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1 Theoretical Perspectives on Medicine and Society Over the past two decades or so there has been an increasing propensity for the boundaries between disciplines to blur, particularly among the humanities and social sciences. As a result, it is becoming more and more difficult to ascribe labels to scholarly endeavours. Literary studies, psychoanalytic theory, philosophy, social psychology, cultural studies, linguistics, history, sociology and anthropology have all experienced changes which bring them closer together in their projects. Of particular note is the emergence of the ‘linguistic turn’, or the increasing attention paid to language and discursive processes in the production and maintenance of social life and subjectivity. In line with these developments, the scholarly activities which may loosely be gathered under the rubric of the sociology of health and illness have altered focus. There have been several major impetuses fuelling this change. One is the emergence of a growing disillusionment with scientific medicine on the part of both intellectuals and some consumers in the late twentieth century. As the effectiveness and benevolence of medicine began to be challenged, so too was its claim to inaccessible and arcane knowledge based on objectivity and political neutrality. The other is the impact of poststructuralist and postmodernist theories, including the release in the anglophone world of the translated works of the French philosopher-historian Michel Foucault, and the growing concern of feminist scholarship with gender and the body. In response to these impetuses, anthropologists and sociologists of health and illness, particularly in continental Europe and Britain, but increasingly so in North America and Australia, began to call into question the claims to ‘truth’ and political neutrality of biomedical knowledge (that which is founded upon scientific principles and understandings). In this chapter, the major fields of scholarship and research in the humanities and social sciences that have examined the social role of medicine in western societies are reviewed for the theoretical developments which have occurred over the past fifty years or so. Particular attention is
6 Medicine as Culture paid to the emergence of social constructionism as a dominant perspective appropriate for engaging in inquiries into the socio-cultural dimensions of medicine, health and illness. There is also greater discussion of the sociological tradition compared with those of anthropology, history and cultural studies, as this book is written from and principally positioned within the sociological discipline. For the purposes of this chapter and for clarity’s sake, distinctions have been drawn in the time-honoured way concerning perspectives and paradigms between and within disciplines. However, the caveat is made that such distinctions are, in many cases, no longer as valid or appropriate as once they were. Indeed, one of the strongest points I seek to make in this chapter is that sociologies, anthropologies, histories and cultural studies of medicine, health and illness share an intellectual tradition and trajectory based on the same trends and developments in social theory. The sociology of health and illness As it first developed in the anglophone world, medical sociology (as the sub-discipline was first named and which term is still preferred in the United States) or the sociology of health and illness (the term preferred in Britain and Australia) was primarily concerned with systematic empiricism using the measurement of objective variables deemed quantifiable. Early in its development, in order to be accepted as a quasi-scientific discipline applied to a scientific discipline (that is, medicine), medical sociology adopted largely positivist values which to some extent are still evident, although more so in the United States than Britain and Australia. As a result, often medical sociology could best have been described as a derivative of social medicine rather than as a sub-discipline of critical sociology (Jordanova, 1983; Scambler, 1987; Mechanic, 1993). Accordingly, in line with the assumptions of the model of scientific medicine itself, for much of the history and development of medical sociology and the sociology of health and illness the biological, human anatomy conception of the body has remained unchallenged (Armstrong, 1987a: 651). That is, until social constructionism, in train with the impact of poststructuralism and postmodernism and the ascendancy of feminist and Foucauldian critiques of medicine, began to reassert itself as an influential approach in the early 1980s. There have been three dominant theoretical perspectives in the history of medical sociology/sociology of health and illness: functionalism, the political economy approach and social constructionism. Variants of all three are currently in circulation in scholarship in the sociology of health and illness. However, it is clear that since the 1970s functionalism and, to a lesser extent, the political economy approach have been on the wane, while the social constructionist perspective continues to prosper.
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Page 5 and 6: © Deborah Lupton, 2003 First editi
Page 8 and 9: Introduction Western societies in t
Page 10 and 11: Introduction 3 paradigmatic changes
Page 14 and 15: Functionalism Theoretical Perspecti
Page 16 and 17: Theoretical Perspectives on Medicin
Page 18 and 19: The political economy perspective h
Page 26 and 27: and Fiske, 1992, for introductions
Page 28 and 29: which is verbal is considered a tex
Page 30 and 31: The Body in Medicine 23 professiona
Page 32 and 33: For his part, Frank (1990: 134) sug
Page 34 and 35: The Body in Medicine 27 Such a view
Page 36 and 37: attention of their partners. In thi
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Representations of Medicine, Illnes
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The Lay Perspective on Illness and
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viewed as the cause of disease, the
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Discourses on the moral nature of i
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5 Power Relations and the Medical E
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parent and child, with patients rel
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Power Relations and the Medical Enc
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In another study, the interaction o
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the medical encounter, it is also u
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problems that are encountered regul
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had towards patients, such as his a
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it has also contributed to their li
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Feminisms and Medicine 145 arbitrar
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Feminisms and Medicine 147 Admitted
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The historical legacy of the medica
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Feminisms and Medicine 151 was firm
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Feminisms and Medicine 153 anxietie
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Feminisms and Medicine 155 Research
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Feminisms and Medicine 157 menstrua
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Feminisms and Medicine 159 births i
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Feminisms and Medicine 161 emphasis
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Feminisms and Medicine 163 via the
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Feminisms and Medicine 165 women ma
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of social control’ (Tsing, 1990:
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Feminisms and Medicine 169 are hail
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Feminisms and Medicine 171 menstrua
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Conclusion As medicine continues to
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References Ahmad, W. and Jones, L.
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References 177 Broom, D. (2001) ‘
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References 179 Doyal, L. (1983) The
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References 181 Gallagher, C. and La
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References 183 Holland, R. and McKe
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References 185 Lock, M. (1985) ‘M
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References 187 Montgomery, S. (1991
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References 189 Pringle, R. (1992)
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References 191 Shilling, C. (1991)
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References 193 Wear, A. (1992) ‘M
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196 Medicine as Culture body, cont.
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198 Medicine as Culture habitus, 44
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200 Medicine as Culture metaphors,
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202 Medicine as Culture Wadler, Joy
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