Diagnosis as Topic and as Resource: Reflections on the Epistemology and Ontology of Disease in Medical Sociology

Abstract

This article notes an enduring ambivalence in medical sociology concerning the epistemology and ontology of disease and shows this is precisely an ambivalence concerning whether biomedical disease categories are best understood as topics of, or as resources for, medical sociological research. The first section critically reviews the topic/resource debate in ethnomethodology. The second section elaborates upon the pertinence of this debate to sociological debates directly concerned with the epistemology and ontology of disease. The article concludes by demonstrating how framing the epistemology and ontology of disease in terms of the topics and resources of medical sociological analysis serves to clarify the work of thinking sociologically about disease and helps overcome protracted theoretical challenges that have persistently troubled medical sociological research.

Disorder or difference? How clinician‐patient interaction and patient age shape the process and meaning of autism diagnosis

“…In treating diagnosis as a topic of inquiry, rather than an analyst's resource (Weinberg, 2021), and attending to the particulars of just how the diagnosis is achieved in practice, we can explicate how a deficit-oriented version is reproduced in the local practices of clinicians and others and thereby point to possibilities within the 'diagnostic moment' (Jutel, 2019) for 'doing autism' (to paraphrase Garfinkel, 1967 andWest &Zimmerman, 1987) differently. Specifically, it is possible to stress difference rather than deficit and special talent instead of uniform weakness.…”

Battles over ‘unruly bodies’: Practitioners’ interpretations of eating disorders and the utility of psychiatric labelling

“…Messages concerning EDs are reinforced by ‘science’ and reinvigorated via the government and media. In real‐life terms, problems defined as EDs are not sets of stable diagnoses but are ongoing human processes requiring an array of approaches if their treatment is to be successful (Weinberg, 2021). We query whether successful treatment of eating disorders requires the construction of new psychiatric categories, where many such disorders represent a tension between individual biographical‐familial constellations on the one hand and on norm‐driven attempts at improved symptom lists linked to the formation of professional identities on the other.…”

“…It becomes incumbent on professionals to draw on other forms of professional knowledge to display their superior understanding of 'troubled' eating as complex and labels as an imperfect instrument to be used in their therapeutic armoury. In this way, professionals can 'transcend a priori reductionisms' (Weinberg, 2021), without denying the validity of psychiatric labelling in specific contexts. An important part of how professionals conceive their role is therefore educating students, patients and families about the complexity of EDs and the perils out there, such as on the 'dark net' and pro-Ana chat forums.…”

Exploring valuation practices in diagnosis‐as‐category: The rising dominance of clinical practice in the categorisation of Sepsis, 1991–2016

“…Furthermore, while some sociological studies had presumed a biological, mind-independent and objective ontology of disease, Mol's (2002) path-breaking description of the 'ontologies' of atherosclerosis continued to break down the distinction between disease as objective reality and illness as socially constructed by documenting how distinct medical practices enact multiple ontologies of a single disease, giving rise to an ontology of emergent social practice. We build on Mol's work, but also aim to address two issues concerning her analysis identified by Weinberg (2021). First, we explore the contested status of sepsis as an empirically identifiable medical phenomenon by demonstrating empirically the practices through which various actors attempt to render the reality of sepsis (albeit multiple) a matter of medical consensus.…”