Page 155 - The ISA Handbook in Contemporary Sociology

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126 THE ISA HANDBOOK IN CONTEMPORARY SOCIOLOGY

Both Durkheim and Engels marked out a of deviance, and used medicine as a case
new perspective for looking at health: the study in what we might now call ‘soft polic-
social-causation perspective. This perspective ing’. The sick role offered a space to people
suggests that health is a value that is related whose deviance was unintended, but the
to social factors and unevenly distributed in impersonal physician served as a gatekeeper
society. The themes of cooperation and con- to prevent its various exemptions and claims
flict appear in the work of both authors, on others from being abused, and thereby
although their focus was on the broader disrupting the smooth running of society.
workings of society rather than on the phe- While this was often read in the 1950s and
nomena of health and illness per se. Harriet 1960s as an expression of cooperation and
Martineau, who was a contemporary of consensus as the values underlying the social
Engels, found a more central place for health institution of medicine, we might now prefer
in her sociology. A medical sociologist to see it as a joint process of managing a dis-
before the term was coined, Martineau not ruption of the social order.
only shared Engels’ and concerns with the
relationship between work and health and
what the status of a community could tell us The interactionist and social
about its morals (or social convictions of constructionist perspective
right and wrong) (Martineau, 1838, 1861),
but extended her interest to encompass Parsons may have pioneered the field, but
the experience of illness and a critical analy- there were competing perspectives presented
sis of the relationship between the medi- by the disciples of the Chicago School of soci-
cal profession and the laity (Martineau, ology from the start. This perspective has con-
1844/2003). tinued as the interactionist and social
When modern sociology emerged, health constructionist tradition in the field of medical
was included in some of the early classics. and health sociology. In the American context,
For example, Robert and Helen Lynd (1937) Everett Hughes (1958) and his students,
discuss public health and the politics of med- notably Howard Becker (Becker et al., 1961),
ical provision in the second of their famous introduced the themes of competition and
Middletown studies, but this work did not negotiation in the description and analysis of
generate a legacy of further research. Credit the socialization of the medical student, the
is, then, usually given to Talcott Parsons as work of the physician, and work with clients.
the first major sociologist to devote sustained This was taken up in the influential work of
attention to medicine as a social institution Anselm Strauss and colleagues, who empha-
that, like religion and work, regulates certain sized the ‘negotiated order’ of the hospital and
kinds of behaviour in modern society. medical work (e.g., Strauss et al., 1963).
Medical sociologists often depict Parsons as Working within the same broad tradition,
a conservative figure, because of their lack of Erving Goffman (1959) and Eliot Freidson
attention to the more recent scholarship on (1970) also elaborated the Parsonian view of the
his life and work (e.g., Camic, 1991; sick role and of the role and power of the physi-
Gerhardt, 2002). However, his experiences of cian. It is important not to overstate the opposi-
the 1930s depression in the US, and his first- tion between interactionist and Parsonian
hand observation of the rise of Nazism in approaches: both Goffman and Freidson
Germany, gave him a powerful sense of the reworked Parsons’s penetrating insights into the
fragility of social order. The Social System issues raised by sickness for sustaining the eco-
(Parsons, 1951) was his attempt to explain nomic, political, and moral order of societies
how societies could sustain a sufficient into different theoretical contexts. But both
degree of order to survive through time. He acknowledged its fundamental relevance to the
had a particular interest in the management programme of medical sociology.