Medical Sociology: A Brief Review

AUGUST B. HOLLINGSHEAD

A brief history of the development of medical sociology is presented here.

In the first three decades of the twentieth century medical sociology was
identified first with the field of social work and later with the field of public
health. Not until the 1930s and the 1940s did the interrelations between
society and the health sciences become of interest to sociologists.
After the close of World War II, the expansion of the National In­
stitutes of Health and the interest of private foundations in interdisciplinary
research stimulated and supported the growth of medical sociology as an
area of research and teaching. During the 1950s, the field developed in two
directions: sociology of medicine, centered in departments of sociology in
universities, and sociology in medicine, concentrated in schools of medicine
and health care facilities.
As training programs proliferated through the 1960s, the market for
books on the subject grew quickly. Five textbooks on medical sociology are
reviewed, and some suggestions are made about issues in need of study for
the future development of the field.

Medical sociology involves the convergence of two academic

disciplines with basically different histories. Medicine has been
concerned with the treatment of disease from time immemorial, but
sociology is a product of nineteenth-century thought. The term
sociology was not coined until 1839 when Auguste Comte joined
the Latin socius with the Greek logus, and sociology emerged as
the study of society. A decade later, in 1849, Rudolf Virchow
identified medicine as a social science (Virchow, 1851). Thirty
years later, John Shaw Billings (Buck, 1897:5-6) linked public
health to sociology. As early as 1894, Charles Mclntire (1894:
425-426) described medical sociology as

the science o f the social p h en om en a o f the ph ysician s th em selves

as a class apart and separate; and th e scien ce w h ich in vestigates
the law s regulating th e relations b etw een the m ed ical p ro fessio n
and hum an so ciety as a w h ole; treating o f th e structure o f both,
how the present con d ition s cam e about, w h at progress civ iliza tio n
has effected, and in d eed everything relating to this subject.

However, no systematic follow-up was made to these suggestions

by either Mclntire or by his readers.
In the early years of the twentieth century, medical sociology
M M F Q / Health and Society / F a ll 1 9 7 3 531
532 F a ll 1 9 7 3 / Health and Society / M M F Q

became identified with social work and public health. In 1902,

Elizabeth Blackwell used the term medical sociology as a title for
a collection of her essays on social work and public health. Eight
years later, James P. Warbasse published his book Medical Sociol­
ogy, which advocated health education (Rosen, 1972). In 1910,
the American Public Health Association organized a section on
sociology, with social workers and some physicians as members,
but few sociologists identified with this organization. The section
limped along until 1921, when it was abandoned.
In the 1930s and the early 1940s, a few sociologists, notably
Michael M. Davis and Bernard J. Stern, were concerned with
health, disease, physicians, and other medical topics. Programs of
the New Deal to alleviate the problems of poverty and ill health
centered attention on social welfare. World War II interrupted
many of these programs, but it created new challenges that brought
together scientists, engineers, medical practitioners, and men of
affairs. When the war was over, the lessons of interdisciplinary
cooperation learned during the years of crisis were not forgotten.
During the early postwar years, private foundations stimu­
lated interdisciplinary activities: The Milbank Memorial Fund or­
ganized its annual conference in 1947 around social medicine; the
annual conference in 1949 was focused on mental health. In 1949,
the Russell Sage Foundation began its program for the utilization
of the social sciences in professional practice. The cross-fertilization
of ideas, combined with research support, stimulated interdiscipli­
nary efforts to deal with social and medical issues of interest to
social scientists and physicians.
The strengthening of the National Institutes of Health in the
late 1940s, particularly the establishment of the National Institute
of Mental Health, brought together researchers in the basic bio­
logical and social sciences and provided an opportunity for persons
from the different academic disciplines to work together on the
review of grant applications for the support of research by the
federal government. From the very beginning, NIMH study sec­
tions included in their membership social scientists, specifically
sociologists. (The present writer was one of these early sociologists
to serve on an NIMH study section.) Colleagues on study sections
began to communicate with one another; they became aware of
the strong and weak points of one another’s disciplines; they
learned the limits of their own competence; and they came to
M M F Q / Health and Society / F a ll 1 9 7 3 533

respect one another. The interaction of professional persons with

different ideas, interests, and training, combined with the avail­
ability of funds to support research, stimulated the convergence
of medical and social scientists into the planning and execution
of research projects. Thus, the development of medical sociology is
related closely to the expansion of the National Institutes of Health.
During the 1950s, collaboration between physicians and so­
ciologists was carried forward on two points: research and teach­
ing. Both teaching and research began to be pursued in schools
of medicine and schools of public health. A parallel development
was the organization of training programs in departments of soci­
ology. The combination of a research literature, trained manpower,
and positions for sociologists in the health field, as well as in colleges
and universities, laid a foundation for medical sociology as a sub­
stantive area of teaching, research, and service (see Hawkins,
1958). By the end of the 1950s, the mutual efforts of physicians,
medical scientists, and sociologists had built a bridge between the
health sciences and services and sociology. The foundations of the
bridge are bedded, on the one side, in health services (medicine,
epidemiology, life sciences) and, on the other side, in behavioral
sciences (anthropology, psychology, sociology).
In the middle 1950s, Robert Strauss (1957) suggested that
the emerging field of medical sociology might logically be divided
into two parts: the sociology of medicine and sociology in medi­
cine. This suggestion proved to be a watershed in the subsequent
development of the field. Sociology in medicine has tended to be
concentrated in schools of medicine, schools of public health,
hospitals, and health departments. Sociology of medicine is cen­
tered in departments of sociology in colleges and universities. As
time has passed, both sociology in medicine and sociology of
medicine have focused their attention on the dimension of the
field that is of interest at that moment.
The first graduate program leading to the Ph.D. in medical
sociology was initiated by Yale University in 1954, with the first
students entering training in July 1955. The field grew rapidly.
By the fall of 1965, there were fifteen special graduate programs
in medical sociology leading to the Ph.D. degree in departments
of sociology in universities in the United States; in 1972, there
were thirty-nine in the United States and Canada. In addition, in
1965, forty-three graduate departments in the United States offered
534 F a ll 1 9 7 3 / Health and Society / M M F Q

courses in medical sociology; in 1972, forty-seven American and

five Canadian universities offered graduate courses in medical so­
ciology (see American Sociological Association, 1965; 1972-73).
In 1955, only two sociologists held teaching appointments in
schools of medicine and only two in schools of public health. A
decade later, in 1965, fifty-seven sociologists held teaching ap­
pointments in schools of medicine and twenty-four held appoint­
ments in schools of public health (New and May, 1968). Figures
are not at hand as to the number of sociologists holding appoint­
ments in schools of medicine and/or public health at the present
time. To the best of our knowledge, there are one or more soci­
ologists who have teaching appointments on the faculties of all
schools of public health today, but not in all schools of medicine.
The American Sociological Association organized the Section
on Medical Sociology in 1960. Within two years it became the
largest section with a substantive interest in the association. This
section has continued to attract the largest numbers of participants
of any section within the association. The position of medical
sociology was strengthened in 1966, when the Journal of Health
and Social Behavior became an official publication of the American
Sociological Association.
Today, interrelations between society and the health sciences
are officially recognized. Research in the social and cultural aspects
of health care has tripled since 1960, and medical sociology has
been called a “new basic science” in medicine (White, 1973:25).
In Great Britain, the inclusion of social science in basic medical
education was sanctioned by the Royal Commission on Medical
Education in 1968; in the United States, scores on behavioral
science questions in Part I of the national board examinations were
computed by the National Board of Medical Examiners (The
National Board Examiner, 1971:1, 4; 1972:1) for the first time
in 1973.
The market for textbooks, handbooks, and readers, created
in the 1950s by developments mentioned above, has grown in the
last decade, and numerous volumes, prepared as textbooks or source-
books, have been published in recent years. The literature on
medical sociology (or behavioral science) has developed, in large
part, since the early 1950s. It is not our purpose here to present
a bibliography. Citations of hundreds of publications are given
in the five books I have selected for comment here: (1) David
M M F Q / Health and Society / F a ll 1 9 7 3 535

Mechanic, M e d ic a l S o c io lo g y : A S e le c tiv e V ie w ; (2) Rodney M.

Coe, S o c io lo g y o f M e d ic in e ; (3 ) Howard S. Freeman, Sol Levine,
and Leo G. Reeder (eds.), H a n d b o o k o f M e d ic a l S o c io lo g y (2nd
ed.); (4) E. Gartley Jaco (ed.), P a tie n ts, P h y sicia n s, a n d Illn ess
(2nd ed.); and (5) Mervyn W. Susser and W. Watson, S o c io lo g y
in M ed icin e (2nd ed.).

M e d ic a l S o c io lo g y : A S e le c tiv e V ie w

Mechanic (1968) has developed a perspective of medical soci­

ology that may serve as an introductory guide to teaching in this
field. The perspective is based on the assumption that health and
illness are to be understood in the larger context of striving by
individuals to adapt to life situations. That is, individuals in given
environments— those who are sick as well as those who deal with
sick persons, whether in caring for them or in carrying out re­
search on them— struggle to solve the problems they face within
the context of their own needs. Thus, sickness and coping with
sickness are essentially efforts to control the environment. This is
the “stuff of human behavior” (Mechanic, 1968:2). Within this
frame of reference, Mechanic develops the theme that an under­
standing of health and disease must be sought within the complex
social and cultural pressures that enmesh persons in particular
life situations. Hence, a knowledge of the coping process needs to
be taken into account in dealing with sick people, in training
health workers, and in planning services to prevent, control, or
cure disease. Mechanic believes medical sociology cuts across the
prevention of disease, the cure of disease, the training of health
personnel, and the organizations society develops to cope with
the illness. The text is divided into three parts: Part I (five chap­
ters) is an explication of Mechanic’s perspective on medical
sociology; Part II (three chapters) examines methodological ap­
proaches to studying disease processes, demographic factors which
influence morbidity and mortality, and the interplay between en­
vironmental stresses and disease; Part III (two chapters) is con­
cerned with medical organization, primarily in the United States,
and the environmental factors in hospitals that affect the course
of illness and patient care.
There are two appendices to the volume. The first is focused
536 F a ll 1 9 7 3 / Health and Society / M M F Q

on the ways hospital workers function to control their work and

minimize uncertainty. The second explores the possibilities of using
a coping approach to rehabilitate the mentally ill. A bibliography
of 468 items is included.
This volume was designed as a text for beginning students.
It is well written with clear transition from idea to idea. Many
complex questions are too simplified to cover all dimensions of
the problems at issue, but Mechanic deliberately chose and de­
veloped a selective view for this introduction to medical sociology.

S o c io lo g y o f M e d ic in e

This book is designed to provide to the beginning student “a so­

ciological perspective and interpretation for the many facets of
medicine and medical behavior” (Coe, 1970 :vii). The focus is
on interactions between the patient and the physician in an orga­
nizational context: the physician’s office, the hospital, the medical
school, and the community. The text is divided into four parts:
Part I deals with disease and the sick person; Part II surveys
health practices and practitioners; Part III examines health insti­
tutions, primarily the hospital; Part IV focuses on cost and organi­
zation of health services.
The viewpoint presented is that the field of medical sociology
is concerned with the study of how disease affects human groups,
the ways human groups react to disease, the institutions a partic­
ular culture develops to deal with disease, and the interrelations
between institutions that provide medical care and the institutions
in the society that support health care. In contemporary American
society this viewpoint brings into the purview of medical sociology:
the distribution of diseases in the population, their etiology, pre­
vention, treatment, and control; the specific occupations concerned
with the care of the sick—the medical, nursing, and paramedical
professions; institutions especially devoted to the care of sick per­
sons—hospitals, clinics, and supporting health services of all kinds;
educational institutions to train health personnel— schools of medi­
cine, nursing, and public health; pharmacies and pharmaceutical
companies; voluntary associations developed around specific dis­
eases; research organizations built around the search for causes,
treatment, and cure of diseases; institutions developed to spread
M M F Q / Health and Society / F a ll 1 9 7 3 537

the costs of treatment, such as Blue Cross; and the impact of sick­
ness on the patient and the family.
Coe explicitly states that his book is focused on an examina­
tion of medicine as a system of behavior. This is a good introduc­
tory text. It includes several topics, such as folk medicine and the
role of organized medicine in public health, which are ignored or
inadequately treated in the other volumes under review. Coe’s
textbook is more inclusive and contains more details than Mechan­
ic’s. In my experience, students prefer Coe’s book to Mechanic’s.

H a n d b o o k o f M e d ic a l S o c io lo g y

The second edition of this handbook (Freeman et al., 1972) was

organized and edited by the same men who were responsible for
the first edition, published in 1963. The introduction to the first
edition by Hugh R. Leavell is reprinted here; in addition, there
is an introduction to the second edition by John H. Knowles.
There is a bibliography on social research in health and medicine,
and the ideas and data in each essay are supported by extensive
references.
Each essay is a self-contained unit. There is very little over­
lap between the specific chapters in each of the four parts of the
book: Part I, The Sociology of Illness (five essays); Part II,
Practitioners, Patients, and Medical Settings (six essays); Part
III, Sociology of Medical Care (five essays); and Part IV, Strategy,
Method, and Status of Medical Sociology (three essays).
The authors are recognized in their fields (thirty-one are
sociologists; five are physicians), and each has brought to bear
in the essay prepared for this volume materials to support his
contribution to particular facets of the general question of inter­
relations between society and health. The essays, for the most
part, are well written and each brings specific issues into focus.
The essay by the editors on the present status of medical sociology
should be of considerable interest to professionals engaged in the
care of the sick. The other essays are more focused and may be
studied for the light they throw upon that segment of the field
under review.
An essay on the evolution of social medicine by George
Rosen (physician and medical historian) th o r o u g h ly reviews the
538 F a ll 1 9 7 3 / Health and Society / M M F Q

high points of the interrelations between social factors and medi­

cine through the years and suggests: “Perhaps, one should en­
deavor to introduce a new designation: the sociology of health”
(Freeman et al., 1972:52). In addition, Patricia L. Kendall (soci­
ologist) and George G. Reader (physician) have supplied a
summary/evaluation of the contributions of sociology to medicine
and a comprehensive overview of sociology in medicine.
This is a reference book rather than a textbook. It is a volume
that should be consulted often by physicians and behavioral
scientists.

P a tie n ts , P h y s ic ia n s , a n d I lln e s s

This is a book of readings (Jaco, 1972). The individual contribu­

tions were prepared originally for publication in a professional
journal or as a part of a larger research report, rather than as a
chapter for a book. Consequently, each selection is focused on a
particular problem, and each paper is loaded with footnotes. The
reprints are organized into three parts: Part I, Society and Disease
(seven articles); Part II, Societal Coping with Illness and Injury
(thirteen articles); and Part III, Society and Health Care Adminis­
tration (ten articles).
Although this anthology is published as a second edition, it
is composed of essentially new materials. The two pieces retained
from the 1958 edition are by Talcott Parsons and Albert F. Wes-
sen. Forty authors are represented: thirty-nine behavioral scien­
tists (primarily sociologists) and one physician. Jaco has prepared
a brief introduction to each part of the book, but no effort is made
to connect the thought structure of one article with that of another,
and no summary or conclusion is included; the reprints just stop.
The primary value of this book is the inclusion of a series
of interesting papers from disparate sources in a single volume.
The subtitle, A Sourcebook in Behavioral Science and Health, is
expressive of its potential use.

S o c i o l o g y in M e d i c i n e

The first edition of this textbook (Susser and Watson, 1971) was
published in 1962. The authors, a physician and a sociologist,
M M F Q / Health and Society / F a ll 1 9 7 3 539

draw upon their experiences in Africa, Britain, and the United

States to illuminate the text. They skillfully interweave medical
concepts— disease, illness, sickness, treatment, etiology, prevention,
and so on— with sociological concepts— culture, society, economy,
social structure, social class, status and role, social organization,
social mobility, social change, social system, patterns of behavior,
associations, institutions, bureaucracy, personality, the family cy­
cle, the life arc, and social networks— and sociobiographical factors
—race, sex, age, and constitution of the individual— into a very
meaningful presentation of a complex body of data that clarify
their subject matter, namely, sociology in medicine. The central
thrust of the text is to the culture of the society in which the ill
person lives.
The second edition has an up-to-date and extensive bibliog­
raphy at the end of each of the eleven chapters. It includes twenty-
two well-constructed statistical tables and forty-five figures, mainly
line graphs and histograms. Stated simply, this is a carefully
organized, smoothly written, well-documented, and well-illustrated
application of sociological concepts to the field of medicine.
This text is likely to prove more useful to students in schools
of medicine and public health than to graduate students in soci­
ology. However, it should be of some value to the latter because
it develops a perspective that is missing in the other books re­
viewed here.

The incorporation of three of the five books, reviewed briefly above,

into a single source would provide the student in a graduate de­
partment of sociology or in a school of medicine or public health
with divergent approaches to the field of medical sociology or act
as a reservoir of detail upon which he could draw in the develop­
ment of an understanding of interrelations among health, disease,
medicine, and society. The present writer has had twenty years
of experience teaching medical sociology to graduate students in
sociology and public health and to physicians and nurses. My
personal preference would be to use Coe, Freeman et al., and
Susser and Watson. Another sociologist might prefer a differ­
ent combination.
The five books reviewed here present, in summary form, the
contributions made by medical sociology up to the late 1960s to
our understanding of health and disease in Western urbanized
societies. They also indicate the role played by medical sociolo­
540 F a ll 1 9 7 3 / Health and Society / M M F Q

gists in the development of sociology, particularly since 1950.

However, none of these books looks to the future. None of them
asks the question: What remains to be done in future years to
further the development of sociology in medicine and sociology
of medicine?
I cannot offer a definitive answer to this question or satis­
factory solutions to the problems it raises. For this, prolonged
systematic thought and research are needed. However, I believe
there are several issues that should be addressed before the future
development of medical sociology can be demarcated to the satis­
faction of medical scientists and sociologists. First, there are
boundary problems to be worked out between sociology and health
professions, organizations, and institutions. The key issue here is
a definition of the role and status of the sociologist: What does
the sociologist do? Will he be able to go, in Erving Goffman’s
terms, “back stage” (Goffman, 1956:152) and seriously examine
health care and report his findings without being accused of dis­
turbing the “doctor-patient relationship”?
Another area of concern is the impact of illness on the patient
as well as on the nuclear and extended family. A neglected subject
in the books under review is the role and function of the para­
medical occupations in the care of the chronically ill, the disabled,
and the aged. Research might be undertaken to study the role of
new paramedical professions such as doctor’s assistant and nurse
practitioner. Systematic research is needed on the division of
health care between the public and private sectors of our society
and on the interrelations between health care and the medical-
industrial complex— entrepreneurial medicine, the pharmaceutical
industry, government, and the public. The evaluation of health
care by a process more objective than the current peer review is
indicated, but, while the voice of the consumer is being raised
about the cost and quality of health care, sociologists have given
little attention to the murmuring of the populace.
Medical sociology is in sore need of research on different
approaches to health care prevalent in different cultures and so­
cieties. Before the universality of propositions enunciated as theory
can be accepted without qualification, cross-societal studies of
health care are indicated. The concepts that have been developed
primarily in Western society, e.g., the concept of the sick role
M M F Q / Health and Society / F a ll 1 9 7 3 541

as fo r m u la te d b y T a lc o tt P a r so n s, n e e d to be te ste d in non-
W estern u n d e r d e v e lo p e d so c ie tie s .
In fu tu re y e a r s, m e d ic a l s o c io lo g y w ill p r o b a b ly find th e
answ ers to th e se q u e stio n s a n d w ill r a ise m a n y n e w q u e stio n s.
W e e x p e c t th a t th e g r o w th o f th e fie ld w ill c o n tin u e a n d , as it
adapts to th e issu e s an d c h a lle n g e s o f th e tim e s, it w ill m e e t th e
needs o f so c ie ty .

A u gu st B . H o llin g s h e a d
W illiam G rah am S u m n er P r o fe sso r
Y ale U n iv e r sity , 1 9 6 5 Y a le S ta tio n
N ew H a v en , C o n n e c tic u t 0 6 5 2 0

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Jaco, E. G artley
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ALTENSTETTER, CHRISTA Planning for health facilities in

the United States and in West Germany Winter ......................... 41
ANDERSEN, RONALD and JOHN F. NEWMAN Societal
and individual determinants of medical care utilization in
the United States Winter ................................................................... 95
BATTISTELLA, ROGER M. and THEODORE E. CHESTER
Reorganization of the National Health Service: Background
and issues in England’s quest for a comprehensive-integrated
planning and delivery system Fall ................................................... 489
BLUMSTEIN, JAMES F. and MICHAEL ZUBKOFF
Perspectives on government policy in the health sector
Sum m er........................................................................................................ 395
BRESLOW, LESTER New resources and new alliances for
schools of public health (Symposium: The impact of the
New Federalism on schools of public health) Fall ..................... 455
BRYANT, JOHN H. Introduction .......................................................... 437
Summary and Comment (Symposium:
The impact of the New Federalism on schools of
public health) F a ll................................................................................ 469
COHEN, HARRIS S. Professional licensure, organizational
behavior and the public interest Winter ............................................ 73
DERBYSHIRE, R. C. Comments (see COHEN, HARRIS S.,
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FALK, I. S. Medical care in the U.S.A.: 1932-1972. Problems,
proposals and programs from the Committee on the Costs
of Medical Care to the Committee for National Health
Insurance Winter .................................................................................. 1
FREIDSON, ELIOT Prepaid group practice and the new
“demanding patient” Fall .................................................................. 473
GORDON, JEOFFRY B. Comments (see FALK, I.S., Winter)
HABER, LAWRENCE D. Some parameters for social policy
in disability: A cross-national comparison Summer ................... 319
HAVIGHURST, CLARK C. and LAURENCE R. TANCREDI
“Medical adversity insurance”—A no-fault approach to
medical malpractice and quality assurance Spring ....................... 125
HOLLINGSHEAD, AUGUST B. Medical sociology: A brief
review Fall .................................................................................... 531
NAVARRO, VICENTE National health insurance and the
strategy for change S p rin g ................................................................. 223
REINHARDT, UWE E. Proposed changes in the organization
of health-care delivery: An overview and critique Spring .......... 169
ROEMER, MILTON I. and WILLIAM SHONICK HMO
performance: The recent evidence Summer .................................. 271

M M F Q / H ealth and S ociety / F a ll 1 9 7 3 543

544 F a ll 1 9 7 3 / Health and Society / M M F Q
SHEPS, CECIL G. Schools of public health in transition
(Symposium: The impact of the New Federalism on schools
of public health) Fall .......................................................................... 462
STALLONES, REUEL A. Missions of schools of public health
(Symposium: The impact of the New Federalism on schools
of public health) Fall .......................................................................... 447
STUART, BRUCE and RONALD STOCKTON Control over
the utilization of medical services Summer ................................. 341
VUORI, H AN N U Teaching of community medicine in the
United States: An outsider’s view Spring ..................................... 253
WEGMAN, MYRON E. Impact of the New Federalism on
resources of schools of public health (Symposium: The
impact of the New Federalism on schools of public
health) Fall ........................................................................................... 440