SOCIOLOGY OF HEALTH AND ILLNESS

Grinnell College

Susan J. Ferguson

Sociology 265.01

Office:  Carnegie 112

Fall 2004

Office Phone:  ext. 3133

Time:  12:45-2:05 p.m. T/Th

Office Hours:  2:30 p.m. T/Th
and by appointment

COURSE DESCRIPTION:

This course examines the social contexts of health, illness, and medical care.  It gives prominence to the debates and contrasting perspectives which characterize the field of medical sociology.  Topics include the social, environmental, and occupational factors in health and illness; the politics surrounding breast cancer and the AIDS epidemic; the patient's perspective on illness; the development of the health professions and the health work force; ethical issues in medicine as they relate to medical technology; and health care reform.  In exploring these topics, emphasis is given to how the social categories of gender, race, social class, and sexual preference affect both illness and health care.

COURSE OBJECTIVES:

  1. To investigate the social contexts of illness and medical care.
  2. To investigate the patient's perspective on the experience of illness and how patients respond to the care of physicians.
  3. To investigate the social-historical development of the medical system in the United States, including the changing role of physicians and other health care providers.
  4. To investigate the historical role of women in the medical system as patients, practitioners, and health care providers.
  5. To investigate current ethical issues and debates about new medical technologies and their impact on doctor-patient relationships and on access to health care.
  6. To investigate current problems in the organization of U.S. medical care as well as alternatives for change.

COURSE REQUIREMENTS:

A.  Exams:  There will be two take-home exams (a mid-semester exam and a final exam) that will cover prior lecture and reading material.  Any additional material provided by assignments, guest speakers, or videos also will be covered on the exams.  The final exam is not comprehensive.  Both exams are already scheduled in the course syllabus and students are expected to take the exams during the time period that is listed.  There will be no makeup exams unless you have spoken with me prior to the exam and have a valid excuse.  Each exam will count 25% of your final grade.

B.  Assignments:  In addition to the two exams, there will be two required outside assignments.  The purpose of these assignments is to determine how well you can make an argument utilizing material learned in class.  The two assignments are outlined as follows:

  1. A 3-4 page position paper on the issue of individual responsibility in health care that you will be assigned to investigate and discuss in a debate format in class.
  2. A second 3-4 page position paper on an ethical debate related to medical technology that you will be assigned to investigate and present your opinion on in class.

The two position papers are relatively short in length, and instructions will be given at least a week prior to when they are due.  All assignments should be typed and reflect thoughtful writing skills.  Late assignments, if accepted, will be graded down.  Each position paper is worth 10% of your final grade.

C.  Class Presentation:  Teams of two students will lead a course discussion and present material on a course-related topic.  In addition to summarizing that day's readings, each group will present additional information, including a bibliography of books and articles on that topic to hand-out to the class.  Specific guidelines for this presentation are on the next page.  This class presentation is 15% of your final grade.

D.  Attendance and Participation:  Since this course is an upper-division sociology seminar, students are expected to take an active role in shaping their learning environment both within and outside the classroom.  This role includes regular class attendance, leading and participating in class discussions, and group work. 

Attendance will be taken at the beginning of each class.  Moreover, each student will arrive to class ready to participate by having discussion questions or comments already written down.  Class participation, including these short discussion papers, class discussions, and attendance is worth 15% of your final grade.

Please note:  There will be no extra credit work

Class Presentation:  A Suggested Protocol

1. Duplicate and distribute handouts and bibliographies to class participants.
   
2. Spend the first ten minutes verbally summarizing the readings' main findings and conclusions.  Offer your evaluation of the reading material as well as your thinking on the larger topic.  Discuss the link between your selected topic and broader issues of medical sociology.
   
3. Identify the common theme(s) in the articles.  Synthesize the findings by showing how the articles relate to each other.  You also might note similarities between your topic and issues that were previously discussed in class.
   
4. In addition, each presenter is expected to read at least three additional readings on the topic and present this information to the class.  Presenters may use the suggested readings or something they found during their literature search.
   
5. Be prepared to identify a number of questions that the articles raise.  Pose these questions to members of the class.  In essence, these questions will serve as a guidepost for discussion during the remainder of the class time.  The following questions are some examples:
   
a.

How might these issues vary by race, class, gender, generational group, or sexual preference?  Are these principles universal in nature or specific to a particular group?
 
b. What are the social and historical roots of this process?
 
c.

Who cares?  Why are these processes and issues germane to the health, illness, and the practice of medicine today?
d.

Why are we discussing this issue in a sociology course?  Make links to broader concepts, principles, and debates in sociology.
     
e.

Does this apply exclusively to the United States or might it apply equally to the practice of medicine in other industrial or developing nations?

Additional Thoughts:  Each team should make every effort to make their presentation interesting and lively.  Use outside resources whenever possible.  For example, you may want to find current data on your topic and present this information in class.  You might even devise a class exercise that illustrates an important concept or issue in the readings.  Do not hesitate to use visual or literary material.  These suggestions are not obligatory.  They merely serve to remind you that you have some flexibility and creativity in this presentation.

MAKE YOUR PRESENTATION INTERESTING, STIMULATING, & WORTHWHILE!

REQUIRED READINGS:

The following books are available at the College Bookstore and are on reserve in Burling Library.

Abraham, Laurie Kaye. 1993. Mama Might Be Better Off Dead:  The Failure of Health Care in Urban America. Chicago:  University of Chicago Press.

Brown, Phil. 2000. Perspectives in Medical Sociology. Third Edition. Prospect Heights, Ill:  Waveland Press.

Conrad, Peter. Editor. 2005. The Sociology of Health and Illness:  Critical Perspectives. Seventh Edition. New York: Worth Publishers.

Kasper, Anne S. and Susan J. Ferguson. Editors. 2000. Breast Cancer: Society Shapes an Epidemic. New York: St. Martin’s Press.

Klass, Perri. 1987. A Not Entirely Benign Procedure. New York:  Signet.

Lorde, Audre. 1987. The Cancer Journals. San Francisco:  Aunt Lute Books.

In addition to the above books, there are required supplementary readings that will be made available at the Reserve Desk in the library.  Also note that on the course outline below, some of the readings are required and some are suggested.  The suggested readings are additional sources and many also are on reserve in the Burling Library.  Please keep up with the syllabus by reading the assigned chapters or articles prior to the day that topic is discussed.  It is essential to come to class prepared to discuss the readings because the readings are the foundation of the course. 

Questions to Think About While You Are Reading:

Summary:

1). What are the author's main arguments or hypotheses?

2). What types of evidence or research does the author present in support of their arguments?

3). What are some implications of the author's findings or arguments?

Evaluation:

4). Do you agree with the author's conclusions?  Why or why not?

5). Do you have any problems with this study or how it was conducted?

COURSE SCHEDULE WITH ASSIGNED READINGS:

PART I: 

HEALTH AND ILLNESS IN PERSPECTIVE
     

Aug. 26 (TH): 

Course Introduction:  What is Medical Sociology?
     
 

1).

Conrad, Peter. "General Introduction" in Conrad, pp.1-4.
     
 

2).

Brown, Phil. "Introduction to the Book" in Brown, pp.xiii-xviii.
     

Aug. 31 (TU): 

Sociological Perspectives on Health and Illness

     

Required Readings:
     
 

1).

Mishler, Elliot. "Critical Perspectives on the Biomedical Model" in Brown (1992 Edition), pp.153-66. (Supplemental reading).
     
 

2).

McKinlay, John and Sonja McKinlay. "Medical Measures and the Decline of Mortality" in Conrad, pp.7-19.
     
 

3).

Brown, Phil. "Naming and Framing:  The Social Construction of Diagnosis and Illness" in Brown, pp.74-103.
     

Suggested Readings:
     
 

1).

Bell, Susan. “Experiences of Illness and Narrative Understandings” in Brown, pp.130-145.
     
 

2).

Freidson, Eliot. “The Social Organization of Illness” in Brown, pp.285-294.
     
 

3).

Frank, Arthur W. “The Remission Society” in Conrad, pp. 163-166.
     

PART II: 

THE SOCIAL PRODUCTION OF ILLNESS
     

Sept. 2 (TH): 

Social Factors in Health and Illness:  Gender and Sexism
     

Required Readings:
     
 

1).

Ehrenreich, Barbara and Deirdre English. 1990. "The Sexual Politics of Sickness." Pp.270-284 in The Sociology of Health and Illness:  Critical Perspectives, edited by Peter Conrad and Rochelle Kern. Third Edition. NY:  St. Martin's Press. (Supplemental reading).
     
 

2).

Lorber, Judith. “Women Get Sicker but Men Die Quicker: Gender and Health” in Brown, pp.40-70.
     
 

3).

Brumberg, Joan. "Anorexia Nervosa in Context" in Conrad, pp.108-121.
     

Suggested Readings:
     
 

1).

Waldron, Ingrid. "Gender Differences in Mortality: Causes and Variation in Different Societies" in Conrad, pp.38-54.
     
 

2).

Gilman, Charlotte Perkins. 1973. The Yellow Wallpaper. Old Westbury, NY:  The Feminist Press. (On reserve in the library).
     

Sept. 7 (TU): 

Social Factors in Health and Illness:  Race and Racism
     

***In Class: 

Video titled "The Deadly Deception" on the Tuskegee Experiment
     

Required Readings:
     
 

1).

Takaki, Ronald T. 1985. "'Diseases' of the Mind and Skin." Pp.16-35 in Iron Cages:  Race and Culture in Nineteenth-Century America. Seattle:  University of Washington Press. (Supplemental reading).
     
 

2).

Jones, James. "The Tuskegee Syphilis Experiment" in Brown, pp.376-388.
     
 

3).

Williams, David R. “Race, SES, and Health: The Added Effects of Racism and Discrimination” in Brown, pp.21-39.
     
 

4).

Abraham, Laurie Kaye. Mama Might Be Better Off Dead, pp.1-24.
     

Suggested Readings:
     
 

1).

Jones, James. 1981. Bad Blood:  The Tuskegee Syphilis Experiment. NY:  The Free Press. (On reserve in the library).
     
 

2).

McCord, Colin and Harold P. Freeman. "Excess Mortality in Harlem" in Conrad, pp.30-37.
     

Sept. 9 (TH): 

Social Factors in Health and Illness:  The Intersection of Race and Social Class
     

Required Readings:
     
 

1).

Syme, S. Leonard and Lisa F. Berkman. "Social Class, Susceptibility, and Sickness" in Conrad, pp.24-30.
     
 

2).

Wilkinson, Richard. “Health Inequalities: Relative or Absolute Material Standards?” in Conrad, pp.98-103.
     
 

3).

McCally, Michael et al. "Poverty and Ill Health: Physicians Can, and Should, Make a Difference" in Brown, pp.5-20.
     
 

4).

Abraham, Laurie Kaye. Mama Might Be Better Off Dead, pp.25-43.
     

Suggested Readings:
     
 

1).

House, James S., Karl R. Landis, and Debra Umberson. "Social Relationships and Health" in Conrad, pp.74-82.
     
 

2).

Pearlin, Leonard I. and Carol S. Aneshensel. “Stress, Coping, and Social Supports” in Brown, pp.146-153.
     
 

3).

Marmot, Michael and Tores, Theorell. "Social Class and Cardiovascular Disease:  The Contribution of Work" in Conrad (5th Edition), pp.93-105.
     
     

Sept. 14 (TU): 

Social Factors in Health and Illness: The Failure of Health Care for the Poor
     

Required Readings:
     
 

1).

Davis, Bridgett. 1990. "Speaking of Grief:  Today I Feel Real Low, I Hope You Understand."  Pp.219-225 in The Black Women's Health Book, edited by Evelyn White. Seattle:  Seal Press. (Supplemental reading).
     
     
 

2).

Klineberg, Eric. “Dying Alone: The Social Production of Urban Isolation” in Conrad, pp.83-97.
     
 

3).

Abraham, Laurie K. Mama Might Be Better Off Dead, pp.44-133; 146-178.
     

Suggested Readings:
     
 

1).

Wilkinson, Richard G. "National Mortality Rates:  The Impact of Inequality?" in Brown (Second Edition), pp.76-82.
     

Sept. 16 (TH): 

Social Factors in Health and Illness: Occupational and Environmental Hazards
     

Required Readings:
     
 

1).

Smith, Barbara. "Black Lung:  The Social Production of Disease" in Conrad, pp.55-67.
     
 

2).

Kotelchuck, David. "Worker Health and Safety at the Beginning of a New Century" in Brown, pp.182-192.
     
     
 

3).

Brown, Phil. "Popular Epidemiology and Toxic Waste Contamination:  Lay and Professional Ways of Knowing" in Brown, pp.157-181.
     

Suggested Readings:
     
 

1).

Rosner, David. 1991. Deadly Dust:  Silicosis and the Politics of Occupational Disease in Twentieth-Century America. Princeton, NJ: Princeton University Press. (On reserve in the library).
     
 

2).

Phoenix, Janet. "Getting the Lead Out of the Community" in Brown, pp.632-644.
     
 

3).

Conrad, Peter. "Wellness in the Work Place:  Potentials and Pitfalls of Work-Site Health Promotion" in Conrad, pp.540-551.
     
 

4).

Erikson, Kai. "Three Mile Island:  A New Species of Trouble" in Brown (Second Edition), pp.206-221.
     

Sept. 21 (TU):

Individual Rights v. Individual Responsibility: Are Individuals "Responsible" for Their Health?

     

***In Class: 

Position Paper #1 Due and Class Debate

     

Required Readings:
     
 

1).

Knowles, John. "The Responsibility of the Individual" in Conrad (Fifth Edition), pp.379-392.  (Supplemental Reading)
     
 

2).

Crawford, Robert. "Individual Responsibility and Health Politics" in Conrad (Fifth Edition), pp.393-401.  (Supplemental Reading)
     
 

3).

Abraham, Laurie Kaye. Mama Might Be Better Off Dead, pp.134-145.
     
 

4).

McKinlay, John B. "The Case for Refocusing Upstream:  The Political Economy of Illness" in Conrad, pp.551-564.
     
 

5).

Sidel, Victor. "A Tale of Two States" and follow up article in Conrad,

pp.55-62.

    
     

PART III: 

THE CULTURAL SHAPING OF HEALTH AND ILLNESS
     

Sept. 23 (TH): 

Cultural Influences on the Experience of Illness
     

Required Readings:
     
 

1).

Helman, Cecil G. 1994. "Cultural Factors in Epidemiology." Pp.319-337 in Culture, Health and Illness. Oxford:  Butterworth-Heinemann. (Supplemental reading).
     
 

2).

Todd, Alexandra Dundas. "Western Reflections on Eastern Medicine" in Brown, pp.333-362.
     
 

3).

Goldstein, Michael. “The Emergence of Alternative Medicine” in Brown, pp. 363-372.
     
 

4).

Schneirov, Matthew and Jonathan David Geczik. “Alternative Health and the Challenges of Institutionalization” in Conrad, pp.366-377.
     

Suggested Readings:
     
 

1).

McCarthy Brown, Karen. 1991. Mama Lola:  A Vodou Priestess in Brooklyn.  Berkeley:  University of California Press. (On reserve in the library).
     
 

2).

Logan, Michael H. and Edward E. Hunt, Jr. Editors. 1978. Health and the Human Condition:  Perspectives on Medical Anthropology. Massachusetts:  Duxbury Press. (On reserve in the library).
     
 

3).

Zola, Irving Kenneth. "Pathways to the Doctor---From Person to Patient" in Brown, pp.198-213.
     

Sept. 28 (TU): 

The Experience of Illness and the Politics of Breast Cancer
     

Required Readings:
     
 

1).

Lorde, Audre. The Cancer Journals, pp.9-54.
     
 

2).

Ferguson, Susan J. and Anne S. Kasper. “Introduction—Living With Breast Cancer” in Kasper and Ferguson, pp.1-22.
     
 

3).

Zones, Jane S. “Profits from Pain: The Political Economy of Breast Cancer” in Kasper and Ferguson, pp.119-151.
     
 

4).

Steingraber, Sandra. “The Environmental Link to Breast Cancer” in Kasper and Ferguson, pp. 271-299.
     

Suggested Readings:
     
 

1).

Read other chapters in Breast Cancer: Society Shapes an Epidemic.
     

Sept. 30 (TH): 

Discussion of Breast Cancer, continued
     

Required Readings:
     
 

1).

Lorde, Audre. The Cancer Journals, pp.55-77.
     
 

2).

Rosenbaum, Marcy E. and Gun M. Roos. “Women’s Experiences of Breast Cancer” in Kasper and Ferguson, pp. 153-181.
     
 

3).

Kasper, Anne S. “Barriers and Burdens: Poor Women Face Breast Cancer” in Kasper and Ferguson, pp.183-212.
     

Suggested Readings:
     
 

1). 

Read other chapters in Breast Cancer: Society Shapes an Epidemic.
     

Oct. 5 (TU): 

The Experience of Illness and the Politics of AIDS
     

***To Be Scheduled.  Video:  "And The Band Played On"
     

Required Readings:

     
 

1).

Fee, Elizabeth and Nancy Krieger. 1993. “Understanding AIDS: Historical Interpretations and the Limits of Biomedical Individualism.” American Journal of Public Health 83(10):1477-1486.
     
 

2).

Herek, Gregory M. “AIDS and Stigma” in Conrad, pp.121-129.
     
 

3).

Weitz, Rose. "Life With AIDS" in Brown, pp.242-255.
     

Suggested Readings:
     
 

1).

Shilts, Randy. 1987. And The Band Played On:  Politics, People, and the AIDS Epidemic. NY:  St. Martin's Press. (On reserve in the library).
     
 

2).

Conrad, Peter. "The Social Meanings of AIDS" in Brown (1992 Edition), pp.416-428.
     

Oct. 7 (TH): 

Societal Response to the AIDS Epidemic
     

Required Readings:

     
 

1).

Verghese, Abraham. 1994. Pp.9-15 in My Own Country:  A Doctor's Story of a Town and Its People in the Age of AIDS. NY:  Simon and Schuster. (Supplemental reading).
     
 

2).

Epstein, Steven. “Democracy, Expertise, and AIDS Treatment Activism” in Brown, pp.609-625.
     
 

3).

Bosk, Charles L. and Joel E. Frader. "AIDS and Its Impact on Medical Work:  The Culture and Politics of the Shop Floor" in Conrad, pp.253-265.
     

Suggested Readings:
     
 

1).

Rosser, Sue. 1991. "Perspectives:  Women and AIDS." AIDS Education and Prevention. 3:230-240.
     
 

2).

Articles from "Has America Adequately Funded AIDS Research and Treatment?" Pp. 70-93 in The AIDS Crisis, edited by Bruno Leone. San Diego, CA:  Greenham Press. 1991.
     

PART IV: 

THE SOCIAL ORGANIZATION OF MEDICAL CARE
     

Oct. 12 (TU): 

The Rise of Medical Authority I:  The Dominance of Physicians
     

Required Readings:
     
 

1).

Conrad, Peter and Joseph Schneider. "Professionalization, Monopoly, and the Structure of Medical Practice" in Conrad, pp.170-176.
     
 

2).

Starr, Paul. "The Growth of Medical Authority" in Brown, pp.557-565.
     
 

3).

Wertz, Richard and Dorothy Wertz. "Notes on the Decline of Midwives and The Rise of Medical Obstetricians" in Conrad, pp.176-188.
     
 

4).

Rosenberg, Charles. "Rise of the Modern Hospital" in Brown, pp.523-539.
     

Suggested Readings:
     
 

1).

Buss, Fran Leeper. 1980. La Partera:  Story of A Midwife. Ann Arbor, Michigan: The University of Michigan Press. (On reserve in the library).
     
 

2).

Logan, Onnie Lee and Katherine Clark. 1989. Motherwit:  An Alabama Midwife's Story. NY:  E. P. Dutton. (On reserve in the library).
     

Oct. 14 (TH): 

The Rise of Medical Authority II:  Nurses and the Order to Care
     

***In class: 

Video titled "Sentimental Women Need Not Apply:  A History of the American Nurse" and Discussion
     

Required Readings:

     
 

1).

Reverby, Susan. "A Caring Dilemma:  Womanhood and Nursing in Historical Perspective" in Conrad, pp.243-253.
     
 

2).

Killion, Cheryl. 1990. "Service Without Subservience:  Reflections of a Registered Nurse." Pp.240-250 in The Black Women's Health Book, edited by Evelyn White. Seattle:  Seal Press. (Supplementary reading).
     
 

3).

Chambliss, Daniel. “Nurses’ Role: Caring, Professionalism, and Subordination” in Brown, pp.591-604.
     

Suggested Readings:
     
 

1).

Charon, Rita. “To Listen, To Recognize” in Brown, pp.566-573.
     
 

2).

Melosh, Barbara. 1982.  The Physician’s Hand: Work Culture and Conflict in American Nursing. Philadelphia: Temple University Press.
     

Oct. 16th - Oct. 24th: FALL BREAK:  NO CLASS  (Begin Reading Perri Klass' book)
     

PART V: 

BECOMING A HEALTH CARE PROVIDER
     

Oct. 26 (TU): 

The Socialization of Doctors I:  The Medical School Experience
     

Required Readings:

     
 

1).

Fox, Renée. "Training for Uncertainty" in Brown (1992 Edition), pp.450-459.  (Supplemental Reading).
     
 

2).

Anspach, Renee. "The Language of Case Presentation" in Conrad, pp.347-365.
     
 

3).

Klass, Perri. A Not Entirely Benign Procedure, pp.13-152.
     

Suggested Readings:
     
 

1).

Konner, Melvin. 1987. Becoming a Doctor:  A Journey of Initiation Into Medical School. New York:  Viking. (On reserve in the library).
     
 

2).

Mishler, Elliot G. "The Struggle Between the Voice of Medicine and the Voice of the Lifeworld" in Conrad, pp.319-330.
     

Oct. 28 (TH): 

The Socialization of Doctors II:  Internships and Residency
     

***To Be Scheduled:  PBS Video "So You Want To Be A Doctor?" (60 min)
     

Required Readings:

     
 

1).

Gamble, Vanessa Northington. 1990. "On Becoming a Physician:  A Dream Not Deferred." Pp.52-64 in The Black Women's Health Book, edited by Evelyn White. Seattle:  The Seal Press. (Supplemental reading).
     
 

2).

McKinlay, John B. and Lisa D. Marceau. “The End of the Golden Age of Doctoring” in Conrad, pp.189-215.
     
 

3).

Mechanic, David. “Changing Medical Organization and the Erosion of Trust” in Conrad, pp.224-230.
     
 

4).

Klass, Perri. A Not Entirely Benign Procedure, pp.153-286.
     

Suggested Readings:
     
 

1).

Light, Donald W. “Countervailing Power: The Changing Character of the Medical Profession in the United States” in Conrad, pp.215-224.
     
 

2).

Lorber, Judith. "Women Physicians in Three Countries" in Brown (1992 Edition), pp.459-467.
     
     

PART VI: 

MEDICINE AS AN INSTITUTION OF SOCIAL CONTROL
     

Nov. 2 (TU): 

Medicine, Deviance, and Social Control
     

Required Readings:

     
 

1).

Zola, Irving. "Medicine as an Institution of Social Control" in Conrad, pp.432-442.
     
 

2).

Conrad, Peter. "Medicalization and Social Control" in Brown, pp.104-129.

 

   
 

3).

Clarke, Adele E., et al. “Biomedicalization:   Technoscientific Transformations of Health, Illness, and U.S. Biomedicine” in Conrad, pp.442-455.