Initially, the idea that pharmacists might usefully study sociology may appear a little odd. After all, pharmacists are surely concerned with drugs use, an activity which requires a sound understanding of the disciplines of physiology, pharmacology, pharmaceutical chemistry and pharmaceutics. Prescriptions need to be carefully checked and the therapeutic and adverse effects of medicines thoroughly understood. But of course, pharmacy is also āpeople workā; drugs are dispensed to patients directly, or indirectly via informal carers, or other health professionals in the health care team. Furthermore, the general public seeks advice from pharmacists about medicines, treatments, alternative therapies and other aspects of their illness management and health maintenance. Pharmacists therefore need to be good communicators who are equipped with the appropriate skills for ensuring that they offer effective pharmaceutical care, and to this end there is now a range of texts available on communication and related skills for pharmacists. A sociological understanding of the issues of health, illness and health care can contribute to a deeper understanding of this people work. Sociologists have contributed to a better understanding of the actions and experiences of patients, the public, and health professionals who work within the health care system. This has resulted in a better appreciation of the nature of the relationships between health professionals and patients.
All of us have experience of health and illness. No doubt you will have been a patient, or you will have treated yourself when you felt ill, or you may have taken care of friends or relatives when they were unwell. This means that you will already have some knowledge and experience of the subject matter of this book. However, because the issues of health and illness are so familiar, it is difficult to distance ourselves from these and subject them to academic scrutiny. Indeed, a characteristic feature of sociology is that it often involves the systematic study of aspects of everyday life which are so familiar or routine that we do not give them a second thought. This means that it is all too easy to make assumptions about the way things are, and although they may appear to be āobviousā they might in fact not be so. For instance, it is easy to assume that how we experience a disease and its symptoms are the consequence of biophysical changes in our bodies. However, social scientists have shown that the same physical symptoms can be interpreted in very different ways in different contexts, not only by patients but also by practitioners. For example, in Germany, low blood pressure is routinely treated by physicians as a disease, whereas in the UK this is not the case. Disease categories are not unambiguous descriptions of anatomical and physiological processes but are also imbued by the language, metaphors and values of a particular society (Sontag, 1978; Martin, 1994). They may also be contingent upon the nature of social and political relations in a given historical period. Consider hysteria for example, a disease classification that is now very rarely used by medical practitioners but which was common in the early part of the last century (Figlio, 1978). The diagnosis of disease is also affected by social factors. For example, a study undertaken in New Zealand found that out of 822 coronary bypass operations performed in 1983, only ten were carried out on the minority indigenous population ā the Maori ā even though the death rates from heart attack are significantly higher amongst that group (Pomare, 1998). This suggests that diagnostic procedures might not be purely objective but are in fact affected by social issues ā the subject matter of sociology.
WHAT IS SOCIOLOGY?
Sociology is an academic discipline which makes use of a wide range of research methods to study society and social behaviour or social actions. Pharmacists, as a result of their school education and subsequent exposure to the pharmaceutical sciences as undergraduates tend to define themselves primarily as scientists. Science and āscientific methodā are part of their identity. On being introduced to sociology, students often approach it with preconceived ideas of it being āsoftā, āvagueā, āundisciplinedā and at times pretentious, peddling ideas that are little more than common sense. However, this presumption disregards the fact that sociology is a coherent discipline with a long tradition of applying a scientific perspective to social behaviour. Sociology is a science, generating and testing hypotheses, rigorously applying robust methods of empirical investigation to generate data whose analysis and interpretation leads to the formulation of theories. Sociology has amassed a body of knowledge from a variety of sources, employing a range of methodologies which may at first sight appear strange to pharmacists. These include social surveys, observations, analysis of language, and interviews (see Chapter 9). This knowledge has to be sufficiently robust to withstand exhaustive and widespread peer criticism, taking into account conflicting interpretations.
Throughout this book we will refer to a range of key sociological concepts which are outlined in Box 1.1. For clarity, these concepts have been reduced to their simplest terms, though we have sought to retain their essence and indicate in the text how they are likely to be important for the practice of pharmacy.
Social action is complex and we should not expect to unravel the complexity of the social world, and our behaviour within it, by simply applying ācommon-senseā understandings. Bauman (1997) argues that sociology differs from common sense in the following respects:
- Responsible speech. Sociological propositions are not founded on beliefs, but on corroborative evidence.
- Size of the field. We understand common sense only from our individual perspective, i.e. it is partial knowledge. Sociology pursues a wider perspective ā recognising the link between individual accounts and social processes of which individuals may be unaware.
- Making sense. From a common-sense perspective, accounts of our actions are attributed back to someone ā our actions are the intention of an individual. Sociologically, our actions are understood to be the result of our interdependency with our fellow members in society.
- Make the familiar strange. Common sense is self-affirming: āthings are as they areā, and āpeople are as they areā. Sociology scrutinises the familiar in order to understand how common sense is as it is.
| Agency: | Undetermined voluntary action by individuals |
| Norm: | Shared and expected social behaviour |
| Social role: | Expected actions associated with particular social positions |
| Social structure: | Recurring patterns of interrelationship between individuals or groups |
| Socialisation: | Acquiring and internalising the norms and values of a particular group |
| Society: | Configuration of cohesive social relationships within a particular group |
| Sociology: | Observation and analysis of societies |
Box 1.1 Glossary of basic sociological concepts
The sociological imagination
In order to understand the processes that guarantee our ability to live cohesively together as members of a society, it is insufficient to take an individualistic point of view. That is, it is not sufficient to understand or explain peopleās actions solely through the behaviour of the individual or individuals concerned. Rather, it is necessary to take a wider social perspective and to understand the social forces that impinge, influence, or interact with the individual. These social forces are usually beyond the control of the individual. In many ways this forms the essence of sociological inquiry, which involves asking the question: what is the relationship between individual behaviour (or āsocial actionā) and the social context (or āsocial structureā)? To develop an appreciation of the interaction of the individual in society is to come close to what the sociologist, C.W. Mills (1959) calls the āsociological imaginationā; that is, āthe urge to know the social and historical meaning of the individual in societyā.
An essential tool of the sociological imagination is the ability to distinguish between what Mills terms āpersonal troubles of the milieuā and āthe public issues of social structureā. The complex relationship between individual social action and structured collective social action lies at the heart of the theoretical foundations of sociology and distinguishes it from the allied disciplines of social psychology and economics. We can consider society on two levels ā the individual level (agency) and the collective level (structure). The sociologist aims to understand the interaction between these two. Let us take an example from Mills (1959):
āConsider marriage. Inside a marriage a man and a woman may experience personal troubles, but when the divorce rate during the first four years of marriage is 250 out of every 1,000 attempts, this is an indication of a structural issue having to do with the institution of marriage and family, and other institutions that bear upon them.ā
Another example of an individual trouble that became a public issue is the controversy concerning the mumps, measles and rubella (MMR) vaccination in recent years. When a small group of individuals have personal worries over the triple vaccine, perhaps based on their beliefs about the potential harmful effects of vaccination per se, they may simply refuse it for their children. However, when a movement develops that questions the vaccineās safety, what once was a personal trouble becomes a public issue that impacts on public health and the publicās relationship with health practitioners, medical āexpertsā and the State.
How people act, think and behave is a result of the way in which they have been ābrought upā. In sociological terms, the relationship between our behaviour as both individuals and as members of society is termed āagency/structureā. That is to say, the way we, as individuals, act is shaped by our social environment. In this sense we can never be free of the influences exerted on us by the social order to which we belong. Social rules and social norms have become internalised; that is, they become internal to the individual and are thus self-imposed rather than being subject to the control of others. Norms refer to actions that are expected or considered ānormalā in any given society.
We can see then, that individuals and the relationships between individuals are influenced by structural, i.e. broader social, economic and political circumstances. Sociology is not just about the collection of facts and information but is concerned primarily with understanding and interpretation. It can be confusing and daunting for those who are not used to this way of learning and thinking. What the sociologist studies is often familiar, i.e. it concerns our everyday activities. āThe sociologist does not look at a phenomenon that no one else is aware of, but he or she looks at the phenomenon in a different wayā (Berger, 1966).
SOCIOLOGICAL PERSPECTIVES AND THEIR APPLICATION TO PHARMACY
The boundaries of the discipline of sociology are difficult to define. This is in part because of the diverse and diffuse nature of its subject matter (namely people and society), but also because within the discipline of sociology there are many different approaches or perspectives ā indeed there are many different types of sociology. While all the perspectives seek to understand how social structures interact with individual behaviours, they vary in terms of their level of analysis. Some are orientated towards micro-level issues, such as the actions and beliefs of individuals, while others illuminate macro-level issues that pertain to the way in which the āstructuresā of society are organised. These would focus on questions such as: How are education or health care systems structured? How do economic systems work? What are the main social divisions within our society? Turner (1995) has usefully summarised three levels of analysis (individual, social and societal), and he illustrates the topics which might usefully be studied at these levels (see Table 1.1).
Working at the first level, sociologists examine peopleās accounts of their experiences of illness and how they maintain their health. The aim here is to illuminate aspects of everyday life from the perspective of the individual. Sociological perspectives orientated towards the individual level of analysis are the āinterpretive perspectivesā so called because they āinterpretā how people make sense of, and give meaning to, their lives or actions. Within interpretive approaches, attention is focused on how people interact at a face-to-face level; how they see their lives, make sense of their social circumstances and/or their physical symptoms. The key idea here is āmeaningā, which refers to the way people make sense of what is happening to them. Sociologists therefore talk to and observe people to try and find out how they define their circumstances. To get an insight into how p...
