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Theoretical Perspectives on Medicine and Society 13
In so doing, the approach allows alternative ways of thinking about the
truth claims of biomedicine, showing them to be as much social products
as lay knowledges of medicine. Such a project has brought together sociologists,
anthropologists, philosophers and social historians interested in
the cultural assumptions in which biomedicine is grounded and the practices
that sustain it. The feminist movement has led the way in devoting
attention to the ways in which medical and scientific knowledges are used
to privilege the position of powerful groups over others. It has developed
a trenchant critique of the ‘biology as destiny’ ideology which has frequently
been adopted in the medical context to deny women full participation
in the public sphere (see Chapter 6 for a detailed discussion of
feminist scholarship as applied to medicine).
There are a range of political positions taken by scholars adopting the
social constructionist approach (Bury, 1986). Some view medical knowledge
as neutral, while others emphasize the social control function of
discourses, arguing that such knowledge and its attendant practices
reinforce the position of powerful interests to the exclusion of others.
However, social constructionist scholars generally avoid viewing power
as being wielded from above and shaped entirely by the forces of capitalism,
recognizing instead a multiplicity of interests and sites of power. The
notion that medicine acts as an important institution of social control has
remained, but the emphasis has moved from examining medical power as
an oppressive, highly visible, sovereign-based power, to a conceptualization
of medicine as producing knowledges which change in time and
space. Those adopting the social constructionist perspective argue that
medical power not only resides in institutions or elite individuals, but is
deployed by every individual by way of socialization to accept certain
values and norms of behaviour.
While the social constructionist perspective is currently rather fashionable,
particularly in Britain, Australia and continental Europe, it is not a
universally accepted perspective in sociology, a discipline that has traditionally
been characterized by antipathy between competing paradigms
(the Marxist/conflict perspective versus the functionalist/consensus
school, for example). Constructionist analyses have been criticized for
concentrating upon medical discourse at the macro-level, for making
broad generalizations and avoiding a detailed examination of the microcontext
in which discursive processes take place (such as the everyday
experiences of people) for their insistence that discourses have general
social effects, regardless of social class, gender or ethnicity and for not recognizing
human agency and the opportunity for resistance (Outram,
1989; Shilling, 1991; Turner, 1996).
Critics of the social constructionist approach have argued that the
approach, like all others influenced by the poststructuralist movement,
can descend into relativism and nihilism if taken to its logical conclusion,
that all knowledges are social products, and that therefore the insights of
social constructionist analyses are themselves to be questioned. How are