Medical Professionals and the Organization of Knowledge PDF
Preview Medical Professionals and the Organization of Knowledge
MEDICAL PROFESSIONALS and lhe ORGANIZATION KNOWLEDGE or MEDICAL PROFESSIONALS and lhe ORGANIZATION KNOWLEDGE or Eliot Freidson Judith Lorber editors ~~ ~~~J~~n~~~up LONDON AND NEW YORK First published 1972 by Transaction Publishers Published 2017 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN 711 Third Avenue, New York, NY 10017, USA Routledge is an imprint of the Taylor & Francis Group, an informa business Copyright © 1972 by Taylor & Francis. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Catalog Number: 2008005498 Library of Congress Cataloging-in-Publication Data Medical professionals and the organization of knowledge / [edited by] Eliot Freidson and Judith Lorber. p.cm. Originally published: Chicago : Aldine-Atherton, 1972 under the title: Medical men and their work. Includes bibliographical references and index. ISBN 978-0-202-36208-3 (alk. paper) 1. Social medicine. I. Freidson, Rliot, 1923-2005. II. Lorber, Judith. III. Freidson, Eliot, 1923-2005. Medical men and their work. [DNLM: 1. Professional Practice—Collected Works. 2. Attitude of Health Personnel—Collected Works. 3. Health Knowledge, Attitudes, Prac- tice—Collected Works. 4. Professional Role—Collected Works. 5. Sick Role—Collected Works. W 21 M4893 2008] RA418.F73 2008 362.1—dc22 2008005498 ISBN 13: 978-0-202-36208-3 (pbk) For Our Parents- Grace, Sop hie, and Henry Foreword This collection of papers is intended to convey, in as systematic a fashion as possible, an approach to the field of medical sociology which stresses the way in which men shape and organize the knowledge, perception, and experience of illness, and much of the substance of illness behavior, its management and treatment. While man is a biological organism, he responds to himself and others in terms of the social meanings he assigns to his experience with the physical and biological world. It is now well established in such medical fields as psychosomatic medicine and psycho pharmacology that the unique symbolic equipment of the human animal is intimately connected with the functioning of the body. This being so, it stands to reason that proper understanding of specifically human rather than generally "animal" illness requires careful and systematic study of the social meanings surrounding illness. The content of the social meanings surrounding ascribed physical states (and indeed what is to be considered a physical state) varies from culture to culture, and from one historical period to another. At least as important as the content of those social meanings, however, is the organization of those groups of men who serve as their carriers and, sometimes, creators. In the case of illness, a critical difference exists between those considered to be competent to diagnose and treat the sick and those excluded from this special privilege-a separation as old and as ubiquitous as the shaman or medicine-man. This difference becomes solidified when the expert healer becomes a member of an organized, full-time occupation, sustained in a monopoly over the work of diagnosis and treatment by the force of the state, and invested with the authority to make official designation of the social meanings to be ascribed to physical states. When this stage of social organization occurs, only the expert healers are permitted to say what is and what is not legitimate illness, and who is and who is not legiti mately ill. vviiiiii Foreword The medical profession is today in that position in the United States and in other advanced nations. Its organization and its knowledge set many of the conditions for being recognizably and legitimately ill, and it controls many of the circumstances of treatment. It thus plays a central role in shaping the experience of being ill. It is with this fact of modern life in mind that we emphasize in this collection papers on the character of experts or professionals in general, and of medicine as a profession in particular. Similarly, we sample the literature on other occupations working with medicine in shaping the experience of being ill. Only after presenting materials that lay out the occupational and institutional boundaries set by health workers and their institutions do we present papers exploring the social identity of the sick person who, in interaction with health workers, also participates in the creation of the experience of being ill. This inter actional process surrounding the invocation and negotiation of the social meanings of illness is, it must be remembered, precisely the process that makes illness among humans a phenomenon different from thll4 to be found among other animals. It is the process about which medical science has virtually no systematic knowledge and about which it is the task of sociology to learn. In sum, by our selection of papers we have tried to emphasize the role of medicine as a profession, and of other health occupations and health institutions in creating and maintaining some of the more powerful social meanings and consequences of illness. We have, furthermore, emphasized that health or health care is a form of work organized into special insti tutionalized practices. Given the limited space available to us, we have had to leave out a whole universe of literature devoted to specific administra tive details of the various modes of financing and organizing health care. Such literature, which is growing rapidly at present because of the concern with developing a better and more equitable system of national medical care, is certainly useful and important. We are convinced, however, that attention to generic sociological analyses of healing as a form of work, of health workers in interaction with patients, and of the social meanings of health and illness, the well and the sick, the healer, the healed and the unhealed, are likely to be more useful in the long run for the solution of practical problems of medical care than a preoccupation with comparative ly mechanical administrative and financial issues. We believe that the papers in this volume can suggest the source of organization of the behavior of the people involved in the health care system, and so some of the strategies required for improving the operation of that system. Contents I. MEDICAL MEN Medical Men as Professionals 1. Doctors and Lawyers: A Comment on the Theory of the Profes- sions I Dietrich Rueschemeyer, Brown University 5 2. Professionals and Unions in Israel I Joseph Ben-David, Hebrew University and University of Chicago 20 3. The Professionalization of Ayurvedic and Unani Medicine I Charles Leslie, New York University 39 4. Incomplete Professionalization: The Case of Pharmacy I Norman K. Denzin, University of Illinois 55 5. "Socialized Medicine" in Practice /William A. Glaser, Bureau of Applied Social Research, Columbia University 65 Medical Men in Practice 82 6. A Brief History of Medical Practice I Ve m Bulloug~h, San Fernando Valley State College, and Bonnie Bullough, University of California at Los Angeles 86 7. Changing Attitudes of the Medical Profession to Specialization 1 George Rosen, School of Medicine, Yale University 103 8. Pathology: A Study of Social Movements Within a Profession I Rue Bucher, Abraham Lincoln School of Medicine, University of Illinois 113 9. A Sociology of Psychiatry: A Perspective and some Organizing Foci I Leonard Schatzman and Anselm Strauss, University of California at San Francisco 128 10. Military Psychiatry: The Emergence of a Subspecialty I Arlene K. Daniels, Scientific Analysis Corporation, San Francisco 145 11. Ethnic and Class Differences Among Hospitals as Contingencies in Medical Careers I David N. Solomon, McGill University 163 12. Authority and Decision-Making in a Hospital: A Comparative Anal ysis I Rose Laub Coser, State University of New York at Stony Brook 174 13. Processes of Control in a Company of Equals I Eliot Freidson, New York University, and Buford Rhea, State University of New York at Plattsburgh 185
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