Download File - Catherine Bliss

S207: Sociology of Health and Medicine
TH 11:00-2:00PM
Prof. Catherine Bliss
Email: [email protected]
PARNASSUS
Office: SBS 455
Office Hours: by appointment
Course Description:
This course is a core theory seminar in the Sociology doctoral program whose principal
goal is to introduce students to the sub-discipline of medical sociology. In this quarter,
we will focus on the more macro-level perspectives in the field, explore the historical
context and intellectual traditions that gave rise to these traditions in medical sociology,
and become familiar with many of its central scholars, theories, and works.
Topics we will focus on include: the development of medical sociology, and how
medicine—as a profession, set of practices, economic sector, market, and way of
thinking—came to be an object of sociology scrutiny, theoretical and substantive
concerns in the larger discipline of sociology reflected and refracted in medical
sociology, the structure of the medical professions and the health care system in the U.S.
and its changes over time, and future concerns for the sociology of health and medicine.
Course Requirements:
Requirements for this class include attending all course meetings, having done the
assigned reading. There will be several presentations each class session to move the
discussions forward.
The major piece of required work will be a final paper, 20-25 pages in length, which
explores in depth one of the course’s themes agreed upon by each student and the
instructor. You will be expected in your writings to show that you know how to use
theory and philosophical analysis of the assumptions, premises, language, logic, and
structure of theory.
See the course website for updates, discussions, and materials. Students are responsible
for purchasing the required book: Starr, Paul. 1982. The Social Transformation of
American Medicine. New York: Basic Books. Individual articles are posted on Moodle.
1
Week 1. Introduction and Roots
Discussion Questions:
1. What is theory? What is sociological theory?
2. How did medicine, illness, and then health more broadly come to be objects of
sociological investigation?
3. What is distinctive about approaching medicine and health as social phenomena?
What kinds of questions does such an approach make us ask about how modern
health care, the experience of illness, and the role of health professionals, medical
institutions, and ideas about health in social affairs came to be?
Readings:
Mechanic, David. 1993. Social research in health and the American sociopolitical
context: The changing fortunes of medical sociology. Social Science and
Medicine 36(2): 95-102.
Pescosolido, Bernice and Jennie J. Kronenfeld. 1995. Health, illness, and healing in an
uncertain era: Challenges from and for medical sociology. Journal of Health and
Social Behavior 35(Extra Issue): 5-33.
Cockerham, William C. 2005. Medical sociology and sociological theory. Pp. 3-22 in The
Blackwell Companion to Medical Sociology, edited by William C. Cockerham.
Malden, MA: Blackwell.
Week 2. Classical Perspectives: Talcott Parsons and the Sick Role
Discussion Questions:
1. How is Parsons a product of his historical and intellectual time? In what ways does
his work reflect the prevailing concerns in sociology at that moment?
2. What are the theoretical bases of structural functionalism?
3. How did Parsons accomplish the task of rendering medicine and sickness legitimate
objects of sociological scrutiny? What theoretical arguments and claims did he make
in order to do so?
4. What are the claims of the concept of the sick role? In what ways does the sick role
illuminate how Parsons believed medicine in particular, and society more generally,
to work?
5. In what ways are Parsons’ concerns with values, social order, and societal functioning
still relevant today? What can we take from his scholarship into contemporary
medical sociology?
Readings:
Ritzer, George. 1996. Modern Sociological Theory, 4th ed. Pp. 95-96 and 99-108.
Parsons, Talcott. 1951. The Social System. New York: The Free Press, p. 428-479.
Parsons, Talcott. 1975. The Sick Role and Role of the Physician Reconsidered. MMFQ
Health & Society 53(3): 257-278.
Williams, Simon J. 2005. Parsons revisited: from the sick role to …? health: 9(2): 123144.
2
Week 3. Classical Perspectives: Eliot Freidson and Professional Dominance
Discussion Questions:
1. What relationships does Freidson’s earlier work draw between professionalism,
professional autonomy, and professional status in medicine?
2. What is Friedson’s position on the social nature of illness? How does it compare to
Parsons’ theory of the sick role?
3. According to Freidson, what is the nature of the professional claim? On what
grounds does med have and exercise authority and wield pwr?
4. Is Freidson’s understanding of medical authority—its sources, maintenance, and
implications—of a different character than those of Parsons and of Starr? In what
ways are they similar or different?
5. How does Freidson’s attention to the actual content of medical work open up new
avenues for sociological inquiry? How do we see the effects of such moves today?
Readings:
Freidson, Eliot. 1970. The Profession of Medicine: A Study of the Sociology of Applied
Knowledge. New York: Harper & Row. Chapter 4 (Google Books).
Freidson, Eliot. 1994. Professionalism Reborn: Theory, Prophecy, and Policy. Chicago:
University of Chicago Press. Pp. 61-74.
Halpern, Sydney and Renee R. Anspach. 1993. The study of medical institutions: Eliot
Freidson’s legacy. Work and Occupations 20(3): 279-295.
Starr, Paul. 1982. The Social Transformation of American Medicine. New York: Basic
Books. Pp. 3-29.
Week 4. Perspectives on the Rise of Modern Medicine
Discussion Questions:
1. What is politics about, at the most basic level? What is “political economy”? What
assumptions are embedded in that very phrase, in putting and considering politics and
economy together?
2. For the most part, medical sociologists tend to agree that medicine and physicians
accumulated great prestige and professional control through the mid-20th century.
How do they variously explain the rise of modern medicine? What social processes
do they claim underlie this overall trend?
3. For each of the authors assigned for this session, what are the connections between
his understanding of society and social reality, and the ways he theorizes the rise of
modern medicine?
Readings:
Starr, Paul. 1982. The Social Transformation of American Medicine. New York: Basic
Books. Pp. 112-144, 198-199 and 215-232.
3
Navarro, Vicente. 1984. Medical history as justification rather than explanation: A
critique of Starr’s The Social Transformation of Medicine. International Journal
of Health Services 14(4): 511-28.
Navarro, Vicente. 1980. Work, ideology, and science: The case of medicine.
International Journal of Health Services 10(4): 523-550.
Waitzkin, Howard. 1989. Social structures of medical oppression: A Marxist view. Pp.
166-178 in Perspectives in Medical Sociology, 1st ed., edited by P. Brown.
Belmont, CA: Waveland Press.
Starr, Paul. 2004. Social Transformation Twenty Years On. Journal of Health, Politics,
Policy & Law 29(4/5): 1005-1019.
Week 5. The Changing Political Economy of Health Care
Discussion Questions:
1. How do different authors characterize the changing social organization of medical
institutions and health care over the past several decades? What do their various
characterizations indicate about the theoretical and political lenses through which
they view health care?
2. Is there a crisis in health care? What is the nature of this crisis? How is this an
ongoing social construction, why and how is this framing of the situation mobilized,
and to what ends?
3. What implications do aspects of the changing political economy of health care have
for the social relationships between patients and health professionals? For how health
care is provided and organized? For society as a whole?
4. How can we bring in the modern state into our understanding of medicine and health
care? To what degree, in what ways, and how does it and its interests exert
influence? How does this square with scholars we’ve read previously who argue that
medicine is more of an autonomous, professional domain?
5. Can one theory or explanation account for both the rise as well as the purported fall of
the status of modern medicine?
Readings:
Starr, Paul. 1982. The Social Transformation of American Medicine. New York: Basic
Books. Pp. 379-449.
Navarro, Vicente. 1986. Crisis, Health and Medicine. New York: Tavistock. Pp. 19-41.
Estes, C.L. 1991. Privatization, the welfare state and aging: The Reagan-Bush legacy. Pp.
199-209 in The Nation’s Health, 5th ed., edited by P. R. Lee and C. L. Estes.
Sudbury MA: Boyd & Fraser.
Week 6. Medicalization and Social Control
Discussion Questions:
4
1. In what ways are understandings of medicine as an institution of social control a
product of their time? With whom were such works in conversation with?
2. What are the historical continuities and disjunctures between early work on medicine
and social control, and theories of medicalization and biomedicalization?
3. What are some of the distinctions between medicalization and biomedicalization?
How are these substantively and theoretically important?
4. Do the concepts of bio/medicalization comprehensively describe all of the ways in
which medicine as an institution and its professionals exert social control over the
definition, experience, and treatment of illness? What are some critiques of
medicalization and biomedicalization theories?
5. Where might we look today to see examples of bio/medicalization in practice?
Where are they being contested? How are they being modified or reconfigured?
How might such processes change into the future? Given these changes, do you feel
that medicine as an institution of social control is becoming weaker, stronger,
different in character and/or effect?
Readings:
Fox, Renee C. 2001. The medicalization and demedicalization of American society. Pp.
414-419 in The Sociology of Health and Illness, 6th ed., edited by P. Conrad. New
York: St. Martin’s Press.
Conrad, Peter. 2005. The shifting engines of medicalization. Journal of Health and Social
Behavior 46: 3-14.
Clarke, Adele, Janet K. Shim, Laura Mamo, Jennifer R. Fosket, and Jennifer R. Fishman.
2003. Biomedicalization: Technoscientific transformations of health, illness and
U.S. biomedicine. American Sociological Review 68(2): 161-194.
Mamo, Laura and Jennifer Ruth Fosket. 2009. Scripting the Body: Pharmaceuticals and
the (Re)Making of Menstruation.” Signs 34:925-949.
Week 7. Inequality Within and Beyond the U.S.
Discussion Questions:
1. What are some of the contours of health inequalities in America? Globally? What
are some of the social characteristics and differences that pattern health inequalities?
2. What are the benefits of seeing socioeconomic position as a fundamental cause that
provides the key to understanding socioeconomic inequalities in health? What about
race or racism as a fundamental cause?
3. Given Farmer (1999) and Labonte and Schrecker (2006), in what ways are the
production of inequalities outside the U.S. similar to, as well as distinctive from, that
taking place within U.S. borders? Can we use the fundamental cause concept to help
explain global health disparities? What would the fundamental causes be in this
case?
4. How do globalization theories help account for: (a) global health inequities; (b) the
role of U.S. biomedicine in sustaining, exacerbating, or countering those inequities;
and (c) what do those theories claim about the future trajectories of those inequities?
5
5. How can we move our understanding of health inequalities—its sources, mechanisms,
consequences—forward? What is needed? More theories? New concepts? More
empirical research?
Readings:
Robert, Stephanie A. and James S. House. 2000. Socioeconomic inequalities in health:
An enduring sociological problem. Pp. 79-97 in Handbook of Medical Sociology,
5th ed., edited by C. E. Bird, P. Conrad, and A. M. Fremont. Upper Saddle River
NJ: Prentice Hall.
Link, Bruce & Phelan, Jo. 1995. “Social conditions as fundamental causes of disease.”
Journal of Health & Social Behavior 35 (Extra Issue): 80-94.
Farmer, Paul. 1999. Infections and Inequalities: The Modern Plagues. Berkeley, CA:
University of California Press. Pp. 1-17.
Labonte, Ronald and Ted Schrecker. 2007. Globalization and social determinants of
health: Introduction and methodological background. Globalization and Health 3:
Parts 1-3.
Williams, David, Selina A. Mohammed, Jacinta Leavell, and Chiquita Collins. 2010.
“Race, socioeconomic status, and health: Complexities, ongoing challenges, and
research opportunities.” Annals of the New York Academy of Sciences 1186: 69101.
Week 8. Risk and Biopower
Discussion Questions:
1. How does Foucault excavate the emergence of the clinical or medical gaze? How has
the spatiality of the practice of medicine, according to Foucault, changed over time,
and what is the significance for disciplinary knowledge and power of this shift?
2. What is the relevance of the Panopticon for considering how medical power works in
contemporary society? What is the relevance of governmentality and biopower for
considering how medical power works in contemporary society?
3. What are the visions of the state that are embedded within conceptions of biopower,
its emergence, and its modern manifestations? In other words, how can we connect
governmentality and biopower?
4. What is the significance of the rise of risk as an orienting concept for modern society
and for medical sociology? What are some of the growing sets of practices motivated
by the concept, and what are their implications for individuals, social institutions, and
governments?
5. How do emergent notions of risk, surveillance, and biopower reconfigure (or do
they?) medical sociology’s historical concerns with patient-provider relations,
professional dominance, the political economy of health care?
6. In what ways do notions of risk and biopower dovetail with health inequalities, social
control, and (bio)medicalization?
Readings:
6
Foucault, Michel. 1963/1973. The Birth of the Clinic. Trans. by A. M. Sheridan Smith.
New York: Vintage. Pp. 22-37.
Foucault, Michel. 1980. The eye of power. Pp. 146-165 in Power/Knowledge: Selected
Interviews and Other Writings, 1972-1977, edited by Colin Gordon. New York:
Pantheon Press.
Lupton, Deborah.1999. Risk. London: Routledge. Pp. 84-103.
Petersen, Alan and Deborah Lupton. 1996. The New Public Health: Health and Self in
the Age of Risk. Thousand Oaks, CA: Sage. Pp. 1-26.
Rose, Nikolas. 2007. The Politics of Life Itself: Biomedicine, Power, and Subjectivity in
the Twenty-First Century. Princeton, NJ: Princeton University Press. Pp. 9-40.
Week 9. Contemporary Debates and Emerging Issues
Discussion Questions:
1. Sociological writing and sociologists themselves often exhibit a dual, inter-related,
and reciprocal character: on the one hand, analytic—that is, describing what is, what
has changed, and providing explanatory accounts for these; on the other hand,
prescriptive—advocating ways to ameliorate what is defined to unjust, inefficient,
unethical, or otherwise amiss in a social situation. What are the various prescriptions
that these authors offer for changing the health care system for the better?
2. What are the “definitions of the situation” or articulations of the “problems” of health
care that underlie these prescriptive agendas?
3. What is on the horizon for macro-level perspectives in medical sociology? How do
these reflect historically prevailing concerns in our discipline?
4. What are some of the emergent issues in the systems and organizations and
institutional practices we construct to manage health and sickness, both those
highlighted in the readings and those you see on the horizon? What are some of the
big changes that we as medical sociologists need to confront and analyze? In what
ways do these shifts compel new thinking and theorizing?
Readings:
Farmer, Paul. 2005. Pathologies of Power: Health, Human Rights, and the New War on
the Poor. Berkeley, CA: University of California Press. Pp. 213-246.
Pescosolido, Bernice A. 2010. Taking ‘the Promise’ Seriously: Medical Sociology’s Role
in Health, Illness, and Healing in a Time of Change. Pp. 3-20 in Handbook of the
Sociology of Health, Illness, and Healing: A Blueprint for the 21st Century, edited
by Bernice A. Pescosolido, Jack K. Martin, Jane D. McLeod, and Anne Rogers.
New York” Springer.
Timmermans, Stefan and Stephen Haas. 2008. Toward a sociology of disease. Sociology
of Health & Illness 30(5): 659-676.
Week 10. Recap and Discussion of Final Papers
7
8