a person’s class position influences the risk and outcome of multiple diseases in multiple ways, higher SES persons have the resources to better avoid health problems or minimize them when they occur, and the association has endured indefinitely. The reason that SES is related to multiple disease outcomes through multiple pathways that change over time is that individuals and groups use their resources to avoid risks and adopt protective strategies. Consequently, the theory’s basic principle is that a superior assortment of flexible resources permits higher SES persons to avoid disease and death in varying conditions. More recently, Phelan and Link (2015) have identified racism as another fundamental cause.
Critical Realism
Critical realism is a relatively new theoretical perspective that emerged in Britain and is based on the work of philosopher Roy Bhaskar (1994; 1998) and sociologist Margaret Archer (1995; 2000; 2003; Archer et al. 1998). Critical realist theory argues that social constructionism does not account for agency and provides an “oversocialized” view of individuals overemphasizing the effects of structure, while other theorists, like Bourdieu, opt for a “seamless” approach to agency and structure, but the operations of the two in reality are not synchronized. Consequently, critical realism treats agency and structure as fundamentally distinct but interdependent dimensions that need to be studied separately in order to understand their respective contributions to social practice. The “analytical decoupling of structure and agency” is necessary, states Williams (1999:809), “not in order to abandon their articulation, but, on the contrary, so as to examine their mutual interplay across time; something which can result both in stable reproduction or change through the emergence of new properties and powers.”
Critical realism takes the position that social systems are open to process and change and that people as agents and actors have the critical capacity, reflexivity, and creativity to shape structure, yet, in turn, are shaped by structure. But the key factor for the critical realist is the capacity of the individual to transform structure and produce variable outcomes (Archer 1995). Structure, for its part, is relatively enduring, although it can be modified, and deep structures have generative mechanisms going beyond the observable that influence behavior. A goal of critical realism is to connect agency and structure in a way that the distinctive properties of both can be realistically accounted for without being reduced to a single entity. Among the studies in medical sociology employing critical realism to date are examinations of the body from the standpoint of chronic illness and disability, which focus on the interrelationship of biological and social factors in shaping outcomes (Williams 1999), an attempt to develop a sociology of health inequalities which goes beyond orthodox social epidemiological studies (Scambler 2002; 2018) and a study of psychiatric categories (Pilgrim 2014). That critical realism in relation to health is an ongoing project is evidenced by a new “practical handbook” published in the UK for researchers in that domain of study (Alderson 2020).
CONCLUSION
The notion that medical sociology is atheoretical is wrong. This chapter has provided a brief account of the history and variety of viewpoints in sociological theory that have been utilized within the field and provided influential statements on the relationship between society and health. Beginning with Parsons, medical sociology in reality has a rich theoretical tradition spanning almost 70 years and incorporating the work of both classical and contemporary theorists. Debates in general sociology, such as those involving the opposition of symbolic interactionists and conflict theorists to structural-functionalism and the agency versus structure dispute, became points of theoretical contention in medical sociology as well. During the latter part of the twentieth century, structural theories like structural-functionalism were largely abandoned in favor of agency oriented theories like symbolic interaction, labeling theory, and the agency side of social constructionism. However, improved statistical techniques to measure the effects of structure – such as hierarchical linear modeling – forecast a paradigm shift back to greater considerations of structure and structural approaches to theory. Although it is too early to determine the ultimate direction of theory in medical sociology this century with exact precision, these improved statistical procedures should provide a more comprehensive approach to research with theory guiding and adjusting to this capability. Already the theoretical basis for work in the field is extensive and its potential explanatory power is likely to increase. Medical sociology has become a theoretical subdiscipline.
References
1 Abel, Thomas and William C. Cockerham. 1993. “Lifestyle or Lebensführung? Critical Remarks on the Mistranslation of Weber’s ‘Class, Status, Party’.” Sociological Quarterly 34(3): 551–6.
2 Abrams, Elissa M. and Stanley J. Szefler. 2020. “COVID-19 and the Impact of Social Determinants of Health.” Lancet May 18. https://doi.org/10.1016/s2213-2600(20)30234-4.
3 Alderson, Priscilla. 2020. Critical Realism for Health and Illness Research: A Practical Handbook. Bristol: Policy Press.
4 Annandale, Ellen. 2014. The Sociology of Health and Medicine: A Critical Introduction, 2nd edition. Cambridge: Polity Press.
5 Archer, Margaret, Roy Bhaskar, Andrew Collier, Tony Lawson, and Alan Norrie. 1998. Critical Realism: Essential Readings. London: Routledge.
6 Archer, Margaret S. 1995. Realist Social Theory: The Morphogenetic Approach. Cambridge: Cambridge University Press.
7 Archer, Margaret S. 2000. Being Human: The Problem of Agency. Cambridge: Cambridge University Press.
8 Archer, Margaret S. 2003. Structure, Agency, and the Internal Conversation. Cambridge: Cambridge University Press.
9 Becker, Howard S. 1973. Outsiders: Studies in the Sociology of Deviance, 2nd edition. New York: Free Press.
10 Becker, Howard S., Blanche Greer, Everett Hughes, and Anselm Strauss. 1961. Boys in White: Student Culture in Medical School. Chicago, IL: University of Chicago Press.
11 Berger, Peter L. and Thomas Luckmann. 1967. The Social Construction of Reality. New York: Anchor.
12 Bhaskar, Roy. 1994. Plato Etc.: The Problems of Philosophy and Their Resolution. London: Verso.
13 Bhaskar, Roy. 1998. The Possibility of Naturalism: A Philosophical Critique of the Contemporary Human Sciences. London: Routledge.
14 Blumer, Herbert. 1969. Symbolic Interactionism. Englewood Cliffs, NJ: Prentice-Hall.
15 Bourdieu, Pierre. 1984. Distinction: A Social Critique of the Judgement of Taste. London: Routledge.
16 Bourdieu, Pierre. 1990. The Logic of Practice. Cambridge: Polity Press.
17 Clarke, Adele, Laura Mamo, Jennifer Ruth Fosket, Jennifer R. Fishman, and Janet K. Shim (eds.). 2010. Biomedicalization: Technoscience, Health and Illness in the U.S. Durham, NC: Duke University Press.
18 Clarke, Adele E., Carrie Friese, and Rachel Washburn. 2018. Situational Analysis, 2nd edition. Thousand Oaks, CA: Sage.
19 Claus, Elizabeth. 1982. The Growth of a Sociological Discipline: On the Development of Medical Sociology in Europe, Vol. I. Leuven, Belgium: Sociological Research Institute, Katholieke Universiteit Leuven.
20 Cockerham, William C. 1983. “The State of Medical Sociology in the United States, Great Britain, West Germany, and Austria.” Social Science & Medicine 17: 1513–27.
21 Cockerham,
