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Multilevel Approach to Sociomedical Research: Beyond Convergent Validation, Summaries of Social Sciences

The importance of a multilevel and theoretically holistic approach to sociomedical research, which goes beyond a multimethod strategy. It discusses the limitations of convergent validation and suggests revisions to cultural characteristics upon which sociomedical research is based. The document also touches upon the use of multiple levels of organization in sociomedical research and the importance of dealing effectively with people's difficulties through classification.

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1.3
Classification
and
Process
in
Sociomedical Understanding: Towards a
Multilevel View
of
Sociomedical
Methodology
ROBERT
A.
RUBINSTEIN
,
SUSAN
C.
SCRIMSHAW,
AND
SUZANNE
E.
MORRISSEY
lNTRODU
CTlON
The various social sciences that contribute to the
understanding
of
health, illness, and health sys-
tems employ a variety
of
research methodol-
ogies.
In
this chapter
we
distinguish between
methodology and methods.
By
methods,
we
mean the particular data collection tools -such
as surveys, interviews, observations, and the
like -and the techniques
of
data
analysis -
such as statistical manipulations, content analy-
sis,
or
coding schemes. Methodology, in contrast,
is
concerned with the epistemological and onto-
logical foundations
of
inquiry.
Our
main concern
in
this chapter
is
with methodology.
Methodologies include not only the methods
used for data collection and ways
of
manipulat-
ing these data for analysis,
but
also their under-
lying theoretical and philosophical assumptions.
Each discipline, such as sociology, anthropo
l-
ogy, psychology, economics, and epidemiology,
has its own favorite array
of
methods, which are
the subject
of
debate, even within the discipline.
Across disciplines, there has been a historical
misunderstanding, and sometimes disrespect,
regarding the methods
of
other fields, yet
at
the same time, disciplines borrow methods
from each other, sometimes without recognizing
their similarity to methods which they claim to
disparage.
Increasingly,
we
see a convergence and com-
bination
of
methods among the various social
sciences. Shared theoretical approaches
or
philosophical commitments
that
underlie the
methodologies do not always accompany this
convergence in
data
collection and analysis stra-
tegies. In this chapter
we
explore the importance
and implications
of
going beyond a multimethod
strategy to take a multilevel and theoretically
holistic approach towards sociomedical re-
search, and relate the increasingly sophisticated
methods
of
research
that
seeks a better under-
standing
of
the complex relationships between
health, illness, and healing (which
we
call socio-
medical research) to such an imperative. In this
regard, sociomedical inquiry focuses not only on
the biological, organic correlates
of
health and
illness, but also on the roles played by social and
cultural factors for the triggering
of
the onset
of
disease
or
for the role played by these factors
in
increasing the susceptibility
of
individuals and
populations to disease.
We define holistic as an approach that takes
the broader context into account. This includes
the wider settings
of
both space and time.
For
example, an observed health system should
be
seen
in
the context
of
a wider community and
culture, and the requirements
of
that health
sys-
tem may vary with seasonal variations in disease
entities as
well.
We define multilevel in terms
of
the unit
of
analysis.
For
instance, health out-
From: The Handbook of Social Studies in Health & Medicine,
G.L. Albrecht, R. Fitzpatrick and S.C. Scrimshaw, editors.
London: Sage Publications, 2000.
pf3
pf4
pf5
pf8
pf9
pfa
pfd

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Classification and Process in

Sociomedical Understanding: Towards a

Multilevel View of Sociomedical

Methodology

ROBERT A. RUBINSTEIN , SUSAN C. SCRIMSHAW,

AND SUZANNE E. MORRISSEY

lNTRODU CTlON

The various social sciences that contribute to the understanding of health, illness, and health sys- tems employ a variety of research methodol- ogies. In this chapter we distinguish between methodology and methods. By methods, we mean the particular data collection tools - such as surveys, interviews, observations, and the like - and the techniques of data analysis - such as statistical manipulations, content analy- sis, or coding schemes. Methodology, in contrast, is concerned with the epistemological and onto- logical foundations of inquiry. Our main concern in this chapter is with methodology. Methodologies include not only the methods used for data collection and ways of manipulat- ing these data for analysis, but also their under- lying theoretical and philosophical assumptions. Each discipline, such as sociology, anthropo l- ogy, psychology, economics, and epidemiology, has its own favorite array of methods, which are the subject of debate, even within the discipline. Across disciplines, there has been a historical misunderstanding, and sometimes disrespect, regarding the methods of other fields, yet at the same time, disciplines borrow methods from each other, sometimes without recognizing their similarity to methods which they claim to disparage.

Increasingly, we see a convergence and com- bination of methods among the various social sciences. Shared theoretical approaches or philosophical commitments that underlie the methodologies do not always accompany this convergence in data collection and analysis stra- tegies. In this chapter we explore the importance and implications of going beyond a multimethod strategy to take a multilevel and theoretically holistic approach towards sociomedical re- search, and relate the increasingly sophisticated methods of research that seeks a better under- standing of the complex relationships between health, illness, and healing (which we call socio- medical research) to such an imperative. In this regard, sociomedical inquiry focuses not only on the biological, organic correlates of health and illness, but also on the roles played by social and cultural factors for the triggering of the onset of disease or for the role played by these factors in increasing the susceptibility of individuals and populations to disease. We define holistic as an approach that takes the broader context into account. This includes the wider settings of both space and time. For example, an observed health system should be seen in the context of a wider community and culture, and the requirements of that health sys- tem may vary with seasonal variations in disease entities as well. We define multilevel in terms of the unit of analysis. For instance, health out-

37 Sociomedical Understanding in Classification

of a combination on comes may be dependent

family provider behaviors, factors, individual

community the and factors, cultural setting,

context.

convergent valida- that We take for granted

systemic organization, of tion from a single level

while serving well efforts to increase the sophis-

is methods in sociomedical research, of tication

inadequate basis for the future development an

the of sociomedical research. We discuss some of

multilevel view has with our that continuities

previous work, mainly in anthropology. Then

upon discuss some cultural characteristics we

based, been has research sociomedical which

revision. of these are in need that and we suggest

expert of paid to the role is Particular attention

technology, and the of knowledge, the valuing

experience. of reports of discounting

CoNTEXT HrsTORICAL REcENT

only be dealt with can Problematic situations

effectively once they have been defined as prob-

al. 1984). et lems (Rubinstein 1984; Rubinstein

ordi- that Problematic situations are situations

troublesome and for which nary persons find

professional research- For they often seek help.

by problematic situations are constituted ers,

depart from the expected, anomalous that data

dis- be may results anomalous Such results.

taken as a site for profitable investi- or missed

; 1984 al. et Rubinstein 1970; (Kuhn gation

Ward and Werner 1984).

specialized knowl- on In most areas relying

from to construct problems the ability edge,

troublesome experience develops of the analysis

1983), Schon 1980; practice (Argyris through

less formally, in rules or codified, more is and

classification. The methods and methodology of

used by sociomedical researchers give them ways

construing physical, psychological, and other of

problems to of 'difficulties' as particular kinds

be explored and understood. Sociomedical cate-

gories thus reduce people's problematic experi-

our which to ences to relatively familiar patterns

be applied. These methods and methods can

approaches are increasingly recognized as cultu-

rally and socially situated (Freund and McGuire

al. 1991). This has the et Romanucci-Ross 1999;

ethno- or introducing a cultural bias, of effect

centricity, in these approaches and their results.

that the information of e value and utilityTh

the on part results from their use depends in

meaning the between conflict or congruence

people by them to ascribed significance and

Romanucci- ; 1991 (Kottak practitioners and

Ross 1991).

II years, a schism War the early post-World In

developed within the sociomedical research com-

methods applied who those between munity

techniques hypothetico-deductive on based

science, of grounded in positivist philosophies

and those who applied more inductively defined

of visions alternative in based techniques

1994; (Hollis pragmatism as such science,

differences these Because 1998). Schweizer

involved competition for resources and also for

authoritative, useful knowledge, of the definition

for some time these two traditions developed in

one another (Diesing to antagonistic relation

1991). This antagonism was often expressed as

a contest between qualitative and quantitative

hy- time, some For methods. to approaches

quantitative - approaches - pothetico-deductive

achieved a certain dominance and set the terms

sociomedical methods (Hempel about debates of

1998). Schweizer 1996; ; Kuipers 1965

three decades, quali- or During the past two

humanist with associated methods tative

approaches in the social sciences have gained

authority as objectivity in science has been called

on the implications contingent and into question

scientific knowledge have been explored (Latour

greater 1987). This exploration has created a

result that the knowledge claims that recognition

hypothetico-deductive and inductive ap- from

contingent and incomplete. both proaches are

many among remains Considerable suspicion

the represen- of the usefulness about researchers

tations produced by each method. Nonetheless,

the epistemological difficulties shared by these

approaches have resulted in a greater willingness

reconcile to ways seek researchers to among

this rapproche- of them. The most obvious fruit

increase in efforts to integrate an ment has been

methods qualitative and quantitative research

1986; al. et Janes 1981; (Brewer and Collins

Scrimshaw 1990).

Perhaps the most basic principle underlying

methods ought to that these efforts is the view

knowl- our of increase the validity and reliability

a phenom- of edge by using multiple measures

enon (Jenkins and Howard 1992; Pelto and Pelto

1996). The high value placed on this convergent

triangulation, has been one area or validation,

where qualitative and quantitative approaches

have sought common ground.

re- sociomedical to interest of Phenomena

a number of any on searchers might be found

At 1). systemic organization (Figure of levels of

the macrolevel, health policy researchers might

find their attention directed to the societywide,

encoded symbolically of artifacts behavioral

the microlevel sociomedi- at information, while

cal researchers might focus on individual bio-

disease. and illness of aspects logical

Sociomedical research typically involves the use

39 Sociomedical Understanding in Classification

professionally adaptive of and the development

niches such as medical anthropology.

As anthropologists have joined other socio-

to seeks that research in researchers medical

'problem oriented - answer practical questions

in there has been a discernible shift - research'

report anthropologists methods of kinds the

1993; al. et Lurie 1986; (Gorman using

1986). More frequently Perloff Rubinstein and

anthropologists instance, for before, than

a or one only on relies that research report

that they are the phenomenon of indices few

increasingly be these whether investigating,

reflexive or well-bounded quantitative measures

analytical frameworks. Also reported are more

results based on short-term ethnographic field-

Scrimshaw 1992; work (Manderson and Aaby

Zambrana 1992; Scrimshaw and Gleason 1992;

focus so tightly on that studies or et al. 1997a),

other that life social of aspects particular

ignored (Chambers or are lost data of sources

1984). Ward and Werner 1997; McGuire 1985;

converged have methods anthropological As

sociomedical in standard more those with

research, the commitment to holism has seemed

some irony in this, as it was is to fade. There

that holism penchant for the anthropological

early medical anthropolo- of brought the work

sociomedical other of notice the to gists

noted, be should It 1955). (Paul researchers

studies focused tightly more that however,

One holism. exclude completely not need

is anthropological holism of important feature

that influences or factors to alert remain to

data to of were not within the original scope

the in these include to and collected, be

research if they seem important to the problem

hand. This, even a focused study, can change at

and expand in response to the researchers' will-

ingness and ability to take the broad view. This

to be collected, and some- data change in the

are questions which from view the in times

asked and observations are made as the study

precisely what makes traditional is progresses,

qua- about quantitative researchers so nervous

retain to helps what also is It litative work.

continually is researcher the because holism,

on influences possible broadest the to open

the phenomenon under investigation.

VALIDITY' 'CONVERGENT AND HOLISM

Despite its having faded in prominence, the hol-

the of istic perspective remains in our view one

most valuable developments in efforts to under-

a perspective is It standing the human condition.

problem- from lacking lamentably is that

1982; (Hall research sociomedical oriented

Simon 1983), despite 1983; and Walker Penfold

of precisely in the intersection is it that the fact

of biological, psychological, and social aspects

health and illness that it might most naturally

found. To some degree, sociomedical research be

has drifted away from holism because such a

move enabled well-bounded studies that could

form the basis upon which claims for funding

because and rest, could resources other and

the grant-review of the social organization of

process which disburses research support.

research reward structure for The resulting

thoughtful interdisci- of works against the kind

plinary research required for holistic investiga-

instance, extensive publication records For tion.

cap- is are taken as indications that a researcher

able and 'productive,' which in turn encourages

researchers to go to press with 'the least publish-

able bit' rather than with fuller and more inte-

the Also, topic. their of treatments grative

pressure for productivity frequently constrains

publica- - researchers to report positive results

negative results, even when such or null of tion

results might provide interesting clues about the

sociomedical phenomena, are dis- of dynamics

couraged, if only informally.

decisions face researchers before Indeed,

about publication they must first find support

this regard they face chal- In for their research.

also make holism in sociomedical that lenges

instance, For research more difficult to achieve.

specialized to directed are proposals grant

within work highly rate that sections review

the of paradigms disciplinary particular the

seek to integrate theory that Proposals members.

disciplines thus of methods from a number or

of between the institutional arrangements fall

the review process. Funding agencies, often in

directors, of boards or response to the public

in periodically emphases funding their shift

sociomedi- of order to stay on the 'cutting edge'

cal knowledge. This allows the funding agencies

to claim that they are pushing the development

researchers not, or Wittingly knowledge. of

respond to these 'fads and fashions' by altering

their research, even, perhaps, before they have

upon problems earlier the Investigated fully

and (Lane focused work their which

Rubinstein 1996b).

is the holistic perspective of the values of One

technical and scientific that recognition the

knowledge are understood to be always incom-

1980; Brewer thus fallible (Argyris plete, and

1983; Pacey 1967; Cantril 1981; Collins and

Simon 1983; Schon 1984; al. et Rubinstein

always is 1983). Because specialized knowledge

incomplete informa- of constructed on the basis

tion about phenomena, it must always be seen as

provisional.

Health and Medicine in l Studies ia Soc of Handbook^40

course, a of knowledge is, of The contingency

that other perspectives of fundamental insight

falli- and also emphasize the provisional nature

the world. This prin- of knowledge our of bility

instance, in the American found , for is ciple

Rescher 1980; Peirce (Almeder of Pragmatism

  1. and James (1978), in the skeptical phi-

Salmon (Popper 1962; Hume David of losophy

1967), and in contemporary evolutionary epis-

Collins 1981; Campbell and temology (Brewer

these diverse sources, the 1973, 1974). Given

knowl- of the fallibility and provisional nature

edge deserve to be taken most seriously.

of the methodological implications of Some

by epistemologists work- out this have been set

volutionary epistem-'e of tradition ing in the

realism' hypothetical 'critical or ology,'

; 1973 Cohen and Naroll 1973; (Campbell

This 1984). a!. et Rubinstein ; 1981 Pinxten

col- of because each way that work emphasizes

is carries a particular perspective, it data lecting

important to use multiple measures to assess a

equally is phenomenon. Problem-oriented work

requires multiple and limited in its perspective,

'tunnel if be used disciplinary perspectives to

to be avoided. is vision' (Pacey 1983)

instance, David Hufford (1982a) made a For

the 'sleep of studies of comprehensive review

and nightmare by characterized disorder'

experience - which incubus an and paralysis

g experience. HuffordHa Old Hufford calls the

shows that the accounts offered by researchers

Old the disciplines that studied the of from each

of experience are all characterized by a kind Hag

sociolo- s, anthropologists, Thu vision. tunnel

gists, and medical folklorists ascribe it to tradi-

tion, treating the phenomenon as culture-bound

researchers attempt to character- Sleep artifact.

sleep disorder of ize the phenomenon as a kind

sleep, REM of sual patternsunu associated with

the of None and psychiatrists as a mental illness.

researchers are able to account fully for the phe-

experience, yet as Hag Old the of nomenology

of Hufford (1982a: 116) points out, the effect

plainex to been their disciplinary efforts 'has

the phenomenon away while discouraging the

it. ' of a thorough description of development

sociomedical research the prescription for In

pursue a to been has vision tunnel avoiding

(Campbell validation' 'convergent of strategy

iteration' 'multiple and 1959) Fiske and

1973), and its propo- (Werner and Campbell

is it at nents have been explicit in arguing th

as legitimate many differ- er important to consid

knowing' (Balshem 1993; Gifford of ent 'ways

; Lieberson 1992). 8619

for multilevel research designs adds ll ca Our

the principles methodological two sethe to

the convergent validation be that requirement

a necessary is This s. made from multiple level

the of addition because precisely what aspects

phenomena under study are salient to an inves-

tigation depend upon how the problem being

73; : 1989 (Albrecht framed is investigated

; 1989 Tanur and Fienberg ; 1998 Diez-Roux

only Not 1983). Schon a!. 1984; et Rubinstein

of knowledge contingent because each our is

measures provides only partial information our

or (as critical hypothetical realism emphasizes),

because particular professional lore provides a

as because, but solutions, of range limited

con- is pointed out, the world (1960) Whitehead

infinite concatenation an processes in of structed

our systems within systems. At any given time of

of portion small a only capture will models

reality.

described well is phenomenon a if Even

come from a that measures of with a variety

that of single-level, maintaining the authority

requires very strong, and single-level account

our in clauses if ' indefensible, 'as ultimately

(Humphrey behavior social of explanations

1983). Convergent validation on a Simon 1984;

the result is that guarantee not l doeseve single l

phe- of not fundamentally provisional. Accounts

nomena are useful only when they capture those

levels that are required to answer a particular set

failing to recog- By questions (Holland 1987). of

are we nature, multilevel essential their nize

of e that the phenomena um more likely to ass

rather e, concern are themselves stable over tim

act ifart an is the apparent stability if than to ask

analysis used. of the techniques of

addition to the critical hypothetical realist In

is knowledge our analysis which emphasizes that

knowing with which of fallible because the ways

access only particular per- data our gather we

also tenta- is knowledge our reality, on spectives

tive because every phenomenon has multilevel

are which of combinations aspects, differing

questions. different resolving for important

of levels multiple by introduced The fluidity

as important for problem-defin- is organization

for research in is ing sociomedical research as it

Adequate prob- ).b 8219 2a, 198 general (Hufford

three least at meet must work lem-defining

multiple (I) essential methodological principles:

ons, and (3) mul- ti measures, (2) multiple itera

tiple levels in analysis.

of nature recognizing the complex Anyone

sociomedical phenomena ought to concur with

the intuitive requirements for complexity and

However, it l accounts just outlined.eve multil

elslev remains to specify how to decide which

is inap- It ganization need to be considered.or of

propriate to propose decision rules for making

must se judgement at this time because the that

much more experi- of be developed in the light

explicitly attempts to that searchre ence with

explanatory ade- of meet this intuitive model

cial Studies in Health and M edicine So Handbook of 42

social construction and relativiza- of processes

diffi- physical' 'strictly to equally apply tion

erosis'cl arterios 'cerebral as culties - such

(Sicherman 'neurasthenia' 1974), (Feinstein

'dwarfism' or 1969), (Scott 1977), 'blindness'

(Ablon 1984) - as they do to psychological dif-

and (Penfold 'depression' as ficulties - such

(Kaplan 1983), 'personality disorders' Walker

'schizophrenia.' or 1983),

Both approaches to sociomedical categories

with lyve effecti deal to that acknowledge

people's difficulties they must be able to classify

them according to some system, and thereby to

problematic processes as problems. nd understa

each of e between advocates bat The point of de

those to granted status the on view focuses

sha it because important is which problems,

actice.pr implications for sociomedical research

realist inter- e- the one hand, the normativ On

ds to aea sociomedical categories l of pretation

which are reliance of world view the hallmarks

oblem assess-pr 'objective' technology for on

knowl- rt expe of sis on the rolemphae an ment,

the of acceptance limited a and edge,

their experi- of reports 's people of authenticity

gmatist-pra the hand, er tho the On ence.

iewv world a s upports ach pproa nominalist

pert ex y situated, lla ci at sees technology as soth

and tentative, and partial as knowledge

perience as authentic ex s of theirport people's re

is It n. ctio tru for problem cons nt and importa

es that form the turea these, and other similar, f

research sociomedical of contexts cultural

categories.

AL EDIC i OMoc S OF ESR uLTU C HE T

R ESEARCH

ses tusta ontological and l ca epistemologi The

ded to sociomedical categories are impor- oracc

e the cultural con- fin because they help to de nt ta

which that sociomedical research practice in text

situated, and circumscribe what phenomena is

n- co While there is a y. are researchable and wh

practitioners, the re- ll siderable range among a

sociomedical categories results from of view st lia

or vi s a view of health care and behart o uppand s

from that underlying ntre ffe y di ll is radica that

that the ewvi uris o It agmatist perspective.pr eth

ent ofpm st views in the develo liea ivileging rpr

d arow unt sociomedical research has had some

plicit ex tant to makepor im is It consequences.

the consequences for sociomedical research of

ews of research. Wevi st li rea the dominance of

y ll especia is suggests why it on i ss think this discu

be research l ca sociomedi that nt ta or imp

s.i ysl ana of oached from multiple levelsppr a

Here it may be useful to consider in a bit more

these untoward of depth one interesting example

health and of privileging a realist view of effects

illness. An illustrative example is found in the

'hyperac- of search for the biological validation

This disorders. deficit' 'attention and tivity,'

research of untoward result occurs in the context

of can be characterized by the application that

multiple iteration - that and multiple measures

half-a-dozen About by convergent validation. is

biological measures have been of different types

discussed As .' 'disease the validate to used

below, the results have been equivocal - provid-

a of ing only tenuous support for the validation

normal and troubled en general difference betwe

not including specific support for but children,

. Nonetheless, ADDH and ADD subtypes like

search results are robust in indicatingre these

these nonspecific differences, and thus the clini-

cal community continues to treat hyperactivity

ll s as a disease entity was wetu as though its sta

major five been have ereTh established.

hyper- of e biological validationth aches to pproa

e outlined below.ar eseTh entity. an activity as

Re- hyperactivity. manage drugs nt Stimula

children if that reasoned have searchers

hyperactive as sedno diag been ve ha who

this y, therap pharmacological to respond

at thereth evidence prima facie response is

underlying pathology physiological a is

. In 9) 719 hyperactivity (Brown and Sleator

hyperactive children with of fact, treatment

the therapy of choice for many is nt a stimula

hyperac- that take it turn clinicians, who in

tivity is an objective, nonnormative disease.

at there isth ct e fath This is the case despite

to se pones little clinical specificity in this r

success port g therapy. Several studies re dru

the eattr to g therapydru using stimulant

problems pediatric of spectrum entire

spondre 1983), and 'normal' children er (Rutt

ses ofpon sre are similar to the that in ways

hyperactive children when they are adminis-

gs.dru nt tered stimula

c- fa sk perinatal difficulties are ri nd Prenatal a 2

gators ti Several inves_. tyi iv eractypr h fo tors_

have tried to validate hyperactivity biologi-

cally by linking it to difficulties encountered

Some s. during the pre- and perinatal period

ated that suchtr of these studies have demons

oral dif- vi difficulties are related to early beha

ulties. However, it appears from the litera-fic

in diminish rapidly these that e tur

other factors in on to ti importance in rela

of the environment, and that the influence

ve ti hyperac on s nteve perinatal and e-pr

e-pr yll ear by the diagnostica pp or disa vi beha

them- In 3 years. of ribed 'age of onset'sc

not do events natalri pe and pre- lves,se

44 Handbook of Social Studies in Health and Medicine

Set-Theoretic Metaphor

At the center of the dynamic system of meanings in which sociomedical research has been grounded is the belief that the difficulties dealt with by medical practitioners are a set of health behavioral activities, experiences, or physio- logical events. This 'set-theoretic metaphor' (Straight 1979)- which treats behavior as a set of discrete, stable 'things' to be discovered - allows researchers to assume that their job is to discover the elements of this set. Because this is a discovery process, not a process of eva- luation and construction, this cultural assump- tion serves as a heuristic that allows researchers to carry out their work without reference to aspects of the problematic situation not included within their expert's technical knowledge. Moreover, this set-theoretic metaphor allows practitioners to assume a reductionist locus for causality and, by placing a premium on the internal elegance and parsimony of their theore- tical systems, it pushes researchers to systemati- cally oversimplify various asymmetries in the processes with which they deal, as for example when quantitative data are smoothed to exclude 'o utliers,' or qualitative researchers take a nar- row solipsistic reflective stance. It is useful to reca ll that 'lay' and 'profes- sional' understandings often differ. For example, in considering how various publics understood the ri sks assoc iated with needle exchange pro- grams, Lurie and his colleagues found that what people considered as relevant to calculat- ing 'risk' varied depending on their po sition within the political, le gal, or health professions, · or the general population (Lurie et a!. 1993). Such a finding is not unu sual, as Mary Dou glas and others have shown (Douglas and Wildavsky 19 82; In g ham 1994). All heuristics have biases (Piattelli-Palmarini 1994; Simon 1983; Wimsatt 1980). Among those introduced by the rea li st dominance of socio- medical research is the belief that the social stru cture of some settings (in this case; medical se ttings) allows us to take for gra nt ed the mean- ings of pr oblematic (or other) activity. Co ntr ary to this view , however, a number of researchers have shown that the meaning of human conduct is a lw ays 'established as a result of the conjoint adjustive responses of interacting and communi- cating individuals' (Maines 1977: 239).

Dominance of Expert Knowledge

In much of sociomedical research our expe rt knowledge is given a special statu s. In part, this follows from a view that expe rt knowled ge

is stable and cumulative. In this view, 'profes- sional practice is a process of problem so lving. Problems of choice or decision are solved through the selection, from ava il able means, of the one be st suited to established ends' (Schon 1983: 39-40). This view fosters a kind of 'scientism' th at leads to an emphasis on dealing with proble- matic situations by means of technique alone. In the realist view, sociomedical categories are said to be objective and 'scientific.' This general perspective also underlies the realist view of the social arrangements of practice. Because the professional technology is taken to be neutral (or seeking ways to achieve neutr ality), its use allows the introduction of the belief that prob - lem definitions are objective, and that the tech- nology for dealing with those objective problems is itself culturally neutral and value free (Martin 19 87; Sibley 1995). Following t hi s conception of practice allows the practitioner to ignore the fact that the prob- lem definition is negotiated, and that this nego- ti at ion process a ffe cts the ends to be achieved and the ways that these ends will be reached. The search for the single-le ve l validation of research ca tegories results in the use of just such an 'objective' technical fix. The privileged position given to sociomed ical categories, of the research methods developed to describe and acco unt for these phenomena, and their deriva ti ve technology results in reinforcing the guild interests of sociomedical researchers (Balshem 19 93; Gifford 19 86; Lane 1994). By giving special, privileged status to information derived by sociomedical research methods, problematic si tuations are removed from public discussion and made into topics for expert tr eat- ment. The claim that these discussions are neu- tral and value-free elevates their status, and insulates the sociomedical research professionals from the consequences of their work. Yet there is considerable debate abo ut the sta- tus and adequacy of exp ert knowledge. In parti- cular, there is considerable debate about how such knowledge develops. Does expert knowl- edge come from a smooth process, a process that consists of fits and starts, but in a stru ctured fashion or does expert knowledge result from disjunctive and more h ap hazard processes (Diesing 199 1)? ·

Discounted Experience

Treating the goal of sociomedical research as seeking to describe and account for health beha- vioral activities, a nd experiences and categories that are objectively discoverable entities, not o nl y supports a privileged view of expert know!-

Health and Medicine in Studies Social of Handbook 46

methodological work in of The recent history

sociomedical research reaffirms the contingent

of understanding our of and dynamic nature

behavior, health, and illness. During the middle

contingencies these century, twentieth the of

research. in sociomedical temporarily receded

of metaphors structuring the result, a As

and 'control' (as in disease control and 'proof'

efforts (Lane our dominate to eradication) came

that clear is it Now 1995). Rubinstein and

despite great technical advances and technical

knowledge claims must be our sophistication,

made with care; they must be made relative to

made with a more hand and at the question

especially so because we is modest tone. This

people's behavior and under- that now recognize

illness are and standing associated with health

and (Lane situated culturally always

the committing avoid To 1996a). Rubinstein

descriptions' cultural detachable of 'fallacy

(Rubinstein 1992) and seeing homogeneity and

essen- is dynamic processes, it of stability instead

researchers continue to that sociomedical. tial

the upon draw and another one learn from

offer. to best their fields have

on order to achieve this, we must focus In

the the- at disciplines of realizing the integration

oretical and methodological levels, not merely

technique. This and method of level the at

of kinds the of re-evaluation a require will

as useful knowledge. count that ought to data

the place necessarily will re-evaluation That

meaning as equal to quantification of treatment

essential is This realignment 1990). (Scrimshaw

in specificity greater to lead will it because

sociomedi- of interpretation our research and in

such inter- on is, after all, It cal phenomena.

our of pretive acts that the quality and utility

work ultimately depends.

MENTS EDG WL CKNO A

Lane, D. Sandra Albrecht, Gary thank We

Bernard for their ll Gretel Pelto, and H. Russe

this chapter and of comments on earlier drafts

Isabel Martinez for research assistance.

R EFERENCES

erica: The SocialAm in People Little Ablon, J. (1984)

Praeger. York: New Dwarfism. of Dimensions

AIDS of nt designge intelli 'The Albrecht, G. (1989)

H. Freeman, and Sechrest, L. ategies', intr research s

us onFoc Health Services Research: A A. Mulley (eds),

pp. 67- 74. , NCHSR : DC Washington,. AIDS

S. Charles of Philosophy The (1980) R. Almeder,

Totowa, NJ: Rowman and Littlefield. ce. Pier

Rigorous of Contradictions Inner (1980) Argyris, C.

Press. New York: Academic h. Researc

the Community: Class in Cancer (1993) Balshem, M.

DC: Washington, Authority. Medical and

Press. Smithsonian Institution

Women (1995) (eds) D.A. Gordon, and R. Behar,

California of Berkeley: University Writing Culture.

Press.

Anthropology: in Research Methods (1994) Bernard, R.

Thousand Qualitative and Quantitative Approaches.

Sage. CA: Oaks,

Scientific (1981) B. (eds) Collins, and M. Brewer,

Francisco: San Sciences. Social the in Inquiry

Jossey-Bass.

E. (1979) 'Methylphenidate in Sleator, Brown, R. and

dose effects on in hyperkinetic children: Differences

  1. 408- 4: 6 Pediatrics, impulsive behavior',

selection as epistemol- Natural Campbell, D. (1973) '

A Handbook ogy', in R. Naroll and R. Cohen (eds),

York: New Cultural Anthropology. in Method of

Press. Columbia University

Campbell, D. (1974) 'Evolutionary epistemology', in

Popper. Karl of The Philosophy (ed.), Schilpp A. P.

Co. Publisping Court Open IL: Salle, La

nvergent'Co (1959) D. Fiske, and D. Campbell,

multitrait- the by validation riminantsc di and

56: Bulletin, Psychological , x' matri multimethod

  1. 10 81-

" Motivation" ergo sum: 'Sentio, (1967) ntril, H. Ca

  1. 10 - 91 65: Psychology, of Journal ', Reconsidered

A Anthropology: Applied 1985)( E. Chambers,

Prentice NJ: Cliffs, Englewood Guide. Practical

Hall.

Collins, B. (1981) 'Hyperactivity: Myth and entity', in

Scientific Inquiry B. Collins (eds), and M. Brewer

Jossey Francisco: San Sciences. Social the and

pp. 385-412. Bass.

Deviance and (1980) Schneider, J. and P. ad, nrCo

St. ckness.Si to Badness From Medicalization:

Louis: C.V. Mosby.

(1979) J. s, McManu d'Aquili, E., Laughlin, C.D. and

Structural Biogenetic Ritual: A of Spectrum The

ess.Pr Columbia University York: New Analysis.

pre- of he cultural constructions'T Davis, D. (1996)

C. in ', syndromes menopause and menstrual

Gender and Health: (eds), ll Brette C. and Sargent

River, Saddle Upper onal Perspective. ti Interna An

: Prentice-Hall. NJ

he technocratic body and 'T Davis-Floyd, R .E. (1996)

the organic body: Hegemony and heresy in women's

(eds). ll Brette C. and Sargent birth choices', in C

International Perspective. An er and Health:nd Ge

. ll River, NJ: Prentice-Ha Saddle Upper

The Gordon Diagnostic System. 984) (1 C. Diagnostics,

Clinical Diagnostics. : CO Golden,

Work? How Does Social Science (1991) P. Diesing,

of Pittsburgh: University Reflections on Practice.

ess.Pr Pittsburgh

47 l Understandingca Sociomedi in Classification

g context back into epi- in (I 998) ' Bring A. Diez-Roux,

multilevel ana- in demiology: Variables and fallacies

216-- 88: Public Health , of American Journal lysis',

s: 994) 'Multilevel model (I and Forristal, J. T. DiPrete,

of Review Annual substance', and Methods

    • 331 20: Sociology,

and Risk (1982) A. Wildavsky, and M. Douglas,

Technical and of Culture: An Essay on the Selection

of Berkeley, CA: University rs. Environmental Dange

s. Pres California

diagnostic rea- of Feinstein, A. (1973a) 'An analysis

clinical of disorders The domains and I. soning.

and gy Biolo of Journal Yale macrobiology',

  1. 212- 46: e, in Medic

diagnostic rea- of analysis An Feinstein, A. (1973b) '

intermediate decisions', of The strategy 2. soning.

: 264-83. 46 e, in cdi Biology and M e of Yale Journal

diagnostic reason- of n analysis'A (1974) A. Feinstein,

Yale clinical algorithms', of The construction 3. ing.

  1. 5- 47: e, in Biology and Medic of Journal

, J. (I 989) Combining cognitive Tanur and S. Fienberg,

Science, and statistical approaches to survey design',

    • 1017 243:

and rse Discou and Todd, A.D. (eds) (I 986) S. Fisher,

and Education , Medicine , Authority: Institutional

New Jersey: Ablex. Law.

Anthropology: pturing caRe (1991) (ed.) R.G. Fox,

of Santa Fe, NM: School t. en the Pres in Working

Press. American Research

lth , eaH M.B. (1999) McGuire, and P.E.S. Freund,

Body: A Critical Sociology. Social eth Illness, and

ll. Ha Prentice Saddle River, NJ: Upper

Jumps: A case of Gifford, S.M. (1986) 'The meaning

S. Janes, C. in risk', of the ambiguities of study

and Anthropology (eds), Stall R. and Gifford

the to Epidemiology: An Interdisciplinary Approach

Dordrecht: Reidel. lth and Disease. eaH of Study

San in epidemic AIDS 'The (1986) M.E. Gorman,

anthropological and Epidemiological Francisco:

Stall R. Gifford, and S. Janes, C. in perspective',

An Epidemiology: and Anthropology (eds),

lthea H of Study the to Approach Interdisciplinary

Dordrecht: Reidel. and Disease.

(1997) (eds.) J. Ferguson, and A. Gupta,

of Berkeley: University Anthropological Locations.

Press. California

Berkeley: Disasters. Planning Great (1982) P. Hall,

Press. Califorp.ia of University

Scientific Explanation. of Aspects G. (1965) C. Hempel,

Press. New York: Free

Cultural (1987) (ed.) Quinn, N. and D. Holland,

Cambridge: Thought. and Language in Models

Press. University Cambridge

Science. Social of Philosophy The (1994) M. Hollis,

Press. Cambridge: Cambridge University

in Comes that Terror The (1982a) OJ. Hufford,

of Study Experience-Centered An Night: the

Philadelphia: Traditions. Assault Supernatural

Press. Pennsylvania of University

New disbelief', of 982b) 'Traditions (I Hufford, D.J.

-56. 47 8: York Folklore,

  1. 'The supernatural and the sociol- (I Hufford, D.J.

New knowledge: Explaining academic belief ', of ogy

    • 21 9: York Folklore Quarterly,
  1. ' Reasons, rhetoric and religion: (I Hufford, D.J.

York New Academic ideology versus folk belief',

    1. 77 I I , I Folklore,

in Hufford, D.J. (I 987) Contemporary folk medicine',

American in Unorthodox Medicine N. Gevitz (ed.),

MD: Johns Hopkins University e, Baltimor Society.

Press.

Regained: Consciousness (1984) N. Humphrey,

Oxford: Mind. of Development the in Chapters

Press. Oxford University

the about speculations 'Some 1994) ( R. Ingham,

4: Medical Sociology, in Advances risk', of concept

. 112 - 89

of Meaning and the Pragmatism (1978) W. James,

Cambridge, MA: Ayer. J. Truth, Introduction by A.

1909]. and 1907 [originally Press Harvard University

(1986) (eds) S. Gifford, and R. Stall, , C. Janes,

Boston: Reidel. Anthropology and Epidemiology.

ethno- of (1992) 'The use P. and Howard, C. Jenkins,

of the study in graphy and structured observations

in diarrhea of transmission the for factors risk

: 15 Medical Anthropology, Highland New Guinea',

. 16 1-

', DSM-m of women's view 'A (1983) M. Kaplan,

738-92. 38: Amercan Psychologist,

Chicago: Selves. Crafting (1990). O.K Kondo,

Press. Chicago of University

come first: don't (1991) 'When people C.P. Kottak,

Some sociological lessons from completed projects',

First: People Putting (ed.), Cernea M.M. in

Development. Rural in Variables Sociological

Washington, DC: World Bank.

Scientific of Structure The (1970) T.S. Kuhn ,

Chicago of University IL: Chicago. Revolutions.

(2nd edn). ss Pre

the by approximation 'Truth T.A.F. (1996) s, Kuiper

Balzer and hypothetico-deductive method', in W.

of Theory Structuralist (eds), Moulines C.U.

Berlin: de Gruyter. pp. 83-113. Science.

population control to repro- 'From Lane, S.D. (1994)

Social a,genda', ductive health: An emerging policy

    • 303 I 39: and Medicine, Science

health 'Public Lane, S.D. and Rubinstein, R.A. (1995)

scapegoating?: Reemergent tubercu- or iatrogenesis

the of Annual Meeting losis and patient blaming',

November. American Anthropological Association,

the 'Judging (1996a) R. Rubinstein, and S. Lane,

other: Responding to traditional female genital sur-

31-40. 26: Hastings Center Report, geries,'

(1996b) R.A. Rubinstein, and S.D. Lane,

in programs · and Problems health: 'International

a. J. Sargent, T. C. in anthropological perspective',

396-423. (eds). Westport, CT: Greenwood. pp.

: MA Cambridge, Action. in Science (1987) B. Latour,

Press. Harvard University

49 Understanding Sociomedical in Classification

Cultural in Methods of Handbook R. Bernard (ed.),

  1. -8 39 London: Altamira. pp. Anthropology.

of y Stud Blind Men : A of e Making Th (1969) R. Scott,

Sage Russell York: New Socialization. Adult

Foundation.

RAP: and Gleason, G .R. (eds) (1992) N.S. Scrimshaw,

Qualitative Procedures: Assessment Rapid

of Evaluation and Planning for es Methodologi

International Boston: Programs. Health-Related

Countries Developing for Foundation Nutrition

(INDFC).

(1985) 'Bringing the period down: S.C. M. Scrimshaw,

confront settlement squatter and Government

and Pelto J. P. in Ecuador', in induced abortion

of ls Leve Micro and Macro (eds), deWalt W.

Westview CO: Boulder, Anthropology. in Analysis

Press.

mbining quantitative and'Co (1990) S.C. Scrimshaw,

intra-household of the study in qualitative methods

P. N. and Rogers L. B. in allocation' , resource

Resource Intra-household (eds), Schlossman

Development for Methods and Issues Allocation:

Food and Nutrition Bulletin Planning, Policy and

Nations United Japan: Tokyo, 15. Supplement

Press. University

Parker, and L., Carballo, M., Ramos, S., Scrimshaw,

Rapid Assessment Procedures: AIDS / HIV R. (1990)

Studying for Approaches Anthropological Rapid

Behaviours. and Attitudes, efs, li Related Be AIDS

Geneva: World Health Organization.

anthro- of Scrimshaw, S.C.M. (1992) 'The adaptation

of assessment rapid to methodologies pological

S. N. in care', health primary and nutrition

Rapid RAP: Scrimshaw and G. R. Gleason (eds),

es Methodologi Qualitative Procedures: Assessment

Health-Related of Evaluation and Planning for

Nutrition International Boston: Programs.

(INDFC). Countries Developing for Foundation

    • 25 pp.

York: New Exclusion. of Geographies (1995) D. Sibley,

Routledge.

a diagnosis: Doctors, of (1977) 'The uses B. Sicherman,

of the History of Journal people and neurasthenia',

    • 33 32: Medicine and Allied Sciences,

Affairs. Human in Reasons (1983) H.A. Simon,

Press. Stanford: Stanford University

(1979) 'The set-theoretic metaphor versus H.S. Straight,

the develop- in ing metaphor ss the information-proce

Callebaut, W. in behavioral-science theory', of ment

Vandamme (eds), F. and Pinxten, M. D. Mey, R.

Ghent: Policy. Knowledge and Science of Theory

Communication and Cognition Books.

(eds) C. and Voegelin, I. Rouse, , L. Eiseley, , S. Tax,

Today. Anthropology of Appraisal An (1953)

Press. Chicago of Chicago: University

Hidden Arguments. Political Ideology (1988) S. Tesh,

New Brunswick, NJ : Policy. and Disease Prevention

Press. Rutgers University

(1984) ' Difference and dis- 0. Ward, J.J. and Werner,

ethnographic data ', in R. Rubinstein and in sonance

Process: and Epistemology (eds), Pinxten R.

Ghent: Communication and Anthropological Views.

Cognition Books.

Power Epidemics and History. Disease, 1997) ( S. Watts,

University Yale New Haven, CT: and Imperialism.

Press.

and Campbell, D.T. (1973) 'Translating, 0. Werner,

of working through interpreters, and the problem

(eds), Cohen R. and Narroll R. in decentering',

Anthropology. Cultural in Method of Handbook

Press. Columbia University York: New

New Reality. and Process (1960) Whitehead, A.N.

Norton. York:

(1980) 'Reductionistic research strategies W. Wimsatt,

selection contro- of units the in their biases and

l and ca Histori 2. Scientific Discovery, Vol. versy',

Dordrecht: Reidel. Scientific Case Studies.

Dunkel- and S.C., Scrimshaw, R.E., Zambrana,

care and medical risk 'Prenatal (1996) C. Schetter,

African and Latino primiparous income low in

Systems and Health, Families, women', American

    • 349 14:

Zambrana, R.E., Scrimshaw, S.C. M., Collins, N. and

health beha- 'Prenatal (1997a) C. Dunkel-Schetter,

pregnant in factors risk psychosocial and viors

acculturation', of Mexican origin: The role of women

    • 1022 87: Health, Public of American Journal

Dunkel- and S.C. Scrimshaw, R.E. Zambrana,

behaviors and psycho- 'Prenatal (1997b) C. Schetter,

low- in social factors associated with substance use

23: Nursing, Pediatric women', pregnant income

    1. 253