IntroductionTowards a sociology of diagnosis: Reflections and opportunities
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
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