matter, the broadening of theoretical influences, and the resultant complexity. Our primary aim here is to stimulate a forward-looking conversation among medical sociologists by reviewing previous conceptualizations and proposing a new model to serve as a basis for discussion. Our model classifies medical sociology in terms of its major subfields as defined by substantive topics, theoretical orientations, and scientific contributions. We review the unique contributions of each subfield while recognizing an underlying unity driven by common training in sociological theory and methods. We end with several recommendations for a more refined and directed conceptualization of the field.
There are several reasons why we should be having these discussions. When we define our major subfields and contributions to the study of health, we (1) claim our independence from other health sciences (e.g. medicine), (2) maintain our status in the marketplace of health research (e.g. as health psychologists and public health researchers publish more and more on socioeconomic inequalities), and (3) develop as a cumulative science through a formal recognition of the expansion of our field’s purview. Before Straus (1957), for example, some questioned whether sociology should be considered a “third branch to medicine” (Boulton 2017: 242). When we stop reflecting and leave our subfields undefined, we lose track of our major contributions across generations of medical sociologists and in the broader interdisciplinary field of health research, leaving scholars from other health sciences (e.g. public health) unable to identify them. We also create intellectual vacuums for less fruitful discussions. For example, when we stopped discussing subfields in the late 1980s, we began the great “moniker debate” over whether to continue using the term “medical sociology” or to rename ourselves something else to be more inclusive of work related more to health than medicine. Instead of taking up that debate, we intend to redirect the conversation to how best to represent our disciplinary structure. Ultimately, we believe that focusing more on our major subfields and contributions to sociology and the broader study of health will support more productive and substantive conversations about what medical sociology has to offer.
PREVIOUS SUBFIELD MODELS
The establishment of subfields within medical sociology was a major advance in its early development. In the 1950s, Straus (1957) proposed a two-subfield structure that included the sociology of medicine and sociology in medicine. These subfields were important because they (1) organized studies depending on the extent to which they served the interests of sociology vs. medicine and (2) sought to highlight the unique contributions of sociology to the study of health, illness, and medical practice. In the 1980s, Petersdorf and Feinstein (1980) suggested a more elaborate six-subfield model that was still based on sociology’s stance vis-à-vis professional medicine, including sociology in medicine, sociology of medicine, sociology for medicine, sociology from medicine, sociology at medicine, and sociology around medicine. Still others advocated for a sociology with medicine (Bury 1986; Horobin 1985; Levine 1987). Although elaborations on Straus’ original model never really took hold (Cockerham 1983; Hollingshead 1973; Ruderman 1981; Straus 1999; Wardwell 1982), we argue that, after decades of scholarship, the two-subfield model no longer adequately represents our contemporary disciplinary structure or our contributions to the study of health. For example, many medical sociologists no longer define themselves primarily in relation to medicine (whether critical of, or allied with it), and areas of inquiry that have distinct sociological identities have become more prominent (e.g. social epidemiology). For these reasons, we take Straus’ (1957) original concerns with disciplinary structure in a new direction by defining subfields that are distinguished by substantive topics, theoretical orientations, and contributions to the interdisciplinary study of health.
Handbooks and textbooks typically divide the field substantively. For example, the third edition of the Handbook of Medical Sociology (Freeman, Levine, and Reeder 1979) was organized into five parts: “Health and Illness,” “Health Care Providers,” “Individual and Organizational Behavior,” “Health Policy Dimensions,” and “Methods and Status in Medical Sociology.” The most recent sixth edition of the Handbook of Medical Sociology (Bird et al. 2010) adopted a different set of three organizational categories: “Social Contexts and Health Disparities,” “Health Trajectories and Experiences,” and “Health-Care Organization, Delivery, and Impact.” The Handbook of Health, Illness, and Healing (Pescosolido et al. 2011) offered yet another distinct seven-part scheme: “Rethinking Connecting Sociology’s Role in Health, Illness, and Healing,” “Connecting Communities,” “Connecting to Medicine: The Profession and Its Organizations,” “Connecting to the People: The Public as Patient and Powerful Force,” “Connecting Personal & Cultural Systems,” “Connecting to Dynamics: The Health and Illness Career,” and “Connecting to the Individual and the Body.”
When we turn to important textbooks, we find four major sections in Cockerham (2017) (Health and Illness, Seeking Health Care, Providing Health Care, and Health Care Delivery Systems) and four major sections in Weitz (2017) (Social Factors and Illness, The Meaning and Experience of Illness, Health Care Systems, Settings, and Technologies, and Health Care, Health Research, and Bioethics). In Weiss and Lonnquist (2016), we see a more complex structure with no major sections or organizational schemes. Although these formats are effective for textbook presentations of the literature, they are more a collection of topics than major subfields that might organize the field.
One of the challenges we face is defining our field’s substantive scope and its most significant contributions to knowledge in a way that is contemporary, comprehensive, and efficient. Although Straus’ (1957) original model was efficient, it no longer adequately represents the field. The organizational schemes of books are more contemporary, but their structures are inefficient in the sense that the categories are numerous and inconsistent across volumes. The compromise we propose is a modest elaboration on Straus (1957) that reflects contemporary developments in the field.
A NEW FOUR SUBFIELD MODEL
Building on previous conceptualizations, Figure 1.1 identifies and describes four major subfields of medical sociology: (1) Social Epidemiology, (2) Social Psychology of Health and Illness, (3) Sociology of Medicine, and (4) Sociology in Medicine. These subfields are intended to represent the field according to substance, theory, and contributions to knowledge.
Figure 1.1 Major Subfields of Medical Sociology.
According to the ASA Committee on Certification in Medical Sociology (1986), our subject matter includes “descriptions and explanations or theories relating to the distribution of diseases among various population groups; the behaviors or actions taken by individuals to maintain, enhance, or restore health or cope with illness, disease, or disability; people’s attitudes, and beliefs about health, disease, disability and medical care providers and organizations; medical occupations or professions and the organization, financing, and delivery of medical care services; medicine as a social institution and its relationship to other social institutions; cultural values and societal responses with respect to health, illness, and disability; and the role of social factors in the etiology of disease, especially functional and emotion-related.”
Our proposed subfields are intended to capture this broad range of topics, but not to be mutually exclusive or exhaustive. We fully acknowledge that some researchers may identify with more than one subfield. We believe that the diversity of research conducted in our field has and will continue to challenge the representativeness of our proposed disciplinary structure. With this in mind, our aim is not to find a perfect representation of the field or to dismiss other organizational schemes. Instead, our aim is to create a representative structure so that we can see the scope of our field more clearly. What does sociology contribute to the study of health and medicine? We argue that our subfield model answers this question
