RWJF Health & Society Scholar, 2003–2005An Eye for the Unexpected
When everyone shares the same point of view—about the value of cardiopulmonary resuscitation (CPR), for example—chances are there is more to the story. That, at least, is one of the principles guiding the work of Stefan Timmermans, MA, PhD, a medical sociologist who chairs the Department of Sociology at the University of California, Los Angeles.
“I am more interested in trying to see how a consensus emerged and what the consequences are, and what is being left out of the consensus, than I am in advancing that consensus,” he acknowledges. His book Sudden Death and the Myth of CPR, for example, suggested that the primary purpose of CPR was to assure families that everything possible had been done for their loved ones, rather than to save lives—which it rarely does.
“Whenever there is a consensus, I am suspicious.”
Another unifying theme in his work, Timmermans says, is a fascination with “how people do things, not what they say they do... how they are actually living their lives.” That, too, has been an intellectual touchstone as he writes books that have covered topics as varied as traumatic death and newborn genetic screening. He is also the author of dozens of peer-reviewed articles and book chapters.
Looking at health through a fresh lens. With its thoughtful analysis of how people act together, medical sociology brings a fresh lens to the study of health-related issues. Studies can look at groups as small as two—the interaction between a patient and a doctor, for example—or as large as the health of an entire population.
“We look at all the different ways that health affects people’s lives in a broad variety of settings,” Timmermans explains. An example is a workplace accident that leaves a person paralyzed. A physician might focus on the biological impact, a public health practitioner might consider the adequacy of safety standards. But a medical sociologist is more likely to ask, “How does it change your relations, your future, your employment opportunities? How does that change your entire life?”
A way out of a mid-life crisis. Timmermans earned his doctoral degree in sociology from the University of Illinois, Champaign-Urbana in 1995, and then joined the faculty at Brandeis University in Boston. Eight years later, he took a leave to become a Robert Wood Johnson Foundation Health & Society Scholar. The decision reflected a “mid-life, mid-career crisis,” he says, coming at a time when he was considering whether to leave the field of sociology to pursue other, more interdisciplinary options.
As a member of the first cohort of Health & Society Scholars, Timmermans was based at Harvard University, one of six universities participating in the two-year interdisciplinary fellowship program. (To learn more about the program, read the Program Results Report.)
At Harvard, he focused on the intensive caregiving role that health professionals expect from a mother when her child is diagnosed with asthma. A Social Science and Medicine article, “Caretaking as Articulation Work: The Effects of Taking Up Responsibility for a Child with Asthma on Labor Force Participation,” (65, 1351–63, 2007) emerged from that exploration. In the article, Timmermans discussed “how health professionals socialize mothers into an intensive caretaking role for their children with asthma, how mothers negotiated and perform that role, and the impact of care work on their labor force participation.”
Far from pushing him away from sociology, his experience as a scholar gave him a fuller appreciation of its unique vantage point. “I am not as constrained by these practical, health-promoting boundaries that public health has drawn around itself,” he discovered. “Hanging out, taking courses and seminars with these very smart, accomplished public health researchers made me aware that as a sociologist, I have a lot of theoretical tools that are useful to bring to bear on some of the questions they address.”
That recognition convinced Timmermans that he wanted to be part of a more research-oriented institution. After completing the fellowship in 2005, he joined the University of California, Los Angeles as a professor of sociology. In 2011, he was appointed department chair.
Dealing with sudden or violent death. Meanwhile, he continued his unconventional and often provocative work. One book project, completed while he was still a scholar, was Postmortem: How Medical Examiners Explain Suspicious Deaths, published in 2006. It drew heavily on his observations of forensic pathologists as they performed autopsies—of homicide victims, people who had committed suicide, babies, older adults, and others.
“They all died in bad circumstances. There are no happy stories in a medical examiner’s office.”
In a medical examiner’s office, says Timmerman, “They open up the bodies, do an autopsy and then they have to decide, ‘Was the death natural, accidental, homicide, suicide, or undetermined?’ The question that the book tries to address is ‘Why do we believe these forensic pathologists have the authority to speak on behalf of that death?’”
Timmermans received two awards for Postmortem: the British Sociology Association’s Sociology of Health and Illness book award and the American Sociological Association’s Eliot Freidson award for best medical sociology book.
Postmortem, like Sudden Death and the Myth of CPR, is in part about the need to find meaning from certain kinds of deaths. In the model introduced by the hospice movement, largely drawn from experiences with cancer and HIV, “people put their affairs in order, control symptoms, say goodbye, and then hope for a peaceful passing,” Timmermans explains. But this “well-understood script of how dying should be” doesn’t apply to traumatic, sudden, or unexpected death, making them much more mystifying.
As a result, we need “death brokers,” Timmermans believes—people who can “broker these strange deaths for the rest of society, fold them into categories that we consider meaningful.”
Screening newborns. Timmermans latest book, co-authored with Mara Buchbinder, PhD, and released in 2012, is Saving Babies: The Consequences of Newborn Genetic Screening.
Every baby born in the United States is screened for more than 50 genetic disorders. In an ideal world—where the genetic test clearly reveals the likelihood of disease, and treatments are available to prevent it—screening holds great promise. But Timmermans points out that all too often the clinical significance of a “positive” screening test result is unknown. “How do parents deal with information that says it might be a disease or it might not?” he wanted to know.
“It might be nothing, but if it is the disease, it would be really bad.”
To study the consequences and risks of newborn genetic screening, Timmermans and Buchbinder observed and interviewed families, doctors, and policy-makers. “The premise was to understand what it means to say that newborn screening saves babies. We argued that saving babies depends on a lot of often-overlooked issues falling into place—such as basic access to health care or having parents closely monitor their kids at all times.”
Appreciating mentors and becoming one himself. When he is not offering up sometimes-contrarian analyses, Timmermans teaches graduate and undergraduate sociology courses, including “Suicide, Death, and Trauma.” The topic is challenging, he says, but it often has profound meaning for his students. “I’m drawn to topics that really make a difference in people’s lives. It helps them articulate and understand and think through some of these issues they have had some vague thoughts about.”
Mentoring graduate students and junior faculty is another passion, and a way to return the support he once received as a 22-year-old Belgium immigrant new to the American academic system.
“I love working with people one on one, trying to instill self-confidence and give them the methodological and analytical skills to become good researchers. I am not the kind of person who tells people you have to do it this way, or I’m not interested in working with you. It is about going on a journey together.”
One thing is certain: there is no predicting the twists and turns of a journey with Stefan Timmermans.
RWJF perspective. The Foundation created the RWJF Health & Society Scholars program in 2001 to build the field of population health. "There is a growing recognition that health is the result of the interaction of multiple factors including socioeconomic and physical environmental factors and health behaviors," said Pamela G. Russo, MD, MPH, senior program officer. "The evidence shows that these types of factors play a much larger role in determining health at the population level than do the traditionally considered health care and biological determinants of health."
"The program seeks to integrate paradigms and knowledge from a variety of disciplines to develop an understanding of how these determinants affect the health of populations, and thereby to design interventions with greater power to reduce health disparities," said Russo.The final cohort of scholars for the program are entering in 2014 and will complete their fellowships in 2016.