Social constructionism and medical sociology: a study of the vascular theory of multiple sclerosis

M.R. Bury has radically questioned the value of social constructionism for medical sociology (1986). The present authors have already responded to this wide-ranging critique (Nicolson and McLaughlin 1987). This article aims to complement our theoretical discussion by embodying its principles in empirical case study. A recent debate surrounding the pathogenesis of multiple sclerosis is analysed in terms of the skills, interests and backgrounds of the medical personnel involved. It is noted that the proponents of the vascular theory possess developed expertises in interpreting disease in structural, vascular terms, whereas their opponents' skills lie in immunology or neurology. Different observers have produced different conceptions of the disease because modes of observation, and the points from which observation takes place, differ. It is also noted that the debate over the causation and treatment of MS has occurred between a large and powerful social group and a weak and marginal one. The effects of this power inequality on the production and assessment of knowledge about MS are investigated. The significance of the case study for Bury's misgivings as to the value of social constructionism is discussed, particular concern being taken to clarify the notions of instrumental realism, of reflexivity, and of the alleged dispensability of medicine.