Elsevier

Social Science & Medicine

Volume 73, Issue 6, September 2011, Pages 793-800
Social Science & Medicine

Introduction
Towards a sociology of diagnosis: Reflections and opportunities

https://doi.org/10.1016/j.socscimed.2011.07.014Get rights and content

Introduction

In 1978 Mildred Blaxter declared in the pages of Social Science & Medicine that: ‘The activity known as “diagnosis” is central to the practice of medicine but is studied less than its importance warrants’ (p. 9). Thirty-one years later, she published a moving autobiographical article in the journal Sociology of Health and Illness recounting her own diagnosis of cancer (Blaxter, 2009). What is striking about this article, “The Case of the Vanishing Patient” is first the sociological impact which she assigned to diagnosis and second, the ways in which she has woven sociological theories through her data to make sense of her personal diagnostic process. She draws upon science and technology studies (STS), cultural sociology, illness narratives, sociology of professions, relations between practitioners and patients, the sociology of knowledge and finishes by offering analytic insight of and pragmatic implications for health care delivery. Diagnosis, she demonstrates, serves as a prism which absorbs and reflects a panoply of issues central to the experience and practice of medicine and health care. It also evokes collective responses, as Robert Aronowitz (1991) has written, providing an insight into the society in which diagnoses occur.

The sociological study of diagnosis both requires, and can contribute to, a diversity of sociological methods and theories, making the development of a sociology of diagnosis as a discrete field of study a viable exercise. The raison d’être for this Special Issue is to demonstrate the merits of such a sub-discipline by bringing together a collection of empirical pieces confirming this topic as an innovative vein of research and nudging forward the research agendas that it generates. In so doing, we build on a few isolated claims that a sociology of diagnosis can form a concrete body of work and can both deploy, and contribute to, the sociological understandings of health, illness and health care.

Section snippets

Calls for a sociology of diagnosis

Nearly two decades on from Blaxter’s plea that sociologists should pay more attention to medical diagnosis, Phil Brown (1995) emitted a similar call. It was he who first used the term ‘a sociology of diagnosis,’ and argued that it should form a central strand of medical sociology’s endeavour to articulate the social construction of health, illness and perhaps most crucially disease (more on his current views later in this article). Although the paper itself was influential, any attempt to forge

Diagnosis – an absent presence

We can re-read the literature in the sociology of health and illness and see that diagnosis has not been neglected, and certainly studies of diagnosis as a social process are clearly present. Similarly the contestation and consequences of disease classification are evident. One could argue that diagnosis has had an absent presence in the sociology of health and illness. It figures in a number of important debates and literatures within the field, most obviously in the history of medicine,

What is diagnosis?

At its most basic, a medical diagnosis is both a category and a process (Blaxter, 1978). A medical diagnosis is perhaps most readily recognized as the official label that classifies disease or a medically-related problem. Clinical practitioners are able to draw upon a range of nosologies, taxonomies and other authoritative classification systems for diagnostic guidance. The International Statistical Classification of Disease, Injuries and Causes of Death (ICD) the Diagnostic and Statistical

Diagnosis as category

While medical classification of the 18th century rested on symptom-based taxonomies, wherein there was a correspondence between the symptom and the disease; and the medical classification of the 19th century determined that diseases were based on observable pathological lesions; 20th century classifications became increasingly fuzzy. Blaxter’s (1978) paper took the case of alcoholism to demonstrate this problematic. It was an example of the vogue to reinsert the person in to the patient’s body.

Diagnosis as process

The activity of diagnosis is the result of negotiation, multiple investigations, and trial and error. As we have noted above, diagnostic tests may be out of kilter with the observation of clinicians, just as those observations may fail to align with the experience of the individual, or the views of a second clinician. Reading and interpreting the patient’s body is a complex business. How practitioners reconcile seemingly incompatible findings is demonstrated elegantly by John Gardner and his

Consequence

The final set of papers in this Special Issue considers how diagnosis—as well as the way in which it is organised, structured and delivered—results in consequences for those to whom the diagnosis applies. These papers focus on the consequences for patients and carers. They also reveal the contrasting implications of the absence and conversely, presence, of contested diagnoses. There are paradoxes inherent in medical diagnosis. A diagnosis can vindicate and blame, can legitimise or stigmatise,

Towards a sociology of diagnosis: issues and agendas

What this collection of articles presents is, we hope, a valuable insight about the social framing and consequences of diagnosis within Western medicine. But it is far from the last word. The assembly of these papers punctuates additional layers and complexities of this topic. If we see diagnosis as medicine’s classification tool, and if the power of classification is, as David Armstrong writes in this volume to both define and limit analytic possibilities then we can hardly group the contents

References (72)

  • J. Gardner et al.

    Patchwork diagnoses: The production of coherence, uncertainty, and manageable bodies

    Social Science & Medicine

    (2011)
  • M. Halpin

    Diagnosis, psychiatry and neurology: the case of Huntington disease

    Social Science & Medicine

    (2011)
  • A. Jutel

    The emergence of overweight as a disease category: measuring up normality

    Social Science & Medicine

    (2006)
  • S. Lee et al.

    The medicalization of compulsive buying

    Social Science & Medicine

    (2004)
  • S. Olafsdottir et al.

    Constructing illness: how the public in eight Western nations respond to a clinical description of "schizophrenia"

    Social Science & Medicine

    (2011)
  • R.E. Olson

    Managing hope, denial or temporal anomie? Informal cancer carers' accounts of spouses' cancer diagnoses

    Social Science & Medicine

    (2011)
  • L. Prior et al.

    Talking about colds and flu: the lay diagnosis of two common illnesses among older British people

    Social Science & Medicine

    (2011)
  • C.I. Salter et al.

    Risk, significance and biomedicalisation of a new population: older women's experience of osteoporosis screening

    Social Science & Medicine

    (2011)
  • K.S. Schaepe

    Bad news and first impressions: patient and family caregiver accounts of learning the cancer diagnosis

    Social Science & Medicine

    (2011)
  • C. Schubert

    Making sure. A comparative micro-analysis of diagnostic instruments in medical practice

    Social Science & Medicine

    (2011)
  • I. Singh

    A disorder of anger and aggression: children's perspectives on attention deficit/hyperactivity disorder in the UK

    Social Science & Medicine

    (2011)
  • C. Trundle

    Bio-political endpoints: diagnosing a deserving British nuclear test veteran

    Social Science & Medicine

    (2011)
  • C. Willig

    Cancer diagnosis as discursive capture: phenomenological repercussions of being positioned within dominant constructions of cancer

    Social Science & Medicine

    (2011)
  • S. Zavestoski et al.

    Patient activism and the struggle for diagnosis: Gulf War illnesses and other medically unexplained physical symptoms in the US

    Social Science & Medicine

    (2004)
  • H. Arksey

    RSI and the experts: The construction of medical knowledge

    (1998)
  • T. Arnold

    On the divisions and mutual relations of knowledge: A lecture read before the Rugby Literary and Scientific Society, April 7, 1835

    (1839)
  • R. Aronowitz

    When do symptoms become a disease?

    Annals of Internal Medicine

    (2001)
  • R.A. Aronowitz

    Lyme disease: the social construction of a new disease and its social consequences

    The Milbank Quarterly

    (1991)
  • P. Atkinson

    Medical talk and medical work

    (1995)
  • M. Balint

    The doctor, his patient and the illness

    (1964)
  • M. Blaxter

    The Case of the Vanishing Patient? Image and experience

    Sociology of Health & Illness

    (2009)
  • M. Bloor

    The South Wales Miners Federation, Miners’ lung and the instrumental use of expertise, 1900–1950

    Social Studies of Science

    (2000)
  • G.C. Bowker et al.

    Sorting things out: Classification and its consequences

    (1999)
  • P. Brown

    Naming and framing: the social construction of diagnosis and illness

    Journal of Health and Social Behavior, Health Module

    (1995)
  • P. Brown et al.

    A gulf of difference: disputes over Gulf War-related illnesses

    Journal of Health and Social Behavior

    (2001)
  • M.R. Bury

    Chronic Illness as biographical disruption

    Sociology of Health and Illness

    (1982)
  • Cited by (0)

    View full text