DISEÑO Y CÁLCULO DEL ANILLO 7

A comparison of the three major theoretical paradigms in sociology is provided in table 2.1. Sociologists use these theoretical perspectives as the basic tools for analyzing social issues. The sociologist’s perspective shows their as-sumptions about how the world works and how change occurs. It will guide the questions the researcher asks and, in many ways, solutions to any problems that are identified.

Table 2.1

Comparison of Major Sociological Paradigms

Drawing on the example of changing medical paradigms noted early in this chapter, a look at how sociologists apply their perspectives to medicine il-lustrates the different questions and criticisms each of these three paradigms raises. Looking at how these perspectives apply to medicine also demonstrates the complexity of the social issues that sociologists address.

Structural-Functionalist Perspective on Health Care

From a functionalist perspective, medicine is one of the interdependent parts of the social system that helps to maintain the stability of the system as a whole. According to Talcott Parsons (1951), who contributed to many early so-ciological studies of medicine, the function of the health-care system is to en-able people to be healthy enough to do all the things they need to do to keep society functioning (Shilling 2002). They can contribute to society by being healthy workers, parents, consumers, and all the other things that healthy people do. In this view, people should want to be well. When they become ill, they should seek care from medical professionals and follow their guidance to get well. Doctors should use the skill and power derived from their training and ex-pertise to direct the behavior of patients and cure illness. “Good” patients seek medical care and follow doctor’s orders. “Good” doctors direct and help their pa-tients to follow their guidance. A sociologist studying health care from a func-tionalist perspective might be interested in how, for example, public health officials can increase rates of people getting flu shots. Solutions to any problems identified would likely focus on adjusting the workings of the system.

Critics argue that the functionalist perspective on medicine applies only to some conditions and some people. For example, it does apply to acute illness such as the measles or the common cold. However, it does not adequately ad-dress chronic illness. Current medical capabilities might slow the decline or sta-bilize the condition of people with diseases such as heart disease, arthritis, or Alzheimer’s disease, without the current ability to cure them. Thus, the perspec-tive does not fit reality. No matter how much people try to get well or how much their doctors try to make them well, that outcome will not occur.

Critics also charge that the health-care system does not function opti-mally because of the profit motive that is sometimes at odds with the function of providing health care. Some people want to get well but cannot afford the things that are most likely to make that happen. Expensive or experimental technolo-gies are not available to all who might benefit from them. The functionalist view also encourages the medical professional to be in charge of treatment, leading some critics to argue that it does not adequately support the growing interest and knowledge of patients who want to take an active role with their physician in di-recting their own health care.

Social-Conflict Perspective on Health Care

A conflict perspective on health care focuses on issues involving in-equality and tension within the health-care system. Conflict theorists would not

deny that modern health care can help people in maintaining or restoring their health. However, a sociologist looking at medicine from this perspective would identify a number of inequities that exist within the system. In studying medicine, they would ask the common social-conflict question “Who benefits?,” looking at such things as what groups hold power within the system and competing inter-ests. For example, one issue on which conflict theorists have focused a great deal of attention is the role of capitalism in health care (e.g., Navarro 1993, 2000).

They identify problems within the system that are related to these inequalities, such as the number of uninsured in America and the lack of physicians in poverty-ridden areas. The power relations within and among various countries also im-pacts health and life quality across the globe (patterns of poverty and disease, the high rate of AIDS in Africa and the relative unavailability of AIDS drugs there, etc.). Feminists might call attention to the frequent lack of inclusion of women in clinical trials for various treatments or the way that the largely male medical es-tablishment took obstetrical care out of the hands of women (Oakley 1984). So-lutions would likely focus on eliminating inequalities.

Critics of the conflict paradigm often argue that it takes a negative view of the system, citing, for example, works such as Ivan Illich’s book Medical Nemesis (1976). Illich argued that the medical establishment is more interested in perpetuating its own self-interest than curing patients. Conflict theorists are also criticized for discounting the many important advances in improving levels of health and life expectancy in recent decades as well as the contributions that med-ical technologies have had on our quality of life. For example, technologies such magnetic resonance imaging (MRI), although expensive and not accessible to all who could benefit, have had major impacts of the health of many people.

Symbolic-Interactionist Perspective on Health Care

Symbolic interactionists take a micro look at health care. Rather than focusing on the structure of the larger system or its interrelationships with other parts of society, these sociologists look at how people experience the health-care system. For example, they study the experiences of people who have ill-nesses such as AIDS that are associated with negative perceptions of the sick person (e.g., Tewksbury and McGaughey 1997). They study issues such as self-image and personal interactions of the disabled (e.g., Zola 1982). They focus on relationships between patients and physicians such as how they interact, what they discuss, who leads that discussion, whether physicians address all of their patients’ concerns or only select ones, and the outcomes of these interac-tions for the patient. Soluinterac-tions to any problems identified would focus at these individual levels.

Critics sometimes argue that this approach gives too much attention to individual situations rather than situations that are generalizable to others. That means symbolic interactionists have to focus on how much the individual inter-actions they study really reflect interinter-actions of other people, not just that one in-teraction. Critics also charge that symbolic interactionists studying health issues

ignore the larger social forces at work shaping health (poverty, racism, politics, etc.).

As this example shows, no one perspective can fully explain all the so-cial aspects of medicine. Each reveals important information and different ques-tions and soluques-tions. Applying these three perspectives to medicine allows the sociologist to look at the structure of medical care (functionalism), any issues of power or tension (conflict), and collective definitions of the situation (interpre-tive). Taking into account the many ways that sociologists study medicine allows a more comprehensive understanding of the complexities and issues involved.

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