Sociology for Nursing & Health Sciences GS Purushothama
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SociologyCHAPTER 1

“Sociology has a long past but only a short history”. Society has been a subject for speculation and inquiry since the dawn of civilization. But it is only within the last hundred and fifty years that the study of society has become a separate subject, Historically the term ‘sociology’ was coined in 1839 by French philosopher and sociologist Auguste comte. He proposed that like other phenomena the society also should be studied scientifically.
Etymologically, the word sociology has hybrid origin of two languages—Latin and Greek. The word ‘socius’ is Latin term meaning friend, companion or associate. The Greek ‘logos’ or ‘ology’ mean study of. It also means doctrine, discourse, or theory. By combining the words, it can be illustrated as socios + logos = sociology (study of human association). Thus literally, sociology is the study of companionship, meaning social interaction and its resultant relationship that exists between companion or group of human beings.
  1. Auguste Comte sociology is the study of social phenomena, that is subject to “natural invariable laws, the discovery of which is the object of investigation”.
  2. Durkheim, sociology is the “science of social institution”.
  3. MacIver and Page sociology is the “science of social relationships”.2
  4. Alex Inkeles, “sociology is the study of society, institutions and social relationships”.
  5. Ginsberg, “In the broadest sense, sociology is the study of human interactions and interrelations, their conditions and consequences”.
  6. Max Weber, “sociology is a science which attempts the interpretative understanding of social action in order thereby to arrive at a casual explanation of its cause and effects”.
A review of these definitions reveals that they mention the phenomena studied by sociology. The levels of social reality studied by sociology are broadly–social relationship, institutions and society. The founder thinker Auguste Comte emphasizes the scientific nature of the study. Weber's reference “to interpretative understanding” draws our attention to the role of subjective factors in social reality. While most of the other definitions focus on different levels of social structure.
Sociology, as a branch of knowledge, has its own unique characteristics. The following are the main characteristics of sociology as enlisted by Robert Bierstedt in his book “The social order”.
  1. Sociology is an independent science: Sociology has emerged into an independent science. It is not treated and studied as a branch of any other science like philosophy or political philosophy or history. As an independent science it has its own subject matter, boundary and methodology.
  2. Sociology is a social science and not a physical science: Sociology belongs to the family of social sciences and not to the family of physical sciences. As a social science, it concentrates its attention on man, his social behavior, social activities and social life. As a member of the family of social sciences, it is intimately related to other social sciences like history, political science, economics, psychology, anthropology, etc.3
  3. Sociology is a catergorical and not a normative discipline: As a science, sociology is necessarily silent about questions of value. It does not make any kind of value-judgments. Its approach is neither moral nor immoral but amoral. It is ethically neutral. It cannot decide the directions in which sociology ought to go. It makes no recommendations on matters of social policy or legislation or program. It only means that sociology as a discipline cannot deal with wrong, moral or immoral.
  4. Sociology is a pure science and not an applied science: Sociology is a pure science, because the immediate aim of sociology is the acquisition of knowledge about human society, not the utilization of that knowledge. Sociologists never determine questions of public policy and do not recommend legislators what laws should be passed or replaced. But the knowledge acquired by a sociologist is of great help to the administrator, the legislator, the diplomat, the teacher, the foreman, the supervisor, the social worker and the citizen.
  5. Sociology is relatively an abstract science and not a concrete science: As an abstract science, it deals with the pattern of social phenomena. Sociology is not interested in concrete manifestation of human events. It does not study any particular wars or association. But, it is concerned with war or association as a social phenomena. It is in this sense sociology is an abstract science not a concrete science.
  6. Sociology is a generalizing and not a particularly or individualizing science: It tries to make generalization on the basis of study of some selected events. For example, a sociologist makes generalizations about the nature of secondary groups. He may conclude that secondary groups are comparatively bigger in size, less stable, not necessarily spatially limited, more specialized, and so on.
  7. Sociology is an empirical and rational science: As an empirical science, it emphasizes experiences and the facts, that comes to light from observation and experimentation. 4It collects facts. As a rational science, it upholds reason and coordination and arranges the facts collected. If arranged properly, coordinated facts, speaks far themselves. Facts ease theorizing. Theory is based on fact.
    It is clear from the above that sociology is an independent, social, categorical, pure, abstract, generalizing and both rational and empirical.
There are two main schools of thought among the sociologists on this issue, viz.
  1. Specialistic or Formalistic School of Thought
  2. Synthetic Schools of Thought
According to the formalistic school, the subject matter of sociology consists of forms of social relationships. “George Simmel, Small, Vier Kanalt-Max Weber, Tonnier, Von Wiser” are the main advocates of their schools of thought. These sociologists want to keep the scope of sociology distinct from other social sciences. They regard sociology as pure and independent. According to George Simmel, sociology should confine its study to formal behavior instead of studying actual behavior. In the same way sociology, too, comprehends the forms of social relationships and activities, not the relationships themselves. Sociology is a specific social science which describes, classifies, analyzes and delineates the forms of social relationships, the processes of socialization and social organization, etc.
George Simmel has mentioned some forms of relationship, e.g. competetion, domination, imitation, division of labor, subordination, etc. Small's way of thinking concurs with Simmel's. According to Small, sociology does not undertake to study all the activities of society. Every science has a delimited scope. The scope of sociology is the study of the genetic forms of social relationships, behaviors and activities, etc. It has been said by Vier Kandt that sociology can be definite science only when it abstains from a historic study of concrete societies. 5According to Max Weber, the scope of sociology consist in the interpretation of social behavior.
According to Von Wiese, the scope of sociology is the study of forms of social relationships. He has divided these social relationships into several kinds, which make a material contribution towards the understanding of the contentions of the formalistic school. Tonnies has supported the idea of pure sociology. He has differentiatied between the society and community on the basis of forms of relationships. In this way, according to the specific aspect of social relationships and behavior, their forms, and its cope is limited to them.
The following arguments have been advanced against the opinion of the formalistic school.
  1. Other sciences also study forms of social relationships.
  2. The establishment of pure sociology is impractical.
  3. Forms of social relationships differ from the forms of geometry.
  4. Separated from the concrete relations, abstract forms cannot be studied.
Synthetic School
As against the specialistic school the synthetic school wants to make sociology as synthesis of the social sciences or a general sciences.
Emile Durkheim, Hobhouse and sorokin” subscribe to this point of view. According to this opinion, sociology is the science of sciences and all social sciences are included in its scope, it synthesizes all of them. According to this contention all the aspects of social life are inter-related, hence the study of one aspect cannot suffice to understand the entire fact.
In this way, the subject matter of sociology and the other sciences are the same, only there is a difference in their respective view points. In studying any social phenomena, it is necessary to contemplate upon all its aspects. Suppose you want to analyze and study the causes of family disorganization from the sociological view point, then you will have to seek the 6assistance of economics, history, psychology and other science. This wide field has been divided into the following classes:
Social morphology: This includes all those subjects which are fundamentally demographic, such as population, its size, density, distribution, etc.
Social physiology: It is inclusive of all those subjects which are studied by particular social sciences, such as religion, economy, language, morals, law, etc.
General sociology: This is the philosophical part of sociology. Its function is the formulation of general social laws.
Social control: It consists of the study of factors such as law, religion, customs, norms, etc. which exercise some kind of control over the individual in society.
Social processes: In this, they studied those internal relation like cooperation and conflict, etc. which exist among men or groups of human beings.
Social pathology: This grouping studies the factors leading to social disorganization and ways and means of preventing social disorganization.
It would have become evident after a perusal of the field of sociology mentioned above, that the scope of sociology is very wide. It studies all the various aspects of society such as social traditions, social processes, social morphology, factor of social control, social pathology, and mutual relationships of social incidents, effect of extrasocial elements upon social relationships and phenomena, etc. of social life. Actually, it is neither possible nor essential to determine the scope of sociology.
By examining sociology on the basis of the six foregoing essentials, it can be known that sociology possesses all the essential characteristics of a science.
  1. Sociology employs the scientific method: All the methods of sociology are scientific. Scientific methods include as scales of sociometry, a schedule, questionnaire, interview and case history, etc. In these methods, the first step is the collection 7of data through observation, which is then systematically recorded. Following this, the data is classified and finally laws are enunciated on the basis of accepted data. The validity of these laws are verified.
  2. Sociology is factual: Sociology makes a scientific study of facts and the general principles involved in them. Comte went to the extent of describing sociology as social physics.
  3. The principles of sociology are universal: In this way, the laws of sociology prove true at all times and places. For example, the principle that individual disorganization and social disorganization depend upon each other, is true in all times and at all places.
  4. Sociology principles are veridical: In this way, the laws of sociology prove true at every verifications and reverification. Their validity can be examined by anyone. For example, wherever the number of divorces are increasing, family disorganization would be showing an upward trend, this principle can be examined anywhere statistics concerning divorces can be obtained.
  5. Sociology delineates cause effect relationships: In the foregoing example of divorces and family disorganization, sociology has discovered a cause-effect relation between phenomena of divorce and family disorganization as one of its cause. In the same way, sociology traces cause-effect relationships in social disorganization and other incidents, activities, and relationships in society, and the formulates laws concerning them.
  6. Sociology can make predictions: On the basis of cause effect relationship, sociology can be anticipate the future and make predictions concerning social relationships, activities, incidents, etc. If disorganization in the families becomes pronounced, it can make prediction concerning the number of divorces, illicit relationships, and many other thing. It is clearly evident from the foregoing description of sociology is a science. In this way, the laws of sociology are effectively universal and veridical.8
Sociology can lay a claim to being a science because it employs the scientific method in its study. Its exactness, the capacity to predict, the possibility of measurement in it, etc.
There is a continuous debate among the scholars about the scientific nature of sociology, Scholars are divided on the issue whether sociology is a science or not. It is argued that if sociology claims itself to be a science, then, it should be able to meet the standards of science as we understand them today.
Three Major Criteria of Sociology as a Science
WF Ogburn is of the opinion that sociology is a science based on following factors
  1. The reliability of knowledge
  2. The organization of knowledge
  3. Method of study.
The Reliability of Knowledge
Science depends upon reliable knowledge. In this regard, sociology has made a promising beginning. Sociological studies of population, the family, group behavior, the evolution of institutions, the processes of social change, social stratification, social mobility and such other topics are regarded as considerably reliable. Science seeks to establish generalizations that are universal.
The Organization of Knowledge
The science should be organized. The organization of science rests upon the relationship, which the parts of knowledge bear to each other. As regards the organization of knowledge, sociology is able to acquire dependable knowledge in a number of areas such as family, marriage, racism, social problems, etc. Though this knowledge is not as precise as the one collected in the field of physical sciences, it is quite impressive. It has inspired sociology to make fresh venture stoopen new branches.9
Method of Study
Science follows the scientific method, its studies and investigations. Scientific method starts with a hypothesis is verified through experimentation.
Sociology has quite a number of other methods besides the experimental method. The historical method, case study method, social survey method, the functional method, the statistical method, etc., can be cited here as examples. These methods are often found to be fruitful in sociological studies.
To conclude, we may say that ‘science’, after all is a method to discover the truth. Experimental method is not the only method of relating the truth. There are many methods and techniques in sociology. Right application of different methods in the spirit of objectivity will certainly yield fruitful results.
The study of sociology has a great practical value in the modern world. Some of the uses of sociology are as follows:
  1. Sociology studies society in a scientific way: Through the study of sociology, the truly scientific study of the society has been possible. Because of its bearing upon many of the problems of the present world has assumed such a great importance. It is considered to be the best approach to all social sciences and the key study for the present situations. Scientific knowledge about society is pre-requisite to any marked improvement in the state of human affairs.
  2. Practically sociology gives more knowledge about social institution: The family, education, religion, the state, industry and work, the community and association, these are the great institution through which society functions. Sociology studies these institutions and their role in development of the individual and suggests suitable measures for restrengthening them with a view to enable them to serve the individual better.10
  3. The study of sociology is indispensable for understanding and planning of society: Society is a complex phenomenon, it is impossible to understand it and to solve its various problem without study of sociology. A certain amount of knowledge about the society is necessary before any social policies can be carried out. For example, a policy of decreasing birth rate is considered desirable, the best means for achieving this goal cannot be determined in exclusively economic terms because matters of family organization, customs and traditional values must be taken into account and these require a sociological type of analysis.
  4. Sociology is of a great importance in the solution of social problem: The present world is suffering from many problems which can be solved only through scientific study of the society. It is the task of sociology to study the social problems through the methods of scientific research and to find out solutions for them.
  5. Sociology has been instrumental in changing our attitude towards human beings: It orders to have insight into and appreciation of the motives by which others live and the conditions under which they exist, a knowledge of sociology is essential.
  6. Sociology has changed our outlook with regard to the problem of crime, etc.: The sciences of criminology and penology and social work and social therapy which are rendering commendable service in understanding social situations and solving individual problems are but handmaids of sociology.
  7. Sociology has made great contribution to enrich human culture: Human culture has been made richer by the contribution of sociology. Sociology has given us training to have rational approach to questions concerning oneself, one's religion, customs, morals and institutions. It has further taught us to be objective, critical and dispassionate. It enables man to have a better understanding both of himself and of others. By comparative study of societies and groups other 11than his own he is able to see many things as relevant to his existence which would otherwise escape his notice.
  8. In view of its importance, sociology is becoming popular as a teaching subject also: It is being accorded an important place in the curriculum of colleges and universities.
  9. Sociology for civil services: The importance of sociology is further proved by the fact that the subject of sociology is also included in the subjects to be offered by candidates competing for the higher examinations such as IAS, IFS, and the like. It is rightly felt that without the study of sociology, the training and knowledge of the candidate aspiring to hold a high post in the administrative set up of his country will be incomplete and imperfect.
  10. Sociology throws more light on the nature of man and it improves as understanding of society and increases the power of social action. Sociology not only help us to know our society but also others, their manners, motives, aspirations, status ever their culture, etc. The study of society made people to become broad minded and help us to overcome the prejudices, misconception, egoistic, ambitions, class and religions, racial hatreds.
  11. Sociology has helped several governments to promote the welfare of child and women, tribal, youth, SC, ST and others.
To sum up, it keeps us up-to-date on modern situation; it contributes to making good citizens; it contributes to the solution of community problems, it adds to knowledge of the society, it helps the individual find his relation to society, it identifies good government with community and it helps one to understand causes of things and so on.
In India, the importance of the study of sociology is still greater. The Indian society is undergoing a rapid transformation. Joint families are disintegrating. The strength of the bond of marriage is waning. The number of broken homes are increasing. Linguism, traditionalism and casterism are raising their ugly heads.
There is wide corruption at every level of governmental machinery. The problem of unemployment is very serious. 12Increasing urbanization has brought the problems such as homicide, slums, epidemics, crime, juvenile delinquency, group conflicts, etc. the people are adopting more and more to agitational methods. There is a major confusion in the system of education; and a crisis of character everywhere. In first step towards a solution of the various problems, besetting the Indian society is to understand the social background of these problems. Sociology will assist in understanding this back ground.
Uses of sociology in nursing and health sciences
  1. Sociology will help the doctors and nurses to know the culture and social life of the patients so as to make the medical services more effective and meaningful.
  2. Medical sociology is extremely useful for the entire health care services in knowing the significance of social forces in health, health values and motivations. In organizing and administrations of public health programs the sociological knowledge is necessary.
  3. Sociology will help the nurses and doctors to identify the social background of the patients which improves the quality of treatment.
  4. Sociology helps the nurses to improve their care for special groups like children, aged, retarted and diseased, etc. and it helps them to build interpersonal relationship between patients, medical personnel, and the government in the implementation of preventive curative and promotive aspects of health in the society.
To understand why eating disorders have become so common in current times, we should think back to the social changes. Anorexia actually reflects certain kinds of social change, including the impact of globalization.
  1. The rise of eating disorders in Western societies coincides directly with the globalization of food production, which has increased greatly in the last three or four decades.
  2. The invention of new modes of refrigeration plus the use of container transportation have allowed food to be stored for 13long periods and to be delivered from one side of the world to other. In a society in which food is abundant, we are able for the first time to design our bodies in relation to our lifestyle habits (such as jogging, bicycling, swimming and yoga) and what we eat.
  3. Eating disorders have their origins in the opportunities, but also the pro-found strains and tensions this situation produces. Anorexia and other eating disorders reflect the current situation in which women plays a much larger part in the wider society than they used to but are still judged as much by their appearance as by their attainments.
  4. Eating disorders are rooted in feelings of shame about the body. The individual feels herself to be inadequate and imperfect, and her anxieties about how others perceive her become focused through her feelings about her body. An ideal of slimness at that point become obsessive-shedding weight becomes the means of making everything all right her world. Once she starts to diet and exercise compulsively, she can become locked into a pattern of refusing food altogether or of vomiting up what she has eaten.
  5. The spread of eating disorders reflects the influence of science and technology on our ways of life today: calorie-counting has only been possible with advance of technology but the impact of technology is always conditioned by social factors.
One of the main concerns of sociologists is to examine the experience of illness. Sociologists ask how illness, such as anorexia is experienced and interpreted by the sick persons and by those with whom she comes into contact. Illness has both personal and public dimensions. When we become ill, not only we do experience pain, discomfort, confusion and other challenges, but others are affected as well. People in close contact with us may extend sympathy, care and support. They 14may struggle to make sense of the fact of illness or to find ways to incorporate it into the patterns of their own lives. Others with whom we come into contact may also react to illness; these reactions in turn help to shape our own interpretations and can pose challenges to our sense of self.
Like many of the ideas, health and illness are terms, which are culturally and socially defined. Cultures differ from what they consider to be healthy and normal. All cultures have known concepts of physical health and illness, but most of what we now recognize as medicine is a consequence of developments in western society over the past three centuries. In pre modern cultures, the family was the main institutions capping with sickness or affection. They have always been individuals who specialized as healers, using a mixture of physical and magical remedies, and many of these traditional system of treatment survive today in non-western cultures throughout the world. For approximately 200 years now the dominant Western ideas about medicine have been expressed in the biological model of health.
This understanding of health and illness developed along with the growth of modern societies. In fact, it can be seen as one of the main features of such societies. Its emergence was closely linked to the triumph of science and reason over traditional or religious based explanations of the world. Members of traditional societies relied largely on folk remedies, treatments and health techniques which were passed down from generation to generation. Illness were frequently regarded in magical or religious terms and were attributed to the presence of evil spirits of “sin” for patients and average town-dwellers, there was no outside authority that was concerned with their health in the way that states and public health systems are today.
Health was a private matter, not a public concern. The rise of both the nation-state and industrialization brought about 15drastic changes in this situation. The human population was seen as a resource to be monitored and regulated as part of the process of maximizing wealth and power. The state began to take a heightened interest in the health of its population, as the well-being of its members affected the nation's productivity, level of prosperity, defensive capabilities and rate of growth. The study of demography— the size, composition and dynamics of human population-assumed much greater importance. The census was introduced in order to record and monitor changes occurring in the population. Statistics of all sorts were collected and calculated: birth rates, mortality rates, average ages of marriage and child-bearing, suicide rates, life expectancy, diet, common illness, causes of death and so forth.
Michel Foucault (1926–1984) has made an influential contribution to our understanding of the rise of modern medicine by drawing attention to the regulation and disciplining of the bodies by the state. He urges that sexuality and sexual behavior were of central importance to this process. Sex was both the way in which the population could reproduce and grow, and a potential threat to its health and well-being. Sexuality not linked to reproduction was something to be repressed and controlled. This monitoring of sexuality by the state occurred in part through the collection of data about marriage, sexual behavior, legitimacy and illegitimacy, the use of contraception and abortions. This surveillance went hand-to-hand with the promotion of strong public norms about sexual morality and acceptable sexual activity.
The idea of public health took shape in an attempt to eradicate ‘Pathologies’ from the population—the ‘social body’. The state began to assume responsibility for improving the conditions in which the population lived. Sanitation and water system were developed to protest against diseases. Roads were paved and attention was devoted to housing, regulations were gradually imposed on slaughter house and facilities for food processing. Burial practices were monitored to ensure that they did not pose a health threat to the population. A whole series 16of institution, such as prisons, asylums, work houses, schools and hospitals emerged as part of the move towards monitoring, controlling and reforming the people.
The Biological Model
The application of science to medical diagnosis and cure was the major features of modern health care systems. Disease came to be defined objectively, in terms of identifiable objectivity signs located in the body. As opposed to symptoms experienced by the patient. Formal medical care by trained experts became the accepted way of treating both physical and mental illness. Medicines became a tool of reform for behavior or conditions perceived as deviant from crime to homosexuality to mental illness. There are three main assumptions on which the bio medical model of the health is predicted.
  1. Disease is viewed as a breakdown within the human body that diverts it from its normal state of being. The germ theory of disease, developed in the late 1800s, holds that there is a specific identifiable agent behind every disease. In order to restore the body to health, the causes of the disease must be isolated and treated.
  2. Mind and body can be treated separately. The patient represents a sick body—a pathology—rather than a whole individual. The emphasis is on curing the disease, rather than on the individual's well-being. The biomedical model holds that the sick body can be manipulated, investigated and treated in isolation, without considering other factors. Medical specialist adopt a medical gauge, a detached approach in viewing and treating the sick patient. The treatment is to be carried out in a neutral, value free manner, with information collected and complied, in clinical terms, in a patient's official file.
  3. Trained medical specialists are considered the only experts in the treatment of disease. The medical profession as a body 17adheres to a recognized code of ethics and is made up of accredited individuals who have successfully completed long-term training. There is no room for self-taught healers or ‘non-scientific’ medical practices. The hospitals represents appropriate environment in which to treat serious illnesses; these treatments often rely on some combination of technology, medicines or surgery.
Criticism on Biomedical Model
Over the past few decades, the biomedical model of illness described above has been the object of growing criticism.
  1. Some scholars have claimed that the effectiveness of scientific medicine is ‘overrated’. In spite of the prestige that modern medicine has acquired, improvements in overall health can be attributed far more to social and environment changes than to medical skill. Effective sanitation, better nutrition and improved sewerage and hygiene were more influential, particularly in reducing the infant mortality rates and deaths of young children. Drugs, advances in surgery, and antibiotics did not significantly decrease death rates until well into the twentieth century.
    Ivan Illich (1975) has even suggested that modern medicine has done more harm than good because of iatrogenesis, or ‘self-caused’ disease. Illich argued that there are three types: clinical, social and cultural iatrogenesis, where the ability to cope with the challenges of everyday life is progressively reduced by medical explanations and alternatives. To critics like Illich, the scope of modern medicine should be dramatically reduced.
  2. Modern medicine has been accused of discounting the opinions and experience of the patients seeks to treat. Because medicine is supposedly based on objectives, scientific understandings of the causes and cures of specific physical ailments, there is little perceived need to listen to the individual interpretations that patient due to their conditions. Each patient is a ‘sick body’ to be treated and 18cured. Critics argue, however, that effective treatment can only take place when the patient is treated as a thinking, capable being with their own valid understandings and interpretations.
  3. Critics argue that scientific medicine posts itself as superior to any alternative form of medicine or hailing. A belief has been perpetuated that any thing that is ‘unscientific’ is necessarily inferior. As we have already seen, they assertion that modern medicine is somehow a more valid form of knowledge is been undermined by the growing popularity of alternative forms of medicine, such as homeopathy and acupuncture.
  4. Some sociologist have argued that the medical professions wields enormous power in defining what does and does not constitute illness. Some of the strongest criticisms along these lines have come from women who argue that the process of pregnancy and child birth have been appropriated and ‘medicalized’ by modern medicine. Rather than remaining in the hands of women—with the help of midwives in the home—child birth now occurs in hospitals under the direction of predominantly male specialists. Pregnancy, a common and natural phenomenon, is treated as an ‘illness’. Laden with risks and danger. Feminists argue that women have lost control over this process, as their opinions and knowledge are deemed irrelevant by the experts who now oversee reproductive process. Similar concerns about the medicalization of normal conditions have been raised in relation to hyperactivity in children. Unhappiness or mild depression and tiredness (frequently labeled Chronic Fatigue Syndrome). Many of the assumptions of the biomedical model are being increasingly questioned, as world in which it developed changes.
  5. Critics have argued that the assumptions underlying the biomedical model of the health have lent themselves to grasp political manipulation, in particular through eugenics; they attempt to genetically improve the human race through ‘good breeding’. Scientific and medical experts in Nazi 19Germany took this policy to their most extreme, by claiming that they had identified a racially superior light skinned aryan's race. Their eugenics programs lead to the genocide of millions of people who belonged to groups the Nazi's saw as biologically inferior, such as Jews and Gypsies as well as the system at Atic murder of more than 250,000 disabled people.
    In Scandinavia, political leaders and geneticists adopted policies for compulsory sterilization because they were concerned that the emerging welfare state would encourage the ‘unfit’ to reproduce and would therefore reduce the quality of the ‘national stock’. In Sweden alone, 63,000 people, 90% of them women, were sterilized between 1934 and 1975. Norway, a much smaller country, sterilized 48,000 people in the same period. British and Dutch medical experts and policy-makers, by contrast, adopted voluntary sterilization, together with the mass institutionalization and segregation of the ‘feeble minded’
    A great deal of scientific Endeavor is now being devoted to the expansion of genetic engineering, which makes it possible to intervene in the genetic make-up of the fetus so as to influence its subsequent development. Genetic reprogramming will ensure that these illnesses are no longer passed on from generation to generation. It is now scientifically possible, for example, to ‘design’ bodies before birth in terms of color or skin, hair and eyes, weight and so forth. Several of the criticisms of the biomedical mode, discussed above, apply also to the genetic engineering debate. Many of those with concerns about the biomedical model will question the role of medical experts in exerting their authority over the technology. Some sociologists have argued that differential access to genetic engineering might lead to the emergence of a ‘biological underclass’. Those who do not have the physical advantages genetic engineering can 20bring might be subject to prejudice and discrimination by those who do enjoy these advantages. They might have difficulty finding employment and life or health insurance. For sociologists, the rapid pace in which new medical technologies are advancing raises an increasing number of new and difficult questions.
Medicine and Health in a Changing World
There is a growing realization that it is not only medical experts, who possess knowledge and understanding about health and illness. All of us are in a position to interpret and shape our own well-being through our understanding of our bodies, and through choices in our everyday lives about diet, exercise, consumption patterns and general lifestyle. These new directions in popular thinking about health, along with the other criticisms of modern medicine outlined above, are contributing to some profound transformations within healthcare systems in modern societies.
In earlier times, the major illnesses were infectious diseases such as tuberculosis, cholera, malaria and polio. They often took an epidemic proportion and could threaten a whole population. In industrialized countries today, such acute infectious diseases have become a minor cause of death; some of them have been substantially eradicated. The most common causes of death in industrialized countries are now noninfectious chronic diseases such as cancer, heart disease, diabetes or circulatory diseases. This shift is referred to as the ‘health transition’. Whereas in premodern societies the highest rates of death were among infants and young children, today death rates rise with increasing age. Because people are living longer and suffering predominantly from chronic degenerative diseases, there is the need for a new approach to health and caring.
There is also increased emphasis on ‘lifestyle choices’—such as smoking, exercise and diet—which are seen to influence the onset of many chronic illnesses. Where these 21contemporary transformations in healthcare will result in a new ‘health paradigm’ to replace the biomedical model, as some scholars have suggested, is unclear. But, it is certain that we are witnessing a period of significant and rapid reform in modern medicine and in people's attitudes towards it.
The Sick Role
The prominent functionalist thinker Talcott Parsons (1952) advanced the notion of the ‘sick role’ in order to describe the patterns of behavior, which the sick person adopts in order to minimize the disrupted impact of illness. Functionalist thought holds that society usually operates in a smooth and consensual manner. Illness is therefore seen as a dysfunction which can disrupt of the flow of this normal state of being. A sick individual, for example, might not be able to perform all of his or her standard responsibilities or might be less reliable and efficient than usual. Because sick people are not able to carry out their normal roles, the lives of people around them are disrupted; assignment at work go unfinished and cause stress for coworkers, responsibilities at home are not fulfilled, and so forth.
According to Parsons, people learn the sick role through socialization and enact it with the cooperations of others—when they fall ill. There are three factors of the sick role.
  1. The sick person is not personally responsible for being sick, illness is seen as the result of physical causes beyond the individual's control. The onset of illness is unrelated to the individual's behavior actions.
  2. The sick person is entitled to certain rights and privileges including a withdrawal from normal responsibilities.
  3. The sick person must work to regain health by consulting a medical expert and agreeing to become a patient. Sick people who refuse to consult a doctor, or who does not heed to advice of a medical authority, puts his or her sick role status in jeopardy.22
Parsons sick role has been refined by other sociologists, who suggest that all illnesses are not ‘the same’ as far as the sick role is concerned. Fridson (1970) identified three version of the sick role which corresponded with different types and degrees of illness.
  1. The conditional sick role appeals to individuals who are suffering from a temporary condition from which they can recover. The sick person is expected to ‘get well’ and receive some rights and privileges according to the severity of the illness.
  2. The unconditionally legitimate sick role refers to individuals who are suffering from incurable illnesses. Because the sick person cannot do anything to get well, he or she is automatically entitled to occupy the sick role. The unconditionally legitimate role might apply to individuals suffering from alopecia (total air loss) or severance (in both cases there are no special privileges, but rather an acknowledgment that the individual is not responsible for illness), or from cancer or Parkinson's disease, which result in important privileges and the right to abandon many or most duties.
  3. The illegitimate role obtains when an individual suffers from a disease or condition that is stigmatized by others. In such cases, there is a sense that the individual might somehow bear responsibility for the illness; additional rights and privileges are not necessarily granted. Alcoholism is one example of a stigmatized illness which affects a sufferer's right to assume the sick role.
Critiques of the ‘Sick Role’
Some writers have argued that the sick role ‘formula’ is unable to capture the experience or illness. Others point out that it cannot be applied universally. For example, the sick role theory does not account for instances when doctors and patients disagree about a diagnosis, or have opposing interests. Some individuals suffer for years from chronic pain or from 23symptoms that are repeatedly misdiagnosed. In other cases, social factors such as race, class and gender can affect whether, and how readily, the sick role is granted. The sick role cannot be divorced from the social, cultural and economic influences which surround it. The realities of life and illness are more complex than the sick role suggests. Moreover, in modern societies the shift away from acute infectious disease towards chronic illness has made the sick role less applicable. Living with illness is experienced and interpreted in a multiplicity of ways by sick people, and by those who surround them.
The twentieth century witnessed a significant overall rise in life expectancy for people who live in industrialized countries. Diseases such as polio, scarlet fever and tuberculosis have virtually been eradicated. Compared to other parts of the world, standards of health and well-being are relatively high. Many of these advances in public health have been attributed to the power of modern medicine. There is a commonly held assumption that medical research has been- and will continue to be- successful in uncovering the biological causes of disease and in developing effective treatments to control them. Although, this approach to health and disease has been extremely influential, it is somewhat unsatisfactory for sociologists. This is because, it ignores the important role of social and environmental influences on patterns of health and illness. The improvements in overall public health over the past century cannot conceal the fact that health and illness are not distributed evenly throughout the population. Research has shown that certain groups of people tend to enjoy much better health than others. These health inequalities appear to be tied to larger socioeconomic patterns.
Sociologists and specialists in social epidemiology—scientists, who study the distribution and incidence of disease and illness within the population, have attempted to explain the link between health and variables such as social class, gender, race, age and geography. While most scholars 24acknowledge the correlation between health and social inequalities, there is no agreement about the nature of the connection or about how health inequalities should be addressed. One of the main areas of debate concentrates on the relative importance of individual variables (such as lifestyle, behavior, diet and cultural patterns) versus environmental or structural factors (such as income distribution and poverty.
Class and Health
Research on health and class has revealed a clear relationship between patterns of mortality and morbidity (illness) and an individual's social class. In Britain, the Black Report—a major nationwide study (DHSS 1980)—was important in publicizing the extent of class-based health inequalities. Many people found the results shocking. Although there was found to be a trend towards better health in society as a whole, significant disparities were seen to exist between various classes, affecting health indicators from birth weight to blood pressure to risk of chronic illness. Individuals from higher socioeconomic positions are on average healthier, taller and stronger, and live longer than those lower down the social scale. Differences are greatest in respect to infant mortality. But poorer people are at greater risk of dying at all ages than more affluent people.
Some of the main class-based inequalities in health have been summarized by Browne and Bottrill. They include:
  1. Unskilled manual workers in the lowest occupational class are twice more likely to die before retirement age than professional white-collar workers in the top occupational class.
  2. Twice as many babies are still born or die within the first week of life in unskilled families than in professional families.
  3. An individual born into the highest occupational class (professional white collar workers) is likely to live on average seven years longer than someone born into the lowest occupational class (unskilled manual workers).25
  4. Some 90% of the major causes of death are more common in the two lowest occupational classes than the three higher occupational classes.
  5. Working-class people visit their doctors more often and for a wider range of ailments than people in professional occupations; long-standing illness is 50% higher among unskilled manual workers than among professionals.
  6. Class-based health inequalities are even more pronounced among the long-term unemployed; people in work tend to live longer than those who are without work.
Studies conducted in other industrialized countries have confirmed that there is a clear class gradient to health. Some scholars believe that the relative health inequality between the richest and poorest members of society is widening. Materialist or environmental scientists see the cause of health inequalities in large social structures such as poverty, wealth and income distribution, unemployment, housing, pollution and poor working conditions. The patterns in health inequalities between classes are seen as the result of material deprivation. Reducing inequalities in health can only be done by addressing the root cause of social inequalities in general.
Gender and Health
Disparities in health between men and women have also been noted in research. Women enjoy a longer life expectancy than men in almost every country in the world (UNDP 2004) although heart disease affects men more than women; it is still the most frequent killer of both men and women under the age of sixty five.
  1. Men, however, suffer from higher rates of death from accidents and violence and are also more prone to drug and alcohol dependency.
  2. Women in industrialized countries report twice as much anxiety and depression as men. According to some observers, the multiple roles which women tend to perform-domestic work, child care, and professional responsibilities- 26may increase the stress on women and contribute to higher rates of illness. Women's lives are inherently different from men's in terms of the roles and tasks that are commonly performed—domestic work, sexual reproduction, childbearing and mothering, regulating fertility through birth control and so forth. Heather Graham has studied the effects of stress on the health of white working class women. She has highlighted the fact that women at the lower socioeconomic end of the spectrum have less access to support networks in times of life crisis than do middle-class women.
  3. Working class women, tend to encounter life crises (such as job loss, divorce, eviction from housing or the death of a child) more often than other groups, but generally have weaker coping skills and fewer outlets for anxiety. Not only is the resulting stress harmful both physically and psychologically, but some of the coping strategies which are turned to, such as smoking, are also damaging. Graham argues that smoking is a way of reducing tension when personal and material resources are stretched to breaking point.
    Ann Oakley and her colleagues (1994) have studied the role of social support in the health of socially disadvantaged women and children in four English cities. She argues that the relationship between stress and health applies both to major life crises and smaller problems, and that it is felt particularly acutely in the lives of working class people.
  4. Oakley notes that social support such as counseling services, hotlines or home visits can act as a ‘buffer’ against the negative health consequences of stress commonly experienced by women. Other studies have shown that social support is an important factor that can help people in adjusting to disease and illness.
Ethnicity and Health
Although health in industrial societies is ethnically patterned, our understanding of the relationship between ethnicity and 27health is partial at best. An increasing number of sociological studies are being conducted in this area, but the evidence remains inconclusive.
  1. Nevertheless, the incidence of certain illnesses is higher among individuals from African-Caribbean and Asian backgrounds. In the UK, mortality from liver cancer, tuberculosis and diabetes are higher among these populations than among the whites.
  2. African-Caribbean suffers from higher than average rates of hypertension and sickle-cell anemia.
  3. People from the Indian subcontinent experience higher mortality from heart disease than the average for the UK.
  4. Some scholars have turned to cultural and behavioral accounts to explain ethnic health patterning. In a similar way to cultural explanations of class-based health inequalities, emphasis is placed on individual and group lifestyles which are seen to result in poorer health. These are often seen as linked to religious or cultural beliefs, such as dietary and cooking habits or consanguinity (the practice of intermarriage within families at the level of second cousins).
  5. Social-structural explanations for ethnic patterning in health focus on the social context in which African-Caribbean and Asians frequently experience multiple disadvantages which can be harmful to their health. These might include poor or overcrowded housing conditions, high rates of unemployment and over-representation in hazardous, low-paying occupations. Such material factors are then compounded by the effects of racism, either experienced directly in the form of violence, threats or discrimination, or in ‘institutionalized’ forms.
Health and Social Cohesion
In trying to unravel, the causes of health inequalities, a growing number of sociologists are turning their attention to the role of social support and social cohesion in promoting good health. In several articles, and in his book ‘unhealthy Societies: the afflictions of inequality’ (1996), Richard Wilkinson argues that 28the healthiest societies in the world are not the richest countries, but those in which income is distributed most evenly and levels of social integration are highest. High levels of national wealth, according to Wilkinson, do not necessarily translate into better health for the population.
  1. In surveying empirical data from countries around the world, Wilkinson notes a clear relationship between mortality rates and patterns of income distribution. Inhabitants of countries such as Japan and Sweden, which are regarded some of the most egalitarian societies in the world, enjoy better levels of health on average than do citizens of countries where the gap between the rich and the poor is more pronounced, such as the United States.
  2. In Wilkinson's view, the widening gap in income distribution undermines social cohesion and makes it more difficult for people to manage risks and challenges.
  3. Heightened social isolation and the failure to cope with stress are reflected in health indicators.
  4. Wilkinson argues that social factors- the strength of social contacts. Ties within communities, availability of social support, a sense of security, are the main determinates of the relative health of a society.
Medical sociology is the sociological study of the social institutions of medicine, its knowledge, practice and effects. Medical sociology investigates the social organization and production of health and illness, includes relevant aspects of sociology of the professions and Science and Technology studies that relates to medicine and health care. Medical sociologists works on public health, demography, and social gerontology to explore phenomena at the intersection of the social and clinical sciences.
Medical sociology is extremely useful for the health services. Sociologists examine diseases in their social settings prevention of diseases largely depends on social causer. Doctor-patient 29relationship, nurse and patient relationship, medical education and training, hospital administration, etc. are also studied in medical sociology.
Early works in medical sociology was conducted by Lawrence J Henderson whose theoretical interests in the work of Vilifredo Pareto inspired Talcott Parsons interests in social system theory. Talcott Parsons is one of the founding Fathers of Medical Sociology and applied social role theory to internal relations between sick people and others. Key contributors to medical sociology since the 1950s include Howard Becker, Mikebury, Peter Courad, Jack Dugles, David Silverman, etc.
The field of medical sociology is usually taught as a part of wider sociology, clinical psychology of health studies of graduation and postgraduation studies, where it is sometimes combined with the study of medical ethics or bioethics, etc.