Structural-Functional Analysis of Health & Medicine
In the 1930s, Harvard sociologist Talcott Parsons began working on the issue of the doctor-patient relationship and was developing the foundation of medical sociology when he introduced the idea of the sick role into the vocabulary of scholarship. Parsons, considered to be the founding father of sociological structural-functionalism, created a new field for social studies, which has ever more importance today in the face of rising medical costs and the challenges presented by the recent developments in biomedical technologies. This article will discuss Parsons's structural-functional approach to sickness and the sociology of medicine.
Keywords Bioethics; Clinical Sociology; Doctor-Patient Relationship; Equilibrium; Health Care; Human Relations Movement; Information Society; Parsons, Talcott; Pharmaceutical Industry; Sick Role; Structural-Functionalism
Sociology of Health
In 1929 a young lecturer named Talcott Parsons (1902-1979) was recruited by philosopher Ralph Barton Perry to set up a sociology course curriculum for a social ethics class at Harvard alongside Perry and economics lecturer Carl Bigelow. Parsons, who as a college student wanted to become a physician like his brother, had discovered social science while still at college and then studied the field in London and Heidelberg, Germany, in the mid-1920s. In London, he was introduced to the ideas of functionalism by anthropologist Bronislaw Malinowski.
One of Parsons’s most prominent teachers at Heidelberg was physician and psychologist Karl Jaspers, who at the time had already was an established philosophy teacher and who would become one of the leading voices of existential philosophy with Martin Heidegger and Jean-Paul Sartre. With Jaspers's lectures, Parsons was familiarized with the works of the founding fathers of sociology: Georg Simmel, Emile Durkheim, and Max Weber. He later discovered the work of Italian Vilfredo Pareto, whose key concepts he would integrate into his earliest publications and would also apply in his work on medical issues.
In the late 1920s, the Harvard Department of Industrial Physiology (which was located at the Business School and incorporated disciplines such as hygiene and fatigue research) in cooperation with the Harvard Medical School was undertaking studies into improving student health and improving the efficiency of industrial workers. The leading voices of these efforts were physiologist Lawrence Henderson and Australian psychologist Elton Mayo. Under their aegis, the Human Relations Movement at Harvard was created and the famous Hawthorne Study was undertaken at the Western Electrical Works in Chicago. They introduced the novel idea that a worker's social life and physical and psychological well-being had an important effect on his efficiency on the job. The motto was "bringing the human back in," and this created an interest in social science studies at Harvard, which had no Department of Sociology of its own at the time. The Sociology Department was subsequently created in 1931 with the Russian Pitrim Sorokin as department head and Parsons as lecturer and liaison with other departments and Harvard professors, including Lawrence Henderson.
In 1931, Henderson, whose curiosity in social questions and problems had been sparked by many conversations with the Harvard Business School Dean and friend Elton Mayo, was introduced by Morton Wheeler to the work of Pareto. One of Pareto's central conceptions, the idea of equilibrium, was a common concept for members of the Human Relations Movement, as well as for Parsons. Henderson knew the concept from physiological studies, for the idea was handed down in studying physiological regulation from the German philosopher-physiologist Rudolf Hermann Lotze to the French physiologist and science-theoretician Claude Bernard, while Mayo was familiarized with the idea of equilibrium through the works of French psychologist and Freud rival Pierre Janet. Parsons, on the other hand, knew the concept from an economics perspective, which he initially taught at Harvard, from the work of Taussig and Frank H. Knight, and from a sociological perspective from early sociologists like Franklin Giddings, John Boodin, Charles Cooley, and Edward Ross
While working on a manuscript that would become his landmark publication, "The Structure of Social Action," Parsons worked in parallel on a medical study of the patient-doctor relationship as early as the summer of 1933 (Stingl, 2008). Unaware of Henderson's increasing interest in social problems in medical questions, he approached Henderson in the same year with his idea of using Pareto's equilibrium model to explain the questions of a patient's respect for the doctor in relation to the doctor's self-respect and the question of negotiating a treatment price between doctor and patient, which differs from the business world significantly.
Bringing together his own thoughts on the matter with Parsons's ideas, Henderson would write his landmark essay "Physician and Patient as a Social System," which he first delivered as a speech in front of a group of Harvard medical students in 1934.
Parsons's own theorizing continued in this direction until he discovered the prerequisites of the use of structural-functional theory from anthropology for sociology, utilizing the work of Malinowski, Radcliffe-Brown, and Durkheim. Studying functional problems that society resolved by the creation of social roles—such as the role of the father, the role of the industrial worker, etc.—he postulated that the state of being sick has the structure of a social role. Finally publishing the ideas in 1951 in his seminal work, "The Social System," Parsons created the systematic study of the medical field by sociologists where predecessors such as Louis Wirth and his clinical sociology had failed.
Parsons's predecessors, Malinowski and Radcliffe-Brown, conflated the teachings of biology and psychology to create functionalist anthropology. To modern students this is often surprising, for psychology is often tentatively thought of as the situation of consulting a psycho-analyst or therapist. But psychology in the late nineteenth and early twentieth century was originally more part of physiology in the laboratory context. At the same time, the clinical approach and the experimental or laboratory approach were in conflict over which discipline should have dominance over defining normalcy and pathology for the human organism. The most influential scholars would come to the conclusion that neither should have dominance and that they equally deserve attention to secure medical progress. Lawrence Henderson is a good example of this situation. Coming from clinical training, he went on to pursue experimental work instead for decades before eventually combining both attitudes within the scope of his research and teachings in the 1930s.
The same is true for sociology as a discipline. While Louis Wirth and others tried to establish sociology as a method of intervention and a clinical discipline, Parsons installed the Harvard Laboratory of Social Relations in the 1940s. He also followed the distinction of Tönnies, which distinguishes sociology as pure, applied, and empirical.
When studying the effects of systems, structures, and functions in health and medicine, medical sociology is not the only facet one must consider. Specifically, anthropology has rediscovered the medical field as an area of research. Since alternative medicine has experienced a boom in Western countries (in particular with the success of acupuncture and homeopathy) different classifications of health and medicine have come under scrutiny, such as Chinese medicine. It can be found that the "sick role" has an entirely different...
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