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Available online 12 June 2011
In the past two decades, research on the sociology of diagnosis has attained considerable inuence
within medical sociology. Analyzing the process and factors that contribute to making a diagnosis amidst
uncertainty and contestation, as well as the diagnostic encounter itself, are topics rich for sociological
investigation. This paper provides a reformulation of the sociology of diagnosis by proposing the concept
of social diagnosis which helps us recognize the interplay between larger social structures and individual or community illness manifestations. By outlining a conceptual frame, exploring how social
scientists, medical professionals and laypeople contribute to social diagnosis, and providing a case study
of how the North American Mohawk Akwesasne reservation dealt with rising obesity prevalence to
further illustrate the social diagnosis idea, we embark on developing a cohesive and updated framework
for a sociology of diagnosis. This approach is useful not just for sociological research, but has direct
implications for the elds of medicine and public health. Approaching diagnosis from this integrated
perspective potentially provides a broader context for practitioners and researchers to understand extramedical factors, which in turn has consequences for patient care and health outcomes.
2011 Elsevier Ltd. All rights reserved.
Keywords:
Diagnosis
Risk
Social movements
Environment
Public health
USA
Canada
Reservations
Introduction
Sociological analysis of diagnosis has achieved considerable
inuence in the last two decades, providing important insight into
how we understand health, disease, and illness. It has also
expanded how we view the social and cultural inuences that
shape our knowledge and practice on health and illness.
This includes studies of diagnosis that have gone beyond the
interaction between physician and patient, to take into account the
larger social, structural, and temporal forces that shape diagnosis
(see, for example, the categorization of homosexuality as a mental
disorder and the role of gay rights activists in the American
Psychiatric Associations deliberations) (Cooksey & Brown, 1998).
Recently we have also seen the emergence of diseases whose
etiologies, symptoms, and, therefore, diagnoses, are often contested
or uncertain. This combination of medical and social uncertainty
leads us to propose a reformulation of the concept social diagnosis as
a new way of thinking about the sociology of diagnosis. This paper
explores social diagnosis by rst, outlining a conceptual framework
of social diagnosis; second, discussing the different actors who
contribute to social diagnoses; and third, providing a case study of
* Corresponding author.
E-mail address: Phil_Brown@brown.edu (P. Brown).
0277-9536/$ e see front matter 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.socscimed.2011.05.031
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social body and the body politic. As Hoover points out, in addition to
losing the nutrition from shing and gardening, people also lost the
physical and cultural activity involved in that food production. This
led to fewer burned calories, affecting the individual body, but also to
broader losses affecting the social body e the failure to connect with
ancestral ways and to pass traditions onto youth. Eating is an
important social experience, and the sharing of food is an integral
part of Mohawk culture, full of morals around cooperation and
proper behavior. This larger unity of the body politic is especially
important at present, when the community is less united due to
overlapping tribal, US, and Canadian governing bodies. Akwesasne
environmental health activists used their mobilization around
contamination as a way to achieve general social unication and
harmony. When people seek to take control of individual and social
levels of obesogenic and diabetogenic conditions, this crisis that
originates in massive contamination has the capacity to provide new
unity.
In effect, we see that what might appear as a straightforward
diagnosis of a metabolic disease is in fact much more complex.
Hoovers analysis of the social diagnosis of this condition builds on
the community-based participatory research by the laypeople and
traditional healers of Akwesasne, in alliance with university
scholars and environmental health scientists, and implicates individual, social and cultural, and body-politic disease contributors.
Such analysis informs us that by the time it reaches the body politic,
biological disease goes to the core of the social fabric, and warrants
an overall restructuring of power, capacity, and community.
Further, we see that struggles over diagnosis are simultaneously
struggles over causation. In this light, we can understand the multitemporality of diagnosis: it is not only about the present, where
people seek knowledge about the symptoms they experience. It is
also about the past, whereby people seek the causes of problems
that led to a current diagnosis. As well, it is about the future, where
the medical and social sequelae of the diagnosis reside along with
the treatment and prognosis.
Conclusion
Studying diagnosis provides a window into many components
of health and illness, and presents an organizing conguration and
master frame. Our expansion into understanding and elaborating
on social diagnosis makes this broader framework more applicable
to an even greater number of research arenas. The act of diagnosing
an illness is important on multiple levels. It is about an individuals
relationship to the illness or act of diagnosis, the collectivity of
people who suffer from an illness, and the larger social structures
that inuence the illness and its diagnosis. In other words, it is
about locating an individual and a group in relation to key social
structures.
In this paper, we have sought to understand the unique context
in which social diagnoses are formedda sociology of social diagnosis. To reiterate, social diagnosis is social in that it considers both
larger social structures, as well as the various social actors which
contribute to the diagnosis. In other words, a broad range of social
factors goes into the making of a diagnosis, which is carried out by
a myriad of social actors. The diagnosing of individuals can allow for
the broader diagnosis of a group of illness sufferers, and an even
broader diagnosing of communities, as the Akwesasne example
clearly illustrates. From here, we have drawn ve key lessons which
will not provide a one-size-ts-all framework, but will help pragmatically identify the role social diagnosis can play across many
different situations and among different constellations of actors:
1) Social diagnosis moves beyond individual-level explanations
for health outcomes;
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Hoover, E. (2010). Local food production and community illness narratives: responses
to environmental contamination in the Mohawk community of Akwesasne. PhD
Dissertation: Anthropology Department. Providence: Brown University.
Kawachi, I., Kennedy, B., & Wilkinson, R. (Eds.). (1999). The society and population
health reader: Income inequality and health. New York: The New Press.
Klinenberg, E. (2002). Heat wave: A social autopsy of disaster in Chicago. Chicago: The
University of Chicago Press.
Krimsky, S. (2002). Hormonal chaos: The scientic and social origins of the
environmental endocrine hypothesis. Baltimore: Johns Hopkins University Press.
LaVeist, T. (Ed.). (2002). Race, ethnicity, and health: A public health reader. New York:
Jossey-Bass.
Lefkowitz, B. (2007). Community health center: A movement and the people who made
it happen. Piscataway, NJ: Rutgers University Press.
Maskin, A., Cailteux, K. L., & McLaren, J. M. (2001). Medical monitoring: a viable
remedy for deserving plaintiffs or tort laws most expensive consolation prize?
Specialty Law Digest: Health Care Law, 272, 9e38.
Morello-Frosch, R., Zavestoski, S., Brown, P., Altman, R. G., McCormick, S., &
Mayer, B. (2006). Embodied health movements: Responses to a scientized
world. In K. Moore, & S. Frickel (Eds.), The new political sociology of science:
Institutions, networks, and power. Madison, WI: University of Wisconsin Press.
Navarro, V. (1976). Medicine under capitalism. New York: Prodist.
Newbold, R. R., Padilla-Banks, E., Snyder, R. J., Phillips, T. M., & Jefferson, W. N.
(2007). Developmental exposure to endocrine disruptors and the obesity
epidemic. Reproductive Toxicology, 23(3), 290e296.
Richmond, M. E. (1917). Social diagnosis. New York: Russell Sage Foundation.
Scheper-Hughes, N., & Lock, M. (1987). The mindful body: a prolegomenon to future
work in medical anthropology. Medical Anthropology Quarterly, 1(1), 6e41, New
Series.
Waitzkin, H. (2000). The second sickness: Contradictions in capitalist healthcare.
Lanham, Maryland: Rowman & Littleeld Publishers, Inc.
Welch, H., Schwartz, L., & Woloshin, S. (2011). Overdiagnosed: Making people sick in
the pursuit of health. Boston: Beacon Publishing.
Williams, D. R. (1994). The concept of race in health services research, 1966e1990.
Health Services Research, 29(3), 261e274.
Wright, R. J., & Steinbach, S. F. (2001). Violence: an unrecognized environmental
exposure that may contribute to greater asthma morbidity in high risk innercity populations. Environmental Health Perspectives, 109(10), 1085e1089.
Zavestoski, S., Brown, P., Linder, M., McCormick, S., & Mayer, B. (2002). Science,
policy, activism, and war: dening the health of Gulf War veterans. Science,
Technology & Human Values, 27(2), 171e205.