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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 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]

This paper provides a new way of conceptualizing the career of the mentally ill. Most persons who experience an episode of a serious mental disturbance lead a normal life, while a few persons lead lifetimes that revolve around their mental disorders. The processes leading to either result can only be understood by integrating the traditional labeling and psychiatric perspectives with lay understandings of the concepts of "mental illness" and "nervous breakdowns." A selection of key concepts from these perspectives leads to a better understanding of the different paths persons take as they move through the pre-patient, inpatient, and post-patient phases of the "career of the mentally ill." This perspective makes understandable a number of counterintuitive relationships. For example, it explains why most hospitalized mental patients (1) have a negative stereotype of the "mentally ill," (2) do not perceive themselves as "mentally ill, yet (3) perceive themselves as benefiting from treatment, and (4) do not progress into a career of secondary deviance. [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]

This paper argues a number of points about measurement in the sociology of mental health: (1) measurement is critical, (2) measures should represent and assess elements of human experience, taking measure of life as people feel it, sense it, and understand it, and (3) social scientists should create a human science, producing information for the people it studies so that they can better understand and control their own lives. We argue that a human science is best achieved with the use of indexes, not diagnoses, to measure mental health. We present a brief history of diagnostic instruments and detail how a diagnosis is made. We show how use of diagnoses to measure mental health discounts much human suffering. They dichotomize the true range of feelings and emotions into crude either/or distinctions that do not reflect the reality of people's lives, and they often exclude suffering such as that due to loss or illness that does not meet medical model preconceptions about mental disorder. Using diagnoses to measure mental health presents a reified image of hidden disease knowable and manageable only by trained professionals--beyond the capacity of the suffering individuals to understand and control. [ABSTRACT FROM AUTHOR]

The paper uses data from a sample of 1 percent of the male population of England and Wales to examine the contribution of social mobility between the censuses of 1971 and 1981 to socioeconomic differences in health. Compared to others in their social class of origin, men who had been downwardly mobile were more likely, and the upwardly mobile were less likely, to report a limiting long-term illness. However, when compared to others in their classes of destination, those who moved down reported less illness, and the upwardly mobile reported more. Prevalence of ill health in mobile men was somewhere between that in the group they left and the group they joined. Social mobility was a common event and, combined with existing socioeconomic differences in health, it acted to constrain rather than to increase these differences. [ABSTRACT FROM AUTHOR]

The stress process paradigm is one of the most widely held perspectives in the sociology of mental health. While this model has been applied to a large number of research problems, relatively little work has examined whether the paradigm can assist in understanding the link between socially induced stressors and their consequences for the mental health of immigrants. In this paper, we employ a stress process formulation to examine the interplay among stressors, psychological and social resources, and psychological distress among a large sample of Korean immigrants living in Toronto, Canada. Data from a longitudinal study of over 600 respondents indicate that the stress process paradigm provides a useful perspective for understanding how chronic stressors associated with the immigration experience manifest themselves in psychological distress. Our results suggest that social and psychological resources have important deterrent effects on the experience of stressors and their subsequent distressful consequences. Ethnic social support and mastery are especially important factors in this process. [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 Becker in connection with his receipt of the Leo G. Reeder Award for distinguished service to medical sociology. The address was given August 22, 1992, to the Medical Sociology Section of the American Sociological Association during its annual meeting, held in Pittsburgh, PA. [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]

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 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]

The rationalization of standardized entry credentials has been particularly marked in the health occupations and professions over the past century. This reflects broader trends in the rationalization of the workplace in Western societies. Alcoholism-intervention occupations are currently undergoing a transformation of recruitment away from recovered alcoholics and toward persons with formal academic credentials. The focus of this paper is on the rationality of this transformation. We consider the comparative job performances and job-related attitudes of recovered alcoholics and non-alcoholics in an alcoholism-related occupation. Data from a nationwide survey of 726 occupational program consultants reveal parity in the job performances of the two groups. The differences that are found between the two groups indicate more intense identification with the job among the recovered alcoholics. [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]

The article provides a comment to the study by Robert J. Johnson and Frederic D. Wolinsky regarding their evaluation of the "Journal of Health and Social Behavior" relevant to the observations connected with the period from 1977 to 1987. Is is claimed that the decline of the the periodical's stature based on attempts to broaden its scope of journal coverage, reduction in subscription and changes in editorial policy. There is an implication that two committee reports caused a decline in citation which serves as the author's measure in stature. The frequency of citation of particular articles depends on many things including the content, quality of reported work, the author's reputation, the number of investigators and the visibility and reputation of a journal. It is argued that the change in the journal's image has lessened its visibility in the stress area and reduced the impact of some papers.

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]