1 Prepublication Copy for Kathy Charmaz and Dana Rosenfeld. 2010. “Chronic Illness.” In William Cockerham (ed.) New Blackwell Companion to Medical Sociology (pp. 312- 333). London: Blackwell. Chapter 14 Chronic Illness Kathy Charmaz and Dana Rosenfeld Throughout the history of medical sociology, social scientific study of chronic conditions has taken two major directions: epidemiological studies of specific populations in relation to disease and analyses of the experience of illness, the primary focus of this chapter. In the sociological literature, disease and illness are neither interchangeable nor equivalent. Disease is the undesirable biological process or state affecting the individual, and illness is the person’s experience of the disease, including its social and psychological impacts. Just as disease may be unrecognized and unfelt (see Conrad 1987: 2), deeply disturbing symptoms may arise without being diagnosed as a disease, even in the absence of perceivable organic causes. To study illness, then, is to study human experience without reference to organic causes, although it may include lay understandings of these causes and the experience of diagnosing them. To an extent, these directions of inquiry reflect Robert Straus’s (1957) distinction between a sociology in medicine and a sociology of medicine – a distinction that is not just heuristic but deeply political. According to Bryan Turner (1992), tensions between these two approaches are grounded in the core question of who the social-scientific study of health and illness serves: medicine itself (expanding and legitimating its existing powers) or the sociological understanding of human action. Sociology in medicine, Turner argues, is beholden to medicine’s conceptual resources, concerns, and governing and funding bodies, working within these but remaining outside the ill person’s experience (similarly, epidemiological studies use existing medical categories to directly serve health care professionals and policymakers). Sociologists of medicine, however, examine the nature and experience of health and illness, which medically derived categories cannot capture (see also Rosenfeld 2006a). At the same time, it remains free of the task of solving practical problems as established by medical agendas, and critically approaches the institution of medicine and its categories, assumptions, and agendas as social constructions and problematic areas of inquiry. William Cockerham (2010) has, however, critiqued the division between sociology in and sociology of medicine as overly simplistic <1> because the lines between them blur in policy research. Exploring the intriguing question of the extent to which his point applies to chronic illness goes beyond our focus here. This chapter also leaves aside the equally interesting sociological question of the social causes of the unequal distribution of chronic organic conditions; we emphasize the history and contributions of studies of the lived experience of chronic illness. <2>