The historical sociology of medicine in India: Introduction to the special section.

This introduction to a special section brings together three papers first presented at a panel, 'Medical Professions in South Asia: Historical and Contemporary Analyses', at the 26th European Conference on South Asian Studies, held in Vienna, Austria and online, in July 2021. All three papers deal with aspects of the professionalisation of biomedical doctors in India since its independence in 1947. The authors bring together historical and sociological approaches to illuminate the growth of specialisms, patterns of practitioner-patient interactions and efforts to maintain occupational closure and maintain status in the face of growing challenges. The introduction concludes with a discussion of the relevance of these papers for the sociology of health and illness in India and beyond.

[Manfred Pflanz (1923-1980) - A key Protagonist for the Institutionalization of Social Medicine and Medical Sociology in Germany]. / Manfred Pflanz (1923­1980) ­ zentraler Akteur bei der Institutionalisierung von Sozialmedizin und Medizinsoziologie.

Manfred Pflanz, an internist with his focus on social medicine, medical sociology and epidemiology, (1923-1980) played a key role in the institutional integration of social science expertise into medicine in the Federal Republic of Germany during the 1960s and 70 s. The present study, a biographic sketch of Pflanz, describes his work, his programmatic ideas on social medicine and medical sociology, and his activities as an expert consultant in public health for various political entities. This should enable getting an insight into the origins and ramifications, as well as the contemporary programs and international embeddedness of the overlapping fields of social medicine and medical sociology in Germany.

[Sociological Research and Teaching in the Context of Medical Faculties - An Autobiographical Report]. / Soziologische Forschung und Lehre im Kontext medizinischer Fakultäten ­ Ein autobiographischer Rückblick.

With the introduction of medical psychology and medical sociology as examination subjects in the medical curriculum, as enacted by the year 1970 in Germany, medical faculties established professorships and departments for these disciplines. This raised the concern of how the two separate scientific cultures of the social and behavioural sciences and of medicine, rooted in basic sciences, could reconcile their teaching and research activities in a constructive way. It turned out that the quality and the thematic affinity of new research aligning with core medical interests were important preconditions of successful integration of the new disciplines. This paper exemplifies a respective success in case of a scientific development in medical sociology. Based on a theoretical model, a longstanding, internationally collaborating research program analysing social determinants of stress-related disorders resulted in a series of innovative insights. Furthermore, the paper illustrates close links between biographical luck and structural opportunities and constraints, and it emphasizes the important role of committed inter-disciplinary scientific collaboration.

Working it out: Will the improved management of leaky bodies in the workplace create a dialogue between medical sociology and disability studies?

This article focuses on the workplace as a significant site of convergence between the disciplines of medical sociology and disability studies. As disability remains on the margins of sociological exploration and theorising relating to health and work, disabled workers remain on the margins of the workforce, subject to disproportionate rates of unemployment, under employment and workplace mistreatment. The article focuses on the experiences of people with 'leaky bodies', focussing specifically on employees who experience troubling menstruation and/or have gynaecological health conditions. It brings together data from three studies conducted between 2017 and 2020; interviews with disabled academics (n = 75), university staff with gynaecological health conditions (n = 23), and key stakeholders in universities (n = 36) (including university executives, line managers and human resources staff). These studies had separate, but linked foci, on the inaccessibility of workplaces, managing gynaecological health conditions at work and supporting disabled people at work respectively. Drawing on the Social Relational Model of disability and theories of embodiment, we explore the experiences and management of workers with leaky bodies in UK University workplaces. Data illustrates how workplace practices undermine embodied experiences of workers with 'leaky' bodies by maintaining workplaces which ignore their material reality. We highlight that addressing embodied needs alongside acknowledging disabled people as an oppressed political category represents a theoretical meeting point for disability studies and medical sociology.

Can a disability studies-medical sociology rapprochement help re-value the work disabled people do within their rehabilitation?

This paper draws attention to the health-related work that disabled people do when engaging with rehabilitation services. Medical sociology has a rich history of looking at the 'illness work' that patients do, while disability studies scholars have explored the cultural value placed upon paid work and the effects on social status of being unable to work. Yet, a longstanding froideur between these two disciplines, which have fundamentally opposed ontologies of illness and disability, means that neither discipline has attended closely to the rehabilitation-related work that disabled people do. The concept of 'adjusting' to illness highlights seemingly irreconcilable disciplinary differences. Yet this article argues that the notion of 'adjustment work' can elucidate the socio-political character of the work disabled people do in their rehabilitation, which could create a more substantial and sustainable dialogue on this subject between disability studies and medical sociology. To make this case, we discuss interview data from the Rights-based Rehabilitation project, which sought to explore disabled people's lived experiences of rehabilitation.

Epistemic injustice as a bridge between medical sociology and disability studies.

This paper explores the potential of the perspective of epistemic injustice to reconcile medical sociology's attention to the micro level of experience and interpersonal exchange, and disability studies' focus on the macro level of oppressive structures. The first part of the paper provides an overview of the concept of epistemic injustice and its key instances-testimonial, hermeneutical, and contributory injustice. We also consider previous applications of the concept in the fields of health care and disability, and we contextualise our investigation by discussing key features of postsocialism from the perspective of epistemic injustice. In the second part, we explore specific epistemic injustices experienced by people who use disability support by drawing on interviews and focus groups conducted with parents of disabled children in present-day Bulgaria. In our conclusion, we revisit our methodological and theoretical points about the potential of epistemic injustice to facilitate mutually beneficial exchanges between medical sociology and disability studies.

Affect, dis/ability and the pandemic.

The pandemic has heightened anxieties, impacted mental health and threatened to create an overwhelming sense of existential dread. We recognise the material ways in which disabled people have been differentially impacted by Covid-19 and make a case for understanding the affective dimensions of the pandemic. We develop a theoretical approach - cutting across medical sociology and critical disability studies - that understands affect as a social, cultural, relational and psychopolitical phenomenon. We introduce a public engagement project that took place in March and April of 2020 that garnered blogspots from around the world to capture the pandemic's impact on the lives of disabled people. Our data analysis reveals three key affective themes: fragility, anxiety and affirmation. To understand the emotional impacts of Covid-19 upon the lives of disabled people we embed critical analyses of affect in the dual processes of disablism and ableism: the dis/ability complex. We conclude by considering how we might conceive of a post-pandemic recovery that places the health and well-being of disabled people at the centre of proceedings.

A legacy of silence: the intersections of medical sociology and disability studies.

Disability remains on the margins of the social sciences. Even where disability is foregrounded as a category of analysis, accounts regularly emerge in silos, with little interdisciplinary dialogue acknowledging the potential intersections and points of convergence. This discord is particularly acute within medical sociology and disability studies, yet there is mostly a legacy of silence about the relationship between the two disciplines. Drawing upon data from a qualitative study with parents of disabled children in the UK, I show the value of meshing ideas and tropes from medical sociology and disability studies to make sense of parents' lived experiences. They described the challenges of living with 'impairment' and a need to readjust expectations. At the same time, parents were keen to not align with a deficit framing of their lives. They talked in affirmative terms about their children as sources of joy and vitality, perceived themselves as 'normal', and described convivial, even unremarkable, interactions in public spaces. Yet, parents encountered difficulties when navigating institutional settings and bureaucratic arrangements, or what was commonly referred to as 'the system'. Their troubles were not located in their children's bodies, but in-as per a disability studies sensibility-cultural and structural systems preventing their capacity to live well I argue that both disability studies and medical sociology offer something to the analysis, thereby recognising the gains of not simply buying into the tradition of one worldview. I conclude by imploring for more concrete conversations between both disciplines.

Frailty as biographical disruption.

Biographical disruption positions the onset of chronic illness as a major life disruption in which changes to body, self and resources occur (Sociology of Health & Illness, 4, 1982, 167-182). The concept has been used widely in medical sociology. It has also been subject to critique and development by numerous scholars. In this paper, we build on recent developments of the concept, particularly those taking a phenomenological approach, to argue that it can also help in understanding other disruptive health-related experiences across the life course, in this case the onset of frailty. We draw on the findings of 30 situated interviews with frail older people, relating their experiences of frailty to the concept of biographical disruption. We show that frailty shares many similarities with the experience of chronic illness. Using the lens of biographical disruption to understand frailty also offers insights relevant to recent debates around both concepts, and on the continued relevance of the idea of biographical disruption given changing experiences of health and illness, including the circumstances in which biographical disruption is more and less likely to be experienced. Finally, we reflect on the potentials and limitations of applying the concept to a health-related condition that cannot be categorised as a disease.

When biographical disruption meets HIV exceptionalism: Reshaping illness identities in the shadow of criminalization.

Drawing on interviews with civil society actors in the AIDS Service Organization (ASO) sector in Canada, this article explores how these actors contribute to shaping the illness identities of people living with HIV/AIDS in the shadow of efforts to criminalize exposure to HIV. While the biographically disruptive qualities associated with an HIV diagnosis have been addressed in the medical sociology literature, we turn our attention to the key role played by ASOs as interlocutors in this process. Paying specific attention to the intersection of processes of medicalization and criminalization, we ask how they are re-stigmatizing a condition that has shifted in the public consciousness from its earlier association with deviance and moral culpability. One important implication of our findings concerns the need to take greater account of how the illness identity and experience can be shaped by a 'biography of telling', of a renewed pressure to disclose intimate details of one's health status as a way to perform responsible practices of citizenship.

Conflicting experiences of health and habitus in a poor urban neighbourhood: A Bourdieusian ethnography.

An ethnographic study of health and wellbeing was undertaken in a deprived urban neighbourhood in the UK Midlands. Drawing on Bourdieu's concepts of habitus, capital and field, we discerned three different, even conflicting, ways of understanding and acting on health: (i) older adults discussed their wellbeing in relation to the local context or field, walking the dog, helping at the community centre and visiting the off licence, (ii) young professionals and students who lived in the neighbourhood were oriented towards leisure facilities, career opportunities and supermarkets outside of the neighbourhood, disdaining local facilities and (iii) community activists and carers discussed health in terms of providing for others but not themselves. Bourdieu is frequently used in medical sociology to highlight how poor people's lifestyle is constrained by their habitus; we suggest paying more attention to its both enabling and differentiating contradictions as well as the constraints it entails. Empirically and in terms of health promotion findings suggest that supposedly healthy activities, such as going to the gym, may also be a means of rejecting the local community; similarly, older people's pottering about in the neighbourhood, which is not usually recognised as a healthy activity, may enhance wellbeing in this context.

[The Importance of Different Topics in Medical Psychology/Sociology from Physicians' and Medical Students' View: Similarities and Differences]. / Die Bedeutung medizinpsychologischer/soziologischer Themen für ÄrztInnen und Medizinstudierende: Gemeinsamkeiten und Unterschiede.

BACKGROUND: The subject of "Medical Psychology/Sociology" is facing various content changes as a result of the currently pending study reforms within the framework of the "Master Plan Medical Studies 2020". These include the further development of the catalogues of exam-relevant topics (GK) and the National Competence-Based Learning Objectives Catalogue for Undergraduate Medical Education (NKLM) as well as the Medical Licensing Regulations (ÄApprO). In this context, the question arises as to which training contents of "medical psychology/sociology", that medical students are confronted with, are of particular importance for their future medical work. METHODS: 332 physicians and 265 students evaluated different contents of the catalogue of exam-relevant topics of medical psychology/sociology (GK-MPS) according to their importance regarding their education or respectively their daily work. In addition, the physicians indicated in free text fields of the questionnaire which situations in their daily work they would have liked to have been better prepared for during medical school. In a combined quantitative-qualitative analysis approach, differences between the 2 groups were identified by t-tests for independent samples with unequal variances (Welch test) and free text information was assigned to the various topics of the GK-MPS and evaluated in terms of content by 3 raters within the framework of a qualitatively oriented category-based text analysis. RESULTS: Both physicians and students considered those topics of the GK-MPS, that involve communication between physician and patient, to be the most important. In addition, physicians rated the topics of physician-patient communication, statistics and prevention as more important than the students did. The physicians would have liked to have been better prepared for special and challenging medical situations in physician-patient interaction. DISCUSSION: The topics of physician-patient communication are still considered to be of particular importance for the medical training of physicians and students, but physicians consider them to be more important than students. CONCLUSION: The study results support the current study reforms towards a stronger emphasis on physician-patient communication and scientific basics as well as the linking of pre-clinical and clinical study contents.

Human Flourishing and Population Health: Meaning, Measurement, and Implications.

Human flourishing has recently emerged as a construct of interest in clinical and population-health studies. Its origins as a focus of research are rooted in philosophical writing dating to Aristotle's concept of eudaimonia, in the work of contemporary psychologists, and in studies by epidemiologists, physicians, and social and behavioral scientists who have investigated religious influences on physical and mental health since the 1980s. Inasmuch as human flourishing has been characterized as multidimensional or multifaceted, with hypothetically broad antecedents and significant outcomes, it may be an especially valuable construct for researchers. For one, it would seem to tap something deeper and more meaningful than the superficial single-item measures that often characterize such studies. This article surveys the rich history of the concept of human flourishing in its multiple meanings and contexts across disciplines, proposes a conceptual model for assessing the construct, and lays out an agenda for clinical and population-health research.

Revisiting the pharmaceuticalisation of pandemic influenza using Lukes' framework of power.

The power of social actors to drive or block pharmaceutical uptake has been a concern in sociological debates on pharmaceuticalisation, including in the case of pandemic vaccination. We build on Steven Lukes' three-dimensional view of power to explore the 2009 H1N1 pandemic vaccination in Sweden and Denmark - two similar countries that arrived at conflicting vaccination strategies. Drawing on interviews with members of each country's pandemic steering group and on document analysis, we explore three consecutive stages of pandemic vaccination response: planning, vaccine procurement and the vaccination campaign. The paper makes two contributions to studies of pharmaceuticalisation and pandemics. Conceptually, we advocate the suitability of Lukes' framework over the 'countervailing powers' framework repeatedly used to model power in the pharmaceutical field. Empirically, our study confirms that government-appointed experts steered pandemic planning in both countries, but we show that the state, industry and the WHO also exerted power by enabling and constraining experts' decision-making, including by keeping some information secret. Furthermore, we argue that mass vaccination in Sweden was a pervasive expression of state power, in Lukes' sense, since it rested on keeping latent the tension between many individuals' health interests and the state's interests in protecting social and economic functioning.

[Medical Psychology and Medical Sociology in Transition - Review and Perspectives of the two Disciplines in Germany]. / Medizinische Psychologie und Medizinische Soziologie im Wandel ­ Bestandsaufnahme und Perspektiven der beiden Fächer in Deutschland.

AIM OF THE STUDY: Through the Master Plan for Medical Studies 2020 and the development of the National Competence-Based Learning Target Catalogue Medicine (NKLM), significant changes in university medicine were started. The aim of the study was a systematic analysis of the state and perspectives of the disciplines of medical psychology and sociology at the medical faculties in Germany. METHODOLOGY: An online survey was conducted on 5 topics (structure, teaching, research, care, perspectives). 46 departments and institutes of medical psychology and sociology were invited to the survey. RESULTS: 40 of the 46 contacted institutions have called up the online questionnaire, 35 have answered in full (return: 76.1%). 77% of the institutions are autonomous. In the median, the institutions have 15 employees (range: 1 to 149). 9 universities have established a model curriculum. More than half of the institutions use and train simulation patients. The main research priorities are clinical research, health care research, neuroscience and classical medical psychology or sociological research topics. The institutions receive primarily public funding and publish 19 publications (80% international, median) each year. Publication opportunities are considered "satisfactory" by 54% of institutions (2003: 44%), and by 29% as "very satisfactory" (2003: 21%). 9 out of 27 medical psychology institutes provide clinical services to patients and relatives with mental or chronic physical illness. Almost half of the institutions expect the Master Plan 2020 to further increase the relevance of the subjects. DISCUSSION: Since 2003 there has been a substantial increase in scientific staff, third-party funding and publications. The sites show a pronounced heterogeneity in terms of size and equipment, which leads to an imbalance in terms of teaching and research as well as clinical services. CONCLUSION: The subjects of medical psychology and medical sociology have developed very heterogeneously in terms of independence, size, equipment and possibilities at the various faculties in Germany. Therefore, it is very important in the future that the 2 disciplines intensify the dialogue with each other and also with other psychosocial disciplines in order to influence the current development regarding NKLM and Master Plan 2020 constructively. On the one hand, this calls for an expansion of disadvantaged institutions and a consolidation of the existing autonomous institutions.

Ethics as ritual: smoothing over moments of dislocation in biomedicine.

Applications of biomedical R&D currently imply substantial societal concerns. This paper explores, based on semi-structured interviews with scientists in Norway, how biomedical researchers experience and tackle such concerns in their daily work. It shows how ritualised routine responses to dislocatory moments help maintain order in the daily work of the interviewed scientists; they do not address directly but instead smooth over concerns by a ritualised way of using ethics. This may foreclose substantive reflection and function as a stabiliser for 'business as usual'. Overall, the current way of responding to concerns as described by the interviewees may contribute to a depoliticisation of important issues. The paper contributes to sociological work on ethics by linking it to recent discussions on Responsible Research and Innovation (RRI) and by the empirical research presented. The insights can also help improve science policies such as RRI.

Gestating bodies: sensing foetal movement in first-time pregnancy.

A large body of literature engages with personal accounts of pregnancy to illustrate the subjugation of women's embodied experience by practices of biomedicine. This article explores this issue through women's accounts of sensing initial foetal movement, drawn from qualitative interviews with 15 women resident in the UK. Participants depict this aspect of pregnant embodiment as ambiguous and indefinite, in contrast to clinical and popular representations of foetal movement. In highlighting the uncertainties characteristic of this corporeal event, the article adds to literature destabilising understandings of pregnant women's and foetal bodies as bounded and distinct. Ambiguous experiences of foetal movement arise in the context of sociocultural framings of pregnancy as 'at risk', and in turn, may be seen to contribute to these representations, with some participants articulating that uncertain sensations could provoke anxiety. In this article, perceptions of foetal movement are emphasised as valuable to women, and as inextricable from the social settings in which they emerge. This research has implications for sociological and feminist discussions of pregnancy, and work exploring the mutual shaping of corporeality and sociocultural contexts more widely.

Exploring the neglected and hidden dimensions of large-scale healthcare change.

Forms of large-scale change, such as the regiona l re-distribution of clinical services, are an enduring reform orthodoxy in health systems of high-income countries. The topic is of relevance and importance to medical sociology because of the way that large-scale change significantly disrupts and transforms therapeutic landscapes, relationships and practices. In this paper we review the literature on large-scale change. We find that the literature is dominated by competing forms of knowledge, such as health services research, and show how sociology can contribute new and critical perspectives and insights on what is for many people a troubling issue.

The brain as an agentic system: how the brain is articulated in the field of neuroenhancement.

This article analyses the material of a European Project on Responsible Research and Innovation in Neuroenhancement (NERRI) to explore how the brain is articulated in this field. Since brains are closely connected to ideas of self, responsibility, free will and being human, and since brain metaphors have important effects on research practices and perspectives, it also matters how people talk about and use the brain. In the NERRI project, the brain is articulated as an agent interacting with or substituting the self; as a system that can, cannot or should not be analysed; and as the part of oneself that can potentially change human nature in positive and negative ways. Since most of the material analysed was produced by neuroscientists or other neuroenhancement experts, this article emphasises the responsibility of the experts in this process. By showing what brain images are disseminated within the field of neuroenhancement, and analysing how this depiction is related to ideas of self or being human, this article does not only intend to contribute to a more empirically based and societally relevant neuroenhancement debate, but also to a more realistic and societally relevant idea of the brain.

Altruism, solidarity and affect in live kidney donation and breastmilk sharing.

Social scientists have recently diverged from mainstream bioethical discussion on the topic of the medical use of human biological materials for therapeutic, reproductive and research purposes. Rather than justifying the donation and provision of biological materials solely in terms of alleviating physical, psychological and social suffering, saving or enhancing life, and advancing biomedical knowledge, this work looks beyond humanist bioethics to take a social justice approach to questions of the life sciences. In this article, I draw insight from these accounts to propose an approach to the sociology of live kidney and breastmilk donation that is situated at the interface of the new sociology of morality and affect studies. To do so, I examine the moral economy of tissue provision with respect to its organisation around the discourse of altruism and the gift. I then turn to recent work on tissue economies, which are in the business of creating and producing biovalue, to discuss the manipulation of affect and the entanglement of new forms of bio-intimacy in the production and reproduction of somatic life. The aim of the article was to contribute to the study of the sociology of donation as a substantive field of specialisation within sociology.