The relevance of medical sociology to psychiatry: a historical view.

Collaboration between sociology and psychiatry is traced to the 1920s when, stimulated by Harry Stack Sullivan and Adolph Meyer, the relationship was activated by common theoretical and research interests. Immediately after World War II, this became a true partnership, stimulated by the National Institute of Mental Health, the Group for the Advancement of Psychiatry, and the growing influence of psychoanalytic theory. The effects of a sociology that focused on issues of health and illness proceeded to grow in medical education, research, and the treatment of mental illness until 1980, when a distinct shift of emphasis in psychiatry occurred. In its role as educator of future physicians, postwar psychiatry developed a paradigm of biopsychosocial behavior but, after 3 decades, changed to a biopharmacological model. The definition of mental illness as a deviant extreme in developmental and interpersonal characteristics lost favor to nosological diagnoses of discrete or dichotomous models. Under a variety of intellectual, socioeconomic, and political pressures, psychiatry reduced its interest in and relationship with sociology, replacing it in part with bioethics and economics. In this article, the detailed underpinnings of these changes are described and interpreted.

Professionalism in the practice of medicine.

Although medicine is universally recognized as the archetype of the professions, it can only be understood as part of the modern medical center, a dynamic social system consisting of the university, the hospital, the medical center and, most recently, corporate managed care. Such a view results in a portrait of medicine as a profession transformed, driven by huge and growing health care markets, its fate tied not only to state bureaucracies, but also to the dynamics of both health and non-health care businesses. The question asked here is how does such a radical change in medical practice affect medical education. Using methods of historical analysis, it appears that medical educators operate as though the educational process itself determines the values, and therefore the present and future behavior of their students. In other words, at the end of their formal education, doctors are fully formed professionals. However, from the analysis of this paper it can be concluded that the physician as an individual cannot function independently of the structure of the society and its general conception of the world. In the structure of medicine s present situation, the ethical standards of professionalism, as they are classically defined, cannot survive. Instead, modern medical graduates, much like their teachers and professional mentors, will be forced to adapt to a situation that is contradictory to the best traditions of medicine. How to stop this process is the urgent question. Three answers are presented.