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Basic readings in medical sociology
372
Book reviews
Basic Readings in Medical Sociology, edited by DAVID TUCKETT and JOSEVH M. KAUFE1ZT.Tavistock Publications, London, 1978. 306 pp. No price given. One of the principal aims of this volume, which is intended as a companion to David Tuckett's earlier book An Introduction to Medical Soeiolo~y is to "provide someone coming to the field (of medical sociology) with the chance to assess the direction, quality, scope and utility of the subject". At the same time, Tuckett and Kaufert feel that this collection of readings will "not only convey an interesting perspective on a topic but also make a systematic attempt to test the validity of ideas". In my opinion, the selection of readings chosen for this volume fails on both counts. Let me first of all consider Tuckett and Kaufert's comments about the systematic testing of the validity of ideas. This, they argue, is "'based upon the premise that the best we can do when we draw inferences from our observations of the social world is to m a k e a ease for the inference" (original emphasis). There are those, of course, who would disagree with the premise that Tuckett and Kaufert are putting forward, though I for one wholeheartedly endorse their view. Also, I agree with Tuckett and Kaufert when they suggest that: The central requirement of this logic, therefore, is that research workers directly face the issue of alternative interpretations and set out their arguments before their audience. Confidence depends on how well the case for a particular interpretation has been made (page xvi). Having made such a convincing case for the possibility of alternative interpretations of sociological observations and phenomena, however, Tuckett and Kaufert hardly deliver the goods with the readings that they have selected for this volume. In part, 1 feel that this is due to some myopia on their part concerning the implications of the logic they are advocating. For if one is putting the onus upon the sociological researcher to face the issue of alternative interpretations and to provide rigorous analyses of data in support on some particular interpretation(s), then one is beginning to say something very important about the way in which sociological research is undertaken. In my opinion, however, Tuckett and Kaufert throw away the opportunity to do just this, and to demonstrate the range and diversity of medical sociology, when they insist that "traditions in regard to research design are so well established in sociology, as well as in other disciplines, that they need not be considered further". This brings me on to the second count against which Tuckett and Kaufert's volume may be criticised. This concerns the scope and diversity of medical sociology. Admittedly, Tuckett and Kaufert acknowledge that "structuralfunctional, conflict, symbolic-interactionist, ethnomethodological and Marxist perspectives have all dominated at different times and each has generated ideas such that we examine medical situations in very different ways as a result". But where is this range of perspectives in the readings chosen for this volume? It strikes me that the editors' belief about traditions of research design needing no further consideration has blinkered their vision of sociological diversity, and allowed (caused?) them to come up with a rather narrow and frankly disappointing representation of basic readings in medical sociology. I now want to illustrate these two points of weakness by considering some of the contents of the volume. The volume is organised into ten parts, by and large in keeping with the organisation of Tuckett's earlier Introduction to Medical Sociology. It may well be the case that this particular way of organising the volume has something to do with the lack of sociological diversity of which I am complaining. But even within the section headings chosen by Tuckett and Kaufert which they acknowledge to be "convenient if somewhat arbitrary" -there is room for a
wider range of perspectives. Take for instance the first section "'Sociology as a science". It consists of four readings. Two of these are highly complementary--and hence remarkably similar--papers on family interviewing as a research tool (one by George Brown and Michael Rutter, the other by Christine Vaughn and Julian Left), while the other two papers are on the pros (by Morris Rosenberg) and cons (by Edward Suchman) of variable analysis. However important family interviewing and variable analysis may be to both past and contemporary medical sociology, they hardly represent the range of methodological perspectives used by medical sociologists in their pursuit of "sociology as a science". In particular, I found the absence of readings on the methodology of observational analysis, interactional analysis, discourse analysis, historical and comparative analysis (I'm quite sure the list could be extended) to be most notable and regrettable. By and large, the same can be said for the choice of readings in the other nine parts of the volume, though it must be said that the substantive areas with which medical sociologists concern themselves are somewhat better represented. The lack of sociological diversity in the volume is also reflected in Tuckett and Kaufert's failure (in my opinion) to demonstrate adequately the logic of "making a case for the inference". Since Tuckett and Kaufert explicitly refer to Brown and Rutter's reading as an exemplar of "work in which different interpretations of data can be thoroughly considered", and given that there are four (out of 30) readings from Brown's work in the volume, 1 want to address my comments on the logic of "making a case for the inference" to this approach. Firstly, it must be said that the Brown and Rutter paper on the use of family interview as a research tool is one of the most sophisticated and carefully argued papers from within the interviewing tradition. I was particularly impressed with the use of "master" tape recordings of interviews for the training of interviewers and for "arriving at common standards for rating of expressed feeling". But these are only two ways in which data collected by tape recordings can be used sociologically. The inference that Brown and his colleagues make about family life and schizophrenic disorders (in Reading 8) --i.e. that there is an unequivocal and independent association between expressed emotion in family life and relapse of schizophrenic symptoms and behaviour--is both interesting and plausible. But despite (or because of) Brown et al.'s rigour and detaildd attention to a number of variables, I came away from this work feeling that I know very little about the nature of expressed emotions as they are found within the context of the family life of people with diagnosed schizophrenic disorders, or about the ways in which these expressed emotions fit into the more general organisation of family life and discourse. Furthermore, l have no way of knowing about these aspects of family life given the way in which the data are presented, and hence I have no way of disputing, agreeing with or offering any other interpretations and inferences about them. Now for the purposes of this volume this is not, and cannot be, a criticism of Brown et al.'s work per se (though a presentation and analysis of some of their tape recorded family interview data would have strengthened their argument and allowed others to offer alternative interpretations and analyses). Rather, it is a criticism of Tuckett and Kaufert for selecting this work as the exemplar of "work in which different interpretations of data can be thoroughly considered", and for failing to include in the volume selections from other sorts of sociological work which could enhance this endeavour. There are some more general features of editing that disturb me in this volume. Most notable is the absence. of any introductory comments to the different sections of the book, It is true that this volume is a companion to Tuckett's earlier b o o k and that it was probably designed to be read as such. But apart from the fact that many
Book reviews readers might use this volume as a source book quite separate from the earlier text, and will therefore n o t have the benefit of its guiding principles, it must be remembered that the section headings are "convenient if somewhat arbitrary". As such, I feel that the editors have some obligation to inform the readers about the reasons for selecting particular readings, and for suggesting what it is that these particular readings are supposed to offer analytically. Furthermore, one of the hallmarks of good editing in a volume such as this is the ability to make links between materials within the volume and with materials that are published elsewhere. I found it disappointing, for instance, that Stanford B. Friedman et al.'s paper on Behavioural Observations on Parents Anticipatin 9 the Death of a Child (Reading 9) was not linked in some way to Fred Davis' paper on Uncertainty in Medical Diagnosis (Reading 17), since they both say something about illness behaviour and illness careers over and above their contributions to their respective section headings. Also, I feel that some suggestions for further reading would have been very helpful either at the end of each reading or at the end of each section. This would have made the volume a better resource for those readers coming to the field of medical sociology (for w h o m this volume is partly intended), and it might also have given the editors the opportunity of placing this selection of medical sociology readings within the wider range of sociological perspectives commented upon in the above.
373
Like most volumes of this kind Tuckett and Kaufert's Basic Readings in Medical Sociology has its share of "classics" (Brown et aL, Margot Jefferys, Fred Davis, T h o m a s Scheff, Irving Zola), those that are worth reading (the papers by Edward Suchman, Radke-Yarrow eta!., Cartwright and O'Brien, Michael Banks et al.) and those which would have benefited the volume had they been omitted (Rosengren and De Vault's paper, Ray Rosenman et al.'s study of coronary heart disease). There are also some excellent selections from authors who are not necessarily professional medical sociologists (Mayer a n d T i m m s ' paper, Joseph Epsom's paper on the mobile health clinic, and Egbert et al.'s study of post-operative pain are ones I have in mind), for which the editors must be applauded. Furthermore, I feel that this volume may be of some use to those who teach in medical schools and who wish to give medical students some idea about medicine as a Social phenomenon, But as for being a volume that displays "the direction, quality, scope and Utility" of medical sociology, and one that demonstrates adequately the logic of "making a case for the inference", I'm afraid that Basic Readin~ls in Medical Sociology does not foot the bill.
M R C Medical Sociology Unit Institute of Medical Sociology Aberdeen, Scotland
PHIL DAVIES
Book reviews
Basic Readings in Medical Sociology, edited by DAVID TUCKETT and JOSEVH M. KAUFE1ZT.Tavistock Publications, London, 1978. 306 pp. No price given. One of the principal aims of this volume, which is intended as a companion to David Tuckett's earlier book An Introduction to Medical Soeiolo~y is to "provide someone coming to the field (of medical sociology) with the chance to assess the direction, quality, scope and utility of the subject". At the same time, Tuckett and Kaufert feel that this collection of readings will "not only convey an interesting perspective on a topic but also make a systematic attempt to test the validity of ideas". In my opinion, the selection of readings chosen for this volume fails on both counts. Let me first of all consider Tuckett and Kaufert's comments about the systematic testing of the validity of ideas. This, they argue, is "'based upon the premise that the best we can do when we draw inferences from our observations of the social world is to m a k e a ease for the inference" (original emphasis). There are those, of course, who would disagree with the premise that Tuckett and Kaufert are putting forward, though I for one wholeheartedly endorse their view. Also, I agree with Tuckett and Kaufert when they suggest that: The central requirement of this logic, therefore, is that research workers directly face the issue of alternative interpretations and set out their arguments before their audience. Confidence depends on how well the case for a particular interpretation has been made (page xvi). Having made such a convincing case for the possibility of alternative interpretations of sociological observations and phenomena, however, Tuckett and Kaufert hardly deliver the goods with the readings that they have selected for this volume. In part, 1 feel that this is due to some myopia on their part concerning the implications of the logic they are advocating. For if one is putting the onus upon the sociological researcher to face the issue of alternative interpretations and to provide rigorous analyses of data in support on some particular interpretation(s), then one is beginning to say something very important about the way in which sociological research is undertaken. In my opinion, however, Tuckett and Kaufert throw away the opportunity to do just this, and to demonstrate the range and diversity of medical sociology, when they insist that "traditions in regard to research design are so well established in sociology, as well as in other disciplines, that they need not be considered further". This brings me on to the second count against which Tuckett and Kaufert's volume may be criticised. This concerns the scope and diversity of medical sociology. Admittedly, Tuckett and Kaufert acknowledge that "structuralfunctional, conflict, symbolic-interactionist, ethnomethodological and Marxist perspectives have all dominated at different times and each has generated ideas such that we examine medical situations in very different ways as a result". But where is this range of perspectives in the readings chosen for this volume? It strikes me that the editors' belief about traditions of research design needing no further consideration has blinkered their vision of sociological diversity, and allowed (caused?) them to come up with a rather narrow and frankly disappointing representation of basic readings in medical sociology. I now want to illustrate these two points of weakness by considering some of the contents of the volume. The volume is organised into ten parts, by and large in keeping with the organisation of Tuckett's earlier Introduction to Medical Sociology. It may well be the case that this particular way of organising the volume has something to do with the lack of sociological diversity of which I am complaining. But even within the section headings chosen by Tuckett and Kaufert which they acknowledge to be "convenient if somewhat arbitrary" -there is room for a
wider range of perspectives. Take for instance the first section "'Sociology as a science". It consists of four readings. Two of these are highly complementary--and hence remarkably similar--papers on family interviewing as a research tool (one by George Brown and Michael Rutter, the other by Christine Vaughn and Julian Left), while the other two papers are on the pros (by Morris Rosenberg) and cons (by Edward Suchman) of variable analysis. However important family interviewing and variable analysis may be to both past and contemporary medical sociology, they hardly represent the range of methodological perspectives used by medical sociologists in their pursuit of "sociology as a science". In particular, I found the absence of readings on the methodology of observational analysis, interactional analysis, discourse analysis, historical and comparative analysis (I'm quite sure the list could be extended) to be most notable and regrettable. By and large, the same can be said for the choice of readings in the other nine parts of the volume, though it must be said that the substantive areas with which medical sociologists concern themselves are somewhat better represented. The lack of sociological diversity in the volume is also reflected in Tuckett and Kaufert's failure (in my opinion) to demonstrate adequately the logic of "making a case for the inference". Since Tuckett and Kaufert explicitly refer to Brown and Rutter's reading as an exemplar of "work in which different interpretations of data can be thoroughly considered", and given that there are four (out of 30) readings from Brown's work in the volume, 1 want to address my comments on the logic of "making a case for the inference" to this approach. Firstly, it must be said that the Brown and Rutter paper on the use of family interview as a research tool is one of the most sophisticated and carefully argued papers from within the interviewing tradition. I was particularly impressed with the use of "master" tape recordings of interviews for the training of interviewers and for "arriving at common standards for rating of expressed feeling". But these are only two ways in which data collected by tape recordings can be used sociologically. The inference that Brown and his colleagues make about family life and schizophrenic disorders (in Reading 8) --i.e. that there is an unequivocal and independent association between expressed emotion in family life and relapse of schizophrenic symptoms and behaviour--is both interesting and plausible. But despite (or because of) Brown et al.'s rigour and detaildd attention to a number of variables, I came away from this work feeling that I know very little about the nature of expressed emotions as they are found within the context of the family life of people with diagnosed schizophrenic disorders, or about the ways in which these expressed emotions fit into the more general organisation of family life and discourse. Furthermore, l have no way of knowing about these aspects of family life given the way in which the data are presented, and hence I have no way of disputing, agreeing with or offering any other interpretations and inferences about them. Now for the purposes of this volume this is not, and cannot be, a criticism of Brown et al.'s work per se (though a presentation and analysis of some of their tape recorded family interview data would have strengthened their argument and allowed others to offer alternative interpretations and analyses). Rather, it is a criticism of Tuckett and Kaufert for selecting this work as the exemplar of "work in which different interpretations of data can be thoroughly considered", and for failing to include in the volume selections from other sorts of sociological work which could enhance this endeavour. There are some more general features of editing that disturb me in this volume. Most notable is the absence. of any introductory comments to the different sections of the book, It is true that this volume is a companion to Tuckett's earlier b o o k and that it was probably designed to be read as such. But apart from the fact that many
Book reviews readers might use this volume as a source book quite separate from the earlier text, and will therefore n o t have the benefit of its guiding principles, it must be remembered that the section headings are "convenient if somewhat arbitrary". As such, I feel that the editors have some obligation to inform the readers about the reasons for selecting particular readings, and for suggesting what it is that these particular readings are supposed to offer analytically. Furthermore, one of the hallmarks of good editing in a volume such as this is the ability to make links between materials within the volume and with materials that are published elsewhere. I found it disappointing, for instance, that Stanford B. Friedman et al.'s paper on Behavioural Observations on Parents Anticipatin 9 the Death of a Child (Reading 9) was not linked in some way to Fred Davis' paper on Uncertainty in Medical Diagnosis (Reading 17), since they both say something about illness behaviour and illness careers over and above their contributions to their respective section headings. Also, I feel that some suggestions for further reading would have been very helpful either at the end of each reading or at the end of each section. This would have made the volume a better resource for those readers coming to the field of medical sociology (for w h o m this volume is partly intended), and it might also have given the editors the opportunity of placing this selection of medical sociology readings within the wider range of sociological perspectives commented upon in the above.
373
Like most volumes of this kind Tuckett and Kaufert's Basic Readings in Medical Sociology has its share of "classics" (Brown et aL, Margot Jefferys, Fred Davis, T h o m a s Scheff, Irving Zola), those that are worth reading (the papers by Edward Suchman, Radke-Yarrow eta!., Cartwright and O'Brien, Michael Banks et al.) and those which would have benefited the volume had they been omitted (Rosengren and De Vault's paper, Ray Rosenman et al.'s study of coronary heart disease). There are also some excellent selections from authors who are not necessarily professional medical sociologists (Mayer a n d T i m m s ' paper, Joseph Epsom's paper on the mobile health clinic, and Egbert et al.'s study of post-operative pain are ones I have in mind), for which the editors must be applauded. Furthermore, I feel that this volume may be of some use to those who teach in medical schools and who wish to give medical students some idea about medicine as a Social phenomenon, But as for being a volume that displays "the direction, quality, scope and Utility" of medical sociology, and one that demonstrates adequately the logic of "making a case for the inference", I'm afraid that Basic Readin~ls in Medical Sociology does not foot the bill.
M R C Medical Sociology Unit Institute of Medical Sociology Aberdeen, Scotland
PHIL DAVIES