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Book Review

Sociology and Medicine: Selected Essays of PM Strong

Anne Murcott (ed)

ISBN: 978-0-7546-3844-5 2006 296 pages Ashgate

Susie Scott
Department of Sociology, University of Sussex, United Kingdom

Sociology has a long-standing, and complex relationship with medicine. Its role has been variously critical, exploratory, cautious and revelatory, creating many opportunities for dialogue between the two disciplines. Now two books are published which comment on the dimensions of this relationship, drawing on empirical studies, theoretical debates and analytical methodologies.

The second book, edited by Anne Murcott, is Sociology and Medicine: Selected Essays by PM Strong. This is a posthumous collection of articles and book chapters by Philip Strong, a well respected scholar in the field of medical sociology. Murcott explains that the purpose of the book is to highlight Strong's key arguments, demonstrate his position on certain theoretical debates, and honour his great contribution to the field (he published thirty-two papers and book chapters over a twenty year career before his untimely death in 1995). Like Conrad, Murcott has structured the volume with three main sections, pertaining to empirical, theoretical and methodological subject matter. However, while Conrad's book focuses on one central issue, this collection is more diverse, addressing wider questions about the place of sociology in relation to medicine. As such, it has a strong epistemological flavour, which complements the empirical data presented and demonstrates Strong's capacity for self-reflexive critical inquiry. Some of the papers in the volume were co-authored with Davis, McPherson and Robinson, and these complement the single-authored pieces.

The first part of the book, ‘Doctors, patients and encounters', presents the majority of the empirical work and focuses on the dynamics of interaction in medical consultations. Strong has a theoretical leaning towards Erving Goffman's (1959) dramaturgical perspective, and uses this approach throughout his analyses. This gives additional depth to the early chapters and paves the way for a smooth transition into the later sections of the book. Indeed, there is an explicit connection between Chapter 4, on the ‘ceremonial order' of the clinic (a term borrowed from Goffman) and Chapter 9, which revisits this study with a critical evaluation of its methodology, namely the ethnographic observation of paediatric consultations. Chapter 1 documents the ‘neutralising techniques' used by paediatricians who are wary of imposing diagnostic labels upon children: parents are reassured that the ‘child' identity remains dominant over any ‘patient' identity, and the doctor's comments emphasise inherent qualities of joyfulness, innocence and wonder in the child. Chapter 2 presents more data to reveal the dramaturgical dimensions of therapeutic encounters, while Chapters 3 and 4 identify more general principles of ceremonial order, rituals and etiquette. Although clearly an admirer of Goffman's work, Strong retains a critical distance from it, and is able to self-reflexively evaluate the uses and limitations of dramaturgy as an analytical tool.

Part 2 of this volume focuses on the place of sociology vis-à-vis medicine, and the relationships between these disciplines and others. A recurrent theme is Strong's argument that sociology should develop more humility. In Chapter 5, for example, Strong points to the hypocrisy of sociologists denouncing the expansion of medical power whilst simultaneously seeking to explain everything within their own discipline: ‘sociological imperialism'. In Chapter 6, he argues for the need to listen carefully to the voices of those whom we might regard as ‘rivals' in the production of knowledge: journalists, managers, novelists and the lay public. Part 3 of the book has a methodological focus, but addresses epistemological issues which sit comfortably alongside those of Part 2. Here we find discussions of some ‘model' analytical approaches, such as epidemic psychology, early modern moral science and positivistic natural science. This is also the section containing Strong's critical evaluation of his own dramaturgical analyses.

This book will appeal mainly to social scientists who know Strong's work or at least familiar with the theoretical debates to which he refers, in particular, medical sociologists with an interest in Symbolic Interactionism, dramaturgy and other ‘micro' level approaches will find it an invaluable, thought-provoking source. Others in the social sciences will appreciate Strong's methodological rigour and sophisticated grasp of epistemological issues, while medical practitioners stand to gain valuable insights into the social aspects of their work. The book may hold less appeal to researchers outside the fields of sociology and medicine, and is pitched at a level beyond that of the general reader. It is perhaps more suited to postgraduates and faculty members than undergraduate students, although some parts may be accessible to the latter. The empirical chapters on the interaction dynamics of clinical encounters, for example, would supplement an undergraduate reading list on the sociology of health and illness, or could be used to demonstrate the applications of interpretivist social theory.

While both these books address the relationship between medicine and society, they do so in different ways and for slightly different audiences. The Conrad monograph is the more accessible of the two, grounded as it is in a much greater wealth of empirical data, but is also the more specialised and focuses on one main thesis: medicalisation. The Strong collection is wider in scope, relating as it does to some major debates in the philosophy and methodology of social science, but paradoxically, this volume may appeal to a smaller audience. Nevertheless, both texts make a valuable contribution to their fields, and remind us of the importance of sustaining channels of communication between the social sciences and medicine.

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