David Mechanic: The persistence of a medical sociologist

Alumni dispatches

This is the first in a Palm Prints series featuring our alumni.

In August 1956, 20-year-old David Mechanic packed his light blue DeSoto, said goodbye to his family in the Bronx, and drove west. A couple of friends rode with him as they headed to Berkeley for PhDs. He was bound for Stanford. 

Three and a half days later, he pulled onto campus and caught sight of Memorial Church. “I was amazed at how beautiful it was,” he said. “Unlike anything I’d ever seen.” 

He didn’t know it yet, but he was at the start of a career that would reshape how scholars and policymakers think about mental health, illness, and medical care.

Today, at 90, Mechanic remains passionate about the work but disheartened by how little has changed, especially in access to affordable medical care and community-based mental health services. “Although I have done a lot in the mental health area and made some progress, we still have a long way to go,” he said in a telephone interview from his home in New Jersey.

Stanford was a world away from the neighborhood where he grew up. His father was a garment industry piece worker earning 50 cents a dress, and ethnic lines divided the local Jewish and Italian communities. By 13 or 14, Mechanic was working odd jobs, packing orders at liquor stores, installing White Rose Tea decals in grocery stores, and conducting consumer research interviews.

“I guess it's like what Dolly Parton said; I didn’t know it at the time that we were poor, but we really were.”

What the neighborhood lacked in wealth, it made up for in academic ambition. The Coops, a workers’ cooperative housing colony where Mechanic lived, turned out an improbable number of scholars. “When I was an assistant professor at Wisconsin, there were four other professors there who were from my neighborhood,” he said. 

Blazing a path

Mechanic entered Stanford’s sociology program on a Ford Foundation Behavioral Sciences Fellowship. The program had only eight professors, and its small size worked in his favor. With few established paths to follow, he was free to create his own, developing a research approach rooted in careful observation and rigorous evidence. 

He found a close collaborator in faculty mentor Edmund H. Volkart, who had access to student health records that Mechanic, as a graduate student, did not. With the records, Mechanic was able to complete his dissertation by studying 614 freshmen, pairing questionnaires with their medical information. The result was counterintuitive: who turned up at the health center, and how often, depended less on how sick students were than on how readily they saw themselves as needing care. 

From this work, he introduced the term “illness behavior,” the idea that education, class, culture, and other social factors influence how people interpret symptoms and whether they seek medical help at all. The concept became a cornerstone of medical sociology, shifting the field’s attention beyond biology toward the social circumstances that determine who walks into a doctor’s office and what happens when they do. Volkart and Mechanic later published two papers on the topic. 

“I believe in the uses of social science to improve people’s lives, but I also believe in the integrity of science and the importance of a willingness to change one’s views when results don’t support one’s beliefs or assumptions,” he said. “The long-term purpose is to make a difference in the world in some important way.”

"I believe in the uses of social sciences to improve people's lives, but I also believe in the integrity of science. The long-term purpose is to make a difference in the world in some important way."

After finishing his PhD, Mechanic took a postdoctoral fellowship at the University of North Carolina at Chapel Hill. There he wrote his first book, Students Under Stress (1962), and several other studies centered on psychiatric health. While working on the articles, he noticed a pattern in power structures within institutions and organizations. He saw that people at the bottom of the hierarchy, like administrators and hospital attendants, can hold power because they control access to information, people, and resources. He turned that observation into a study of its own. 

It started with an administrative roadblock. He tried to collect data from a psychiatric unit at Raleigh’s Dorothea Dix Hospital, and the unit’s aide refused. Mechanic didn’t argue. He drove back to Chapel Hill and sent the aide a courteous note on university stationery, thanking him for his time and for the work the unit was doing. 

When Mechanic returned to make his case a second time, he found the letter framed and hanging in a prominent spot. This time, he got his access. “I learned early that most people don’t get recognition from others, and simply recognizing what they do can be a great help in facilitating change,” he said.

The encounter led to his 1962 paper, "Sources of Power of Lower Participants in Complex Organizations." More than 60 years later, Mechanic says he still receives reprint requests for the article.

Building a field

In 1960, Mechanic joined the faculty at the University of Wisconsin–Madison, where he became Chair of the sociology department. It was during the Vietnam War, and Wisconsin–Madison was at the forefront of the anti-war movement. "We had 24-hour teach-ins for several days to avoid police action which we knew would lead to injuries or worse," Mechanic recalled. 

Mechanic later became the John Bascom Professor of Sociology. During his 19 years there, Mechanic built a strong program in medical sociology and mental health research, wrote two foundational books — Medical Sociology: A Selective View (1968)  and  Mental Health and Social Policy (1969, with the sixth edition published in 2013) — and secured federal funding for interdisciplinary training programs. 

Paul Cleary remembers his time at Wisconsin–Madison with Mechanic. Cleary was admitted to the PhD program in 1971, excited about research but unsure which direction to take until he met Mechanic, who offered Cleary a traineeship in medical sociology. “I naively asked about the subject and was treated to one of the most articulate and compelling explanations about what social sciences could contribute to social epidemiology, health services research, organizations and professions, and health policy that I have ever heard,” said Cleary, the  Anna M.R. Lauder Professor emeritus of Yale University's Department of Health Policy and Management. “I still look at that day as one of the most influential and fortunate in my career.”

Cleary said Mechanic was passionate about the intellectual challenge of addressing social issues but, more importantly, about "the ways social policy fails certain members of our society. He was particularly motivated by the plight of those with mental health challenges.”

When Mechanic moved to Rutgers in 1979, he continued his work in health policy. In 1985, he founded the Institute for Health, Health Care Policy, and Aging Research, which recently celebrated its 40th anniversary. 

At the institute, Mechanic brought together experts from various fields to examine how health systems and financial incentives influence the care people receive, how scarce medical resources are distributed, and why people with severe mental illness and other vulnerable populations so often remain poorly served. 

By then, he had served on many policy boards and committees and pushed for mental healthcare in national forums. At one point, he and others urged the National Center for Health Statistics to add mental health questions to its surveys. Federal staff resisted, calling the metrics too “soft.” Mechanic brought in researchers, including a couple of his former students, to show that psychological distress could be measured reliably. The agency relented. 

It was a small bureaucratic victory with larger implications. Problems that aren’t measured are easier for institutions to overlook. 

Mechanic retired at the end of 2015, at 80. His proudest achievements, he said, are the institute he established at Rutgers and the students he mentored.

“Having had excellent mentors at Stanford, at the Center for Advanced Study in the Behavioral Sciences, and at Wisconsin motivated me to be a better mentor to students, young faculty, and staff,” Mechanic said. “I’m proud of their accomplishments and appreciate the kindness they extend to me as an old guy.”