实践社会学——与Rebecca Olson博士一同探寻你梦寐以求的"学"

欢迎收听《言之有物》播客，通过更好的沟通提升患者护理。欢迎来到《言之有物》播客的又一期节目，我是奥利弗·汤普森。

Welcome to the Words Matter podcast, enhancing patient care through better communication. Welcome to another episode of the Words Matter podcast. I'm Oliver Thompson. So I

希望你喜欢前几期

hope you've enjoyed the last couple

探讨伪科学主张及其思考与回应的节目。为了让大家暂时摆脱挫败感，今天我邀请到丽贝卡·奥尔森博士，聊聊社会学在实践中的作用与价值。丽贝卡是昆士兰大学社会学副教授、社会科学学士项目主任，同时担任SociohealthLab（一个通过理论和社会正义导向的应用社会文化研究推动健康与医疗领域社会变革的研究团体）的负责人。作为转化型定性研究者，丽贝卡与医疗从业者、教育工作者及情绪学者合作，运用社会学视角应对复杂的医疗挑战。她延续了昆士兰大学嘉宾的传统，包括第39期的卡里尼·莫斯基托（生物心理社会模型的权力审视）、定性研究系列第50期的珍妮·塞切尔（废墟中的遗留：后定性研究），以及近期临床推理系列第68期的娜塔莉亚·科斯塔（应对不确定性）。

of episodes exploring pseudoscientific claims and how to think about and respond to them. And to give us all a break from the frustration, today I'm speaking with doctor Rebecca Olson about the role and value of sociology for practice. Rebecca is an associate professor of sociology and program director of the bachelor of social science at the University of Queensland, and she's director of SociohealthLab, a research collective that pursues social transformation in health and health care through theory and justice led applied sociocultural research. And as a translational qualitative researcher, Rebecca collaborates with health professionals, educators, and emotions scholars, bringing sociological insight to addressing complex health care challenges. And Rebecca follows in the growing line of guests based at University of Queensland, including Carini Mosquito, episode 39, where does the power lie, a critical look at the bio psychosocial model, Jenny Sechel in episode 50 of the qualitative research series, What's Left in the Ruins, post qualitative research, and more recently, Natalia Costa, episode 68 of the clinical reasoning series navigating uncertainty.

本期节目中，我们将探讨社会学与社会科学的分野，以及社会学在学术探索中的定位。丽贝卡将介绍社会学作为研究领域的概况，分享她与同行在医疗领域的实践。我们会讨论医疗社会学及其衍生方法论，如扎根理论和民族志研究，并探讨社会学理论对实践的重要意义——没有什么比好理论更能为临床实践提供丰富视角和多元镜鉴。

So in this episode, we speak about the distinction between sociology and social science and where sociology sits within the landscape of intellectual inquiry. And Rebecca introduces sociology as a research field and how she and others have engaged with it in relation to health care. And we talk about medical sociology and the development related methodologies, such as grander theory and ethnographic research. And we talk about the importance and value of sociological theory for practice. And we talk about how there is nothing like a good theory to offer a rich perspective and multiple lenses on clinical practice.

我们将剖析社会世界与自然世界的差异，探讨社会理论的本质与起源。值得玩味的是：尽管社会因素和健康决定因素对理解预测疾病与康复至关重要，社会学知识却在医疗教育和实践中鲜有体现。最后，我们将探索社会学研究如何为实践与政策提供启示。我特别钟爱这次对话——作为临床工作者，我们似乎更习惯接纳其他'学科'如生物学、生理学或神经学。

We talk about the difference between the social world and the natural world, and we also talk about what social theories are and where they come from. And we talk about the irony that while social factors and determinants of health seem to be important in understanding and predicting illness and recovery, yet sociological knowledge does not feature strongly in health care education or practice. And finally, we talk about what we can learn from sociological inquiry and how it can inform practice and policy. So I love this conversation. As clinicians, we seem to be very happy and comfortable with the other ologies, such as biology, physiology, or neurology.

希望这次对话能成为探索社会学如何支持临床思维的契机。现在有请丽贝卡·奥尔森博士。

So I hope that this conversation is a gateway to explore how sociology can support and guide clinical thinking and practice. So I bring you doctor Rebecca Olson.

丽贝卡，欢迎来到播客。

Rebecca, welcome to the podcast.

感谢邀请我。

Thanks for having me.

所以你是继一系列杰出的昆士兰大学嘉宾之后的下一位。我的意思是，我几乎需要为播客单独开设一个昆士兰大学师生专栏，像珍妮、卡里米、娜塔莉亚这些嘉宾。正如我之前对娜塔莉亚说的，这里简直是块孕育天才的沃土——虽然这个比喻可能不太贴切——但确实催生了大量有趣的研究和讨论。欢迎你的到来。

So you're you're following in the the long line of phenomenal UQ guests. I mean, I almost need to have a separate section of the podcast dedicated to UQ faculty and students with Jenny, Karimi, Natalia. So yeah, as I said before, I think to Natalia, it's just this brilliant breeding ground, if that's the right word, probably not the right phrase, but just generating so much interesting research and discussion. So welcome.

谢谢。是的，我们都是社会健康实验室的一员，这个优秀的集体致力于开展以正义为导向、理论驱动的健康研究，用不同的方式做健康研究。

Thank you. Yes, we're all part of Sociohealth Lab, this really great collective where we come together in doing justice oriented, theory driven health research, doing health research differently.

是不是你们那边的咖啡机里加了什么特别配方？还是有什么秘诀让你们都如此高产并做出这么出色的工作？

Is it something in the coffee they put in your coffee machines over there? Or what is it that's just making you all so productive and producing such great work?

哦，咖啡嘛，我想主要是因为我们在这里找到了归属。我们聚集了一群真正热衷于以这种方式做健康研究的人。珍妮当然是其中的核心人物，她擅长构建强大的社区纽带，喜欢把大家聚在一起深入交流——不是走廊里匆匆打个招呼那种，而是真正开启一些事情。我们采用扁平化结构，确保每个人都能参与并感到投入和兴趣。这种方式在凝聚大家共同成长为一个研究社区，以及在探索研究方向上互相学习、尝试新方法方面特别有效。

Oh, coffee, I think it's just a place where we've found a home. We've found a whole range of people who are really interested in doing health research this way. Jenny's of course been a really central part of that. They're a strong community builder and likes to bring people together in conversation and not not just a quick kind of passing hello in the corridor, but let's start something and you know, let's let's do it in a way that has a flat structure that really brings everyone to the table and makes them feel invested and interested. So that's been really useful in bringing everyone along in this kind of journey of becoming something as a community, but also becoming in terms of the direction of our research trajectories, learning from each other how to do it a bit differently.

现在你可以介绍一下自己，包括学术背景、当前工作内容以及你如何描述自己的研究领域。

And at this point, you can introduce yourself, your academic background, what you're currently doing, how you describe what you do.

好的。我是一名健康社会学家和情感社会学家。我在美国长大，但大约二十年前来到澳大利亚完成本科、荣誉学位和博士学位。我的专业是社会学，具体方向是健康社会学——我的一位导师就是医疗社会学家。

Sure. So I'm a health sociologist and an emotions sociologist. So I grew up in The US, but then moved to Australia almost twenty years ago to finish my undergrad and do honors and a PhD. And I did that in sociology, but specifically in health sociology. So I had one of my supervisors was a health or medical sociologist.

通常在美国，由于社会学家与医学合作的历史，他们称之为医学社会学。最初实际上是医学的社会学。但到了五六十年代，进入七十年代后，研究焦点开始扩展，转向了健康社会学这个标签。是的，我当时与导师们一起从事公共卫生和健康社会学研究，专注于癌症护理。完成博士学位后，我开始在公共卫生领域担任讲师，大约七年前转到昆士兰大学，担任健康社会学家的职位。

Typically the, The US they call it medical sociology because of that history of sociologists, medicine really asking sociologists to collaborate with medicine. So it was really sociology of medicine. But after about the fifties, sixties, getting into the seventies, there was a shift towards kind of expanding the focus, which was what has shifted to that label health sociology. So yeah, was working across kind of public health and health sociology with my supervisors and focused on cancer caregiving. And then I started after I finished my PhD, I started up lectureship in public health and then shifted to the University of Queensland about over seven years ago with an appointment as a health sociologist.

我认为今天的讨论至少对我与听众而言，是为了更好地理解社会学研究、证据以及这类探究所产生的知识，以及它如何对医疗保健专业人员和临床医生有所帮助。你提到医学社会学很有趣，当时医学界邀请社会学家协助或更好地理解他们的工作。你知道是什么引发了这一现象吗？我是说，是什么让医生突然对社会学产生了兴趣？他们在工作中观察到了什么，需要通过社会学探究来更好地理解？

And I think the discussion today is trying to, at least for me to and listeners, to get a better understanding of sociological research, evidence, the sorts of knowledge that is generated from that inquiry and how it might be helpful to healthcare professionals and clinicians. You mentioned interesting the medical sociology when the community of medicine asked sociologists for help or to better understand their work. Do you know what initiated that? I mean, made doctors suddenly become interested in sociology? What were they observing in their work that they took notice of to better understand through sociological inquiry?

嗯，我在回想一个具体的研究，但总体上我认为目的是为了更好地理解如何将医学实践应用于不同人群，同时也更好地理解患者的经历以及医学培训。我记得最早的一项医学社会学研究叫《白衣男孩》，是霍华德·贝克和其他芝加哥学派社会学家在堪萨斯一所医学院进行的人种志研究，应该是在五十年代，因为它在六十年代初发表。研究的核心是想了解学生们如何怀着帮助他人、改变世界的理想进入医学院，而毕业时却可能变得有些厌倦，甚至形成了截然不同的生存观念，而非保留当初改变世界、帮助他人的梦想。《白衣男孩》的关键发现是，在如此有限的时间内塞入如此多的内容，生存策略不得不占据主导地位。

Well, I'm trying to think I could think of a particular study, but I think generally the idea was to get a better understanding of how to apply medical practice to a range of different populations and also to get a better understanding of patients' experiences, but also of medical training. So I'm thinking of one of the very first medical sociology studies was called Boys in White. It was an ethnography of a medical school down in Kansas that Howard Becker and other Chicago school sociologists conducted, it must have been in the fifties because it was published in the early sixties. And the idea was really to get a an understanding of how it is that people go in as these students with ideals of really helping people, changing the world, make a difference, and how they come out perhaps somewhat jaded, perhaps with very different, maybe survival ideas about how they're gonna survive rather than retaining those same dreams of kind of changing the world and helping people. And that was that was the key finding of the Boys in White was that there's just so much content that's packed into such a limited timeframe that strategies for survival have to predominate.

学生们必须学会考官想要什么，并优先考虑在那个领域有影响力的人的需求。这导致了对所谓‘隐性课程’的高度关注，当然这是在卫生专业教育中。

The students have to learn what their examiners want and prioritize what the people who kind of matter in that space, what they want. And this is what resulted in a huge focus on what's called that hidden curriculum, of course, within health professional education.

大约十八个月前，我做了一个定性研究系列节目。其中一集是关于扎根理论的，与简·米尔斯和梅兰妮·伯克斯合作，他们提到了霍华德·贝克的《白衣男孩》作为早期定性工作的例子之一——虽然不是最早的人种志，但属于最早的尝试。我认为我们可以用这个例子来说明，与例如扎根理论和更现代的定性方法相比，当时的方法描述得不够详细，后者在数据收集和概念化方面非常细致。你能评论一下这一点吗？你还记得《白衣男孩》是如何进行的吗？

It must have been eighteen months ago now that I did a qualitative research series. One of the episodes was on grounded theory with Jane Mills and Melanie Berks, and they mentioned Boys and White by Howard Becker as an example of one of the first not the first ethnography, but the first attempt to do some qualitative work. And I think we use that as an example of how the methods weren't that well described compared to, for example, grander theory and more contemporary qualitative methods which are pretty detailed in how you collect and conceptualize data. Can you comment on kind of what that fair? Do you recall the kind of how Boys and White was kind of done?

它只是一种自然主义的人种志，主要是观察医学生在工作中的表现，还是

Was it just a kind of naturalistic ethnography, but very much just observing medical students in their kind of work or

在他们的教育中？

in their education?

是的。关于那些方法论决策确实有一些细节，比如为什么要选择这类堪萨斯医学院？他们解释说，是否应该选择一所排名极高、声望卓著的精英医学院？不，他们希望选择一所中等水平的学校，并且这项研究持续了数年。虽然我已有十多年没重读，但这个文本确实给我留下了深刻印象。

Yeah. It was There was some detail on some of those methodological decisions around, you know, well, why choose this kind of Kansas medical school? They delivered, you know, should we choose a really high ranking prestigious elite medical school? No, no, they wanted to pick something very kind of middle of the road and it was conducted over several years. So it was there, I think it might've been, and this is pressing me because I haven't read it for over ten years, but it definitely is a text that stuck with me.

但研究确实详细记录了跟踪观察许多学生的情况，跟随他们、观察他们在解剖实验室等场所的活动，以及参与检查过程，同时还辅以访谈。你说得对，我认为这很大程度上属于后质性探究领域中所描述的质性研究1.0版本——那种发生在黑箱中、难以解释的质性研究。随后出现的质性2.0版本则出现了扎根理论，追求极度详尽（可能过于详尽）的描述。

But it did have some detail about, you know, just shadowing a lot of the students, going along, observing, watching what it was that they were doing on tracks and within say anatomy labs, as well as kind of observing and going alongside with examinations, but also supplemented by interviews. But you're right, I would see that as very much part of what some have described in the kind of post qualitative inquiry space as qualitative one point zero. This kind of, you know, qualitative research is just something that happens in a black box that nobody really knows how to explain. It's just something that goes on. And that was followed by qualitative two point zero where you see grounded theory And there's this attempt to be really, really detailed, perhaps overly detailed.

而且严谨。

And rigorous.

非常。

Very.

几乎达到了定量研究的严谨程度。是的。

Almost a quantitative rigor. Yeah.

没错。格拉泽和斯特劳斯（一位心理学家和一位社会学家）的研究中，你能明显看出美国这两个学科与统计方法的紧密联系，他们逐行编码的方式充分体现了这点。

Yes. Yes. And you can really, with Glaser and Strauss, I believe one's a psychologist and one is a sociologist. And both in The US, both of those disciplines have a very strong affiliation with statistical methods. And you can really see that shining through and how they're describing each step, you know, taking that approach to line by line coding.

同样来自现象学的理念是：你可以带着'悬置'态度进入研究，暂时搁置已知信息，让研究发现自然呈现——当然这...

And this idea as well that you could go into research and be able to kind of bracket that comes from phenomenology. You could, could kind of bracket anything that you knew so that you could try and let the findings emerge, which then of course

没有阅读文献。

Not read the literature.

是的，别读，我是说，连文献都不要读，完全盲目地进入研究，这可能在六十年代、七十年代甚至八十年代还行得通，那时出版物和研究数量还没像现在这样激增。那时可能更像一张白纸。然后是质性研究3.0时代，Charmez——Glaser自己的博士生，一位职业治疗师——说：我不同意你的观点。我们必须认识到解释和解释者在这一过程中的核心地位。之后当然也有人批评最初版本中那种刻板的扎根理论方法。

Yeah, don't, I mean, don't even read the literature, just go in totally blind, which maybe was something you could do in the sixties, seventies, maybe eighties, before of course we saw such a swell in the number of publications and studies that are coming out all the time. It was perhaps more of a blank slate. And then followed by QUAL three point zero where Charmez, Glaser's own PhD candidate, an OT, says, I disagree with you. And we really need to recognize, of course, how central interpretation and the interpreter is to this whole process. And then of course, others since then critiquing that very rigid approach to grounded theory that was in those first iterations.

现在我们进入了质性研究4.0时代，后质性探究，即通过理论进行研究。他们从2.0时代试图忘记所有已知知识的阶段——那时强调从研究中构建理论，试图悬置既有认知——发展到承认理论本就是我们看待世界的方式。它是我们研究的一部分，是我们解释的一部分，我们无法否认这一点。

And now we've got QUAL four point zero, post qualitative inquiry, that's research through theory. So they've kind of gone from the two point zero era of trying to forget everything you know, you know, this is about making theory from the research and trying to kind of bracket anything you know to actually theory is part of how we see the world. It's part of how we do our research. It's part of our interpretations. We can't deny it.

它实际上就是研究工具本身。

It's actually the research tool.

我认为早期经典扎根理论家非常强调不要在初期引入任何理论。但在后期分析阶段，将理论作为数据使用是被接受的。Glaser说过这些都是数据。所以在某个阶段，你可以引入理论来帮助发展形式化的实质理论。但你说得对，后质性研究——这也是我去年与Jenny和Dave Nichols讨论过的——它在如何通过理论思考或与理论共同思考方面要更有目的性。

I think grounded theory, early classic grounded theorists were pretty strong on not bringing theory in early at all. But I think later on in the analysis, it was acceptable to use theory as data. I mean, Glaser said all this data. So at some point, you could bring in theory to help develop kind of formal substantive theory. But you're right, post qualitative research, and this is what I spoke with Jenny about and a bit about with Dave Nichols last year, that it's far more purposeful in how it thinks through theory or thinks with theory.

完全同意。我赞同这种理论前置的观点，这正是社会理论家、社会研究者和批判学者为研究带来的核心价值。理论训练能推动对任何问题的理解，通过多种视角突出某些要素，淡化其他方面。我很欣赏这种大胆主张理论优先的态度，因为这在很多后实证主义研究中是缺失的——那种认为'理论是分离的'的假设。

Absolutely. And I agree with the foregrounding of theory that this is why this is this is a key thing that social theorists, social researchers, critical scholars bring to the research that's valued. There's theoretical training that pushes an understanding of any problem, pushes that understanding from multiple different lenses that foreground certain things, backgrounds, others. And I appreciate the kind of bold, the boldness of really saying theory should come first, because this is what is absent in a lot of that post positivist research. This assumption that, oh, well, you know, theory is separate.

理论要么被视为研究的结果，要么被说成'我们不做理论探讨，这是实证研究'，好像两者可以割裂。但显然，理论早已存在于概念、假设和研究设计中，它始终在场。

Theory is either something that results from the research or, oh, it's not we're not doing a theoretical piece. This is empirical, that the two can be divorced. But of course, it comes in in the con in the concept, in the hypothesis, in the research design. It's there.

是的。我的意思是，认为定量研究完全不受理论或价值观影响，认为它是一种被简化的、纯粹的世界知识，不受理论假设或立场影响的观点毫无道理。即便是真正的实证主义研究，其本身也包含一系列假设或理论前提，这些假设会驱动分析和数据收集。

Yeah. I mean, the idea that quantitative research is just theory free or value free, and that it's this kind of reduced down pure knowledge of the world and is untouched by theoretical assumptions or positioning doesn't make any sense. I mean, even true positivist research has a bunch of assumptions or theoretical assumptions about itself, which it then drives analysis and data collection.

当然，后实证主义的实践，以及维也纳学派（正是它在哲学层面推动了从实证主义到后实证主义的讨论演变）。在这个领域里，那些源自启蒙时代的世界认知与理论建构的哲学假设及其基础被强烈凸显。所以当人们声称理论独立于研究时，实际上他们往往是在强化某种可能源于16、17世纪欧洲哲学理论的观点——尽管他们并未承认这一点。

And the kind of practice, of course, of post positivism and the, what is it, the Vienna Circle that's really responsible kind of philosophically for progressing discussions from kind of positivism to post positivism. Of course, in that space, there's a very strong foregrounding of those philosophical assumptions and their underpinnings from really enlightenment era ways of understanding and theorizing the world. So what ends up happening typically when when people say that theory is separate to their research, it's that they're reinforcing what we might say is kind of maybe 1,600, 17 hundred's style European philosophy theory without acknowledging it. Yeah.

我意识到我们刚展开了一系列讨论。我想稍微退几步，先谈谈社会学本身——试着理解这门学科究竟是什么。比如在晚宴（如果人们现在还举办晚宴的话）或社交场合，当别人问'你是做什么的'，你回答'我是社会学家'时，他们要么点头附和却根本不明白你的工作内容。

I'm conscious we've just launched into a whole range of discussions. And I I guess I wanna just take it a few steps back and and think about sociology and just to, you know, to try and understand what that's all about. And and when you're at a dinner party, if people still have dinner parties or some social event and people say, do you do? And you say, I'm a sociologist. And they either just nod in agreement, not really knowing what you do.

那么社会学究竟是研究什么的？你如何描述这门学科？我们该如何理解社会学？或许还需要将其与社会科学区分开来——这两个术语常被混用，我自己有时也会交替使用，但严格来说它们差异显著。

But what is what's sociology about? And how do you describe what it is? And how should we think about sociology? And maybe just distinguish it from social science, the terms they use interchangeably. I know I sometimes kind of interchange them and it's not correct that they are quite different.

当我自我介绍说'我是社会学副教授'时，对方通常会问'那和心理学差不多吗？'这是最常见的第一个问题。简言之，社会学是对社会的系统研究——研究形成制度与社会结构的人群群体，这些结构塑造了他们看待世界、自我与他人的方式，并持续构建和重构具有意义的社会存在模式。

Well, if I'm introducing and I say, oh, yes, I'm an associate professor in sociology. And they'll say, oh, is that like psychology? Is that the same as psychology? So that's the typical kind of first question. But in short, sociology is the kind of systematic study of society of, you know, groups of people who make meaningful patterns that form institutions and social structures that shape how they see the world, how they see themselves, how they see each other and continue to make and remake meaningful patterns of social existence.

与社会科学的区别？社会学是众多社会科学分支之一。就医学社会学而言，我们最亲近的邻居可能是医学人类学家——他们更强调文化因素，而社会学家则更聚焦于有意义的社会互动。人类学家还喜欢采用生态学视角，将健康与疾病置于文化、意义和环境框架的动态关系中考察。

How is it different to social science? It's one of many social sciences. I think in terms of medical sociology, our kind of closest neighbors are probably medical anthropologists who might emphasize culture a bit more within their focus. Whereas sociologists are focusing perhaps more often on that meaningful kind of social interactions. And anthropologists also like to center the environment, a kind of ecological approach that looks at health and illnesses very much dynamic in terms of cultures, meanings, and environmental framings.

更广泛的社会科学领域还包括心理学、地理学、经济学，以及人类学、犯罪学、政治学、国际关系等众多学科。我们在许多方面共享相似的方法论兴趣——正如前所述，心理学和社会学都以严谨先进的定量研究著称，而人类学与社会学则在民族志访谈及各类定性方法上有着深厚基础。

In the social sciences more broadly, we might include psychology, geography, economics, as well as anthropology, criminology, sociology, political science, international relations. There are a whole range of different theories. And in many ways we share probably a strong interest in similar methods across with, you know, psychology and sociology, as I said before, having strong reputations and very rigorous and advanced kind of quantitative research, but also with anthropology and sociology, having that strong foundation in ethnographic interview and a range of different qualitative methods.

就社会学及其研究方法的应用而言，它在方法选择上持中立态度。社会学家既可以开展关于人们信仰或态度的大规模横断面调查，也可以采用访谈或观察等定性方法进行小型深度研究。因此它实际上综合运用了多种技术手段。

So in terms of the sociology and its use of research methods, it's kind of agnostic with regards to what sort of methods to use them. You can be a sociologist conducting large scale cross sectional surveys about people's beliefs or attitudes or whatever it might be but also do some smaller qualitative in-depth studies using interviews or observations. So it kind of draws upon a range of techniques or methods.

确实如此。社会学本身在研究工具和理论工具上都具有高度多样性。虽然作为个体的社会学家在研究方法上并非中立——我们往往偏好特定工具，尽管都受过定量与定性研究的训练，但通常会倾向于其中一种。

Oh, absolutely. Sociology as itself, sociology itself is very much diverse in its research tools and also, yeah, very diverse in those theoretical tools as well. Sociologists as individuals are not agnostic in our research methods and theoretical tools. We tend to favor particular tools. And although, you know, we all have training in quantitative and qualitative, We tend to, you know, and to gravitate towards one.

有些学者精通多种方法，能自如切换。我参与的项目往往采用混合方法，这与我所推崇的后范式研究路径不谋而合——特别是在研究社会情绪时，我会综合运用从定量生理学方法到互动访谈，乃至让参与者对采集数据开展反思的参与式方法。这不仅能多维度研究情绪，更能突显不同的理论化路径。

There are some who really are well versed in a range of methods and can really easily shift from one side to the other. And projects tend to be diverse in that way. At least the projects that I work on, I collaborate with other sociologists, I collaborate with clinicians, and they tend to always be mixed methods. And this is kind of aligned with that approach that I, I think I mentioned before the, the post paradigmatic approach in particular that I've used in looking at emotions and studying social emotions, and how using a range of different paradigms or kind of research traditions from these more quantitative kind of physiological approaches through to those interactionist ones like interviews, as well as participatory approaches, where we get participants to be reflexive on the data that we've collected. That can really help us not only to study emotions in a range of different ways, but foreground those different ways of conceptualizing and theorizing emotions.

这有助于我们将不同分析框架整合起来。

And it helps us to kind of put those different framings together.

当我举例社会学家研究态度和信仰时，我感觉到你的反应似乎是'这不算社会学'？我想探讨的是：社会学研究的边界在哪里？比如研究Asge的信仰建构或群体认知，看似具有社会学特征，但可能缺乏理论支撑；反之也存在理论深厚的典型社会学项目。

And I think when I use the example sociologists looking at attitudes and beliefs, I sense a reaction to you that maybe that wasn't sociology, or maybe that's I suppose what I'm trying to say is that when are you not when is one not doing sociology, and when is one doing sociology? So for example, what are the boundaries? So for example, let's say looking at Asge's beliefs or how these beliefs are constructed or perceptions or group perceptions. I mean, seems to smell and taste a bit like sociology, but it might be theory free and you may not engage in theory. Likewise, you can have a theory rich, clearly sociological project.

那么社会学研究是否存在明确的界定特征？或者说，能否明确指出某些挂着社会学名号的研究其实并不属于社会学范畴？

I mean, are there any defining features when you're doing sociology? Or actually, you can point to something and say that's not sociological research, even though it's got a title that would appear so.

我记得约翰·尤里（可能发音不准）曾将社会学称为'学科篡夺者'——这个喜欢从其他领域夺取有趣内容并宣称'现在这属于社会学了'的篡夺性学科。

Well, I think it was John Urie or Urie. I'm not sure if I was saying his name correctly, but he famously, at least in my mind, described sociology as a usurpationary disciplinary discipline. So, a usurpationary discipline. It just likes to usurp things from other disciplines that we find interesting and say, oh, okay. Now that's part of sociology.

谢谢。把它放进我们的沙盒里玩一玩。

Thank you. And bring it into our sandbox to kind of play with.

像喜鹊一样。

Like a magpie.

是的。在态度、信念和认知方面，这可能是社会心理学的一个交叉领域。我认为这确实属于那个领域，你可能关注的是个体，但或许是在小群体环境或二元关系中观察个体。它可能具有社会学性质，但如果主要从心理学传统中汲取对态度、信念和认知的理解，那就能将其区分开来。社会学中，我们之所以能将某些内容识别为社会学性质，通常是因为它与社会学理论有紧密联系。

Yeah. In terms of attitudes, beliefs, and perceptions, that might be this kind of crossover space, social psychology. I would see that as really in that space where you might be looking at individuals, but individuals perhaps within a small group setting or just in a kind of dyad. And it might be, it might be sociological, but if it's kind of primarily drawing understandings of attitudes and beliefs and perceptions from that psychological tradition, then that might distinguish it. Sociology, what makes what what enables us to kind of identify something as sociological is typically when it has when it has a strong engagement with theory that's employed in sociology.

因此，无论理论来自社会哲学、人类学还是历史领域，只要它与其他社会学理论对话，或主张解释社会世界的运作方式——而不仅仅是社会如何影响个体——那它就是社会学的。比如流行病学，它与医学社会学有很多交叉，像健康的社会决定因素这类研究。它们非常关注社会世界的不平等和等级制度如何统计性地影响个人罹患心血管疾病的概率，或根据其当前或幼时所居住社区决定其预期寿命。但除非追问‘为何如此’，否则它仍是流行病学而非社会学。

So whether that theory comes from social philosophy, anthropology, even kind of historical, even a historical space, if it's brought in conversation with other sociological theory or is making a kind of claim on how it is that the social world works and not just how the social world perhaps affects individuals solely, then it's sociological. Because I'm thinking of epidemiology, right? Epidemiology, there is a lot of crossover, especially in medical sociology, things like the social determinants of health. They're very focused on how social world inequality hierarchies can have an influence statistically on the likelihood of a person's, you know, a person developing cardiovascular disease, a person having a life expectancy of a certain number, depending on what neighborhood they live in currently or grew up in when they're younger. But it wouldn't, it would be epidemiological unless it's asking those questions of why is that the case?

我们如何理解这些社会结构如何延续不平等？如果只是呈现数据说‘这就是我们发现的生命预期差异’，而不追问原因，那就没有突破。社会学批判传统的核心始终是‘谁从中受益’这个关键问题。

How do we understand these kinds of how these social structures perpetuate those inequalities? If it's purely kind of it's just data that's served and said, here, this is what we found, life expectancy, but not asking those questions of why, then it's not shifting. There's always that critical question of who benefits that's very core to a critical sociological tradition.

我想流行病学是个很好的例子——虽然我可能会曲解你的意思——说明它可以横跨两个领域。根据你使用的理论框架、提出的问题或数据服务的对象，你可以用不同方式构建流行病学研究。这让我想到生物心理社会模型，当我们试图清晰划分生物、心理和社会因素时，实际上它们就像一团相互作用的果冻。流行病学的例子清楚表明，社会决定因素会与生物或医学决定因素相互作用，使情况变得更为复杂。

And I guess it's a great example about epidemiology could potentially and I'm going to paraphrase you and get you wrong as well at the same time that it can sit in both camps. You can maybe frame an epidemiological study depending on how you use theory, the sorts of questions you're asking or that data is serving. I suppose it demonstrates to me the kind of interaction I mean, I'm thinking the biopsychosocial model, for example, when we try to neatly define kind of biological factors or terminant with social, with psychological. And the truth is it's just one big jelly blob of co interacting variables or domains. And the epidemiological example is a good one that clearly the social determinants will influence or be interacting with the biological determinants or the medical determinants, it just becomes a much more complex situation.

完全正确。这也是医学社会学研究的一个关键焦点。有些学者对马默特等人关于压力与地位的研究持批判态度，认为聚焦压力实际上削弱了这些发现潜在的批判锋芒——我们默认等级制度和压力不可避免。而更具马克思主义倾向的医学社会学家则主张，引入对经济和经济上层建筑的关注，会迫使我们追问‘是否有其他可能？’，迫使我们审视经济结构和社会福利体系的瓦解如何影响这些流行病学结果。

Absolutely. And this is a kind of key focus within some of the medical sociology scholarship as well, where, some have been quite critical of some of that research by Marmot and others who focus on kind of stress and status. And by focusing on stress, they argue that it actually takes the kind of critical edge away from the kind of potential of these findings. We accept that hierarchies and stress are inevitable, Whereas some of those more Marxist oriented medical sociologists say, if we bring in a focus on economics and Marxist concept of the economic superstructure, it pushes us to ask how, how could it be otherwise? It pushes us to examine how our economic structures, our dismantling of the social welfare state may be influencing these epidemiological outcomes.

而如果我们聚焦于压力，我们的倾向可能是考虑瑜伽干预和更多个人生活方式干预，而非解决甚至Warmit本人所称的‘原因的原因’。

Whereas if we focus on stress, our tendency might be to think about yoga interventions and more kind of individual lifestyle interventions rather than addressing even what Warmit himself calls the causes of the cause.

我有两个问题纯粹出于个人好奇，因为我不太确定。一是你之前提到‘社会世界’这个概念，我在文献中也会使用这个术语。写博士论文时我以为自己明白它的含义，但现在不太确定了。我想我当时用这个词是因为听起来像是在对社会世界进行探究时，存在一套特定的规则、假设和符合社会世界的范式。然后还有自然世界，我想指的是观察豹子或线粒体之类的。

And there are two questions which I'm just asking for my own curiosity, because I'm not quite sure about them. One is that earlier you mentioned the social world, and I kind of use that phrase and that kind of term is going to utilize throughout the literature. And I thought I knew what it meant when I was writing my PhD, but I'm not quite sure. I think I just put it in there because it sounded like when you're making inquiry around the social world, there's a certain set of rules, a set of assumptions and the kind of paradigms that kind of conform to the social world. Then there's the natural world, which I guess is observing leopards or mitochondria.

这就引出一个问题：我们为什么要区分自然世界和社会世界？比如在医学实践中，你既在显微镜下观察红细胞，同时也面对着被我们称为患者的人或人群——这似乎属于社会世界。这种划分看似人为，但可以理解。

And that's got a I suppose, why are we making the distinction between the natural world and the social world? And when I'm when you're doing medicine, for example, you're looking at red blood cells under a microscope, but also there's a person or a group of people which we're calling patients, and that seems to be in the social world. So that kind of separation seems artificial, but understandable.

许多社会建构主义者借鉴维特根斯坦的观点，认为这些分类本身就是社会建构的。我们视为绝对真理的许多事物，其实基于我们作为社会行动者对事物的归类方式。我们将这些事物群视为以某种方式关联，于是将其归入特定类别。这种标签化过程是心理健康社会学的核心关注点，也广泛适用于各类健康问题研究，其影响非常现实。

And a lot of social constructionists see, you know, drawing on Wittgenstein, these categories as socially constructed. That a lot of, a lot of what we see at, that we take for granted as absolute truths, they're based on how it is that we've grouped things together as social actors. We've seen these, these, this constellation of things as aligned in some way. So we've put them in this category. And that's a really core focus kind of labeling is a core focus of in particular sociology of mental health, but also of a whole range of a whole range of health problems where we've seen very real impacts.

当你给某事物贴上标签时，就赋予了该类别标签医疗权威性，比如慢性疲劳综合征、多动症。这些命名一直是医学化研究的重点，因为标签至关重要。正如百年前的社会学家托马斯夫妇所言（我用非性别化方式转述）：我们视为真实的事物，就会产生真实的后果。当我们把这些分类当作真实存在时，就会相应地对它们作出反应。

When you give a label to something, it lends medical authority to that categorical label like chronic fatigue syndrome, ADHD. These titles have been a very big focus of research into medicalization because these labels matter. Once you label something, what is it, what is it, Thomas and Thomas, husband and wife, early sociologists from about a hundred years ago. I'll paraphrase it in a non gendered way, that which we perceive to be real is real in its consequences. When we see these categories as real things, we respond to them accordingly.

这会产生持续的社会影响。关于社会世界与自然世界的分野，其实存在悠久的借鉴自然世界来阐释社会世界的传统。不仅社会世界塑造着我们对自然世界的理解，反之亦然——人们常说‘自然界就是这样运作的’来强化性别期待。当然我们也会举海马和帝企鹅的例子来反驳：自然界并非仅以这种方式性别分化。

And that has flow on kind of social effects. But in terms of what's part of the social world and part of, you know, the the kind of natural world, we there's been a a long history of drawing on kind of the natural world to inform the social world as well. Not only is the social world kind of shaping how we understand the natural world, but it goes vice versa where there's a long, a long history of people saying, oh, well, this is how things happen in nature. It's in terms of reinforcing kind of gendered expectations. And then of course, we bring up seahorses and penguins, emperor penguins to say, no, no, that is not, it's not exclusively gendered in this way in the natural world.

因此很可能的情况是：社会视角也会影响人们对自然界的观察。

So it's also probably the case that that social lens comes into what people observe within the natural world as well.

是这样吗？我是说，回到医疗实践领域，那是一种社会学情境或现象——红细胞在体内流动，有时会发生些状况。这些显然是生物性的，我想说是客观现象。不论我们是否观察它们，它们本质上都会如此运作，我不确定双缝实验那种情况。我无法讨论电子，但暂且不谈这个。

Is it the case? I mean, coming back to kind of health care practice, that's a sociological situation or phenomenon, that there are red blood cells and they float around and sometimes things happen to those. And these are clearly biological, I want to say, objective phenomena. They're essentially going to behave whether or not we're looking at them, I don't know, the double slit thing. I can't talk about the electrons, but forget about that for the moment.

但我理解，也许我们触及了根本问题，临床实践似乎主要是社会学层面的。不过借鉴了自然生物学的概念，我把两者混为一谈了。

But I get, you know, maybe we've hit bedrock here, but clinical practice would seem to be largely sociological. But borrowing on natural, biological, I'm conflating the two.

这让我想起安妮·玛丽·莫尔在研究动脉粥样硬化时提出的多重性概念：一系列不同症状共同指向某个诊断，但它们都附着于同一个社会主体上。这些症状都是由社会行为者在社交互动中呈现的。所以也可能存在一系列更偏向生物学或生物医学的表现形式，但它们都汇聚于同一个社会行为者身上。

Well, reminds me of Anne Marie Moll's concept of multiplicity in studying atherosclerosis, that there's a constellation of a range of different signs that indicate a particular diagnosis, but they all hang together on one social being. They're all, you know, enacted by a social actor in a social interaction. So there might be also a range of more kind of biological or biomedical presentations, but they're coming together in one social actor.

这让我回想起之前与彼得·斯蒂尔威尔和萨布丽娜·康尼克斯的播客对话，我们谈到惰性主义如何将生物、社会和心理因素捆绑在一起——鉴于它们背后的某些基本假设，这些领域并不容易直接关联。

It brings me back, or makes me think about previous podcast conversations with Peter Stillwell and Sabrina Connix, and we spoke about inactivism and how that kind of binds biological or social or psychological, because they're not straightforward to connect given some of the underpinning assumptions around them.

还有我们总想把事物归入整洁独立分类的倾向。比起视事物为炖汤中相互交融的状态，我们更偏爱使用泾渭分明的分类法这种认知捷径。我的OT同事蒂姆·巴列特在教学中喜欢引用约翰·杜威的理论，那种关于交互作用的理解：人与环境的关系不是两个独立范畴，而像炖汤中的蔬菜——稍加烹煮就会变得难以区分，成为同一锅有时胶质般粘稠的混合物。

And our desire to kind of put things in neat and discreet categories. We tend to prefer the heuristic ease of engaging in distinctive baskets rather than seeing things as, you know, interacting in in a stew. And teaching with my OT colleague, Tim Barlett, he he likes to bring up John Dewey's work, that understanding of transactionalism and understanding how the, you know, person and environment and their relationship, it's not, you know, person and environment as two separate categories, but instead they are like vegetables in a stew. Give them a little bit of time and they become almost indistinguishable, part of the same messy, sometimes gelatinous, mushy mix.

我另一个疑问是关于理论的。我们在播客中多次讨论过理论的含义、用途及其起源。比如社会学理论中的符号互动论，或帕森斯的病患角色理论这类知名理论——它们从何而来？

And the other question or thought that I had was around theory. And we've spoken about theory quite a lot in the podcast and what it means, how it's used, but also where they come from. So I guess things like I don't know. I'm thinking of sociological theories, symbolic contractionism, or kind of Parsons sick role, these kind of reasonably big, well known theories. Where do they come from?

难道是布鲁默或帕森斯坐在房间里凭空构想，然后被社会学后辈们全盘接受？这些理论基于实证研究吗？理论从何而来？为何如此重要？从后定性研究的视角看，理论甚至可能比某些数据更重要，或者说没有理论就根本不存在所谓数据。

Is it just, I don't know, bloomer or Parsons sitting in a room thinking up these things, and then they're just consumed by little sociologists gonna take this up? Is it based on empirical study? And where do theories come from, and why are they so important? And arguably, from maybe post qual points of view, that they're almost more important than some of the the data, or or there is no data without the theory.

是的。那种扶手椅理论的时代在二十世纪相当盛行。但随着我们进入后半叶，越来越强调实证数据，同时也需要将理论与实证数据相结合。特别是在扎根理论中，让实证数据驱动至少中层理论的发展。奥利弗，你能再重复一下问题吗？

Yes. That era of kind of armchair theorizing had quite a presence in the twentieth century. But, yes, we as we got kind of towards the the latter half, there was much more of an emphasis on empirical data, but also on that that need to kind of bring theory and empirical data together. And certainly with grounded theory, to have empirical data drive least meso theory development. Can you go back again to what the question was, Oliver?

抱歉。

Sorry.

问题是理论从何而来？我理解扎根理论能生成这些初级、低层次、近乎微观的理论，或是更宏大的正式理论。但那些我只知道三四个的宏大社会学理论，它们源自何处？我们为何要关注它们？

It was where do theories come from? So I get with grounded theory, generate these first level, low level, almost micro theories potentially, or bigger formal theories. But they're bigger sociological theories, of which I only know about three. Where do they come from? And why is it that we should care about them?

是因为它们被证明在某种意义上是'真实'或有效的吗？还是仅从实用角度看它们可行？它们似乎只是为我们提供了某种世界观。为何它们值得被考虑？或者说我们如何构建——这是个非常宽泛的问题。

Is it that they're proven to be kind of true, in air quotes, or effective? Or do they just work from a pragmatic point of view? They just seem to give us some kind of sense of the world. Why do they deserve to be considered? Or how do we make and it's a very broad question.

我明白理论会从基于实证的小范围延伸到更广泛的通用理论。但这些理论究竟是什么？我们在哪里能找到它们？

I get that theories will range from small, empirically based to much broader, general theories. But what are these theories, and where do we find them?

它们从

Where do

何而来？

they come from?

是的。费尔南多·德梅奥曾撰写过医学社会学理论方面的文章，我在健康社会学课程中引用了他的一章内容。他将理论比作截然不同的透镜。因此我在讲解健康社会学理论时，会在PPT幻灯片上放一副眼镜的图片。这些理论确实来源广泛。

Yes. Fernando DeMeo has written about theory in medical sociology, and I use a chapter by him in in my health sociology course. And he talks about theories just as really different lenses. So I put, you know, just a picture of glasses up on the on the PowerPoint slide when I start the lecture on sociological theories that are used in health sociology. And they really come from all over the place.

既有社会学内部的，也有外部的；有些基于书斋式理论推演，有些源于个人毕生研究，还有些仅凭一项研究就引发众多学者追随拓展。比如马克思——他虽非社会学家（社会学学科成形前他就已著述），但正是他推动我们关注经济基础结构，在他看来这才是引发社会冲突、决定社会组织形态的根本。

Inside sociology, outside sociology, some are based on armchair theorizing, some are based on a person's life work, some are based on one study and it's just really taken off and inspired a whole range of other scholars to pick it up, expand it, grow it. So I'm thinking of Marx, of course, who's not a sociologist. He was writing before sociology was really a thing. It wasn't until Durkheim that we had our first kind of professor of sociology. But Marx, of course, is central in pushing us to attend to economics, the economic superstructure and how this is, in his mind, the kind of primary social structure really underpinning conflict and the organization of social life.

还有布迪厄这类人类学-社会学跨界学者，他终其一生都在试图破解社会科学中'结构-能动性'的二元对立。他提出的'惯习'概念，既承认人的主观能动性，又揭示社会结构如何塑造我们的音乐品味、教育经历乃至运动习惯——这些深植于动态社会关系中的习性，远比表面习惯更为深刻。

Then you have people like Bourdieu, a who is a kind of anthropologist sociologist hybrid, who worked throughout his whole career to try and understand the structure agency divide and resolve the structure agency divide within the social sciences. How it is that we can be agentic beings and, you know, feel very autonomous, but at the same time, be socially determined by these structures and how these two come together really in a concept he called habitus. How, you know, have habits. These habits are developed, but they're more than that. These are habits that are connected to your location in an evolving social plane that's related to a whole range, you know, your taste in music, through to your education, through to your embodiment of sport.

这本质上是在消解社会科学界长期存在的'结构VS能动性'之争。简言之，理论就像透镜，帮助我们聚焦某些社会问题特征而弱化其他。多元理论视角能挑战固有认知，促使我们结合实证数据，以更严谨的方式重新定义问题本质与解决方案。

This is all habitus. And trying to kind of collapse that structure and agency debate within sociology and the social sciences more broadly. So, yeah, in short, theories are really just lenses for helping us to foreground some things in our understanding of a social problem and background others. And bringing in multiple lenses can help us to question that initial way of seeing it, disrupt that, and have a rigorous kind of debate perhaps with our empirical data, with the problem we're trying to solve about how else we might view it, conceptualizing it, and problem that pushes us to foreground and what solution that pushes us to propose.

既然理论具有塑造我们看待社会世界的强大力量——它影响着我们选择成为怎样的临床医师、建立何种医患关系——可以说理论渗透在医疗从业者临床实践的每个角落。您如何看待理论在医学教育中的现状？这显然是个尖锐问题，毕竟我学生时代完全没接触过这些。我不禁思考：当年我是透过怎样的视角看待临床实践的？

So given the power, if you like, of theory to kind of shade the world or the social world, which can inform all sorts of things, the sorts of clinicians we might choose to be, the sorts of relationships we develop with patients. I mean, it would seem to color potentially every aspect of our clinical lives as health care professionals. What's your sense of how theories come into health care education? And this is clearly a loaded question because I had none of it as a student. And so I'm thinking about, well, how did I see clinical practice?

我戴着怎样的'理论眼镜'？如今康复治疗、物理治疗或整骨疗法专业的毕业生们，在缺乏系统社会理论教育的情况下，他们的认知框架又是怎样的？我当年接受的其实是高度局限性的专业教条——虽说是理论，却像单焦点镜片。而拥有多元理论工具箱，本应能提供更丰富、更有价值的临床视角。

What pair of glasses did I have? And what glasses do can a graduates have of OT or physical therapy or osteopathy, whatever they might be, given that theory or the social theory wasn't explicitly taught? So I'm kind of seeing the clinical world through the kind of stuff I mean, the osteopathic kind of dogma and theory, I suppose. I guess I was taught theory, but in a very local sense, in a very very kind of focus single pair of glasses. I mean but it would seem to me that having a range of theories to draw upon would give you a a view on the clinical world which would just be useful and helpful and be able to kind of really utilize these different perspectives.

这正是拉德曼在作业科学与作业治疗领域的主张。她借鉴社会学家米尔斯'社会学想象力'的概念，提出'作业想象力'——理论如同棱镜，旋转不同角度就能呈现社会世界的不同切面。拉德曼认为，这能推动作业治疗转型为更注重社会正义、更具理论深度的专业。事实上，我在联合健康跨专业教育研究的系统综述中也发现...

And that's exactly Rudman's argument for occupational science and occupational therapy. Rudman talks about the need for an occupational imagination, drawing on the early sociologist C. Wright Mills' concept of sociological imagination and how theory acts like a prism that helps you to see the world, the social world through a different shade, whichever way you tilt it. So, yeah, Rudman's arguing that that's what occupational therapy and occupational science needs to really push it to become more of a justice oriented profession, as well as more of a theoretically rigorous profession or professions if you see them as distinct. But certainly, so I did a systematic review of scholarship on interprofessional education in allied health.

那项研究大约七年前在医学教育领域发表，我的一个关键发现就是理论在很大程度上是缺失的。在被评审的论文中，只有少数研究运用了任何理论框架。这在教学法上存在问题，同时在应对多专业协作时固有的权力动态方面也存在问题。就像你提到的助产士和整骨疗法，我现在指导的一名高等教育研究候选人正在进行一项融合助产与社会学的博士研究。在这个领域，确实存在一种以女性主义关怀伦理为核心的助产实践，它通过社会倡导的方式策略性地对抗医学主导地位。

So that came out seven seven plus years ago in medical education, and that was one of my key findings, was that theory was largely absent. There were only a few studies that used any theory within the papers reviewed. And that's problematic pedagogically, but also in terms of addressing the power dynamics that are inherent when you bring different professions together. Also, like you're saying about osteopathy and midwifery, I have an HDR candidate who I'm supervising at the moment, and it's a kind of hybrid midwifery sociology PhD. Definitely in that space, there's a feminist kind of ethic of care that's central to midwifery practice, that's strategically and it's positioned in a kind of social advocacy way to be counter to a more kind of medical dominance presence.

是的，更准确地说，我称之为生物医学的'伪客观性'。那种认为生物医学是客观、价值中立的观念，实际上强化了17世纪左右欧洲中心主义对个体本质的认知。特别是在情感领域，大量学术研究表明医学教育往往强化这种身心二元论的观点——尽管医学内外都有众多研究对此提出反驳。

And that more, yep, the, I'll call it the feigned objectivity of biomedicine. That idea that biomedicine is objective, it is value neutral, when actually it's reinforcing a kind of Eurocentric kind of 1,600, 17 hundred's view of what it means to be an individual and an entity. And that certainly when it comes to, you know, emotions, that's what a lot of the scholarship shows that medical education tends to reinforce that kind of mind body dualist way of seeing things. Despite, of course, so much research within and outside of medicine countering that.

那么为什么这些医疗课程不大量注入理论呢？我确信如果分析大多数医疗课程的讲座或学习内容分布，会发现严重偏向医学科学、解剖学、生理学，特别是某种心理学和技术技能。考虑到我们线下讨论过的社会决定因素对人们康复、疾病发展、疼痛形成等方面的重要影响，掌握更多理论知识显然——我不是说单纯知道理论就能提高效能——但如果能更好地理解社会学图景，这无疑会对我们照护的患者群体更有利。

And so why aren't these health care courses just pumped full of theory? Why are we just not having I'm sure if you looked at the breakdown of kind of lectures or learning in most health care courses, it would be hugely biased to the medical sciences, anatomy, physiology, particularly the type of psychology perhaps, technical skills. And given and we were talking about this offline given the important role that social determinants of health and kind of social domains and social factors have on people's recovery, illness, development of pain and all that stuff. It just seems obvious that I'm not saying just knowing a bunch of theories will just make us more effective, but I'm half saying that if we've got a better grasp of the kind of sociological landscape, that's clearly gonna be, I would presume, clearly gonna be beneficial to the patients, the people that we care for.

是的，我完全赞同。而且显然——

Yeah. I wholeheartedly agree. And certainly

我猜你会反对吧？我完全不同意。应该减少社会学内容。

I I imagine you say no. I completely disagree. Less sociology. Yeah.

不，不是的。其实主要原因是课程已经太满了，很难再增加内容。学生希望用最短时间拿到学位，尽快开始执业。而且除了澳大利亚职业治疗课程把社会学列为必修内容外，认证机构通常不作要求。

Don't. No. Well, and of course, for one reason, the curriculum is just packed. It's hard to find space for adding anything in, you know, students want a a degree that's as quick as it can be, they want to get out there and start practicing. And accreditation bodies don't require it other than in Australia occupational therapy where sociology is required as part of the kind of content.

在教授职业治疗师课程时，我们发现这像是'苦口良药'。某种程度上这是一种'不适教学法'——我们突出特权问题，引入学生从未实践过的思维模式，这让他们感到很不适应，但最终会认识到其价值。对吧？

And in teaching some of the the OTs, what we find is that it's a it's a bitter, but valued pill. The the the experience has been that it's it's kind of engaging in some of that, to some extent, a pedagogy of discomfort. We're foregrounding things like privilege. We're foregrounding content that students have not really been practicing, ways of thinking that students feel very unaccomplished in. Right?

这让我想起作为柔道初学者的糟糕感受，毕竟我跳了25年舞，在舞蹈领域非常自信，甚至教舞蹈课。但突然转向另一种体育项目时，明显处于最底层。当新手真的很艰难，非常不容易。

Like, it reminds me of how awful it felt to be a very beginner jujitsu student after doing dance for twenty five years where I felt very, you know, I felt very confident in dance. I've been teaching dance. And then I go into this other kind of athletic pursuit and I was very clearly at the bottom. It's, it's hard to be the novice. It's, it's difficult.

社会学还带来了对公正的关注和对特权的凸显，这让拥有特权的人尤其不适。正如坦尼娅·詹金斯的《医嘱》等书籍所揭示的，某些医疗专业教育轨道实际上非常精英化，尽管表面标榜任人唯贤，整个体系却在强化特权。当我们接触这些促使自我反思的理论时确实会不适。但我和同事梅里尔·特平、蒂姆·巴利特发现，职业治疗专业的学生期末反馈常说：'这学期非常非常困难，但它彻底改变了我看待世界的方式。'

But also with sociology comes that focus on justice and foregrounding privilege that can be uncomfortable for those, especially for those who are privileged. And we do know of course that, especially with books like Doctor's Order by Tanya Jenkins, that really explicates just how elite, elitist some health professional education kind of tracks can be, despite it really having this kind of ideology of being a meritocracy, of course the whole system is very geared towards reinforcing privilege. So that can be uncomfortable when we're engaging with theory that pushes us to kind of be reflexive on that. But, yeah, what we found in the occupational therapy teaching is that with my colleagues, Merrill Turpin and Tim Barlett, OTs, students in their feedback at the end of semester say things like, this was really hard. This semester was really, really difficult, but it has changed the way I see everything.

对于那些真正投入其中、愿意先理解我们抛给他们的各种理论，再加以运用并联系自身生活的人来说，这个过程最终会让他们觉得非常值得。

So it can be for those who really, yeah, jump in and feel like they're okay with first trying to understand all these different theories that we're throwing at them, playing with them, applying them, and then applying that to their own lives, they find it very worthwhile.

是的。据我理解，用社会学理论充实课程至少能弥补社会学技能的缺失——尤其在肌肉骨骼护理领域（这是我的专长）。历史上我们过于关注人体局部：'哦，你膝盖疼？那我看看膝盖，顺便聊聊你周末干嘛、猫咪如何'——这就是我所谓的'社会关怀'。这显然不够。现在确实有股强大驱力，要求我们更好地处理疾病背后的社会因素，但这些真的很难掌握。

Yeah. And flooding the curriculum with sociological theories is one way about addressing, at least to my understanding, the kind of deficit in sociological skills or or at least in musculoskeletal care, which is I suppose my area, where historically we're so interested in bits of people and, oh, you've got knee pain and I'll just, you know, look at the knee and maybe have a chat about, what you're doing in the weekend and how your cat is. That's the kind of social concern I have. That's not fair. I think there's a real drive towards being better at the social stuff or the kind of sociological aspects of someone's illness and suffering and but they're really hard.

比如前两周我接诊的患者，其复杂的社会处境涉及经济虐待等各种问题，让我完全无力提供实质性帮助。这不仅是缺乏社会学知识（当然我也没有），更是欠缺社会工作类技能——如何理解这些根深蒂固的复杂社会困境。所以我们需要的是既能提供抽象理论框架，又能指导具体社会工作的知识体系。

I mean, was thinking about my own practice in the last week or a couple weeks ago, I had a patient that had a really difficult social circumstances, economic abuse, mean all sorts of stuff which I was just what made me I was just totally ill equipped to really help this patient in a meaningful way. And that wasn't necessarily because of a lack of sociological knowledge, which I don't have as well. But it was more so kind of social work type skills and how to begin to understand these deeply complex, deep rooted problems and situations that people are in. So I guess it's social theory with a kind of more abstract stuff, which might inform some of the, I suppose, the social skills or sociological or social working type skills which we we need.

完全正确。就像之前谈到的健康社会决定因素，它们可以形成临床问诊时的检查清单：'要注意这些社会指标'。但发现问题后该怎么办？这些理论的意义远超识别风险因素，它教会我们如何与不同背景的人相处。通过多利益相关方视角，理论能帮我们理解个体生活中层层交织的影响因素。

Absolutely. And it applies that example I was talking about before in terms of the social determinants of health that can kind of form a checklist in a person's mind perhaps when they're in a clinical interaction going like, oh, you know, I need to look out for these certain things, but then, oh, what do I do with it after I've identified that there are these social markers that I need to look out for or, you know, potential variables that are associated with an increased risk of X. But it's so much more than that. And it's about understanding how to see and work with people who are different to us. And theory can really help take that multi stakeholder position to understand the layers of interactions and influence on an individual's life.

这不仅关乎医患关系，也涉及医护之间。比如我们跨专业团队开发的'跨专业技能视频观察工具(VOTUS)'，就是社会学思维产物——它研究权力如何在跨专业团队决策中显现、运作并被超越。

It's not just about clinicians and clients though, or patients. It's also about clinicians and clinicians. These sociological theories, for example, this tool that I've worked in an interprofessional team to develop called the video observational tool for interprofessional skills, VOTUS. That's very much in terms of interprofessional education, a tool informed by sociological thinking. How is power evident, engaged with, and transcended within interprofessional team decision making?

我们的情感如何不仅被突显、关注并加以利用，而非仅仅被视为团队协作之外的附加品或后续事项，而是作为人之为人、关系性存在的核心要素。

How our emotions also foregrounded, attended to, and brought to be made useful, not just kind of pushed to the side as something extra or for after teamwork exists, but central to what it means to be human and relational beings.

确实，我认为你准确指出了社会评分的关键，研究显示临床医生虽熟悉生物心理社会模型并关注社会因素，但他们可能注意到患者生活中的这些社会决定因素或社会层面后，却困惑于该如何处理——比如丧亲之痛不属于我的专业范畴，我缺乏相关技能；或者面对即将无家可归的患者，我能产生什么影响？

And yeah, think you hit the social score nail on the head is that, and I think what comes through is some of the research looking at clinicians kind of used to the bio psychosocial model and attending to social factors is very much that, that they might notice some of these social determinants or these social aspects of someone's life, but kind of thinking, well, what do I do with it? I mean, bereavement, that's not my bag, like, I'm not skilled in it, or it's, you know, the person's homeless or about to be homeless. How can I possibly affect that?

当你不知如何应对这种情况时，确实会感到恐惧。

And that's scary if you don't know what to do in that space.

上周我就确实被吓到了。

Was certainly scared the other week.

是的。几年前我曾与一些姑息治疗医生合作研究，正是关于这种困境。我们访谈了从初级医师到资深姑息治疗顾问的各级临床医师，发现多数准备工作都基于指导原则，强调必须对患者的限寿预后保持开放、诚实的态度。

Yes. Yeah. I did a study with some palliative care doctors a couple of years ago, And it was very much about that space. So we did interviews with junior clinicians through to really experienced palliative care consultants. And much of the kind of preparation is very guidelines based, kind of saying we need to be very open, very honest, frank about a person's life limiting prognosis.

这听起来很高尚——尤其在回顾Glaser和Strauss六十年代在加州开展的关于临终认知开放与封闭的奠基性研究后（扎根理论正源于此）。但这显然与文化考量相冲突，可能违背临终关怀中的文化安全实践。当开放认知与患者家庭意愿相左时，我们无法实施一刀切的协议。

And, you know, make sure that understanding occurs, that there's clarity. And, yeah, that sounds quite noble, especially in light of the research from Glaser and Strauss about closed and open awareness of dying from California in the sixties, which is where grounded theory kind of got its start from that ethnographic research that they conducted. But this, of course, is contrary to cultural considerations. It can conflicts with kind of culturally safe practices in end of life care. We can't have blanket protocols for open awareness when that is contrary to patients and families wishes for, you know, what they want at the end of life.

研究发现初级医师更倾向于坚持'必须永远保持开放'，而资深医师则从这些恐惧情境中学会了如何识别线索：通过家庭互动中的关键词判断其倾向开放或封闭认知；面对聋哑患者时如何通过翻译或闭眼等非语言信号捕捉信息。正如Oliver所言，这种涉及关系与社会维度的照护挑战，往往需要通过经验积累才能从概念认知升华为操作能力和专业素养。

So yeah, what we found was that the junior clinicians were the ones who are more likely to say, yes, you must always be open, always. And it was the more experienced and senior clinicians who had to learn from experience in these scary spaces on how to recognize, how to kind of, how to navigate with family this very tricky interactional terrain. What words do they clue into to judge whether that family is preferring open or closed awareness? What kinds of symbols when you're working with patients and their families, when you're working with a patient who is deaf, how how do you communicate and perceive those clues in a space where you have to perhaps use a translator to speak or where they close off communication by closing their eyes. So, yeah, the this this is, I agree Oliver, and that these this kind of really challenging terrain, relational and the social aspects of care, it tends to be something that is learned, is learned perhaps conceptually, but I don't even think it progresses to procedural or dispositional until perhaps people become far more experienced in their jobs.

他们必须在实践中学习这些，而我认为我们应该让学生更充分地做好准备，比如如何处理痛苦、进行临终关怀对话，以及如何与经历过多重创伤的客户合作。

They have to kind of learn it on the go, where I think we we should be be preparing students more readily for how to do things like handle distress, end of life care conversations, how to work with clients who have experienced layers and layers of trauma.

那么，对于想要在临床实践中采用更多社会学方法或至少开始涉足这一领域的听众和临床医生，你有什么建议吗？因为这个领域似乎充满了理论和文献，看起来有些吓人。对于那些可能还不了解这种思维方式的人来说，有什么简单的入门方法吗？

And I guess with that, what advice might you have for listeners, clinicians listening that want to take a more sociological approach to their practice or at least begin to engage in that area? Are there any because it would seem like a mountainous field of theories and literature and kind of scary. What would be an easy way in to begin to introduce some of these this way of thinking to clinicians who otherwise may not be aware of it?

这是个棘手的问题，奥利弗。确实有很多...

That's a tricky one Oliver. There are quite a range of

当然，收听这个播客是第一步，然后继续深入...

Listen to this podcast, of course, is the first first way in and go through

是的。完整地...好吧，收听奥利弗的所有播客。实际上，播客是一种非常好的参与方式。但我认为学习需要循序渐进。

the Yeah. Entire Well, to all of Oliver's podcasts. Well, and that is. That actually, podcasts are a really great way of engaging. But I think the learning really needs to be stepped.

所以，可以从一些基础教材开始，比如《社会学导论》、《健康社会学导论》、《什么是医学社会学》，从这些入手，真正搭建起知识框架，这样你就能掌握一套理论工具箱。但我觉得还需要更进一步。因为社会学更像是一门应用型研究学科，而非应用实践。这方面可能更多是心理学和社会工作的领域。但这里可能需要更多关注理论，同时也关注照顾他人和自我关怀的人文层面，因为在大学本科阶段的临床教育以及继续教育中，这两者必须齐头并进。

So, you know, starting with some of those really primary texts, primary textbooks, saying, introduction to sociology, introduction to health sociology, what is medical sociology, kind of starting there, and really get that scaffolding together so that you can have a toolbox of theories at your disposal. But I think it needs to go beyond that. Because I think this is kind of perhaps where sociology is more of an applied kind of research discipline, but not an applied practice. I would see that more as kind of the psychology and social work terrain. But this might be where there's a need for greater attention to theory, but also human aspects of care for others and care for oneself because the two have to go hand in hand within clinical education at a uni, an under undergraduate university level, but also a continuing education level.

而且，或许应该摒弃那种'老狗学不会新把戏'的说法...

And, and a kind of perhaps a rejection of that old dogs, new tricks, saying that-

哦，这超出了我的职责范围。我不是社工。这不是我的专业领域。

Oh, it's it's outside of my scope. I'm not a social worker. It's just not it's not my field.

但同样，就像，哦，我一直以来都是这么做的。你知道，对我来说重新审视、学习或改变已经太晚了。像视频反思民族志这样的技术能提供的东西令人惊叹——通过观看自己在实践中的录像，识别出某些元素，听到他人指出其他方面，这些都能促使我以不同角度思考自己的行为，提供的反馈能让我突破习惯性的行事方式。我认为关键在于创造一个安全的环境来进行理论探讨和实践反思，从而真正发挥理论对实践的催化作用。

But also, like, oh, this is how I've been doing it forever. I you know, it's it's too late for me to kind of reexamine or learn anything or change. It is amazing what some of these techniques like video reflexive ethnography can offer in seeing oneself videoed in practice, identify hearing my you know, hearing and seeing myself identify certain elements, hearing others identify other things that can prompt me to to think differently about what I'm doing, provide feedback that pushes me outside of that habituated way of doing and being. And there can be, I think it might be about creating a safe environment to engage in theories and reflection on practice to really catalyze the value of theory to practice.

丽贝卡，非常感谢你。

Rebecca, thank you so much.

谢谢。

Thank you.

如果你喜欢本期播客，请访问www.wordsmattereducation.com获取所有节目注释、资源和博客，并查看关于背痛相关的语言与沟通在线课程。我们下次见。

If you enjoyed this podcast, visit www.wordsmattereducation.com for all the show notes, resources, and blogs, and check out the online course in language and communication in relation to back pain. And I'll see you next time.