The Nature and Status of Medical Sociology

The Nature and Status of Medical SociologyAuthor(s): Robert StrausSource: American Sociological Review, Vol. 22, No. 2 (Apr., 1957), pp. 200-204Published by: American Sociological AssociationStable URL: http://www.jstor.org/stable/2088858 .

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200 AMERICAN SOCIOLOGICAL REVIEW

These are but rough and indirect guides, but they do serve to reduce the randomness of the choices made by the larger society without weakening the essential bonds within each professional community. It does not seem likely, on the other hand, that each professional community has found, unaided, the sociologically correct point of optimum bal- ance between these two.

Summary. The complex structural relations presented here cannot be summarized briefly. We have first noted how important

a characteristic of the profession is that of "community." Second, we have pointed out that it is like many other types of commu- nities in that it exists within and is depend- ent on a larger society. Thus, theoretical notions derived from this nexus may have wider applications. Third, we have analyzed two specific sets of such relations, (1) socialization and social control, and (2) client choice and evaluation of the professional, noting the structural strains and supports of the community and the society. It is suggested here that these relations between and within the contained community and the larger society form an important, but hitherto little explored area.

Directory, edited by George S. Koyl, New York: Bowker, 1955; Martindale-Hubbell Law Directory, 1956; Medical Directory of New York State, Vol. 46, New York: Medical Society of the State of New York, 1955; etc.

THE NATURE AND STATUS OF MEDICAL SOCIOLOGY *

ROBERT STRAUS

University of Kentucky

THIS report is concerned with the professional affiliations and activities of 110 sociologists working in the new sub-spe-

ciality of "medical sociology" during the first half of 1956.

The study on which this report is based was suggested by a small group of medical sociologists and physicians who met in- formally in Washington in September, 1955 during the meetings of the American Socio- logical Society. The discussion centered on the desirability of establishing some channels of communication about the many develop- ments in this area. It was agreed that medical sociologists needed some means of identifying each other and knowing the various ways in which sociologists were relating to medicine. An exchange of this type of information was felt to be vital so that patterns of activity that seemed to work well might be emulated while those involving pitfalls might be avoided in the future. It was suggested that each medical sociologist might want to develop a direct exchange of ideas and experience with others whose affiliation,

program and responsibilities were similar to his own.

In order to facilitate such an interchange of information and to meet other common needs, the informal Committee on Medical Sociology was created. This writer was desig- nated Secretary to the Committee and was asked to undertake the compilation of a directory of medical sociologists.

The following procedures were followed. About fifteen medical sociologists known to the writer were asked to provide the names of persons who they knew were working in the field. From these suggestions, an initial list of 82 names was compiled. This list was then sent to each of the persons named along with a simple one-page questionnaire. They were asked to complete and return the questionnaire if they desired to be identified with medical sociology. They were also asked to suggest the names of persons not listed who they felt should be so identified. Eighty additional names were suggested, and these individuals were invited to complete the questionnaire. Of the 162 forms distributed, 144, or 89 per cent, had been returned by June 1, 1956. It was indicated that primary concern of the Committee would be in identi-

* Paper read at the annual meeting of the American Sociological Society, September, 1956.



THE NATURE AND STATUS OF MEDICAL SOCIOLOGY 201

fying the professional sociologists working in medicine. Thirty-four of the names submitted were those of persons with professional iden- tifications other than sociology: physicians, anthropologists, psychologists, and social workers. They are obviously only some of the men and women in these professions whose interests extend into medical sociology, but they have been included in the directory of medical sociologists prepared by the Com- mittee. However, only the 110 individuals whose basic professional identification is sociology are included in the following discussion.

This covers first, a description of the nature of activities in which medical sociologists are engaged as indicated by responses to the questionnaires distributed for the Committee; and second, an interpretation of these find- ings in terms of the status of medical sociology.

The Nature of Medical Sociology. Medical sociology is described according the five cri- teria: (1) the types of organization with which medical sociologists hold their basic professional affiliation, (2) the proportion of professional activity that is directly related to medical sociology, (3) the nature of function, i.e. teaching, research, or administration, (4) for teaching in medical sociology, an identification of students, (5) for research in medical sociology, an identification and categorization of types of problem and areas of investigation.

Basic Professional Affiliations. Of the 110 sociologists included in this study, 34 were affiliated with an academic medical organization. These included 20 who are employed full time at 11 different medical schools,1 4 who hold joint appointments between medical schools and academic departments of sociology,2 6 who are employed at 4 different Schools of Public Health,3 and 4 employed by 4 Schools of Nursing.4 Five sociologists held primary appointments to the staffs of

hospitals, 18 were working for governmental public health or mental health agencies, and 3 were on the staffs of voluntary health agencies. Altogether 60 were working with organizations having a distinct medical orientation. Of the others, 11 were with private research groups, 5 were on foundation staffs, and 34 had their primary base with an academic department of sociology or an allied field.

Extent of Function in Medical Sociology. Sixty-eight of the respondents reported that they were engaged in medical sociology on a full-time basis. All but 5 of those affiliated with medical organizations were on a full- time basis. The 42 respondents with only a part-time investment in this area included 32 whose basic affiliation is with an academic department of sociology.

Nature of Function in Medical Sociology. Fifty-seven sociologists reported that they were teaching in the broad area of medical sociology. One-hundred-and-eight are con- ducting research in this field. Sixteen have administrative responsibilities.

Teaching. The teaching of medical sociology includes activities ranging from complete courses to occasional lectures and is addressed to such varied groups as medical students, physicians, nurses, students of public health, university graduate students and college undergraduates.

Twenty-four sociologists have been teaching medical students at 16 different medical schools.5 These include 17 men who hold full-time appointments on medical school faculties, 3 whose services are borrowed from departments of sociology, and one each whose basic affiliation is in a School of Public Health, a hospital, a governmental health agency, and a research organization. There appears to be no pattern for the sociologist's teaching in a medical school. Most frequently he is participating in the teaching program of a department of preventive medicine or en- vironmental medicine. In 4 schools he is relating to the teaching in psychiatry. At one school 4 sociologists are participating in an

' Cornell (5), Upstate Medical Center, State University of New York (4), Colorado (2), Down- state Medical Center, State University of New York (2), one each at Baylor, Harvard, North Carolina, Texas, Vermont, Yeshiva, University of Washington.

2 Columbia, Cornell, University of Florida, Yale. 3 Harvard (2), Michigan (2), Minnesota, Pitts-

burgh. 4 Colorado, Cornell, Boston University, North-

western.

5 Cornell (3), State University of New York Upstate (4), Colorado (2), State University of New York Downstate (2), University of Washing- ton (2), Baylor, Harvard, North Carolina, Texas, Vermont, Yeshiva, Pittsburgh, Albany, Wayne, Western Reserve, Chicago.




interdisciplinary course called The Science of Human Behavior. This course uses curricu- lum time formerly assigned to the departments of public health and psychiatry in the first year. Forms of teaching include the complete course, the unit of a course, the series of lectures, incidental lectures, seminars and individual conferences. Although he ap- proaches the problem in many different ways, in nearly all instances the sociologist is trying to provide the medical student with a broader perspective for understanding some of the social and cultural factors that may influence the etiology, or incidence, or prevalence, or course of a health problem; the response of the patient, his family, and his other social groups; or the total management of the situation. The sociologist is becoming a key contributor to the concepts of comprehensive medicine.

In addition to the teaching of medical students, 23 sociologists are teaching or participating in courses for nurses or nursing students, 12 are teaching courses or course units on medical sociology to college undergraduates, and 40 are variously involved in courses or seminars relating to some aspect of medical sociology for physicians, students of public health or other graduate students. One department of sociology (Yale) now provides a special graduate program in medical sociology.

Administration. Administrative duties reported in connection with medical sociology are primarily concerned with responsibility for research projects or programs. Three men reported administrative roles in connection with health agencies, one with a foundation, and one responsibility for a medical school teaching and research program in the social sciences.

Research. One-hundred-and-eight of the 110 respondents indicated that they were engaged in research related to medical sociology. They reported 135 different studies that are classified here into four groups.

Forty-two projects are concerned with mental illness. Twelve of these are focused primarily on the psychiatric hospital. They deal with the social structure of the hospital as a therapeutic community, and the impact of the hospitalization experience on the post- hospital adaptation of patients. Fourteen projects involve the application of behavior

theory to a better understanding of the psy- chotherapeutic process. Eight studies are concerned with the epidemiology of mental illness. Eight projects involve the relationship of psychiatric disorders to social structure.

Forty-two studies are primarily concerned with identifying patterns of human response to illness and delineating clinical uses for social data. Twenty of these are concerned with the medical care practices of various segments of the population and are usually restricted to particular cultural groups. They attempt to identify factors that influence the recognition of health needs and the utilization of health resources. Twenty-two projects are focused on specific diseases or disease factors (heart disease, alcoholism, leukemia, tuberculosis, aging, physical rehabilitation). These are concerned with socio-cultural factors that may be significant to the etiology, prevalence, distribution, course or management of the particular health problems.

Twenty-six sociologists reported involve- ment in studies of the profession of medicine. The greatest number of these dealt with the professionalization process through which the medical student becomes a physician. Others are concerned with the role of the physician, the socialization of nurses, the choice of medicine as an occupation. A few are concerned directly with the use of social science materials in medical or nursing education.

A final group of research projects, 25 in number, are concerned with the organization of medicine and with the supply, distribution, and utilization of health resources. These include 7 studies of the general hospital, several dealing with regional or community patterns of medical service, and others focusing on the family as a unit of health care.

The Status of Medical Sociology. From the foregoing summary of the nature of medical sociology, it is apparent that there is a large and varied activity in this field. The field is, however, developing and chang- ing very rapidly, so rapidly that any attempt to describe it runs the risk of early obso- lescence.

The number of medical organizations now employing sociologists suggests that the profession is fast coming to recognize a value and a need for sociological contributions.



THE NATURE AND STATUS OF MEDICAL SOCIOLOGY 203

Lest we become too confident of our demon- strated worth, it should be noted that a majority of the positions held by sociologists on medical school faculties have been supported by foundations. The Russell Sage Foundation alone has pioneered in providing funds for this purpose with the intention that sociologists be given an opportunity to explore their potential for contributing to the medical program and hopefully to demon- strate their worth. It is encouraging that so many medical schools have taken advan- tage of this opportunity. However, the true test will come only when these schools are faced with the decision of continuing such positions within their own budgets. Thus far, few schools have supported medical sociologists without recourse to outside funds.

A year ago we suggested a logical division of medical sociology into two categories, the sociology of medicine and sociology in medicine.6 We suggested that the sociology of medicine is concerned with studying such factors as the organizational structure, role relationships, value systems, rituals, and functions of medicine as a system of behavior and that this type of activity can best be carried out by persons operating from inde- pendent positions outside the formal medical setting. Sociology in medicine consists of collaborative research or teaching often involving the integration of concepts, techniques and personnel from many disciplines. We further suggested that these two types of medical sociology tend to be incompatible with each other; that the sociologist of medicine may lose objectivity if he identifies too closely with medical teaching or clinical research while the sociologist in medicine risks a good relationship if he tries to study his colleagues.

In many respects the foregoing summary of activities supports these categories. Studies of the profession and those dealing with the organization of health resources are primarily in the sociology of medicine. Teaching activities and research in which the sociologist is collaborating with the physician in studying a disease process or factors influencing the patient's response to illness are primarily

sociology in medicine. On the one hand the sociologist stands apart and studies medicine as an institution or behavior system; on the other hand he is collaborating with the medical specialist in trying to help him in the performance of his educational or therapeutic functions. The major exceptions to this dichotomy were a few sociologists working in the area of psychiatry, who are trying to engage in collaborative activities with psychiatrists at the same time that they are studying the way in which the psychiatrists function. These dual roles in themselves may offer an interesting experiment to students of human behavior.

Medical sociologists, as teachers, while varying greatly in the content and teaching methods they employ, do appear to hold a common objective. They are all trying to provide medical personnel with an understanding of some of the processes of behavior involved in human response to illness and thereby to facilitate a more effective and comprehensive approach to these problems.

In nearly every instance, the sociologist teaching in a medical school is engaged in group teaching with members of other disciplines. This type of teaching provides a significant challenge for both the individual and his profession. It provides a major test for the applicability of sociological content and concepts to the processes and problems of medicine and requires great flexibility and adaptability on the part of the sociologist.

In many respects the role of the medical sociologist may resemble the chameleon. Al- though, like the chameleon, he has a basic structure and a basic integrity that will not vary, his successful adaptation to his environment may depend on an ability to alter certain outward manifestations in accordance with his environment. In medicine, the sociologist encounters individuals who are sci- entists and scholars, others who are primarily practitioners, others whose major interest is education, and some who must be identified in several ways. He finds that he cannot relate to everyone in medicine on common ground. The medical scientist will usually respect and accept the terminology, the con- ceptual schemes and even the jargon of sociology. The practitioner, however, will often expect and demand that the sociologist re- cast his contributions in readily understand-

6 Robert Straus, "The Development of a Social Science Teaching and Research Program in a Medical Center," paper presented at the 1955 meetings of the American Sociological Society.




able terms. There is a danger in this, for if the sociologist begins to talk like a physician, he may eventually come to act like a physician and even to think like a physician. If he sacrifices his identity as a sociologist, he loses the unique contribution he can make to medicine. At the same time the sociologist who resolutely sticks to pure sociology in the face of demands for interpretation (and there is need for pure sociology in medicine at the right time and place) will be mis- understood, ignored or rejected. Often, to be

successful he must find ways of offering his content and theory so that they will be meaningful in the physician's frame of refer- ence.

Successful adaptation for the medical sociologist may require an ability to cast his contributions in accordance with the expec- tations and needs of the particular medical personnel with whom he is relating. If he becomes a good chameleon, he should be able to do so without sacrificing either his integrity or his professional identification.

MOBILITY ORIENTATION AND STRATIFICATION OF 1,000 NINTH GRADERS

RICHARD M. STEPHENSON

Rutgers University

IN the analysis of social mobility in an open class system, three analytically distinct and empirically discernible variants

should be noted. The first of these, mobility resources, refers to those qualities and conditions conducive to upward mobility that are either ascribed to or inherent in the individual, such as economic resources or basic capacities and abilities. The second, mobility skills, refers to learned patterns of behavior and acquired attitudes and values that are instrumental to mobility, such as the deferred gratification pattern, manners, and modes of communication. The third, mobility orientation, refers to aspiration levels within the stratification system that may serve as points of motivation in competition for position in the social structure.'

This paper is concerned primarily with the mobility orientation variable. There are two alternative interpretations of mobility orientation in American society. One assumes that mobility orientation roughly follows class lines, so that the middle and upper classes

are the strivers while the lower classes set a level of aspiration that is largely satisfied within the limits of their own stratum. This view implies that the very orientation of the lower strata prevents them from upward mobility, irrespective of the class distribution of mobility resources or skills. The other assumes that there is a somewhat similar mobility orientation throughout the stratification system, and that regardless of one's position in it, the orientation is toward com- monly perceived and desired goals. This hypothesis places the emphasis upon unequal distribution of resources and skills in ex- plaining class differences in upward mobility.2

A growing body of empirical data, ob- tained largely from attitude studies of adults, has been developed in support of the former hypothesis.3 Mobility aspirations have been

I These factors concern the individual psycho- logically primarily in terms of his socialization and his initial ascribed status. There are, of course, such larger, institutional conditions as class differences in birth rates and historical changes in the occupational structure, which also affect mobility chances. They represent an interesting example of social facts that may have no direct psychological impact upon the individual yet determine his mobility opportunity.

2 These two points of view have been expressed by Allison Davis and Robert K. Merton respec- tively. See Davis' discussion of middle-class "so- cialized anxiety" in "Socialization and Adolescent Personality," Adolescence, Forty-Third Yearbook of the National Society for the Study of Education, Part I, Chicago: Department of Education, Uni- versity of Chicago, 1944, and Merton's hypothesis regarding common "success goals" in "Social Struc- ture and Anomie," in Social Theory and Social Structure, Glencoe: The Free Press, 1949, pp. 125- 149.

3A convenient summary and analysis of class attitudes related to mobility orientation is presented by Herbert H. Hyman in "The Value Sys-



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The Nature and Status of Medical Sociology