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This paper examines the citation counts of papers published in the first 25 years of the Sociology of Health and Illness. According to this measure only a small number of papers have made a major impact on the discipline of sociology of health and illness and an analysis of these select papers identifies some common themes. In particular, ‘successful’ papers have provided important theoretical constructs for the field while exploration of aspects of identity has been a recurrent focus. [ABSTRACT FROM AUTHOR]

The paper seeks to identify and explain shifts in dominance relationships between the medical profession and allied health professions in Germany, taking the occupational fields of nursing and psychotherapy as examples. It suggests an actor-based perspective which focuses on the strategic interplay between collective actors in the fields in question, namely professional associations and unions, state actors, sickness funds, universities, polytechnics and associations of work organisations. It considers the context of governance of the German health care system and an awareness of a changed demand. The thesis is that the interplay between the actors has led to a small reduction of medical dominance. It is examined whether changes in governance structures of the health care system have led to a more favourable context for shifts in the dominance relationships. Moreover, the possible effects of the recent re-organisation of health provision are considered. Based on an empirical investigation using the method of document analysis, the paper shows that there has been a small reduction of medical dominance which is essentially the outcome of the interrelated strategic actions of various collective actors in the fields. A public perception of a new kind of health care demand has facilitated this development. [ABSTRACT FROM AUTHOR]

The aim of this paper is to present an interpretation of the accounts of depression provided by women from South Asian communities. The paper presents the findings from a qualitative study, conducted in the UK, which explored women from South Asian communities and their experiences of depression. It is argued here, through examples of women's accounts of their experiences, that depression is 'embodied', that is, grounded in the materiality of the body which is also immersed in subjective experiences and in the social context of women's lives.Qualitative data were collected from four focus groups and ten individual interviews with women. The analysis involved a discursive approach.Analysis revealed how women made strategic choices in how they presented their symptoms as legitimate and for gaining access to what they perceived to be appropriate healthcare. This is not to argue that this is a culturally specific phenomenon but one which is a feature of all healthcare negotiations. [ABSTRACT FROM AUTHOR]

The concept of social structure is one of the main building blocks of the social sciences, but it lacks any precise technical definition within general sociological theory. This paper reviews the way in which the concept has been deployed within medical sociology, arguing that in recent times it has been used primarily as a frame for the sociological interpretation of health inequalities and their social determinants. It goes on to examine the contribution that medical sociologists have made to the debate over health inequalities, giving particular attention to contributions to Sociology of Health and Illness. These have often provided a focus for discussions outside or critical of the mainstream debates that have been driven primarily by epidemiologists. The paper reviews some of the main points of criticism of epidemiological approaches, focusing in particular on the methodological constraints that limit the capacity of epidemiologists to develop more theoretically satisfactory accounts of the inter–relationships of social structure, context and agency in their impact on health and well being. Some recent examples from the Journal of more theoretically innovative and analytically fine–grained approaches to understanding the impact of social structure on health are then explored. The paper concludes with an argument for a more historically–informed analysis of the relationships between social structure and health, using the knowledgeable narratives of people in places as a window onto those relationships. [ABSTRACT FROM AUTHOR]

The present article reviews, in relation to quantitative work on the social structure, papers published in Sociology of Health and Illness during its first 25 years. Each issue published during the years 1979–2002 has been examined; and quantitative papers, relating to various aspects of the social structure, have been identified. Such papers are found to have formed a minor but substantively significant theme within the Journal. These contributions situate the journal between sociology and social epidemiology. Articles in the Journal, for example, have been part of sociological debates about the measurement of social class, and of social epidemiological debates about the relationship between income distribution and population health. The contribution of Sociology of Health and Illness to a number of such debates is reviewed. The article concludes that the present situation, in particular the intellectual crisis in social epidemiology and social science investment in large data sets, gives the Journal the chance to build on this distinguished tradition by encouraging, through its publication policy, the further development of quantitative medical sociology. [ABSTRACT FROM AUTHOR]

This paper focuses on issues relating to rationing in the context of cancer genetics. It indicates how the allocation of scarce resources to patients in need is not simply a managerial process, but something that is routinely woven into the fine web of organisational activity. In the framework of this study – executed within a UK regional cancer genetics clinic – much of that activity circulates around issues relating to risk assessment. The author first illustrates how risk assessments in cancer genetics affect the distribution of clinical benefits in general. Following that, it is explained how professionals assemble risk categories and how the assembly work relates to rationing. The paper concludes by suggesting that rationing principles should more properly be seen as stratagems that are called upon and manipulated by lay and professional parties, rather than as a set of guide rules imposed top-down by managerial agents. [ABSTRACT FROM AUTHOR]

The aim of this paper is to explore priority setting issues in the British National Health Service (NHS). It focuses on the changing way in which rationing issues are managed by a sample of English health authorities in the wake of Health Service reforms and the separation of function between purchasing and providing health care. The paper employs the conceptual framework of ‘governmentality’, associated with the French social theorist Michel Foucault, to analyse this aspect of contemporary British health policy. Governmentality analysis situates social and economic change as reflecting shifts in the ‘mentality’ of government. The consequence of this new articulation is that the concepts of priority setting and rationing become embedded as dominant discourses and emergent practices within health policy. Equally important is the way in which the perceived shift in the formula of governance also results in a different conceptualisation of the subject of health governance based on the management of individual risk. [ABSTRACT FROM AUTHOR]

This paper argues that children, as an important social group, repay study in connection with the sociology of health and illness. The paper outlines the neglect of children within medical sociology and goes on to open up a discussion towards a sociology of child health. The paper makes three main points. First, consideration of the case of health and illness helps understanding of children's social positioning as a minority group. Secondly, children present a clear case for considering people as embodied health care actors. Thirdly, taking account of children in the sociology of health requires rethinking the division of labour and inter-generational relationships within it. [ABSTRACT FROM AUTHOR]

While sociologists earlier this century often used insights derived from psychoanalytic theory in their writings, contemporary sociology has largely tended to ignore this body of work. This is as true of medical sociologists as it is of others, despite the fact that the 'founding father' of medical sociology, Talcott Parsons, used psychoanalytic perspectives extensively in his theorising on the social aspects of medicine and health. In this paper I make a case for a return to a medical sociology that incorporates understandings of subjectivity derived from psychoanalytic writings, with particular reference to the medical encounter and the illness experience. The paper begins with an overview of psychoanalytic sociology. I go on to review the major insights Parsons developed in his writings and the work of other writers who have more recently used psychoanalytic theory productively in theorising the sociocultural dimensions of medicine and health care. The paper concludes with some thoughts about future directions for taking up the psychoanalytic perspective in the sociology of health and illness. [ABSTRACT FROM AUTHOR]

The aim of this paper is to explore key dimensions of the reproductive experiences of disabled women who are, or who are thinking about becoming, mothers. The paper reports a qualitative study which involved semi-structured interviews with 17 disabled women who were contemplating childbearing, or were pregnant, and/or had young children. The interpretation of these women's experiences is situated with reference to current debates on the meaning and nature of disability, and draws attention to the ways in which these experiences can be understood as manifestations of disablism. More specifically, the paper considers three themes which emerged in the data analysis: the women's engagement with the medical 'risk' discourse; the pressure felt by disabled women to demonstrate that they are, or could be, 'good enough mothers'; and their experiences of receiving unhelpful 'help' from health and social care workers. [ABSTRACT FROM AUTHOR]

Health promotion specialists and health promotion services within the health service have been neglected by policy makers and medical sociologists. This is perhaps surprising, given the high profile of health promotion on the health policy agenda. This paper presents the findings of an exploratory sociological study into the nature and function of health promotion services within the 'reformed' British National Health Service. The analysis draws on qualitative interviews with health promotion specialists, directors of public health and other health workers whose work involves the promotion of health. The paper argues that health promotion services do not fit easily into the purchaser provider divide and that they have experienced considerable organisational change and uncertainty. Four factors have further compounded this lack of fit: a lack of consensus as to what health promotion specialists work should be about; a lack of any secure knowledge base; prevailing images of health promotion and of health promotion specialists; and feelings of vulnerability about the future of health promotion. Furthermore, health promotion specialists are finding it difficult to shed their principles and values and take on the dominant enterprise culture which is characteristic of the new public management. The paper concludes by suggesting three further reasons why health promotion specialists have been marginalised: their insecure occupational status which in turn is linked to a lack of jurisdiction associated with the content of their work; the contradictions which are inherent in the knowledge base of health promotion, and the increasing application of 'modernist' evaluative frameworks, derived from economics, to health promotion interventions. [ABSTRACT FROM AUTHOR]

What is the relationship between class, health and life-styles, and to what extent does health-related knowledge influence subsequent behaviour? These issues have been a source of considerable debate for medical sociologists and others concorned with promoting 'healthier' life-styles over the years, Yet despite a wealth of empirical material, there has been little attempt to theorise this relationship between class, health and lifestyles and the associated issues of structure and agency, accounts and action it raises. This paper attempts to rectify this lacuna through a critical discussion of the work of Pierre Bourdieu, and its relevance to the class, health and life-styles debate. In particular, attention is paid to Bourdieu's analysis of the logic of practice, his concepts of habitus and bodily hexis, and the search for social distinction in the construction of (health-related) life-styles. The paper concludes with a critical commentary on these issues and the relative merits of Bourdieu's analysis for the sociology of health and illness. It is argued that despite certain limitations regarding issues of agency and 'choice', Bourdieu's analysis does indeed shed important light on the health and lifestyles debate, and that further bridge-building exercises of this nature between mainstream theory and the sociology of health and illness are both necessary and fruitful. [ABSTRACT FROM AUTHOR]

This paper provides a review of research and debate in the field of chronic illness. It first outlines some general features of a sociological approach, and then goes on to use recent empirical studies of chronic illness to illustrate some of the main stages involved. These include: onset and the problems of explanation and legitimation, the impact of treatment, and the development of adaptive responses. An attempt is made to distinguish the use of the terms 'coping,' 'strategy' and 'style' in describing adaptation. The paper argues that a sociological approach needs to recognize the positive actions people take, as well as the problems they face. In this way, diversity in managing chronic illness, and the continuing need for a person-based approach to sociological work, are underlined. [ABSTRACT FROM AUTHOR]

This paper offers a review of recent approaches in the 'social constructionism' of medical knowledge. It argues that 'constructionist' propositions offer a bold attempt to resolve some of the problems in earlier formulations of the sociology of medical knowledge, particularly those of Eliot Freidson. However, the paper goes on to argue that social constructionism has failed to tackle the inherent relativism in its stance and that it frequently rests on contradictory intellectual and value premises. The paper concludes that both policy considerations and theoretical consistency require a critical appraisal of social contructionism and its future role in medical sociology. [ABSTRACT FROM AUTHOR]

Diagnoses are the classification tools of medicine, and are pivotal in the ways medicine exerts its role in society. Their sociological study is commonly subsumed under the rubrics of medicalisation, history of medicine and theory of disease. Diagnosis is, however, a powerful social tool, with unique features and impacts which deserve their own specific analysis. The process of diagnosis provides the framework within which medicine operates, punctuates the values which medicine espouses, and underlines the authoritative role of both medicine and the doctor. Diagnosis takes place at a salient juncture between illness and disease, patient and doctor, complaint and explanation. Despite calls for its establishment, almost two decades ago (Brown 1990), there is not yet a clear sociology of diagnosis. This paper argues that there should be, and, as a first step, draws together a number of threads of medical sociology that potentially contribute to this proposed sociology of diagnosis, including the place of diagnosis in the institution of medicine, the social framing of disease definitions, the means by which diagnosis confers authority to medicine, and how that authority is challenged. Through this preliminary review, I encourage sociology to consider the specific role of diagnosis in view of establishing a specific sub-disciplinary field. [ABSTRACT FROM AUTHOR]

This paper seeks to contribute to the recent debate within the field of inequalities in health that has focused on the relationship between income distribution and health. This has contested the extent to which the main effects of income on health are not directly related to material standards but operate through psychosocial mechanisms, linked to how people experience and perceive their relative position. However, whilst this has focused attention on the qualitative dimensions of income inequality as a potential determinant of health inequality, very little empirical work has directly examined lay perspectives. In this study I attempted to address this gap by exploring how two groups of working class men living in contrasting socio-economic areas understood and experienced differences in income and material circumstances and how these were perceived to impact on their health. This study shows that the anger and resentment felt by these men had their roots largely in the perceptions of others and the way others treated them, rather than in income differentials per se. There was little evidence of feelings of shame or inferiority. For men at the bottom of the social ladder, financial hardship was additionally perceived as having the greatest impact on their health and well-being. [ABSTRACT FROM AUTHOR]

Sociologists who do field work in medical settings face an intractable tension between their disciplinary field, which takes a critical perspective toward medicine, and their ethnographic field, which often includes physicians. This paper explores the ethical problems that result from the collision of the two fields. While in the field, ethnographers are forced to choose between sociology and their obligations to host members, as they decide whether to disclose their actual research agendas, whether to ask tough questions or to reveal their concerns, and whether to give advice. The tension persists when field workers leave the field to write, forcing them to choose between competing interpretations and to decide what to reveal or conceal in the interests of confidentiality. Through these moral choices about what to ask, record or present to the reader, ethnographers shape the academic field even as it shapes them. [ABSTRACT FROM AUTHOR]

After a history of neglect, bioethicists have recently turned their attention to the topic of infectious disease. In this paper we link bioethicists’ earlier neglect of infectious disease to their under-appreciation of the extent to which the problem of infectious disease is related to social factors and thus to questions of justice. We argue that a social causation of illness model – well-known to sociologists of medicine, but incompletely understood by bioethicists – will improve future bioethical analysis of issues related to infectious disease. By emphasising the relationships between social and economic structures of inequality and health, the social causation model provides a richer approach to ethical issues associated with infectious disease than the more commonly used biomedical model. [ABSTRACT FROM AUTHOR]

The removal of patients from general practitioners’ (GPs) lists in the UK offers important sociological insights into what happens when the doctor-patient relationship ‘goes wrong’. An interactionist analysis shows how removers (doctors) and removed (patients) strategically invoke ‘rules of conduct’ to account for difficulties in the doctor-patient relationship and for GPs’ decisions to end their relationships with patients. In this paper we extend this analysis through recourse to Bourdieu's theory of practice, by juxtaposing ‘paired’ accounts of the same removal event by both remover and removed. Our analysis demonstrates the unthinking or non-reflective nature of people's understanding of the rules governing social interactions, but also demonstrates how apparent rule violations make the rules explicit and expose patterns of power distribution. We argue that removal of patients amounts to a strategic exercise of symbolic power by GPs, and that this is experienced as an overtly violent symbolic act by patients. A theoretical reconciliation of interactionist theories of the doctor-patient relationship with Bourdieu's theory of practice is both possible and profitable, providing a micro-macro link in which issues of capital and power within the health (care) field are brought to the fore. [ABSTRACT FROM AUTHOR]

Hypertension is a common condition which disproportionately affects African Caribbean people in England, yet this experience is rarely reported in the literature. Whilst a body of literature exists that explores chronic illness experience, little attention is paid to hypertension, nor to ethnicity as a mediating concept in chronic illness experience. This paper explores the meaning and consequences of hypertension for African Caribbean people residing in England. The study conducted was a qualitative study, informed by the ethnographic tradition. The study methods included the conduct of two focus group interviews (10 participants), 21 in-depth interviews and five vignette interviews. Thirty-six people in total participated in the study, both men and women, aged between 37 and 82 years (median age = 59.5 years) in two English cities. The sample was generated by contacting GP surgeries, community groups and associations and included economically active and retired people. The narrative accounts provided illuminate the personal biographies of the mid-life and older participants in the study, providing evidence as to how issues such as ethnicity, migration, cultural adaptation, racism and discrimination may impact upon the chronic illness experience. Participants’ understandings of their self-defined condition of high blood pressure differed greatly from medical conceptualisations of the condition of hypertension. The implications of the study are that in order to provide effective health and social care for individuals of African Caribbean origin with hypertension, care-providers require insight into how migration and cultural adaptation may create major disruption to an individual's life trajectory, to which the subsequent diagnoses of chronic illness are relative in terms of the individual's response and adaptation. [ABSTRACT FROM AUTHOR]

This paper draws on Foucault to understand the changing discourse and impact of structured 'health needs assessments' on health visiting practice. Literature about this activity makes little mention of the long-standing social purposes of health visiting, which include surveillance of vulnerable and invisible populations, providing them, where needed, with help and support to access protective and supportive services. Instead, the discourse has been concerned primarily with an epidemiological focus and public health, which is associated with risk factors and assessments. The use of pre-defined needs assessment schedules suggests that health visiting activity can be sanctioned and clients' needs serviced only if they reach the threshold of pre-determined, epidemiologically-defined risk. Their effect on practice is examined through a conversation analysis of ten health visitor/client interactions using two different structured needs assessment tools. The study indicates that the health visitors, like their clients, were controlled by institutional expectations of their role; analysis of their conversations shows how they achieved the requirements of the organisational agenda. Structuring client needs and health visiting practice through the use of formal needs assessment tools emphasises the epidemiological focus of the health service above the need to arrange support for vulnerable individuals. In this respect, it serves as a marker in the continued medicalisation of health visiting. [ABSTRACT FROM AUTHOR]

This paper explores routine resource allocation processes in health and social care. While there has been a small body of work which has drawn on Lipsky's (1980) insights into street level bureaucracy, few have taken seriously the opportunity offered by ethnography to explore in detail the work of front-line staff as a way of observing policy processes in action. Utilising ethnographic data from research into the continuing care of adults who had suffered a first acute stroke, we analyse how staff accommodated patient need and consider the implications that this had for the quality, equality and equity of service provision. [ABSTRACT FROM AUTHOR]

This paper examines medical intake screening through the process of making appointments with medical specialists. By employing a multi-method, qualitative approach, it shows how decisions to schedule doctors' appointments are based on medical knowledge about physicians' specialties and specific organisational practices. It draws on insights from first-contact interactions between clients and institutional gatekeepers to enrich our understanding of intake screening. In relation to gatekeeping, rationing commonly gets framed as restrictive screening practices, with a preference for denying or limiting access to treatment. Restrictive screening practices are typically organised to elicit a narrow range of information ('facts') relevant to specific eligibility criteria; whereas inclusive intake screening tends to involve less scripted, more complex and open-ended interactional exchanges between workers and clients, wherein workers help clients frame their claims in ways that will increase their chances of getting accepted. Front-office workers hold a preference for inclusive intake screening, a preference that is undergirded by the referral-driven nature of this stage of patient processing, and by a work environment that favours inclusive screening. This finding builds on the literature within medical sociology, but also extends our understanding of frontline decision-making and the distribution of resources within a variety of people-processing institutions. [ABSTRACT FROM AUTHOR]

The paper has three main aims. First, to trace – through the pages of Sociology of Health and Illness – the changing ways in which lay understandings of health and illness have been represented during the 1979–2002 period. Second, to say something about the limits of lay knowledge (and particularly lay expertise) in matters of health and medicine. Third, to call for a re–assessment of what lay people can offer to a democratised and customer–sensitive system of health care and to attempt to draw a boundary around the domain of expertise. In following through on those aims, the author calls upon data derived from three current projects. These latter concern the diagnosis of Alzheimer’s disease in people with Down’s syndrome; the development of an outcome measure for people who have suffered a traumatic brain injury; and a study of why older people might reject annual influenza vaccinations. [ABSTRACT FROM AUTHOR]

In response to the burgeoning interest in ethnic health issues and related published research, a number of recent contributors have attempted to clarify or systematise the usage of overarching terminology like 'ethnicity', 'race', 'culture', and 'racism', including the development of guidelines. However, the operational problems of how to collect ethnicity data in studies of the sociology of health and illness have not been satisfactorily addressed. This paper explores conceptual issues, notably, the meanings of ethnic identity and ethnic origin/ancestry; methodological approaches, including which dimensions to collect, multidimensional versus global measures, and exclusive groups versus optional ethnicity; and also practical issues such as method of assignment. The approach calls for a stronger development of the theoretical understandings of ethnicity and work on how best ethnicity should be conceptualised and measured in the different approaches to explaining ethnic inequalities in health. [ABSTRACT FROM AUTHOR]

This paper describes how the categorisation of patients by staff in a French emergency department (ED) leads to the micro-rationing of care. Although ED staff are reluctant to acknowledge it, they refuse to treat many would-be patients at the reception stage, and advise them to go to other care settings (such as general practitioners’ premises or social dispensaries). The study analyses the judgmental categories staff use to decide patients’ eligibility for care, paying particular attention to their clinical, organisational, moral and social dimensions. Staff ration care at the point of service delivery but they soften the harshness of the rationing by making a positive discrimination in favour of those seen to be in real need. Data from observations and interviews are used to analyse the tensions between the different models of ‘local justice’ employed by doctors. [ABSTRACT FROM AUTHOR]

Social scientists of medicine have largely, although by no means exclusively, focused their research on illness and sickness thus obscuring social scientific investigations of positive health and wellbeing. Undoubtedly, important reasons exist for this but the relevance of studying `healthy' bodies requires emphasis and wider acknowledgement within the newer (embodied, non-dualistic) sociology of health and illness. This is necessary because the concrete corporeal manifestations of `health' in everyday life - components of and preconditions for embodied social practice - may, paradoxically, erode bodily capital while simultaneously contributing to it. Using qualitative data generated during an ethnography of bodybuilding subculture, this paper contributes to the sociology of `healthy' (transgressive) bodies. it describes the somatic representation of health and youth, the so-called erotics of the gym and the perceived benefits of anaerobic exercise for everyday pragmatic embodiment. Contra critical feminist studies, it furthers an appreciative understanding of `risky' bodywork in post- or late modernity and underscores the value of bringing healthy lived bodies into medical sociology. [ABSTRACT FROM AUTHOR]

This paper looks at the recent developments in the field of medical quality assurance in Belgium and the Netherlands. It takes the viewpoint that there is a strong relationship between regulation and quality assurance on the one hand and the health care environment on the other hand. The reasons for the differences between the two countries, which are conspicuous, will be explored. [ABSTRACT FROM AUTHOR]

The article author comments on views of social scientists Michael Kelly and David Field on a paper on medical sociology and chronic illness written by him. Analyzing both the sociologists views, it is found that they suggest, self and identity are core aspects of everyday experience which the onset of illness and the change in bodily functioning profoundly affects. It is this interplay play between self and identity, which they argue, provides a "theoretical bridge" to "manage" the relation between biological and social facts. The author points out that the arguments given by Kelly and Field's article are not new, and were already there in various literatures on chronic illness, disability and stigmatization. Much of their arguments seem to be a rehearsal of very familiar arguments, albeit this time with more than a nod in the direction of biology and the physicality of the human body. The author concludes by proposing an extension of Kelly and Field's argument about the body, self and identity.

Many cultures have distinguished between biological and social death, the latter usually occurring some time after the former. More recently social death has been noted to occur before biological death in terminally ill comatose patients. This paper presents the results of an exploratory study which examined the extent to which social death may occur before biological death among elderly people with dementia. One hundred semistructured interviews were conducted with the caregiving relatives of dementia sufferers. Ratings were made of the degree to which carers appeared to believe their dementing dependent was socially (or 'as good as') dead, as well as note taken of behaviour suggesting that they had discounted the sufferer in social terms. In over one third of caregiving relatives there was evidence of both beliefs and behaviours suggesting that a degree of social death had occurred before the sufferer's biological death. Almost all those categorised as behaving towards a sufferer as if they were socially dead expressed beliefs indicating that this was how the sufferer was perceived. However, perceiving a sufferer in ways which could be characterised as socially dead was not necessarily combined with behaving as though they were. Examples of degrees of social death are presented and discussed against the background of increasing numbers of dementia sufferers in modem Western societies. [ABSTRACT FROM AUTHOR]

People with chronic or terminal diseases not only have to face the biophysical consequences but also the social impact of illness. The social impact or stigma associated with HIV/AIDS is high due to its infectivity and association with deviant behaviour. Social interaction with health professionals is critical for subsequent social adjustment to possession of a discreditable disease, including HIV. This paper examines the subjective reports of 61 people with HIV within this context and identifies processes of stigmatisation in health care settings. In agreement with surveys of health care workers, fear of contagion is identified as the principal source of negative reactions towards people with HIV in health care settings. Issues of confidentiality and the response of people with HIV to stigma in health care settings are also discussed. It is concluded that, although the biomedical model in which health professionals are trained ignores the social impact of disease, HIV-related stigma in health care settings in Scotland is declining as health professionals become familiar with treating people with HIV. [ABSTRACT FROM AUTHOR]

The concept of 'medicalisation' has informed the sociology of health and illness for several decades. Typically, it has been discussed with critical connotations, although some commentators have suggested that it is not unequivocally negative. This paper seeks to clarify the concept, suggests that medicalisation can be both helpful and unhelpful, and identifies the characteristics of beneficial medicalisation. Using data from doctors and patients who are dealing with a refractory, relapsing and disabling condition - Chronic Fatigue Syndrome - we explore the impact of medicalisation in different forms on the participants in the medical encounter. Both doctors and patients were, at times, uneasy about the possibility of a self-fulfilling prophecy through which a medical diagnosis might generate deleterious consequences from a comparatively trivial complaint. However, when such motivations prompted doctors to withhold information (such as a suspected diagnosis), the results were generally increased 'difficulties for the patient. Whether intentional or accidental, medical dominance in any form consistently generated problems for patients. But when medical explanations were mobilised to enhance the coherence of the patient's experience of symptoms, patients found medicalisation to be helpful. Patients whose doctors took their symptoms seriously gained legitimation which helped them in a range of. social relationships. They also received support for their efforts at self-management. Legitimacy, coherence and ,support are all necessary c0mponents for improved .well-being, and doctors can supply such assistance even in the absence of unequivocal diagnosis and proven therapeutic interventions. [ABSTRACT FROM AUTHOR]

Actor-network theory is a form of relational materialism that codifies a body of ideas developed in the sociology and history of technology. At its centre is a non-dualistic account of the relation between 'society' and 'technology'. In this view society is produced through the mutually constituting interaction of a wide range of human and non-human entities (including machines and technologies). This paper outlines some of the key ideas of actor-network theory and suggests that they might be usefully incorporated into medical sociology (and/or anthropology). An illustrative example is given which demonstrates some aspects of the application of such a non-dualist approach to a particular medical device, the metered dose inhaler (MDI), widely used in the treatment and management of asthma. Within a shifting network of socio-technical relations the MDI and various human actors are seen to have mutually constituted each other. Competencies were created and distributed and linked to panoptical practices of surveillance, control and modification. These included attempts to change both the technologies and the human actors who came into relationship with it. The intricate and mutually constitutive character of the human and the technological in the processes and relationships of sickness and healing is thus demonstrated. [ABSTRACT FROM AUTHOR]

Based on a study of leprosy destigmatisation campaigns conducted in Thailand since the 1970s, this article examines the difficulties in their implementation, the extent of their success and the degree to which they are actually needed. The findings indicate that these campaigns are doomed to fail because of problems inherent in any attempt to transmit a normalising message, and also because of stigmatisation derived from the metaphorical use of leprosy in spoken language. The study also found that educating the public about leprosy only increased the risk of stigmatisation. However, it appears that the stigma itself bears the potential for destigmatisation, since the worse the image of the disease, the less likely its identification with the patients diagnosed today, thus sparing them actual negative reactions. These conclusions serve as a basis for examining assumptions about knowledge and power underlying the constructionist analysis of destigmatisation processes. The paper calls to abandon these presuppositions, as they have led constructionism to a pessimistic view of the possibility of destigmatising diseases and disabilities. [ABSTRACT FROM AUTHOR]

The sociological conceptualisation of chronic illness requires a sociology which indicates the physicality of the body theoretically. The aim of this paper is to demonstrate how the body might be integrated into sociological accounts of the experience of chronic illness in a way that acknowledges biological and social facts. Central to our argument is the connection between bodily aspects of self and identity. Self and identity are core aspects of everyday experience and of the everyday experience of illness. With the onset of illness bodily functioning alters and self-conceptions and identity may also change. The body, which in many social situations is a taken for granted aspect of the person, ceases to be taken for granted once it malfunctions. The bodily basis of chronic illness has to be attended to because it limits or interferes with other physical and social activities. The connection between biological and social facts is explored using the concepts of self and identity. [ABSTRACT FROM AUTHOR]

Although general practice has provided the setting for a wide range of medical sociological analyses, those analyses have rarely focussed upon the care of specific patient groups or illness conditions. In the main, medical sociologists have chosen to portray general practice more in terms of their own secular interests in the processes of, for example, power, domination and communication - processes which although evident within the consultation are not unique to it. This topical neglect of the care of specific patient groups within general practice is, I argue, part of a broader neglect of the topic of medical work as conceived by practitioners, which arises at least in part from a combination of methodological, theoretical, ideological and attitudinal factors. This paper uses the opportunity of a study focussing upon general practitioners' treatment of opiate abusing patients to explore these and related issues and concludes with a call for an applied sociology of medical practice. [ABSTRACT FROM AUTHOR]

The Black Report identifies four types of possible explanation for social class differences in health, and judges one of these ('materialist') to be the most important. This paper seeks to support this assessment with additional evidence from the literatures of sociology and medicine. In the process it suggests questions which could usefully be the subject of future research. [ABSTRACT FROM AUTHOR]

The article is in reply to the paper on social constructionism and the development of medical sociology. The central point of sociologists M. Nicolson and N. McLaughlin's reply concerns the realism aspects of constructionism. There is no doubt that this is a difficult area, and Nicolson and McLaughlin attempt a defense of a view of medical knowledge as being simultaneously both realist and socially constructed as well as arguing for methodological relativism. Variations on the theme of the underdetermined character of human knowledge are widely accepted, and the author find nothing remarkable in the view that medical knowledge is influenced and shaped by social circumstance. Medical knowledge may well take on symbolic qualities in modern society and be influenced by social forces in its production. It is quite possible to hold that sociology should study the social processes through which knowledge is produced and yet remain concerned about its validity.

This paper revisits Strong's thesis of `sociological imperialism' some 20 years on in order to assess its relevance to present day developments within and beyond the sociology of health and illness. The thesis, it is suggested, continues to raise a number of key sociological issues of more or less abiding importance, particularly in the light of recent Foucauldian and postmodern critiques of medicine, the body and disease. This in turn paves the way for a further series of critical reflections on the limits of constructionism in particular and the dilemmas of the sociological enterprise in general. Revisiting these issues from time to time, it is concluded, is indeed an instructive exercise: a reminder perhaps, welcome or otherwise, of the limits of our own disciplinary claims on the world and our place within it. [ABSTRACT FROM AUTHOR]

This paper demonstrates the potential interest for the sociological understanding of medicine and health as social institutions of the qualitative study of collective behaviour. it takes, as a case study, the transformation of a widely-circulating contemporary legend, `The Missing Kidney' into a rumour in Nottingham, and elsewhere in the United Kingdom, in 1992. Possible methodological approaches and interpretations are considered, making particular use of the work of the French sociologist, Edgar Morin, and the `mass society' tradition of social theory. it is argued that neither provides an adequate understanding of the phenomenon and that medical sociologists should look to the Chicago tradition of work on collective behaviour, represented by Park and Blumer for inspiration. Using this, it is suggested that the Missing Kidney offers useful insights into lay thinking about professional work and its strategies for the informal social control of medicine. [ABSTRACT FROM AUTHOR]

The article presents information about the New Writers' Prize for volume 15, 1993 issue of the journal "Sociology of Health and Illness," which would be given to writer Gillian Bendelow for her research paper "Pain Perceptions, Emotions and Gender."