The Sociology of Medicine: An Interaction Between Self and Society
The sociology of medicine studies the health and medical system in terms of its social interactions within itself, and with society at large. This approach is interesting because it expands the discussion of the medical system far beyond most people's narrow conception of hospitals, doctors and nurses. From this point of view, the medical system is understood as an element in the medico-industrial complex, and a key component of the capitalist system.
This essay will discuss the medico-industrial complex from the perspectives of structural functionalism and Marxist conflict theory. I will contend that the medical system in Canada is closely intertwined with the class system of this country, and the capitalist objectives of the pharmaceutical companies. While personal details will be kept to a minimum, in recognition of the subjective observer perspective of symbolic interactionism the first person point-of-view will be integral to the analysis.
As I come from China, my responses to the Canadian medical system are largely influenced by my experiences overseas. One facet of the Chinese sociology of medicine is that medicine – and health and illness – extend far beyond the state system. This may be a response to the fact that the state system is not very good and so not trusted. As a result, Chinese have taken over much of the responsibility for their personal health care themselves. Traditional herbal and organic remedies for every complaint are a facet of the Chinese system that is only slightly reflected in the Canadian model. In fact, as I came to understand in my contact with the medical system in Canada, it is a view of health that many medical professionals distrust.
My first real experience of the Canadian medico-industrial complex came last year around exam time when I started becoming sick (vomiting, nausea, sleeplessness) for no apparent reason. I went to a doctor for a check-up, and in the course of talking I told him of the various herbal remedies/supplements that I take. The doctor told me that it was likely I was becoming sick in response to toxic elements in these remedies. He gave me a lecture on the dangers of consuming folk remedies without a physician's advice, and wrote me a prescription for a drug to purge my digestive system of much of their traces.
The above story exhibits elements that render it understandable in terms of the sociology of medicine. As one writer notes:
The sociology of medicine is the study of the ways the institutionalized medical system constructs what it deems to be illness out of what it recognizes as signs and symptoms, and constitutes its response to such 'illness' through the treatments it prescribes. (Clarke, 4)
This definition is significant in terms of my experience of the medical system in that it stresses the central subjectivity of the social actors in a particular situation (Clarke, 36). These social actors can only be truly understood only if their roles are analyzed in the context of the social and economic relations of their particular cultural setting.
In the case of my doctor, I now realize the significance of his diagnosis of my illness as being a response to the herbal supplements that I and my family have been taking for most of our lives. In terms of Marxist conflict theory, the doctor's lecture may be interpreted not simply as a diagnosis but also as an example of the,
“loss of individual autonomy and the creation of dependency. The responsibility for good health has been wrested from the individual as a result of the imposition of the medical model – the prevalence of medical institutions and medical practitioners.” (Clarke, 34)
In terms of history, there has long been a degree of antipathy toward complementary and alternative medicine (CAM) by the medical establishment (Clarke, 347). Certainly, given the size and the financial revenues of the medico-industrial complex – $10.8 billion spent on pharmaceutical in Canada in 1996 (Clarke, 365) – it is obvious that the maintenance of this "cash cow" would be a prime consideration of many individuals in the field.
In terms of my personal experience, I did not feel comfortable with the doctor's diagnosis as I felt oddly deprived of any say or right to control my own life. I felt that my judgement, that of my family, and by extension that of millions of Chinese who had evolved a complex system of natural medicine to compensate for the deficiencies of our medical system, was not only questioned but totally disregarded. The significance of the symbolic interactionist model is clearly applicable to an analysis of my thinking at this point, because my thoughts had shifted from a focus on my health to a focus on my health in my social context. I was not sure what to do: accept the diagnosis and cease taking the supplements, or continue with the supplements in defiance of the doctor's advice.
I chose a middle path, and continued taking the supplements while finding another physician to talk to. This time I was careful to choose a Chinese doctor who had experience with patients from China and their "home remedies". At my initial meeting with this doctor I explained my first consultation and the diagnosis. This doctor nodded, but did not comment on the diagnosis. Instead, he asked for a list of the supplements I had been taking. I had expected this, and had already made a list up to give him.
After reviewing the list, my doctor laughed and said there was nothing "toxic" on the list at all. Instead, he said he thought I was simply suffering from stress and anxiety about my schoolwork, and prescribed regular workouts at a gym.
I must admit to being surprised at this diagnosis, and especially the "prescription". Once again, upon leaving the doctor's office, I felt confused and uncertain as to whether or not to trust his diagnosis. In a sense, both my Chinese and Canadian experiences of health and illness had taught me that health was something to be obtained by consuming something; whether a pill from a pharmacist, or a remedy from a herbalist. To be frank, I thought that going to a gym – while probably a good thing in general – would probably only increase my nausea and stomach sickness.
The deciding factor in my decision, however, was that the second doctor's advice did not seem to deprive me of control over my health. In fact, he reinforced the idea that I had a significant degree of control over my health. So, I took his advice. Two weeks later my symptoms had mostly vanished.
This experience – although subjective and defined largely by social interaction as per the symbolic interactionist theory – greatly impacted my view of doctors and medical care in Canada. From the perspective of Marxist conflict theory, I understand now how the financial interests of the medico-industrial complex can influence – consciously or unconsciously – many of its practitioners to be hostile to rival forms of treatment. However, it also points to the need of the system to situate users in a position of dependency. This position was in conflict with the position of independence of most Chinese with respect to their own health system. This second social position gave me the incentive to question the system of dependency. I am happy that I did so.
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- Clarke, Juanne. Health, Illness, and Medicine in Canada. Toronto: Oxford U P, 2000.
- Shroff, Farah. "All the Petals of the Flower." in Course Kit: Sociology of Health. Toronto: York University, 2000.