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This study examines the role of the interplay between epistemology and legitimacy in shaping the conceptualisation of anorexia. It focuses on the process of knowledge production within a particular medical setting – the journal, Psychosomatic Medicine. The journal was founded as part of the first psychosomatic movement in the history of the US seeking to undermine the epistemological foundation of biomedicine: the mind-body division in medical theory and practice. From its inception, the movement was haunted by an ongoing identity problem, institutional uncertainty and scientific ambiguity. The study relies on four separate data sets – articles appearing on anorexia in Medline, archival sources and editorial board minutes of Psychosomatic Medicine, the journal’s referees and their decisions and the articles on anorexia which appeared in Psychosomatic Medicine. The study shows how in the course of its knowledge production, the journal managed to increase the level of consistency while evaluating papers submitted. At the same time it moved towards the dominant biomedical discourse, either through shifting the psychosomatic focus on anorexia from the mind-body interaction to the ‘anorexic body’ only, or alternatively through reducing the methodological model from causal to correlational. This transition in reasoning in the case of anorexia represents an intriguing trade-off between the scope and the reliability of ambiguous medical knowledge in the face of the overriding need to gain legitimacy within the existing dominant biomedical domain. [ABSTRACT FROM AUTHOR]

Sociologists have researched the subject of illness behaviour for more than five decades. Recently the discussion has taken on new importance because of changes in the delivery of health care and the emergence of patients' rights and increased patient knowledge of medicine. Through a selective review of the literature on illness behaviour, the paper aims to show that singular and segmented approaches to illness behaviour have not clearly elucidated the complexity of the phenomenon. A more comprehensive and structured analysis of illness behaviour can be accomplished with mixed qualitative and hierarchical/structural quantitative techniques. Following a discussion of prior research in social psychology, demography, economics, social networks and geographic systems, this paper offers a template for future analysis of illness behaviour. [ABSTRACT FROM AUTHOR]

Why has there been a very rapid elaboration of the category of personality disorder within psychiatric classifications over the last 20 years? Personality disorder is the site of considerable psychiatric controversy. Its classification, diagnosis, and treatment are disputed not only within psychiatry, but also in closely related fields of forensic and psychological work. For severe cases, the Home Secretary in Britain has recently suggested that pre-emptive incarceration is justified, and many psychiatrists feel that personality disorder is not amenable to treatment. This paper seeks to make a contribution to the sociology of psychiatric knowledge, drawing both on recent work on the sociology of science and technology, and on the relationship between psychiatric practice and government in the late 20th century. [ABSTRACT FROM AUTHOR]

This paper examines the characteristics of those members of the British middle classes who 'go against the grain' of healthy living by both smoking and drinking alcohol over recommended levels. Using logistic regression procedures on GHS data, it concludes that there are significant gender differences, with men being much more likely to adopt such risky health behaviours than women. Further, the social correlates of such behaviours differ for men and women. For men, such behaviours are significantly associated with marital status, the experience of social mobility and region. For women, such behaviours are associated with the presence of dependent children, educational level and the number of hours worked in paid employment. The paper attempts some tentative interpretations of these results by drawing upon the available sociological literature. [ABSTRACT FROM AUTHOR]

Medical dominance is not a transhistorical and invariant property of the medical profession. Rather it is a set of occupational privileges that can be invoked or revoked according to changing alignments of political, economic and cultural power, Using the example of British psychiatry in the context of the health service reforms of the 1980s, it is argued that medical dominance may be fracturing as a result of the policy switch towards community mental health care and the managerial reorganisation of the health services. Knowledge claims and medical procedures that have legitimated the dominant position of psychiatry within the mental health services - a medicoeclectic ideology, a view of doctor superiority over other mental health professionals and the extensive use of physical treatments - are outlined and contrasted with the conflicting ideas and authority structures of community care and health service management. Challenges to medical dominance in mental health, it is contended, are represented by the legislative empowerment of a range of previously subordinated groups of professionals and paraprofessionals. This paper draws primarily upon two sources of data; an ethnography and in-depth interview study of 40 psychiatrists and managers in the Bristol area in 1989-90 and an analysis of the writings of psychiatrists in the professional press. [ABSTRACT FROM AUTHOR]

The placebo effect has been shown to account for between 30 to 40 per cent of the efficacy of 'active' medication for a wide range of pathologies and is probably a powerful agent of cure in other therapies, for example surgery. Medicine has failed, at least explicitly, to confront the implications of this powerful effect, attending to it mainly as a nuisance variable to be controlled for in clinical trials. This paper argues that the existence and extent of the placebo effect represents a challenge to the assumptions behind much medical practice, and throws doubt on the validity of locating disease and healing within a paradigm of scientific rationality. [ABSTRACT FROM AUTHOR]

The article gives a review of the last ten years' of research on illness narratives, and organises this research around certain central themes. Four aspects of illness narratives are discussed: 1. a proposed typology giving three different kinds of illness narratives - illness as narrative, narrative about illness, and narrative as illness; 2. considerations of what can be accomplished with the help of illness narratives; 3. problems connected with how illness narratives are organised; and 4. the social context of telling and its influence on the narrative. It is argued that as social scientists we can use illness narratives as a means of studying not only the world of biomedical reality, but also the illness experience and its social and cultural underpinnings. [ABSTRACT FROM AUTHOR]