Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
The Role of Sociology and
Social Networks in Integrating
the Health Sciences
Bernice A. Pescosolido
Indiana University
Presentation in the Networks and Complex Systems Talk
Series, Indiana University, November 28, 2005
Support is acknowledged from NIMH grant K0242655, Indiana
Consortium for Mental Health Services Research (ICMHSR), and
Indiana University (COAS & OVP)
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
The long-standing debate about the importance of nature
versus nurture, considered as independent influences, is
overly simplistic and scientifically obsolete.
-- Neurons to Neighborhoods (2000:6)
It is time to reconceptualize nature and nurture in a way that
emphasizes their inseparability and complementarity, not
their distinctiveness: it is not nature versus nurture, it is
rather nature through nurture.
-- Neurons to Neighborhoods (2000:41)
In the past 25 years, the study of human health has included
a distinguished, but neglected intellectual tradition put
forth by numerous investigators, who saw the need for
broad integrative frameworks that capture complex
pathways to illness and disease.
-- New Horizons in Health (2001:21)
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
Series of Reports
• New Horizons in Health: An Integrative Approach, 2001
• Toward Higher Levels of Analysis: Progress & Promise in
Research on Social and Cultural Dimensions of Health,
2001
• Bridging Disciplines in the Brain, Behavioral and Clinical
Sciences, 2000
• From Neurons to Neighborhoods: The Science of Early
Childhood Development, 2000
• Through the Kaleidoscope: Viewing the Contributions of
the Behavioral and Social Sciences to Health, 2002
• Breaking Ground, Breaking Through: The Strategic Plan
for Mood Disorders Research of the NIMH, 2002
• Translating Behavioral Science into Action, 2000
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
Basic Problem
• Limits of biomedical approaches
in predicting who gets sick, who
seeks treatment, and who
recovers
Call
• Understanding “contexts”
• Integrating health sciences
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
Dilemma
• How to synthesize
• How to select among panorama
of influences
Possible Solution
• Contexts as social structures
• Social structures as
“association” or “interaction”
• Social networks
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
Claim
• This convergence makes way for
social networks place in
integrated health research
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
Three Baseline Conditions
for a Response
• All levels relevant to health and health care
must be considered, separated out and
linked in an overarching theoretical frame by
a similar mechanism, even when research
targets only one level
• Room must be made to tailor such
frameworks to particular populations,
whether socially (ethnic or age groups) or
medically (disease types) defined
• Find a way to work within “big science” to
address problems from social construction
to social causation that contribute to our
understanding of basic social processes as
well as medical phenomena
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
Current Climate
• “driving the disciplines toward each
other”
• “bringing the behavioral and social
sciences more strongly and visibly
into the full panorama of health
research”
• “groundswell of support”
• “foster communication among
scientists who have been too long
isolated behind disciplinary walls”
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
Looking Up From the
Microscope and the Clinic
• The success of “pure” biomedical
science that has led to the call to look
up from the microscope to the
“environment.”
• Epigenetic modification
• “50% genetics and 50% environment”
• 90% of diseases do not follow simple
genetic rules of inheritance
• Effectiveness not efficiency
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
The Current Landscape of
Integration
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
The “Environment”
• The Black Box of BMS
• Luck, Chance
IOM (Committee on Assessing Interaction Among
Social, Behavioral, and Genetic Factors and Health)
• How should social environments be
conceptualized and measured?
• Which aspects of the social environment
should be included and at what levels of
analysis?
• How do we consider present influences and
those that have accumulated over the life
course?
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
E. O. Wilson
Consilience, 1998
De Waal
• Continued disarray of the social
sciences, 1996
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
Requirements for Integrating
Models and Frameworks
• consider and articulate the full set of
contextual levels that have a documented
role in past empirical research
• offer an underlying mechanism or “engine of
action” that connects levels, is dynamic,
and allows for a way to narrow down focal
research questions
• employ a metaphor and analytic language
familiar to both social and natural science
that can facilitate synergy
• understand the need for and use the full
range of methodological tools proven useful
in the social and natural science
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
Bronfenbrenner: Nested
Contexts
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
The Key: Social Networks
as Theoretical Foundation
• Puts human face on issues of access,
barriers, intervention, by conceptualizing
these as actions of individuals.
• Relationships are “fundamental” mediators
of human adaptations”.
• Networks are the “active ingredients of
environmental influences”. Offers the
underlying engine of action.
Neurons to Neighborhoods
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
NEM-Phase I: Cause &
Consequence of Illness/Disease
Reconsidered (SOS)
• The Role of Others
• The Role of Cultural Toolboxes
• The Role of Time
• The Role of Options
• Embeddedness – “Social Networks”
• Habit/Knowledge – “Content”
• Dynamics
– “Patterns & Pathways”
– “Turning Points, Trajectories”
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
The NEM – Phase I
(Pescosolido, Advances in Medical Sociology, 1991)
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
The NEM – Phase I
Support
Choice, Coercion & “Muddling Through”
46%
25%
33%
(Social Science & Medicine, 1998)
Patterns of Care & Social Influence
(Medical Care, 1998)
Limits
Role of Treatment/Organizations
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
Network-Episode Model –
Phase II
• The Dynamics of Treatment,
Organizational and Policy Change
• Networks
•
“Outside” Networks
•
“Inside” Networks
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
The NEM – Phase II
(Pescosolido & Boyer, A Handbook for the Study of Mental Health, 1999)
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
The NEM – Phase II
Support
• Power of Organizational Context
(Wright, Psychiatric Services, 1997)
Limits
• Role of Disease Course
• Role of Individual
• Role of Community
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
The Network-Episode
Model – Phase III
• The Elaboration of “Contexts”
• Focus on Multi-disciplinary
Integration and Synergies
• People as the Agents of Change
• Networks as Mechanism that Connect
Different Levels and Processes
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
What Should An Integrated
Health Science Model Look
Like?
Crocheted Model
of a
Pseudosphere by:
Daina Taimina
Cornell University
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
Barabási Complex Network
Model
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
The Network-Episode
Model – Phase III (Rejected)
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
The NEM III Under
Construction
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
Nagging Questions
• Need we all embrace the NetworkEpisode Model or even the network
metaphor?
• Does this mean that everyone must be
engaged in multi-level, multi-disciplinary
endeavors?
• How are integrated, multi-level studies
likely to be accomplished?
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
Multi-disciplinary versus
Interdisciplinary
“All too often it is insisted that there is
only one kind of data, one
methodology that should be
employed, when everything we know
about the major issues in the
development of the social sciences
should warn us against such
imperialism.”
Jane Lewis, 2003
The Political Quarterly
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
“Big Science”
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
The Crossroads
“Shackled by tribal loyalty”
“Snarled by disunity and a failure
of vision” ?
OR
Have we traveled different
pathways to a similar vision?
Department
of Sociology
Indiana
Consortium
for Mental
Health
Services
Research
Conclusion
“Biophobia” (Freese et al 2003)
“Methodenstreit” (Swedberg 1989)
“Imperialist intrusion” (Collins, 1986)
OR
“Mutual credibility” (Modell, 2002) ?