the word as scalpel a history of medical sociology may 2002

The Word as Scalpel: A History of Medical Sociology Samuel W. Bloom OXFORD UNIVERSITY PRESS The Word as Scalpel This page intentionally left blank THE WORD AS SCALPEL A History of Medical Sociology Samuel W. Bloom 1 2002 1 Oxford New York Auckland Bangkok Buenos Aires Cape Town Chennai Dar es Salaam Delhi Hong Kong Istanbul Karachi Kolkata Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi Sa˜o Paulo Shanghai Singapore Taipei Tokyo Toronto and an associated company in Berlin Copyright ௠ 2002 by Oxford University Press, Inc. Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 www.oup.com Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Bloom, Samuel William, 1921– The word as scalpel : a history of medical sociology / Samuel W. Bloom. p. cm. Includes bibliographical references and index. ISBN 0–19–507232–4; ISBN 0–19–514929–7 (pbk.) 1. Social medicine—United States—History. 2. Sociology—United States—History. I. Title. RA418.3.U6 B56 2002 306.4'61'0973—dc21 2001037042 135798642 Printed in the United States of America on acid-free paper Acknowledgments Among the many who helped me with this book, Kurt Deuschle stands out. He first suggested the idea for a proposal to the Commonwealth Fund Book Program on the Frontiers of Science. At the time, Kurt was the distinguished and much loved chairman of the Mount Sinai School of Medicine Department of Community Medicine. My first large debt, therefore, is owed to him and to the Commonwealth Fund, especially to former staff members Lester Evans, John Eberhart, and Regin- ald H. Fitz. Special thanks are also due to Susan Garfield and the Rockefeller International Conference Center at Bellagio, Italy, where I developed the first de- tailed outline of what this book eventually became. Soon afterward, my appoint- ment as a Visiting Fellow at the Russell Sage Foundation relieved me of academic duties for six months of total immersion in writing. From these sources, the short book first proposed evolved into the present much more ambitious history. Most of the work was done in the old-fashioned off-line way, at typewriter and then word processor, heavily dependent on documents, interviews, and libraries. Reference librarians at the Levy Library of Mount Sinai School of Medicine, the New York Academy of Medicine, and the New York Society Library were partic- ularly helpful. The kindness and efficiency of archivists regularly solved critical problems, especially those at the Meiklejohn Institute in California, the New York Public Library, the National Archives of the United States, and the University of Wisconsin Center for Film and Theatre Research. Organizations like the National Institutes of Health and the American Sociological Association were always ac- cessible and responsive. But more than any other, I owe thanks to the staff of the Amagansett Free Library. There seemed to be no request too difficult for this remarkable public library of a small New York village. When it comes to individual contributions, it is much harder to assess influ- ence and to adequately express my gratitude. For example, my students in the Ph.D. Program in Sociology at the City University of New York were my primary readers and critics of chapters in draft. I could not possibly list them individually, but collectively, they are at the top of my list of the most helpful. There are also friends and colleagues who served the writing process in what I can only describe as an intellectual context rather than in specific helping roles. Sol Levine, for example, was someone who never waited to be asked. He initiated contact, asked about my work, and then critically responded to anything I sent him. My debt to vi ACKNOWLEDGMENTS him cannot be estimated, and my sorrow for his recent death is deep. Robin Badgley and Bob Straus have played similar roles. Both were partners in various professional activities. Badgley always behaved with quiet humor and unsparing dedication; it was a joyful experience to work with him. Straus has been both friend and co-worker for almost fifty years, so it was fitting that he was selected by the publisher to read the manuscript. His critique included many helpful sug- gestions. Robert K. Merton, Patricia Kendall, Renee Fox, George G. Reader, and Mary E. W. Goss were there at my entry to the field when it was not yet known as medical sociology. Merton’s influence never ended, and all of them have re- mained both friends and professional models. Those individuals who were interviewed are credited throughout the text, and all of their contributions are important. Some, however, deserve special mention, including Eugene Brody, Donald Light, Albert Wessen, David Mechanic, James McCorkle, and Fred Hafferty. Among historians, I am indebted specially to Milton Roemer, Milton Terris, Rosemary Stevens, and David Rosner. Robert H. Felix, Raymond V. Bowers, Herbert Klerman, Kenneth Lutterman, and Herbert Pardes generously shared their experiences at the National Institute of Mental Health. Chloe E. Bird, Peter Conrad, and Allen M. Fremont, editors of the fifth edition of The Handbook of Medical Sociology, commissioned my article, “The Institu- tionalization of Medical Sociology in the U.S.: 1920–1980,” a task which served in unexpected ways to help complete the final draft of this book. Edward W. Barry, the former president of Oxford University Press, encouraged and supported me through many years and two earlier books. He is a rare example of the type of publisher every writer wants. I am also indebted to Valerie Aubrey, my first editor at Oxford, and to Dedi Felman, Jennifer Rappaport, and Robin Miura, my current Oxford editors. Caroline Helmuth was my secretary during the early drafts, but that hardly describes the part she played. She was also research assistant, friend, editor, and genial ally. When Caroline went to California and I was forced to work mostly on my own, Josephine Greene saved me from disaster regularly, serving as my word processing consultant. When I needed to return to early sources, Mary Lou Russell at the Commonwealth Fund was gracious with her time and knowledge. Although my debt is great to everyone mentioned so far, there is another level of gratitude that is reserved for my daughter Jessica, my son Jonathan, and my grandchildren Alexander and Sonia who are the anchors and joy of my existence; but it is Anne, my wife, who, more than any other, has given not only what I needed to write this book but also the greater portion of what is valuable in my life. Contents Introduction 3 PART I. Medical Sociology before 1940 1. The Origins: Medicine as Social Science, Public Health, and Social Medicine 11 2. American Sociology before 1920: From Social Advocacy to Academic Legitimacy 23 3. Between the World Wars 39 4. The University of Chicago 63 5. Regional and Intellectual Influences 83 PART II. Medical Sociology, 1940–1980 6. First Steps toward Social Identity: Effects of the War and Its Aftermath on Medical Sociology 111 7. Postwar Medical Sociology: The Founders at Major Universities, 1945–1960 131 8. The Role of NIMH, 1946–1975 155 9. Becoming a Profession: The Role of the Private Foundations 181 10. From Ad Hoc Committee to Professional Association: The Section on Medical Sociology, 1955–1980 215 PART III. The Current Status of Medical Sociology 11. An Era of Change, 1980–2000 247 Notes 285 Index 335 This page intentionally left blank The Word as Scalpel [...]... Billings was also the organizer of the Sur­ geon General’s Library, later to be the National Library of Medicine, and the com­ piler of the Index Medicus.42 In 1894, Charlie McIntire defined medical sociology as the science of the social phenomena of the physicians themselves as a class apart and separate; and the science which investigates the laws regulating the relations between the medical profession and... and public health, the universitytrained disciplines began to break away from ASSA Beginning in 1884 when ASSA was not yet twenty years old, the academic professional associations ap­ peared in the following order: The American Historical Association, organized in 1884 The American Economic Association, in 1885 The American Anthropological Association, in 1902 The American Political Science Association,... competition among them At Harvard, medical social work was introduced as a distinct specialty in 1905 and was combined with sociology within the Department of Social Ethics that was created in 1920 Richard Clarke Cabot, the first Harvard professor of social ethics, is generally considered the founder of medical social work Cabot, Kane tells us, although he was a physician, emphasized the discrepancy between medical. .. interpretations of social relations, and this theory, for the next three decades, was the guiding theory of much of American sociology In medical sociology, his analysis of the doctor-patient relationship as a social system had a seminal effect Stern, on the other hand, was a Marxist whose social history of medicine emphasized a sociopolitical perspective that was only to come into its own in the 1960s as an important... 1918, the National Confer­ ence of Social Work, while the latter became the major professional association of public health specialists in medicine Gradually, though not without much internal and public struggle, there was a shift away from the advocacy of the reformers, and academics emerged as the leaders of the ASSA Unlike the antebellum colleges, “which placed primary em­ phasis on transmitting a cultural... the American So­ ciological Association (ASA) and with the creation of several journals, including the of cial ASA sponsorship of the Journal of Health and Social Behavior Within medicine, this legitimacy is represented most dramatically by the creation of a new subject matter committee for Part I of the National Board of Medical Exam­ iners (NBME), the Committee on Behavioral Science, signaling the. .. and the rapid indus­ trialization of England produced the first phase of a genuine social medicine, including the use of the survey as a tool for documenting the class differences and their consequences in disease that resulted from the new social order In Germany, meanwhile, the heritage of the medical police was the traditionalization of the ideal of orderly efficiency As a result, “by the middle of. .. was now radically changed in its basic knowledge, its technology, and its therapeutics, and so was the social organization of medical education and medical care 22 MEDICAL SOCIOLOGY BEFORE 1940 Medical sociology was in existence but barely, a foundling of social work in the United States and of social hygiene in Europe and England It was to have a rich period of intellectual development that began... literature of medical sociology, but the focus here will be on the latter, following the steps of institutionalization.6 For such a task, my own occupational history was an advantage I was an early participant in the rapid institutionalization of medical sociology The pattern of my career followed a mirror-course of the major developments in the field During the period when research offered virtually the. .. medical rec­ ommendations and their feasibility, especially because of what he saw as the distance between the world of the medical practitioners and the realities of their impoverished patients Medical social work was expected to bridge that gap, Ca­ bot believed, and he was an eloquent spokesman for teamwork between physician THE ORIGINS 21 and social worker.38 One of his first acts as chair of social . The Word as Scalpel: A History of Medical Sociology Samuel W. Bloom OXFORD UNIVERSITY PRESS The Word as Scalpel This page intentionally left blank THE WORD AS SCALPEL A History of Medical. with the establishment of the Section on Medical Sociology of the American So- ciological Association (ASA) and with the creation of several journals, including the of cial ASA sponsorship of the. unfa- miliar terrain. Here was a famous physician from the past, whose name was part of the lore of the basic science of medicine 13 and who became in midcareer a sociological scholar and teacher