following the experience of a heart attack among middle-aged adults is significantly and dramatically moderated by their level of educational attainment. [ABSTRACT FROM AUTHOR]

About 13,000 physicians from the former Soviet Union have found themselves in the saturated medical market in Israel as a result of the latest wave of immigration. This paper examines the gap in professional altitudes and practices between Israeli and Soviet MDs and the cognitive mechanisms employed by immigrant physicians in the process of adjustment to the new medical culture. The study draws on 25 semistructured interviews with recent (about three years in Israel) immigrant doctors who were at various stages of obtaining a local medical license. Reflecting on the need to redefine themselves as professionals and to confront negative stereotypes regarding ex-Soviet doctors, many respondents stressed the strong sides of Soviet medical training and work style. In their collective self-portrait, immigrant doctors emphasized devotion to patients, clinical intuition, manual skills, and empathy, while flaws were regarded as superficial and improvable by technical training. Conversely, the alleged flaws of Israeli doctors were perceived by these informants as pertaining to the core of medicine: "Excessive dependence on technology," "lack of responsibility toward patients," and "weak preventive orientation" of Israeli colleagues were repeatedly criticized. The paper sheds light on the significant conceptual differences between the Soviet and Western medical traditions and provides a vivid example of the sociocultural construction of medicine. Our findings are also indicative of the interpretative processes and coping strategies that immigrants in general may develop in saturated professional markets. [ABSTRACT FROM AUTHOR]

This paper examines the social origins of the rise in adult mortality in Russia and selected Eastern European countries. Three explanations for this trend are considered: (1) Soviet health policy, (2) social stress, and (3) health lifestyles. The socialist states were generally characterized by a persistently poor mortality performance as part of a long-term process of deterioration, with particularly negative outcomes for the life expectancy of middle-aged, male manual workers. Soviet-style health policy was ineffective in dealing with the crisis, and stress per se does not seem to be the primary cause of the rise in mortality. Although more research is needed, the suggestion is made that poor health lifestyles--reflected especially in heavy alcohol consumption, and also in smoking, lack of exercise, and high-fat diets--are the major social determinant of the upturn in deaths. [ABSTRACT FROM AUTHOR]

Most studies of the health consequences of unemployment ignore the economic context within which job loss occurs. Using data from a subset (N = 1,252) of a national probability sample, this paper compares the effects of current and previous unemployment on depression and subjective physical health status across levels of educational attainment and local job availability. Results show that current unemployment effects among the previously unemployed are strongest in low unemployment areas, particularly among individuals with a college-level education. These findings are interpreted in terms of the two categories of unemployment-related stress most frequently identified in the literature: financial strain, which is thought to be more salient for people in lower socioeconomic statuses, and damage to sense of self, which may primarily characterize higher status victims of job loss. [ABSTRACT FROM AUTHOR]

Drawing from theory on institutionalized organizational environments, this paper analyzes the actions of community-based service programs providing care for people with AIDS. The focus is on the interorganizational relations developed by the lead agencies in demonstration projects attempting to coordinate services in three communities. The paper identifies differential styles of organizational response to developmental and operational issues. These differences are related to the conceptual distinction between organizational responses to technical environments and those to normative, or "institutional," environmental features. Various factors are identified that appear to promote a higher degree of institutionalization in interorganizational relations. Coordination as a reform strategy is seen to have become, in itself, an institutionalized myth to which organizations must subscribe in order to gain legitimacy. [ABSTRACT FROM AUTHOR]

This paper replicates and extends an earlier attempt to use data from the General Social Survey (GSS) to track the distribution of AIDS across demographic subgroups. (The GSS asks respondents whether they know a person with AIDS [PWA].) The gender, racial, age, and regional composition of the set of PWAs reported by GSS respondents is compared with that of the official AIDS cases reported to the Centers for Disease Control (CDC). In an attempt to assess the accuracy of the GSS estimates, a similar analysis is performed in which GSS respondents are asked whether they know a homicide victim. Data from four consecutive GSS samples (1988, 1989, 1990, and 1991) are used, permitting a more detailed exploration of potential biases and problems with the network technique. In addition, time series data from the National Health Interview Survey on the percentage of people who know at least one PWA are used to validate the GSS data. Our earlier findings, that the GSS identifies proportionately more White and midwestern cases than are reported to the CDC, are corroborated by the additional data. Possible explanations for these discrepancies are given, and suggestions are made for improving the utility of the approach. [ABSTRACT FROM AUTHOR]

Building on a detailed study of the Woburn, Massachusetts, childhood leukemia cluster, this paper examines lay and professional ways of knowing about environmental health risks. Of particular interest are differences between lay and professional groups' definitions of data quality, methods of analysis, traditionally accepted levels of measurement and statistical significance, and relations between scientific method and public policy. This paper conceptualizes the hazard-detection and solution-seeking activities of Love Canal, Woburn, and other communities as popular epidemiology: the process by which lay persons gather data and direct and marshal the knowledge and resources of experts in order to understand the epidemiology of disease, treat existing and prevent future disease, and remove the responsible environmental contaminants. Based on different needs, goals, and methods, laypeople and professionals have conflicting perspectives on how to investigate and interpret environmental health data. [ABSTRACT FROM AUTHOR]

Further progress in understanding the significance of stress for psychological well-being requires improved strategies for controlling both inter- and intra-event variability across subjects studied. This paper reports on an innovation in stress measurement suggested by a proposition drawn from crisis theory that recognizes life events as representing opportunities as well as hazards. The crucial contingency is hypothesized to be the outcome of the event with respect to the extent of its resolution in emotional and practical terms. This paper examines the possibility that life events that have been resolved successfully may not contribute to individual stress. Data was gathered from community samples of physically limited individuals and of non-limited comparison subjects. Results from separate analyses of these data generally support this hypothesis. [ABSTRACT FROM AUTHOR]

Although past research indicates that women's higher levels of psychological distress can be accounted for by their greater exposure and vulnerability to role-related stress, the social psychological factors contributing to female vulnerability have not been fully identified. This paper applies identity theory to the phenomenon of gender differences in distress among parents. From an identity perspective, I propose that salience of the parental identity in women's self-conceptions contributes to their vulnerability to parental role strains. Using 1988 survey data from a stratified random sample of married and divorced Indianapolis residents (N=448), I find that gender differences in distress are explained by differences in exposure to parental role strains. Further analyses reveal, however, that salience of the parental identity contributes to both men's and women's vulnerability to parental role strains. These findings underscore the utility of identity theory for explaining psychological distress among women and men. [ABSTRACT FROM AUTHOR]

This paper contrasts economic and professional models of physician admitting behavior. Economic models emphasize physician convenience and income maximization, while professional models emphasize physician autonomy and independence. The paper examines the relative power of these models to explain two types of admitting decisions made by physicians: which hospitals to begin admitting patients to, and how many patients to admit to a hospital. Analyses of physician admitting patterns over a three-year period suggest that economic considerations outweigh professional considerations in both decisions. Results are interpreted in light of recent changes in the profession of medicine and physician-hospital relationships. [ABSTRACT FROM AUTHOR]

This paper explores alternative explanations for the recent sharp decline in cocaine use among high school seniors, using questionnaire data from annual nationwide surveys conducted from 1976 through 1988. Results show important parallels with earlier analyses of the longer-term decline in marijuana use. Although lifestyle factors (e.g., religious commitment, truancy, evenings out for fun and recreation) show strong links with use of marijuana and cocaine, these factors have not developed trends in ways that can account for the declines in use of either drug. Reported availability of either drug has not been reduced. Instead, increases in perceived risks and disapproval appear to have contributed substantially to the recent declines in use of marijuana and cocaine. The findings provide strong support for the use of realistic information about risks and consequences as an important ingredient in efforts to prevent drug use. Coupled with the findings on availability, the results emphasize the importance of efforts to reduce demand (as opposed to supply). [ABSTRACT FROM AUTHOR]

More than 100 studies have cited M. Harvey Brenner's (1973) claim that fluctuations in the economy increase the onset of mental illness and thus generate increases in mental hospitalization. Published attempts to replicate Brenner, however, have considered only twentieth-century data. One of Brenner's most memorable claims was that a stable inverse relationship between mental illness and the economy could be seen over a 127-year span beginning in the early nineteenth century. Unfortunately, no research since Brenner's has considered nineteenth-century populations. In this paper we analyze the hypothesis that economic change provokes a substantial fraction of first admissions to mental hospitals. We used admissions registers from the three institutions to construct a data base that approximates a psychiatric case register for a nineteenth-century American city from 1881 to 1891. Time-series tests show no support for the "provocation" hypothesis. [ABSTRACT FROM AUTHOR]

This paper presents information on the role and significance of social support for the occurrence of health and birth problems among adolescent mothers and their babies. Pregnant teenagers (N = 268) were interviewed during the course of pregnancy and again approximately four weeks after delivery, and hospital records were abstracted. The significance of family support, friend support, and partner support, assessed during the pregnancy, were examined in relation to infant and mother outcomes assessed at or after the birth. Infant outcome was indexed by birth weight, with gestational age controlled; mother outcome in terms of psychological adaptation was indexed by depressive symptomatology among adolescent mothers. Socioeconomic background was found to influence relationships between social support and both infant and mother outcomes. [ABSTRACT FROM AUTHOR]

This paper probes two aspects of the medical profession in Singapore: its structure and its social position. The first section reviews the relevant concepts concerning the structure and the social position of the professions that may be applied to medicine in Singapore. The second section looks into the structure of the medical profession in Singapore from an historical perspective. The third section deals with the internal organization of the medical profession. The fourth section focuses on its social position. The paper concludes with a summary of the main points and a brief comparison of the situation in Singapore with that in other countries. [ABSTRACT FROM AUTHOR]

Emphasis on rural health problems has led to a relative neglect of urban health issues in developing societies. Yet the fact that a large proportion of the limited financial and human resources is allocated to urban health care makes it imperative for researchers and health planners to evaluate the effectiveness of the urban health care system. This paper examines data on health care utilization from a sample survey of 1500 households conducted in three areas of Accra, Ghana in 1982. The factors that influence the use of three types of health care services (clinics, drug vendors, and traditional healers) are examined. Suggestions are made for increasing the effectiveness of the health care system in Accra, with the aim of making medical care more accessible to all families. [ABSTRACT FROM AUTHOR]

This paper is based on ethnographic research in a rural Taiwanese village in which married women with children are a major source of labor for local industry. Responsibility for job and home exposes these women to repeated stressors that can increase their susceptibility to illness. Existing explanatory models linking employment and women's health, however, do not explain adequately the women's response to their wage labor and the consequences of the social aspects of their work on their health. This paper describes women's work and its meaning, and discusses the way in which micro phenomena such as meanings and health states are linked to macro phenomena such as national political-economic processes and the world capitalist system. [ABSTRACT FROM AUTHOR]

This paper presents a critical overview of current concepts and analytic practices in stress research and considers how they can be changed to make the research more consistent with core sociological interests. An overarching concern of the paper is the analytic use of basic information about people's social and institutional affiliations and statuses. It is important that such information be treated not simply as data that need to be controlled statistically; we must examine the bearing of these data on each domain of the stress process: the exposure to and meaning of stressors, access to stress mediators, and the psychological, physical, and behavioral manifestations of stress. The conceptualization and measurement of stressors should move away from their focus on particular events or chronic strains and should seek instead to observe and assess over time constellations of stressors made up of both events and strains. Moreover, the effects of the mediators—coping and social support—are evaluated most fruitfully in terms of their effects in limiting the number, severity, and diffusion of stressors in these constellations. Finally, sociological stress researchers should not be bound to outcomes that better serve the intellectual interests of those who work with biomedical and epidemiological models of stress, nor should the research be committed exclusively to a single outcome. [ABSTRACT FROM AUTHOR]

When I began my psychiatric residency training in Boston in the late 1950s, sociologists and other social scientists were active members of many major academic departments of psychiatry. Collaboration between psychiatrists and sociologists and anthropologists was widespread and had considerable influence on theory and clinical practice. NIMH had established its Laboratory of Socio-Environmental Studies under the leadership of John Clausen. Sociologists and anthropologists were active in policy-making and research activities at NIMH and at many foundations. The influential works of Stanton and Schwartz (1954), Hollingshead and Redlich (1958), and Greenblatt, Levinson, and Williams (1957) reflect this period of collaboration. Over the subsequent three decades, the relationship between sociology and psychiatry changed considerably. Now relatively few academic departments of psychiatry have social scientists on their full-time faculty. Interaction between psychiatrists and social scientists, in many instances, has become adversarial. This adversarial quality, I believe, is reflected in the paper by Mirowsky and Ross. Their paper illustrates a genre of social science criticism of psychiatry which challenges the scientific validity of the concept of mental illness and raises important issues in measurement. Mirowsky and Ross, however, go beyond the scientific issues; they offer a social criticism of recent changes in psychiatry which they perceive to be the "legacy of nineteenth-century epidemiology and microbiology." Mirowsky and Ross are correct in their perception that significant shifts have occurred within psychiatry over the past decade. Yet their historical reconstruction of those changes and their understanding of the scientific basis for current research and clinical practice are seriously limited; they reflect their ideological commitment more than an appreciation of the increased sophistication of recent theoretical discourse and empirical research in psychiatry. In my commentary I will attempt to correct this imbalance by reconstructing the recent history and by explicating the rationale behind the current approach to psychiatric diagnostic categories. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine the effects of political ideology and self-interest on the attitudes of medical students toward national health insurance. Previous empirical studies of the relative importance of ideology and self-interest in explaining attitudes and behavior have been conducted on general population samples. This is the first empirical test of the effects of these factors on the attitudes of professionals in general and of medical students in particular toward a policy issue which is important to their material interests, but which evokes ideological responses at the same time. The findings show that political ideology as well as objective and subjective self-interest are independent dimensions. Both factors are related strongly to medical students' attitudes toward national health insurance. Their relative strength varies considerably with the salience of the issue at hand. Almost uniformly, political ideology has a more pronounced impact on attitudes than does objective self-interest. The differences between the effects of political ideology and of subjective self-interest, however, are not always substantial or significant. [ABSTRACT FROM AUTHOR]

This paper provides a critical review of the social science literature regarding maltreatment of patients in nursing homes. First, two conceptual issues are addressed: problems in defining maltreatment and a rationale for sociological study of the phenomenon. Next, the paper presents a theoretical model of potential causes of patient maltreatment, including exogenous variables, nursing home environment, and staff and patient characteristics. An agenda for research is outlined based on the model. [ABSTRACT FROM AUTHOR]

This paper examines the process of psychiatric diagnosis in a community mental health center walk-in clinic. The results indicate a great deal of conflict and contradiction in the psychiatric evaluation. This is discussed in light of several tensions: (1) mixed agendas surrounding diagnosis; (2) conflict between training and professional practice; (3) conflict created when a public facility is staffed by an elite medical school; (4) conflict between providing mental health services while serving the needs of other public agencies and mandates; and (5) conflict between an ascendant biopsychiatric model and the daily work of clinical therapeutic service. [ABSTRACT FROM AUTHOR]

This paper attempts to explain the higher psychological distress and psychological vulnerability of women and the unmarried as a function of greater exposure to uncontrollable life events (including network events) and perceived lack of control over life circumstances. Panel data on a sample of 1,106 adult heads of household living in Chicago provide measures of relevant variables. Contrary to expectation, event exposure is inconsistently associated with gender and marital status; instead, exposure depends on the types of roles held by individuals. Although group members at higher risk of disturbance perceive less control over their lives, these perceptions neither singly nor jointly with event exposure, explain gender or marital status differences in psychological distress or in vulnerability to negative events in general. In light of these findings, the utilities of a "common stress" and a "unique stress" approach for explaining status differences in symptoms are contrasted. [ABSTRACT FROM AUTHOR]

This paper utilizes a social constructionist perspective to examine the widespread belief among physicians during the early 1980s that an oversupply of doctors was either present or imminent. It was found that the timing and growth of physician beliefs in a "physician glut" during this period could not be adequately explained by net increases in the physician supply, either on an absolute level or relative to the growth of the general population. Rather, this "fact" of a physician surplus was found to be more fruitfully explored as an emergent social phenomenon grounded in the historical evolution of physician-supply themes and the particular clinical practice environment in which physicians found themselves in the late 1970s and early 1980s. [ABSTRACT FROM AUTHOR]

This paper reports a study of the premedical student culture at a major university, based on fieldwork and interviews with 30 premedical students. The paper examines the role of stereotypes in the premedical culture; specifically, the common belief in "cut-throats" among premedical students. Cut-throats are described as excessively competitive, selfish, gradehungry students who cheat, steal books and lab reports, and sabotage lab experiments. Despite the widespread belief, our findings suggest cut-throats are a myth. We found more evidence for cooperative than cut-throat behavior. The myth emerges from the competitive and pressured situation of premedical students and the uncertainty of the medical school admission process, and is in part a manifestation of students' collective anxiety. More significantly, it provides cultural explanations for failure and success for premedical students. We discuss its connection to the general premedical stereotype and its relation to pre-medical education. [ABSTRACT FROM AUTHOR]

This is a "state of the issue" paper about gender and physical health. It organizes the hypotheses proposed for male-female differences in physical health status, therapeutic health behaviors, and longevity and it summarizes empirical research, especially sociological research, on the topic over the past 10-15 years. Capsule summaries of sex differentials in health and of recent trends in health and morality are also presented for American (U.S.) men and women. The central theoretical viewpoint of this paper is that sex differences in health are principally the outcome of differential risks acquired from roles, stress, life styles, and preventive health practices. Psychosocial factors—how men and women perceive and evaluate symptoms, and their readiness and ability to take therapeutic actions—are important as well, but typically secondary to acquired risks. Other factors such as prior health care, biological risks, health reporting, and caretaker effects (for example, physician sex bias) have even smaller importance. We hypothesize that the relative weight of acquired risks and psychosocial factors varies for different types of health problems as follows: (1) Psychosocial factors have their greatest weight in responses to chronic, nonfatal, or low severity diseases and injuries and (2) gender differences are also greatest in responses to these; that is, men and women differ more in their perception, evaluation, and treatment of prolonged, mild conditions than of acute, life-threatening, or severe ones. The paper suggests some strategies for social science research on male-female health differences in the next decade or two. [ABSTRACT FROM AUTHOR]

This paper reports on a prospective longitudinal study in which various aspects of the stress process were examined. Findings indicate that events perceived to be desirable and, therefore, presenting opportunities for gain or mastery were not stressful. Events that were neither desirable nor within control led to distress, symptoms, and physician visits. A longitudinal analysis demonstrated stability of both health and stress and their relationship to one another. While there was an association between stressful events and poorer health, a much weaker relationship was found in regard to change in health. Poorer health resulted in more stress. The stress-illness relationship was not mediated by either expectations of control or effectiveness of social supports. Locus of control predicted baseline levels of distress but showed no relation to change in distress over time or to symptoms. A reciprocal relationship was found between social supports and stressful events. [ABSTRACT FROM AUTHOR]

The proposition that medical treatment decisions can be modified by altering the structural conditions of medical practice has been advanced, but seldom demonstrated empirically. This paper examines the structural conditions under which obstetricians personally opposed to abortion will offer abortion services. Data were obtained in a survey of all private obstetricians practicing in one state during 1975-76. Results of this study indicate that obstetricians with liberal attitudes toward abortion will offer abortion services regardless of the normative structure in which they are located; the treatment decisions of conservative obstetricians, however, are dependent on normative climate. In a practice environment where prevailing professional norms favor abortion, the majority of conservative obstetricians will offer abortion services, despite their personal opposition to this procedure. In an unfavorable climate, however, the behavior of conservative obstetricians is consistent with their attitudes, and relatively few provide abortion services. [ABSTRACT FROM AUTHOR]

The contention that retirement may have an adverse effect on health has become increasingly popular with the recent categorization of this phenomenon as a stressful "life event." The small number of empirical studies examining the health outcomes of retirement, however, appear neither to support nor to refute this hypothesis. Moreover, the serious methodological problems inherent in most of these studies caution against the generalization of findings. o This paper examines the existing research on the health and retirement relationship within the theoretical context of Atchley's process approach to retirement. Recent refinements in the study of life events (e.g., a focus on the timing of the event and the degree of control experienced) are seen as offering important potential contributions both to our understanding of retirement and to the development of more incisive and conceptually sound research in this area. At the same time, the inadequacy of existing life-events scales when applied to an older age group, and the genera/failure to view life changes within a broad sociostructural context are emphasized as weaknesses of the life-events approach that should be taken into account in future research on the complex retirement and health relationship. [ABSTRACT FROM AUTHOR]

This paper empirically examines the reliability and validity of three measures of the health of the elderly: an index measuring the ability to perform the activities of daily living without help (Index of Living Skills), an index measuring functional disability (Shanas's Index of Disability), and an index measuring chronic health conditions (the index subsequently used in the U.S. Health Insurance Study). The data involve a random sample of elderly persons living in Manitoba in 1971. The analyses used -- correlational matrices, factor analyses, internal consistency reliability coefficients, and construct validity -- are reported separately for those living in conventional housing in the community, in subsidized housing, and in institutions providing some form of medical care. The results suggest that the Index of Living Skills measures not one but two underlying constructs (heavy and light tasks), Shanas's Index of Disability is reliable and valid when used among those living in the community and in institutions but not among those in subsidized housing, and the index of chronic conditions is relatively unreliable among all three groups of elderly persons. [ABSTRACT FROM AUTHOR]