11.1 Sociology: Theories and Institutions - Social Structure and Demographics

MCAT Behavioral Sciences Review - Kaplan Test Prep 2021–2022

11.1 Sociology: Theories and Institutions
Social Structure and Demographics


After Chapter 11.1, you will be able to:

· Recall the primary theses of major sociological theories, including functionalism, conflict theory, symbolic interactionism, social constructionism, rational choice theory, and feminist theory

· Contrast manifest and latent functions of given elements of a sociological system

· List the four key tenets of American medical ethics

Sociology is the study of society: how we create society, how we interact within and change society, and how we define what is normal and abnormal in society. Whereas psychologists focus on the behaviors of individuals, sociologists focus on the way groups organize and interact. Of course, it would be difficult to describe society as a whole since human society is not completely uniform and is instead made up of distinct cultures, subcultures, groups, and institutions, each with its own structure, patterns, and interests. As a result, sociologists study the subject at different levels: The micro level consists of family groups and local communities. The meso level consists of organizations, institutions, and ethnic subcultures. And the macro level consists of national and international systems.


Because human interaction is so complex, sociologists have proposed many models, called theoretical approaches to sociology, to help analyze and explain aspects of human social behavior. Sociologists don't necessarily disagree about which model is "best." Rather, each model was created to explain certain aspects of sociology, and is inadequate for explaining other aspects. For example, one theoretical approach we will examine is symbolic interactionism, which studies how humans interact and communicate using language, writing, and other symbols. By contrast, another approach, called conflict theory, examines how groups with little power in society can rise up and create more equality. These two models are not necessarily competing explanations. Rather, they examine such vastly different aspects of human interaction that both models are necessary!

As you read this section, keep track of which aspects of human behavior each model explains, and what the weaknesses of each model are. For example, approaches such as symbolic interactionism, social constructionism, and rational choice (exchange) theory tend to focus on society at the micro- and meso-levels. On the other hand, conflict theory, structural-functionalism, and feminist theory are more applicable at the macro-level.

Symbolic Interactionism

Communication among humans stretches far beyond just language, spoken or written. Our bodies are tools of communication through our posture, facial expressions, and hand gestures. We recognize and put meaning into images like the smiley face, traffic signs, or corporate logos. Sacred emblems like the cross, the Star of David, or the star and crescent communicate deep religious significance. Even our clothing can communicate meaning. Any object, image, sound, or action that carries meaning to humans is a symbol. Importantly, according to this definition, while many physical objects are symbols, a symbol need not be a physical object. For example, spoken words are symbols, and so are meaningful grunts. Body language and hand gestures are symbols. Anything that carries meaning beyond its own existence is a symbol.

Symbolic interactionism is an approach to sociology pioneered by influential sociologist George Herbert Mead that attempts to understand human action and interaction by studying the symbols we use to communicate. This theoretical approach makes three main assumptions about human

· Humans act toward symbols based on the meanings that these symbols carry.

· The meanings symbols carry come from social interaction.

· Humans interpret the meaning of symbols, and this interpretation influences action.

Therefore, according to symbolic interactionism, humans are different from lower animals in that lower animals simply respond to stimuli, while humans have the capability to interpret the stimulus first, then react. For example, a dog might bare its teeth, which is a gesture that other dogs always interpret as a symbol of aggression. Lower animals are not able to conceive of alternative meanings to gestures. By contrast, the thumbs up gesture in American culture generally signifies approval. In a different context, however, it could be used sarcastically to communicate disapproval. And in some Middle Eastern countries, it is an offensive gesture. The meaning of the thumbs up symbol therefore depends not only on social and cultural understanding, but also on a person's interpretation.

ImageFigure 11.1. Symbolic Interactionism Hand gestures do not always carry the same meaning across cultures. The thumbs-up is a sign of approval in American culture; in some Middle Eastern cultures, it is an offensive gesture.

Not only do hand gestures carry different meanings in different cultures, but different cultures have unique languages and slang, alphabets and number systems, traffic signs, and so on. In fact, the meaning of a symbol might differ even from group to group within a culture. The shared understanding of symbols is therefore a micro- or meso-level phenomenon. One major limitation to the symbolic interactionist approach is that it overlooks macro-level structures, like cultural norms or class interactions.

Social Constructionism

The agreed-upon meaning of symbols can change. For example, the peace sign, which today is a symbol signifying peace and freedom in general, originally was used to indicate support for nuclear disarmament specifically. Society's interpretation of the peace sign has therefore broadened over time. This example shows that the meaning of a symbol does not come from the symbol itself, but from implicit social agreement. Symbols are therefore examples of social constructs. A social construct is any idea that has been created and accepted by the people in a society. Social constructionism is the attempt to understand a society through the study of the society's social constructs.

Key Concept

Symbolic interactionism reflects on how we use symbols to interact with each other. Social constructionism reflects on how we, as a society, construct concepts and principles.

Symbols are not the only type of social construct. Abstract ideas might also be social constructs. For example, the definitions of concepts like honor and justice rely on group agreement among individuals within a given society, and these concepts are therefore social constructs. Sociologists also apply social constructionism to physical objects, such as money. Paper money and coinage do not inherently have significant value; it is only because we, as a society, imbue these objects with value that they can be used to trade for goods and services. Other examples of social constructs include work ethic, acceptable dress, and gender roles.

As with symbolic interactionism, social constructionism is useful for explaining micro- and meso-level sociological phenomena. Any social construct depends on the society being studied, and different societies will have different social constructs. Therefore, like symbolic interactionism, a limitation of social constructionism is that this theory cannot account for macro-level sociological phenomena.

Rational Choice (Exchange) Theory

Rational choice theory is one more micro- to meso-level approach to sociology. This theory focuses on individual decision making. According to rational choice theorists, humans will make rational choices to further their own self-interests. This theory claims that people weigh the costs and benefits when making choices, ranking their options based on maximizing perceived benefit. For example, when deciding to purchase a new laptop, rational choice theory claims that a person will gather information about characteristics such as cost, performance, brand recognition, and so on, and then will rank their options and choose the best one.

This laptop example illustrates that rational choice theory is influenced by the study of economics. Rational choice theory becomes a model of sociology when this idea of rational transactions is applied to the social interaction. The rational choice perspective views all social interactions as transactions that take into consideration the benefits and harms to the individual. Every outcome in a given social interaction can be associated with particular social rewards (such as accolades, honor, prestige, or social approval) and with particular punishments (such as embarrassment, humiliation, sanctions, or stigmatization). From the rational choice perspective, an individual carefully considers all of the possible rewards and punishments of each social action and chooses the option that results in the greatest social benefit.

Moreover, according to rational choice theorists, people evaluate whether there is reciprocity and balance in social relationships: People stay in relationships because they get something from the exchange, and they leave relationships when there are more social costs than benefits. Due to this view of relationships as exchanges of social value, rational choice theory is sometimes called social exchange theory, or just exchange theory for short.

Rational choice (exchange) theory is acceptable for explaining some micro- and meso-level sociological phenomena. However, rational choice (exchange) theory does not easily explain charitable, illogical, unselfish, or altruistic behavior.

Conflict Theory

Conflict theory is a macro theory that attempts to understand society by examining the inevitable conflicts between groups in society. Conflict theory has its origins in the writings of Karl Marx, a 19th century social philosopher who examined the influence of capitalism on 19th century society. Capitalism is an economic system in which individuals and corporations, rather than governments, own and control what Marx called the means of production, meaning property, machinery, factories, or any other means of creating a saleable good or service. According to Marx, such private ownership naturally leads to a small, wealthy capitalist (bourgeoisie) class, who control the means of production. In Marx's model, the rest of society is relegated to a lower worker (proletariat) class that performs manual labor. Because the capitalist class owns the means of production, this class has power over the worker class, and the disparity in power and resources between these two groups leads to conflict. According to Marx, the conflict in such a society would be a physical one: Eventually, the worker class would rise up and overthrow the capitalist class and form a new, classless society.

Where Marx focused specifically on conflict between capitalists and workers, modern conflict theory expands this idea to examine any conflict between powerful groups and powerless groups. For example, conflict might exist between the young and the old, between a dominant religious group and another religious group, or between different regions of a country. According to conflict theory, in any such conflict, individuals in the group with power attempt to preserve their power by shaping the structure of society itself. The group with power uses their influence to dictate the laws, customs, and cultural norms of the society. However, according to conflict theorists, if people in lower-status positions recognize this power differential and see that others share a common dissatisfaction, then these individuals can organize to form interest groups, through which they can use tools such as protesting or voting to enact change and equalize power. In short, according to conflict theory, for the powerful in society, maintenance of the status quo is usually desirable, and for the powerless, change comes through disruption and revolution.

Real World

Conflict theory can be applied to healthcare and medicine. Conflict theorists would not deny that modern healthcare can help people maintain or restore their health; however, they may ask who holds the power in the healthcare system. Is it the patient? The doctor? Hospitals? Pharmaceutical companies? Insurance companies? The government? This is an issue the United States continues to grapple with.

While conflict theory is a useful model for describing many large-scale changes and other macro-level societal phenomena, it is not very effective for explaining the choices of individuals in society. Also, conflict theorists tend to focus on social stress and disharmony, so conflict theory is less effective than some other models at explaining social cohesion, cooperation, and altruism.


In some ways, structural-functionalism is the inverse of conflict theory. The founder of structural-functionalism, Émile Durkheim, was interested in how large societies survive over long time periods, and was therefore concerned with social cohesion and stability. Durkheim compared society to an organism and proposed that each group in society has a role to play in the overall health and operation of society. These roles might be very different, in the same way that different organs or even different cells have very different functions within an organism, but each is important. Durkheim called each social group's role its function: the contribution made by that group to the system. According to structural-functionalist theory, the different groups of society work together in an unconscious, almost automatic way toward maintenance of equilibrium.

In structural-functionalism, functions can either be manifest or latent. A manifest function is an intended consequence of the actions of a group within a society. When an organization or institution has unintended but beneficial consequences, these are called latent functions. For example, annual meetings of medical societies have the manifest function of educating a group of physicians, sharing research findings, and setting goals for the next year. Such meetings also create stronger interpersonal bonds between physicians and provide a sense of identity for the group, both of which are latent functions. On the other hand, while both manifest and latent functions provide a benefit to society, dysfunctions are negative consequences of the existence of an institution, organization, or interaction.

Because structural-functionalism focuses on social cohesion and equilibrium, this approach is not well suited for explaining social change. Additionally, while structural-functionalism attempts to explain how groups interact with other groups, it does not explain how individuals interact within a group. To understand those kinds of micro-level interactions, other models are better suited.

Feminist Theory

Feminist theory critiques the institutional power structures that disadvantage women in society. Feminist theory was originally an offshoot of conflict theory. From a conflict theory perspective, feminist theory describes society as inherently patriarchal, with men seeking to preserve their position of power over women through societal privilege and institutional discrimination. For example, some feminist theorists argue that the study of sociology itself has been historically dominated by a male perspective.

In developed countries, gender stratification and inequality typically lessens, often as a result of the activism of feminist interest groups. However, imbalances of power still exist. In the workplace, for example, the term glass ceiling refers to processes that limit the progress of women to the highest job positions because of invisible social barriers to promotion. In contrast, even in cases where men do not seek to climb the job ladder, invisible social forces sometimes push men up to higher positions, a phenomenon called the glass escalator. The glass escalator is especially prevalent for men working in traditionally female occupations.

Behavioral Sciences Guided Example With Expert Thinking


Expert Thinking

In societies facing increasing amounts of migration and ethnic integration, concerns about intergroup conflicts have prompted research into the effects of diversity on a society as a whole. Previous studies suggest that ethnic diversity negatively impacts social cohesion, but critics have pointed out that historic measures of social cohesion have focused on single indicators such as trust or volunteering.

Older studies demonstrated a negative relationship between diversity and social cohesion, but those are in doubt.

The current study sought to operationalize social cohesion across a more comprehensive set of indicators. Ethnic diversity was found to be associated with lower social cohesion with respect to some indicators, particularly volunteering and feelings of safety, but this trend could not be generalized when including a larger scope of indicators of social cohesion, such as neighborhood social capital or belonging. When heterogeneous groups showed increased contact with one another, subject assessment via survey showed a significant increase in feelings of trust, safety, and social capital.

Several results here. Not only were previous studies possibly wrong, but new results show that integration increases cohesion. Not an experiment so no experimenter-controlled IV, looking at association only.

Adapted from: McKenna S, Lee E, Klik KA, Markus A, Hewstone M, Reynolds KJ (2018) Are diverse societies less cohesive? Testing contact and mediated contact theories. PLoS ONE 13(3): e0193337. https://doi.org/10.1371/journal.pone.0193337

How does conflict theory relate to the results of this study?

This question at first might seem tough, as the results of the study seem to suggest that there is less conflict than one would expect in more diverse societies. When faced with a question that asks us to apply a concept to a new situation, it’s useful to think critically about the definition of that concept. According to conflict theory, institutions arise as a result of power differentials between individuals, and those institutions seek to maintain that power differential.

So where is the conflict in this situation? According to the study, there can be a great deal of diversity in an area that has low interaction between different groups. In those situations, some measures of social cohesion decrease, including feelings of safety. So when people are in close quarters with diverse others, particularly when not interacting with those others regularly, perceived threat to the establishment and maintenance of the power differential will increase, which increases the conflict between groups.

However, the study also found that when people in close quarters with a diverse population interact more with diverse others, they report increased feelings of trust, safety, and social capital, indicating a reduction in perceived threat from other groups. We could infer that this increased interaction may counter the conflict theory effects noted earlier: increased trust and safety reduces fear of others, generally, and fear of loss of power, specifically. With a reduction in perceived threat and increased social cohesion, motivation for conflict should decrease, as power differentials are less threatened or groups are actively integrated into the existing power structure.

So, in summary, conflict theory provides some explanation as to why those who are not interacting with their diverse society may experience more perceived threat and conflict motivation. The study further indicates the perceived threat effect, and possibly societal conflict overall, can be countered by increased social interaction.


Social institutions are well-established social structures that dictate certain patterns of behavior or relationships and are accepted as a fundamental part of culture. Social institutions regulate the behavior of individuals in core areas of society. For example, family is a social institution that encourages learning of acceptable behavior, socialization, and bonding.

Institutions exist at the meso-level of sociological analysis because they are a part of society, but are not dependent upon the individuals involved—in the United States, the idea of "government" stays basically the same even though term limits mean that the presidency and legislature experience a complete turnover of personnel every eight years at a maximum. The exact nature of each institution differs from culture to culture, although each institution performs a similar role regardless of culture. Often, institutions are dependent upon and support one another, though competition over resources can bring institutions into conflict. A summary of six of the major social institutions is provided in Table 11.1 at the end of this section.


The definition of family differs greatly from culture to culture. For some, the term means "those people to whom I maintain close ties and who are related to me by blood." For others, family is simply "the people who live in my house." In fact, even terms for different family members (such as sister, father, cousin, and so on) are not conserved across time and culture; different patterns of kinship may be reflected by these terms. For example, it is common in Hawaiian culture to refer to all family members as cousins, while this term would not be used by many other Americans to describe one’s mother’s brother (the term uncle being preferred by many continental Americans). Different patterns of kinship between societies have bearing on responsibility for child rearing, familial loyalty, and even the boundaries of what is considered incest.

Regardless of the definition, family is the most basic of institutions. It is the institution most closely tied to the individual and helps to meet many of our most basic needs, especially when we are young, providing food, shelter, emotional and physical security, and intimacy. Additionally, many life rituals and rites of passage, such as marriage, funerals, and graduations occur in the context of family.


Families help to meet many of the basic needs at the base of Maslow's hierarchy pyramid. Maslow's hierarchy of needs is discussed in chapter 5 of MCAT Behavioral Science Review.

Sociologists studying family relationships may examine the stages of coupling (courtship, cohabitation, engagement, and marriage), changes in relationships between spouses through time, or parenting. Parenting is a complex topic that involves socialization of children; varied definitions of the role of father, mother, and child; and single parenting, same-sex parenting, adoption, and foster parenting. Not all families are composed of a mother, a father, and children. Alternative forms exist, including single-parent families; families that cohabitate with other family members beyond the nuclear family, such as grandparents, aunts, uncles, cousins, godparents, and surrogate kin; and families with marital disunions (divorce). A number of different family structures are illustrated in Figure 11.2.

ImageFigure 11.2. Various Family Structures

Divorce rates in the United States rose significantly in the second half of the twentieth century but have started to drop over the last two decades.

MCAT Expertise

The MCAT will not expect you to know any specific demographic numbers for the exam, but you should be familiar with some of the recent trends seen in the United States population.

While the family can be a source of joy and support, it can also be a source of violence. Spousal abuse (domestic violence) is seen across all social classes and genders and can include not only physical violence, but sexual abuse, emotional abuse, and financial abuse. Domestic violence is the #1 cause of injury to American women, and is most common in families with drug abuse, especially alcoholism. Victims of domestic violence may find it challenging to leave the abusive relationship for a variety of reasons, including lack of a safe haven to escape to, financial restrictions, and psychological disorders (consider the connection to learned helplessness, described in Chapter 6 of MCAT Behavioral Sciences Review). Elder abuse is also seen across all socioeconomic classes, and most commonly manifests as neglect of an older relative—although physical, psychological, and financial abuse may occur as well. The caretaker of the individual is most commonly the source of abuse. Finally, child abuse also most commonly manifests as neglect, although physical, sexual, and psychological abuse are also common. During medical school, you will be trained to recognize certain signs suggestive of nonaccidental trauma, such as a broken femur in a child who is too young to have begun walking or burn marks on the buttocks from placing a child in scalding water. As a physician, you will be considered a mandated reporter, which means that you are legally required to report suspected cases of elder or child abuse. Domestic abuse does not fall under mandated reporting laws, but counseling and information about shelters for victims of intimate partner violence should be provided.


Education, as an institution, aims to provide a population with a set of skills that will be useful to them or to society. In many societies, education is formal—in other words, it takes place in a setting designated for educational purposes using a prescribed curriculum. The function of formal education is to teach skills, facts, and mental processes, but the system also has a social latent function, providing opportunities for peer socialization and reinforcing social stratification, both within individual schools and through comparisons between schools. Education, therefore, includes not only the information and cognitive skills students learn but also the hidden curriculum of transmitting social norms, attitudes, and beliefs to students. Sociological investigations into education may focus on the ethics, morals, practices, political influence, finances, and values of an education system. Sociologists also explore educational trends, including grade inflation and deflation, adult education, online education, and accessibility of education.

Performance in the education system depends not only on a student’s intrinsic abilities, but also on the education system itself. Teacher expectancy refers to the idea that teachers tend to get what they expect from students. Thus, a teacher who places high demands on students—but who also believes that her students can rise to the challenge—will more often see students succeed than a teacher who places the same demands but doubts that the students can achieve them. This is an example of a self-fulfilling prophecy, discussed in Chapter 10 of MCAT Behavioral Sciences Review, and may be due to differences in how teachers motivate, interact, and offer feedback to their students.

Education is susceptible to inequalities across socioeconomic class. Lower socioeconomic status is associated with decreased accessibility to and quality of education. This is not an easy trend to reverse. Low funding, deprioritization of education, and poor historical performance can make it challenging for a failing school district to acquire resources and improve education to its students.

As mentioned earlier, institutions are intentionally or unintentionally connected, and there is a well-known, persistent association between education and medicine. Health disparities between more educated and less educated individuals are significant, and lack of education may be a hurdle to accessing or trusting healthcare providers.


As an institution, religion is a pattern of social activities organized around a set of beliefs and practices that seek to address the meaning of existence. Religiosity refers to how religious one considers him- or herself to be, and includes strength of religious beliefs, engagement in religious practices, and attitudes about religion itself.

Approximiately 75% of the population identifies with one of the five major religions: Buddhism, Christianity, Hinduism, Islam, and Judaism. Because the membership of each of these religions is so large, they are divided into multiple denominations or sects that may share certain beliefs and practices but not others. A denomination is simply a part of a church, a term which can refer both to a large, universal religious group and to the building in which the congregation of such a group meets. Orthodox and Reform are examples of Jewish denominations, and the Sunni and Shia are examples of Islamic denominations. Denominations often coexist, but can come into conflict when their religious beliefs promote opposing values. Whereas the word sect was historically a pejorative term, it now refers more properly to a religious group that has chosen to break off from the parent religion. The Amish would be considered a sect of Christianity. In rare cases, a religious sect may take on extreme or deviant philosophies and transform into a cult.

As the twenty-first century continues, religious groups—many of which have existed in more or less the same form for thousands of years—grapple with finding a place in contemporary society. For many religious groups, this is reflected by a shift toward modernization within the religion and relaxing historical practices. For others, there is a shift away from religion as society secularizes, or moves from a world dominated by religion toward rationality and scientific thinking. For other groups, maintenance of strict adherence to religious code, or fundamentalism, predominates.

While spirituality and religion are not equivalent terms, they are often linked to each other because they both seek to understand the meaning of existence and to identify what is sacred. Spirituality and religion may play a role in a patient’s understanding of disease, may impact healthcare decisions, and can be an essential component of the patient’s coping mechanisms.

Government and Economy

Government and economy can be defined as systematic arrangements of political and capital relationships, activities, and social structures that affect rule making, representation of the individual in society, rights and privileges, division of labor, and production of goods and services. Notably, political and economic institutions impact all other institutions to some extent. That is, the government may sanction or define specific family structures, may finance and regulate education, may recognize some religions but not others, and may play a key role in funding and certifying healthcare and medicine. The effects of the economy on institutions can also be viewed from the individual level. For example, when the economy takes a downturn, large swaths of the population may have trouble supporting their families and paying for health insurance. Note that this institutional influence is bidirectional: because of the economic downturn and changes in family, education, or health, an individual may choose to vote a new political candidate into office, or to support or oppose a particular piece of legislation.

While an in-depth exploration of the American (or any other) government is outside the scope of the MCAT, you could be asked to distinguish between different types of government. A democracy allows every citizen a political voice, usually through electing representatives to office (i.e., a representative democracy). Monarchies include a royal ruler (a king or queen), although the ruler’s powers may be significantly limited by the presence of a constitution, a parliamentary system, or some other legislative body. A dictatorship is a system where a single person holds power, and usually includes mechanisms to quell threats to this power. A theocracy is a system where power is held by religious leaders. Many of these systems of leadership are based around a charismatic authority (a leader with a compelling personality).

In comparative economics, the largest division is between capitalist and socialist economies. Capitalist economies focus on free market trade and laissez-faire policies, where success or failure in business is primarily driven by consumerism with as little intervention from central governing bodies as possible. In capitalism, a private owner or corporation maintains and profits from the success of the business. Capitalist societies encourage division of labor, where specific components of a larger task (say, developing, manufacturing, quality testing, and marketing goods) are separated and assigned to skilled and trained individuals. This promotes specialization and efficiency. Socialist economies, on the other hand, treats large industries as collective, shared businesses, and compensation is provided based on the work contribution of each individual into the system. Profit, then, is distributed equally to the workforce. There are many other forms of government and economy, but these would be defined and explained if necessary on Test Day.

Healthcare and Medicine

The institutions of healthcare and medicine are aimed at maintaining or improving the health status of the individual, family, community, and society as a whole. Healthcare is an ever-changing field, but some of the key goals in American healthcare over the past few decades include:

· Increased access to care

· Decreased costs of healthcare

· Prevention of disease before it occurs

· Association of patients with a primary care physician or a patient-centered medical home

· Increased education for the public with public health outreach

· Decreased paternalism (doctor knows best mentality)

· Reduced economic conflicts of interest for physicians

· Life course approach to health (maintaining and considering a comprehensive view of the patient's history beyond the immediate presenting symptoms)

There has also been a shift in the role of the patient in the medical system. In the mid-twentieth century, sociologists believed that an ill patient takes on what was called the sick role. These sociologists believed that an ill patient is not responsible for their illness and is exempt from normal social roles. But on the other hand, these sociologists also believed that a patient had the obligation to want to become well and to seek out competent help. While this paradigm still exists, patients are now expected to take more ownership of their health through diet, exercise, seeking help before it is needed (through annual primary care visits and screenings), and so on. Modern sociologists also recognize that the notion that sick patients should feel an obligation to want to become better does not fit patients with chronic, long-term, or permanent conditions.

Even our understanding of disease has shifted over time. While some entities formerly defined as diseases are now considered a normal part of the human condition, such as homosexuality and transgenderism, other entities have become medicalized, meaning that these entities are now defined and treated as medical conditions. This shift can be seen in the addition of a number of diagnostic entities to the DSM-5, such as hoarding disorder and binge eating disorder.

The medical community also now recognizes that health is not only characterized by physiological wellness or disease, but also by a person's subjective experience of their health. The phrase illness experience refers to the ways in which people, rather than doctors, define and adjust to changes in their health. For example, people can experience disease without illness, as is the case for someone living a full and productive life with a manageable condition such as HIV. People can also experience illness without disease, such as when a person experiences somatic symptoms as a result of psychological stress.

Sociologists studying healthcare are often interested in social epidemiology. Epidemiology is the study of health and its determinants within a society (discussed in detail in chapter 12 of MCAT Behavioral Sciences Review); social epidemiology is specifically the study of the effects of institutions, social structures, and relationships on health. Social epidemiologists study the effects of racial and economic inequality or government safety net legislation on health and access to health care. They might also be interested in how social conditions early in life affect health care outcomes later.

In addition, many sociologists investigate medical ethics. In the United States, physicians are expected to adhere to four key tenets of medical ethics:

· Beneficence: the physician has a responsibility to act in the patient’s best interest.

· Nonmaleficence: do no harm; the physician has a responsibility to avoid treatments or interventions in which the potential for harm outweighs the potential for benefit.

· Respect for patient autonomy: the physician has a responsibility to respect patients’ decisions and choices about their own healthcare. While there are exceptions to this rule (significant psychiatric illness interfering with decision-making capacity, children, public health threats), patients do have the right to refuse life-saving therapies.

· Justice: the physician has a responsibility to treat similar patients with similar care, and to distribute healthcare resources fairly.

Social Institution

Needs Met by Institution





Transmit knowledge and skills across generations

Teacher, student, dean, principal

Academic honesty, good grades

Doing homework, preparing for lectures, being kind to other students


Regulate reproduction, socialize and protect children

Father, mother, son, daughter, brother, sister, uncle, aunt, grandparent

Sexual fidelity, providing for children, keeping a clean home, respect for parents

Having as many children as one desires, being faithful to one’s spouse


Concerns about life and death, the meaning of suffering and loss, desire to connect with a creator

Priest, pastor, rabbi, imam, worshipper, teacher, disciple, missionary, prophet, convert

God and holy texts (Bible, Torah, Qur’an, and others) should be honored

Going to services, following teachings of the religion, applying beliefs outside of worship


Maintain social order, enforce laws

President, senator, lobbyist, voter, candidate

Transparency, accountability, professionalism

Acting in the best interest of constituents, debating political issues


Organize money, goods, and services

Worker, boss, buyer, seller, creditor, debtor, advertiser

Making money, paying bills on time, producing efficiently

Maximizing profits, the customer is always right, working hard


Heal the sick and injured, care for the dying

Doctor, nurse, pharmacist, insurer, patient

Hippocratic oath, staying in good health, following care providers’ recommendations

Beneficence, nonmaleficence, respect for autonomy, justice

Table 11.1. Social Institutions

MCAT Concept Check 11.1:

Before you move on, assess your understanding of the material with these questions.

1. What are manifest and latent functions?

o Manifest functions:

o Latent functions:

2. For each of the theoretical approaches listed below, what is the primary thesis or idea of the theory?

Theoretical Approach

Primary Thesis or Idea


Conflict theory

Symbolic interactionism

Social constructionism

Rational choice-exchange theory

Feminist theory

3. What are the four key tenets of American medical ethics? Provide a short description of each.

Ethical Principle