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Medicine as social control

A characteristically full and wide-ranging essay, correctly identifying the functionalist, Marxist and feminist perspectives. I have, as usual, made a number of changes to your ording.

I think the omission here is on the NATURE of the social control, which is particularly important in assessing the views of different sociologists.I therefore offer the following reflections:

The medical profession is the recognised authority on illness and treatment (for the reasons you give) and so it has established a monopoly on the official identification of sickness AND on the legitimate practice of healing. It also shapes ideas and expectations of how those who are pronounced sick may behave.

For Parsons, being sick is a 'specifically patterned social role' - and it is for this reason that medicine is a form of social control, which formally defines a person's condition as deviant, and then functions to control the deviant's behaviour. Being sick implies two RIGHTS - the sick person is temporarily exempt from his/her 'normal' social role; he/she is generally not held responsible for the condition, and so is not blamed. Being sick also implies two OBLIGATIONS - the sick person must see being sick as undesirable, and so has an obligation to do everything possible to get well; he/she is required to seek professional advice and to cooperate. The rights and obligations are mutually dependent.

So there are two underlying value themes here. VULNERABILITY - getting better is seen as not possible by individuals of their own accord, and so they must be treated and looked after. This, however, runs the risk of exploitation - since the techniques of healing may be physically invasive, while the relationship is by its nature unequal, and thus requires a high degree of trust. Then, DEVIANCE - the sick are a potential social threat aince there is a danger that they may simply be evading their responsibilities. So it is important to identify the GENUINELY sick, and it is in this respect that the medical profession acts as society's gatekeepers.

Interactionists thus argue that the whole doctor-patient relationship shapes the patient's sense of identity - often they move to a stigmatised status, and are the victims of labelling and stereoytping, both by professional medics and by society at large. Hence, or example, the physically impaired are often spoken to as if they were mentally impaired. In extreme cases, as in the former USSR, unacceptable political views frequently resulted in 'patients' being locked away in psychiatric hospitals.

Of course Parsons assumes that all individuals voluntarily accept the ascribed 'sick role', while in reality many have aversion to medical treatment (or even to visiting a GP); others cannot afford to spend time off work. Others may want to avoid the stigma that is attached to many conditions. Hence patients are certainly not all 'passive' and 'controlled'. Indeed, some may DISSENT - experienced, say, in absenteeism from work, which is then a reaction to attempted medical control. Increasing numbers of sick people, contrary to Parsons, ARE often held responsible for their illnesses, on account of lifestyle choices - often, obesity, heart disease, lung cancer,blood pressure, AIDS fall into this category. Chalfont and Kurtz (1971), for example, demonstrate that alcoholism is not generally accepted as a genuine sickness; similar research comes to the same conclusion about drug addiction and gambling. And Parsons entirely disregards CHRONIC illness, which does not fit his scheme of things at all.

In reality, the doctor-patient relationship shows significant variation, and not all patients are compliant, cooperative, submissive or 'socially controlled'. Parsons, like all functionalists, produces a taxonomy of 'control types'. In the case of paternalism, there is high doctor control and little or no patient input. In the mutuality case, both have knowledge, and so treatment is effectively negotiated. In the consumerist case, the patient has great knowledge of his/her rights, and often also of his/her medical condition; here the doctor assumes a more passive role. Cartwright (1967) found that 56% of GPs complained that their patients 'lacked humility'! Byrne and Long (1976) identified a range of doctor/patient 'communication styles', though found that the doctor-centred was prevalent.

The major source of control (and patient dissatisfaction for that matter) is the ability of doctors to restrict information. Johnson (1972) identifies a 'competence gap' between doctors and patients - the greater the gap, the greater is the doctor's dominance and the patient's dependence. Withholding of information also covers up doctors' own uncertainties about diagnosis or treatment, and - particularly in these days of litigation - minimises the patient's ability to evaluate the doctor's performance and to detect mistakes. Research shows that the middle classes receive longer consultations; they ask for and get more information; hence the competence gap is smaller. Doctors are far less likely to divulge information to working class patients. Women are also less happy with doctor-patient interaction, especially if the doctor is male. Szasz and Hollender argue that the main factor influencing the relationship (and thus the degree of control) is the severity of the disease/condition.

Context also affects the degree of control - doctors have far more power to impose conformity in hospitals, even to the point of giving people new identities as a result of the loss of patient control and the imposition of hospital routines. No essay would be complete without a reference to Goffman (1961) and his analysis of 'total institutions' - it is highly likely (especially wherever the condition is mental) that there will be a process of MORTIFICATION - i.e. a complete and imposed change of personality.(Read 'Asylums' - one of the great Sociology books!)

Finally there is the 'medicalisation of deviance' - the idea that deviant behaviour is DEFINED as sickness needing medical treatment. So who then does the defining? This links nicely with your points about Marxists.

I hope this is helpful.

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Similarities and Differences between subcultural and strain theories

Another good, and very full, essay that encapsulates most of the main arguments and correctly discusses Merton, Cloward & Ohlin and aspects of the Chicago School. Some of the sentences were, however, a little clumsy, and so I have made several alterations.

Merton's account of the dysfunction between goals and means is of course a STRUCTURAL explanation of crime and deviance. He did not claim that ALL individuals who are blocked will become anomic, though there were some fairly clear expectations related to individuals' positions on the 'social ladder'. Merton is criticised for having a 'middle class bias' - in other words, the model requires acceptance of the particular American central value system of the 1930s that he identifies; it is thus the stress on the (financial) achievement ethic that produces the strain. He doesn't really explain why people choose one of his various forms of deviance over another, though the suggestion is that this might be a product of the effectiveness of socialisation in any individual case. Clearly the model is rather too obviously focused upon INDIVIDUALS, though it can be generalised to groups; nevertheless, there is little convincing treatment of deviant sub-cultures. You are also spot on when you explain that he doesn't really look at those delinquent/deviant activities that are not aiming for financial gains - so he would find it difficult, for example, to explain football hooliganism. All the evidence suggests that many such deviant sub-cultures do exist, and although they might well often respond to the world along the lines outlined by Merton, they tend to do so COLLECTIVELY.

Subcultural theorists, such as Cloward and Ohlin, generally claim that deviance is a COLLECTIVE solution, and results from access exclusion from society's goals. I like your reference to the Chicago School's studies of normlessness, and the argument that the city is to blame for deviance. The higher level of deviance in the central zone is seen in large part as a product of DIFFERENTIAL ASSOCIATION, and it is really this theme that Sutherland and Cressy are reintroducing in their research. You might call in on Cohen (1972) who argues that the problem for YOUNG PEOPLE in particular is that they have to unravel COMPETING SYSTEMS of means - i.e. traditional working class norms of solidarity versus middle class stress on educational opportunity and individual ambition - hence the GROUP NEGOTIATES A PATH between the two. Subcultures have their own identities and values, but the key point to stress is that not all of them are necessarily incompatible with mainstream social values. Stress also, as does Frith (1985) that bizarre clothes, hairstyles, music, etc. might be seen as deviant, but they are not necessarily signs of delinquency! Clarke (1976) stresses exclusion from existinf mainstream culture AND sub-cultures in some cases - hence some working class (and ethnic) groups will aim for solidarity, territory and masculinity as the only way of achieving (or recapturing) status.

I hope this is helpful.

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Which Was Brigham Young's Greatest Achievement?

I have provided a potted summary of Young's life and work below; my conclusion - at the end - is that he played a major role in shaping and increasing the prosperity of the American West.

Brigham Young was born in 1801, in Whitingham, Vermont. In 1835, three years after he joined the Mormon Church, he was called to the Quorum of the Twelve Apostles. As successor to Joseph Smith, he led the migration west in 1846–47 to the Rocky Mountains and founded Salt Lake City. He became President of the Church on December 27, 1847. As Church President and Territorial Governor of Utah, he established Latter–day Saint settlements in Utah and throughout the American West. Under his direction, construction commenced on the Salt Lake, St. George, and Logan temples. He brought the telegraph and the railroad to Utah and encouraged cooperative industry among Latter-day Saints. He died in 1877 in Salt Lake City after nearly 30 years as Church President.

Young, previously a Methodist, was immediately attracted to the Book of Mormon, published by Joseph Smith in 1830, and he was baptised into Smith's newly formed Church of Jesus Christ of Latter-day Saints in 1832. The same year he went to Canada as a missionary, and in 1833, after the death of his wife, he led several friends and much of his family to join Smith and the gathering of Zion in Ohio. Young went to Missouri in 1834 when hostile non-Mormons threatened the Mormon community there. He later travelled to England and the eastern states as a missionary, then defended Smith when the Kirtland settlement foundered in 1837. The next year, after following Smith to Missouri, he helped evacuate the community when threatened by anti-Mormon mobs and organised their move to Illinois. In 1841, Smith appointed him President of the Quorum of Twelve Apostles, the governing body of the church, second in authority only to Smith himself.

When Smith was murdered by an Illinois mob in June 1844, Young returned to Illinois and took charge of the church. Facing continued persecution, he led the Mormons westward out of Illinois to Florence, Nebraska on the Missouri River in 1846. In 1847, he led an exploration to the Rocky Mountains. After discovering and selecting the Great Salt Lake region as a safe haven where Mormons could have the freedom to worship and live as their faith decreed, Young returned to Florence, and in December 1847 became president of the church.

In 1848, Young organised and led the great Mormon emigration from Nebraska to Utah, where he remained for the rest of his life. He immediately established Salt Lake City and, through the church, directed religious, political, economic, cultural, and educational affairs. He promoted isolation and economic self-sufficiency, encouraging local manufacture of goods, and discouraging enterprises like mining that would attract outsiders. To strengthen the church and its authority within Utah, Young established Mormon colonies throughout the state and in the neighbouring territories of Arizona, California, Nevada and Idaho. Young constantly encouraged emigration by financing wagon trains and providing converts with hand carts so they could make the 1,400 mile journey from the East by foot. In 1849 Mormons established the provisional state of Deseret, with Young as governor. The next year this area became the territory of Utah, again with Young as governor, but with the announcement in 1852 that polygamy was a basic tenet of the church, a public outcry prompted scrutiny by federal authorities.

President James Buchanan replaced Young as Governor in 1857 and sent the U.S. Army to establish federal rule in Utah. Young fought this 'Mormon War' by cutting off supply lines rather than engage federal troops in battle, but this conflict led to the infamous Mountain Meadows Massacre, an atrocity that would haunt Young till his dying day. In September 1857, a party of 120 emigrants suspected of hostility toward the church was murdered in southeastern Utah by Paiute Indians and a band of Mormons led by John D. Lee, who claimed to be acting under direct orders from Young. But in 1858, Young was pardoned for his alleged role in this atrocity.

Without federal interference, Mormon communities flourished, and Utah's economy boomed during the following decade. In 1869, the completion of the transcontinental railroad at Promontory Point, Utah threatened Young's efforts to safeguard Mormon prosperity and polygamy by maintaining a sanctuary of isolation. Young responded by consolidating political and economic power; he established Mormon monopolies and initiated women's suffrage in Utah, greatly increasing the number of Mormon voters.

But the continued public outcry over Mormon polygamy would not go away. In 1871, Young was tried under an 1862 federal law that prohibited polygamy in US territories. At the time, Young had more than 20 wives and 47 children. When he was eventually acquitted, prosecutors attempted to prove Young's complicity in the Mountain Meadows Massacre 20 years earlier. In 1877, John D. Lee was brought to trial, but he refused to implicate Young. After an initial acquittal, supposedly influenced by the Mormon leader, Lee was retried, found guilty and condemned to death. The question of Young's role was never definitively established. Young died shortly after Lee's trial, in August, 1877. Federal authorities continued their assault against Mormon marriage practices, until in 1890, the Mormon church relinquished the practice of polygamy. In 1896 the territory of Utah was admitted into the Union as the 45th state.

'Mormonism has made me all I am; and the grace, the power, and the wisdom of God will make me all that I ever will be, either in time or in eternity.' Young, as leader of the Mormon Church and architect of the Mormon colonisation of Utah, was therefore one of the most influential figures in shaping the American West, and this is perhaps his most significant achievement.

I hope this is helpful.

emma s's blog
emma s
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