Showing papers in "The Sociological Review in 1972"

Medicine as an Institution of Social Control

Abstract: The theme of this essay is that medicine is becoming a major institution of social control, nudging aside, if not incorporating, the more traditional institutions of religion and law. It is becoming the new repository of truth, the place where absolute and often final judgments are made by supposedly morally neutral and objective experts. And these judgments are made, not in the name of virtue or legitimacy, but in the name of health. Moreover, this is not occurring through the political power physicians hold or can influence, but is largely an insidious and often undramatic phenomenon accomplished by 'medicalizing' much of daMy living, by making medicine and the labels 'healthy' and 'ill' relevant to an ever increasing part of human existence. Although many have noted aspects of this process, by confining their concern to the field of psychiatry, these criticisms have been misplaced.̂ For psychiatry has by no means distorted the mandate of medicine, but indeed, though perhaps at a pace faster than other medical specialities, is following instead some of the basic claims and directions of that profession. Nor is this extension into society the result of any professional 'imperialism', for this leads us to think of the issue in terms of misguided human efforts or motives, li we search for the 'why' of this phenomenon, we will see instead that it is rooted in our increasingly complex technological and bureaucratic system—a system which has led us down the path of the reluctant reliance on the expert.̂ Quite frankly, what is presented in the following pages is not a

Deprofessionalization: An Alternate Hypothesis for the Future:

Abstract: What will be the shape of the society in the 21st century? The year 2000 is only a generation away, and sociologists and 'futurologists' of varying academic persuasions already have delineated some of its minimum parameters. We will live, it is said, in a 'post-industrial' society. This means, according to Bell (1968, p. 152) that the professional and technical class will be pre-eminent, or, in more general terms, that it will be a 'professionalized' society (Freidson, 1971, p. 467). The knowledge explosion in science and technology is the rationale for these forecasts. Expanding knowledge calls for increasing numbers of professionals who have mastered the various bodies of esoteric information, and are capable of applying their technical skill and expertise to the manifold problems of mankind on a vulnerable and shrinking planet. Another related prediction suggests that the service ethos of the professional's style of work is becoming generalized to the total society. In this view, the imputed ideology of the personal service professions-'concern, sympathy and even affection for those who are to be helped by the professional practitioners'-will structure the social order along the ethical lines espoused by the counsellor (Halmos, 1970, p. 14). These estimates for the future elaborate on two basic characteristics of profession-mastery over knowledge and a humanitarian approach in application of that knowledge. They do not, however, explicidy address the third core element of profession: the autonomy of the professional, his freedom from lay control in carrying out his occupational role, in a word, his power. From Greenwood (1957) to Moore (1970), there have been a series of diverse, if often overlapping, definitions of the concept of profession. Basic to all, however, are the dimensions of knowledge monopoly,

Elites in the British Class Structure

Abstract: elite Qosed

IMPERIALISM AND THE PROFESSIONS: Notes on the Development of Professional Occupations in Britain's Colonies and the New States.*

Abstract: The sociology of the professions, as a specialist field, today stands almost alone in ignoring the third world. Despite the weight of fashion, textbooks and readers on the subject obstinately exclude the by now obligatory chapter or section on development. While in some circumstances such spirited rearguard inaction might evince sneaking admiration, an exclusion of the problems of underdevelopment is difficult to understand. This lacuna in the literature is particularly surprising as those social scientists who are concerned with the fate of the third world continually point to the significance of professional occupations for economic and social development. In fact, a maj or theme of the sociology of professions as it relates to changes in the distribution of power in industrialized societies, finds a direct parallel in the literature concerned with 'elites' and emergent stratification systems in the underdeveloped countries of Africa and Asia. The parallel exists to the extent that in both contexts the professions have been regarded as a positive force for social and economic betterment. The professions in the industrialised world have been seen as moderating the excesses of economic individualism by providing an occupational basis for corporate identity while, at the same time, tempering the impersonalising effects of bureaucratic organisation by upholding the values associated with individual responsibility: armed only with the authority of expertise they have humanised the formal hierarchies of the great public and private corporations. In short, the professions have provided many social theorists with a basis for optimism about the possibility of a democratic and prosperous future.! This rosy view of the professions as democratic and humanising

On the Professional Regulation of Change

Abstract: ‘The individuals composing the ruling class possess among other things consciousness, and therefore think. In so far, therefore, as they rule as a class and determine the whole extent of an epoch, it is self evident that they do this in their whole range and thus, among other things, rule also as thinkers, as producers of ideas, and regulate the production and distribution of the ideas of their age. Consequently, their ideas are the ruling ideas of the age.’

Professionalization and the organization of middle-class labour in postindustrial society†

Abstract: Every generation considers itself to be new and modern. And this is proper, for the contemporary is by definition what is only just being experienced in the knife-edge of the present. The problem for the participant and the analyst alike, however, is to determine whether the present is 'really' new and modern, or whether it is, as the elderly are characteristically inclined to believe, just variation on settled and familiar themes. If it is merely the latter, then there is no serious point to changing our way of looking at the present or of assuming that it is leading us toward some qualitatively different future. But if it is the former, then we must ask what the genuinely new means for the future-whether it is part of a trend which leads to far-reaching shifts of emphasis in basic social institutions, or whether it is an isolated event. And if it appears to be part of a distinct trend, we must, as scholars and scientists, examine the value of our conceptual equipment for analyzing it. Unfortunately, our conceptual equipment at any particular time is far more likely to be useful for ordering the past events it was created to deal with than it is for understanding genuinely new events of the present or the future. Our own time seems to be one in which something genuinely new is emerging. Many analysts believe that major changes are taking place in the most advanced industrial societies. Those changes are seen to be as basic and far-reaching as those which occurred two hundred years ago and which are now summed up as the Industrial Revolution. Various writers have struggled to find an appropriate name for the emergent society, but it seems to me that until future historians, from their more advantageous, backward-looking perspective, create and agree on their own epithet, Bell's term, 'postindustrial', is the most

Full‐time people workers and conceptions of the ‘professional’*

Abstract: The concept of 'professional' has been well worked over by sociologists. This includes specific attention to the most visible people working professions of education, social work and the mental health fields. These latter occupations have been variously referred to as 'semi-professions' (Etzioni, 1966); 'personal service professions' (Halmos, 1970); 'new professions' (Marshall, 1965); 'aspiring' professions (Goode, 1969); the 'human services' (Riessman and Pearl, 1965); and many others. Typically, the people working professions have been treated as generically related to the 'traditional' professions, and the sociology of these fields as modes of work has had a close affinity to that of the older professions. The present paper, however, wishes to raise some serious questions about this approach, and by implication the way in which the concept of 'professional' has been used to evaluate all forms of work in modern society. It will be suggested that the ideal type of professional will not do for a sociological analysis of the world of full-time people workers. With a few exceptions, the sociological (and quasi-sociological) literature on professions can be said to assert two major theses concerning professions. First, as best illustrated in a recent book by Moore (1970), it is held that the professional role can be conceptualized by a series of traits, each of which is a component of a complete continuum with professionalism at one end and non-professionalism at the other. A second proposition (most clearly expounded by Etzioni, 1966, 1969; and Goode, 1969) is that a variety of occupations, including especially human service jobs like teaching and social work have progressed only so far on one or some of these continua, but will steadily improve their position in the future: that is, they will become professionalized. 1 The main position taken in this paper is that the nature of human

Young people and their homes: spoiling and ‘keeping close’ in a south wales town

Abstract: There are many stereotypes current in Britain concerning adolescence; probably the most widely held is that this is a period invariably marked by rebelliousness and friction with authority —be it parental, school, university or police. It is also believed that for young people in particular, kinship ties and obligations are irksome and the nuclear family is claustrophobic and restrictive. Freud can certainly be counted among the progenitors and Parsons among the nurturers of the idea that to become adult and mature a child must 'free' himself from adult authority and specifically from familial authority.' From this basic position the argument has been continued along the line that, since in western urban society there is no institutionalization of the readjustment of power and authority between parent and child (in contrast to societies with initiation ceremonies), and because there is a prolongation of the period of (financial) dependency because of increased schooling, the individual boy or girl must struggle for freedom for a long time. Because he or she can never be sure how far the battle has been won, the young person may well be in an anomic situation and therefore insecure and unhappy. While such an account may be valid for geographically mobile, urban, highly educated, middle class families in Britain and America, we should remain unconvinced—lacking good empirical evidence— whether in all groups in British society, and to what extent, adolescence is stormy;^ and also we should enquire how far, in various groups, independence is in fact achieved by the adolescent or young adult or really desired by 'child' or parents. In this article I hope to throw some light on this second point by describing some findings

In the service of man: radical movements in the professions*

Abstract: The decade of the 1960'S witnessed major upheavals in every American institution. Following closely on the heels of the antiwar movement came a revolt against the symbols of authority in the universities, the courts, the schools, the churches, and the professions. While the noisier and more public attacks on institutions were being made by those outside of them, there were also small pockets of organized criticism and discontent being mobilized within major institutions for the purpose of seeking radical change. This paper is about the 'radical caucuses' or separatist movements within the major professions. We shall try to describe the conditions under which they emerge, the composition of their membership, and the specific nature of their goals and strategies. We shall also attempt to analyze the special dilemmas facing radical movements, and the specific conditions necessary for their continuity and effectiveness.

The motor car and the territorial aggression thesis: some aspects of the sociology of the street.

Abstract: The purpose of this paper is two-fold. First, to outline some of the reasons for the relative neglect of sociologists to study or give emphasis in their analyses to transport systems and, in particular, to sodal interaction in the sodal conduit of the street. The sea)nd aim is to present some of the sociological faaors relating to the behaviour of different types of road users in the Greater Manchester area. The frame of reference adopted from which the data have been primarily assembled has been that of the dty's traffic wardens. More specifically, the analysis will polarise around an examination of the territorial-defence theory of aggression, which has been operationalised quite recently, as an explanation for the violent behaviour of motorists on the road and the resulting high inddence of fatalities and serious injuries. The most elaborate rendering to date of this theory of rc^d behaviour is to be found in Whitlock's book Death on the Road\\ which has the aca)mpanying sub-title: A Study in Social Violence.

Professionals in organisations: some preliminary observations on hospital consultants.

Abstract: A a type of formal organization there is some consensus that the hospital is in certain ways distinctive. From an organizational theory perspective observers have made reference to such features as 'multiple subordination' and 'blocked intersystem mobility' and have sought to establish the deviant character of hospital structures when compared with a Weberian model of bureaucracy.^ Reasons advanced for such deviance vary: the 'abstract' product of the hospital has been given attention,^ the nature of the material as human material has been stressed together with the observation that the goals are welfare goals.̂ Attention has been directed to structural variation within hospitals* and more recently a notable attempt has been nMide to distinguish between the types of therapeutic intervention made by different hospitals and to relate this to aspects of hospital structure and functioning.*'' On the other hand the hospital has also provided a convenient arena for studies of professional and professionalising groups. Hughes's early comments regarding the division of labour between different professions and his insights into the profession of medicine,® together with Parsons's important essay on professions,^ have provided a starting point for much further theoretical and empirical speculation. But while the sociology of professions has borrowed heavily from the sociolc^ of organizations in considering the effects of membership of a formal organization for professionals, the reverse has rarely occurred. The sociology of organizations has paid scant attention to the sociology of professions; the question of the consequences for an organization of a substantial professional membership has remained largely unexplored. This paper, using the role of consultants in hospitals as an illustration,

Agricultural workers in the class structure

Abstract: A griculture in general and agricultural workers in particular have l \\ mainly aroused the interest of sociologists in this country in the context of rural community studies. Unfortunately these studies have by no means dealt with a representative sample of the different types of agriculture carried out in Great Britain, so that a very uneven representation has emerged.^ Because of the historical development of this branch of sociology in Britain, such studies have been confined mainly to those areas where the general pattern of agriculture has been the twentieth-century equivalent erf subsistence farming. The anthropologically-oriented community studies of County Clare, Llanfihangel, Westrigg, Gosforth and Ashworthy^—the major British rural studies—^are all situated in the Highland ZOIK where family labour and mutual help are the norm and the use of hired labour is infrequent. Hence Arensberg and Kimball, Rees and Williams have emphasised the gemeinschaftlich qualities of settlements based on agriculture, while only Littlejohn has analysed a rural community where the social relationships in agriculture are those of employer and employee rather than kinship ties. Moreover, community studies in areas of Ei^land where agriculture has a much more industrialised countenance—such as Pahl's study oi the metropolitan fringe in Hertfordshire^—^have concerned themselves with other a^)ects of the social relationships within their locality. Hius while our knowledge of family farming has a fairly sound basis, non-family agricultural workers have been almost entirely overlooked. The more thoroughgoing capitalist system of agriculture in the lowland areas of eastern and south-eastern England remains unexplored. Yet it is here, east of an imaginary line stretching from the Wash to the Isle of Wight,^ that forty per cent, of the agricultural labour force remains concentrated.

Doctors, Patients and the State: Relationships and Decision-Making:

Abstract: Agreat deal of sociological literature on the doctor-patient relationship has emanated from the United States. This is true of both \"\" the seminal theoretical writings in the field and the empirical studies. Both tyj^s again derive from, and in turn feed back into, models of professions, professionalism and professionalisation, themselves originating in the United States. Typically the models emphasise those attributes of professions which are held to distinguish them from other occupations—such characteristics as technical competence, functional autonomy, control over training and entry to the profession, etc. One consequence of this focus has been to restrict, rather artificially, the analysis of professional-client interactions and their outcomes. Typically, we would argue, these analyses adopt one of two modes. The first, earlier mode treats the professional-client relationship as a social system, involving the actors' participation in, or membership of, sodal institutions whidi crucially determine the type and content of the transactions between professional and client. Bloom's essay on the doctor and his patient is one of the more sophisticated analyses in this tradition.* 'The doctor-patient relationship', he writes, 'is conceived of as a system of social roles, derived from culture, and learned and controlled by two major social institutions, the medical profession and the family.' The rdles of each are, in his words, 'derived from culture', that is, to a greater or lesser degree, they are prescribed and enacted when the occasion is deemed appropriate. Empirically this is a notable advance on the doctor r61e—sick role complementarity posti^ted by Parsons two decades ago.̂ This advance lies c^efiy in the scx>pe allowed for variability in the role conceptions stemming from tibe institutional and cultural settings from which the rdles are 'derived'

Priests and Laity: A Profession in Transition:

Abstract: The Catholic priesthood, along with the ministry more generally, is in a state of actual and acknowledged crisis. 1 The most notable evidence of the crisis is in the drop in recruits ('vocations') and the increase in defections from the priesthood. However, the most serious problems may be the confusion over what services should be provided by the profession and over the proper relationship between the priests and the laity. The present crisis is unfolding in the context of an increasingly secular world, which generally threatens the position of the Church in society and questions its right to provide its traditional services. Although the secularization process has been going on for a long time, the American Catholic Church has only recently 'announced' its crisis. This paper explores a number of factors that have combined with the process of secularization to produce the present crisis and the processes that flow from it. Our observations come from a three year study of the diocesan priesthood of a major United States diocese that we conducted under the auspices of the Bishop of the diocese and the elected Senate of Priests. Quantitative data are from our 1970 survey of the priests of this diocese.

Stereotypes of Male and Female Roles and Their Influence on People's Attitudes to One Parent Families:

Abstract: This article is based on a local study of attitudes towards motherless and to a lesser extent fatherless families. It is part of a researdi projea on mothwless families which we have been conducting with the help of a grant from the Department of Health and Social Security. In our main study it became dear that the way fathers caring for children on their own viewed their problems, and what they thought should be done about them, was a)loured by the values and attitudes which they thought existed in sodety at large. What we try to do in this smaller study is to examine, through a random sample survey, some of the ^ u e s and attitudes whidi fathers said they had a)me up against in friends, neighbours and fellow workers. Sudi factors are an important element in the formulation and application of sodal policy. As Warham has said, 'Any piece of sodal legislation is the outcome of attempts to recx)ndle complexes of values which are differently weighted, and differently interpreted, by different individuals and groups within the sodety in which the legislation is formulated and has to operate.'' The relationship between public attitudes and sodal policy is an interesting issue and we discuss this elsewhere.'' In this article we are mainly concerted with stereotypes of male and female rdles which becanK clear in our local study of attitudes towards one parent families.

What Motivates Church Participation? Review, Replication, and Theoretical Reorientation in New Zealand

Abstract: R esearch and discussion in the sociology of religion has tended to adopt one or other of two theoretical models: the epiphenomenal or the ideational.^ The basic difference between the two models centres on the assumptions about the direction of causality. In the epiphenomenal model, needs generated by the individual's 'place' in society are swn to lead to particular kinds of religiosity. In the ideational model, 'secular' values and behaviour are seen to be the consequence of a particular theology or religious orientation. Over the past two decades in the United States most of the research in the sociology of religion, concerned with explanation, has adopted one or other of these models. One area which has produced considerable debate was inspired by Lenski^ and subsequently developed by Lazerwitz,* Stark,'' Demerath,® Dillingham,^ Goode* and Glock.* A recent contribution comes from Estus and Overington,\" comprising a replication and extension of Goode's work. The basic concern has been to explain different types and levels of religiosity, in particular, church participation. Most writers have adopted the epiphenomenal model using ideas like 'deprivation' or 'middle-class life styles', and in the main, type and level of religiosity are seen to be the response to 'dass' generated needs or aspirations. Running parallel to this debate, another has been concerned with the explanation of differences in occupational choice and economic, political and family values and behaviour. Again Lenski's work has provided much of the impetus, but the debate in this case has been with Greeley in particular.*' The basic issue has been the relevance of the 'Protestant ethic' today, with evidence both for and against. However, much of the discussion has either misrepresented the assumptions in Weber's use of the ideational model or has ignored the differences between contemporary Protestant theologies and that of early Calvinism.

Official agents and the legitimation of suffering

Abstract: In modern pluralist societies, notably Britain and the United States, there has been a growth of full-time 'expert' agencies oflBcially empowered to implement legitimation in particular institutions or sectors of society. Thus control of 'the family' is variously (and not always discretely) the responsibility of genetic, marriage and child guidance counsellors as well as 'generic' social workers, doctors, teachers and so on. A major effect of this is to objectify an absolute morality for the whole society to which an individual may be held accountable for those of his actions that are 'public', or private but regarded as having consequences for the public realm. Such agents then act as 'moral entrepreneurs' who attempt to reinterpret and reconstruct deviant appearances so that they can be 'respeaably' identified in terms of the official morality.' In this paper we attempt to show how several ofl&cial agents— doctors, social workers, voluntary associations for the disabled—and also family and friends may act to redefine the situation of parents with disabled children so that they may continue to appear as 'good' parents acting in accordance with the prescriptions of the oflBcial morality of child-rearing or making appropriate use of its rhetoric. Scott has a similar intent in his analysis of the activities of rehabilitation agencies for the blind.He presents some comparison of the typical theories informing such activities in several countries, but his main focus is upon the organizational and other constraints under which they operate. We have largely omitted such considerations and, in contrast, attempt to spell out the major theoretical grounds of the agents' activities and to show how these may act to legitimate the situation of parents of the disabled: to show what implications the 'help' given by agents may have for the parents' ideology. This is not of course necessarily to impute 'evil' intentions and we attempt no

Some suggestions for a sociological approach to the study of government reports

Abstract: There has been no distinctly sodological approadb to the study of Reports of Royal Commissions and Government Committees of Enquiry.^ Since such Reports have, in the past, tended to fall predominantly within the compass of sodal sdentists with a practical interest in sodal policy and sodal administration, the sodologist with more theoretical interests has received little guidance in deciding what are important sodological questions to ask about a Report and what method of analysis might prove most fruitful. Much methodological debate has taken Darwin's comment to heart and has devoted considerable attention to the nature of the assumptions upon which a well-formulated problem depends.'' It is with this question that our paper is ojncerned. Our aim is to suggest one way in which the formulation of sodological problems concerning government Reports may be grounded on well-founded assumptions. One basic question which the sodologist is led to ask can be posed in the very general form *why did the Report say what it did?' We suggest that if these Reports are viewed as forms of sodally-generated 'knowledge', and if their study is located in the sodology of knowledge, then a more rigorous statement of this question can be attempted. This leads us to an issue central to the sodology of knowledge itself.

Mobility of general practitioners during the first few years in general practice.

Abstract: A team of researchers within the Medic:al ScKiology Research Centre, University College, Swansea is engaged in long-term studies of general practice, with particular emphasis at the present time on the sodology of prescribing. These researches are organized around a cohort of general practitioners which wiU provide the base for a series of longitudinal studies. The cohort consists of all those doctors in England and Wales who became unrestricted principals for the first time during the period from 2nd July, 1969 to ist July, 1970 (inclusive). The names and addresses of these doctors (that is the surgery address of the practice where they had taken up an appointment with an Executive Council) were obtained from the D.H.S.S. print-outs which are compiled from the Executive Council registers for each area. A total of 884 doctors was assembled in this way. Information regarding the doctors' date of birth and sex was also included on the D.H.S.S. print-outs for all the cohort doctors. A questionnaire was sent out to each of these doctors approximately six months after they had taken up their appointments. This questionnaire was concerned mainly with collecting prescribing data and was not aimed at tracing the movements of the cohort GPs. From correspondence with the doctors at this stage, however, we realised ±at many doctors had left the practice of their original appointment during this first six month period. It was this fact that led us to examine the basic information made available to us by the D.H.S.S. regarding the age and sex characteristics of the cohort doctors in order to see if these factors were related to mobility.

Social Factors Affecting Work Satisfaction of the Physician's Assistant: A Preliminary Report:

Abstract: The advent of the Industrial Revolution some two centuries ago was associated with societal changes which led to the gradual breakdown of the guild system, encouraged the elimination of the craftsman, and opened the way for the reorganization of industrial production (Ashley, 1925; Schneider, 1957). Industrialization of the crafts resulted in the restructuring of work and the working role in a more rational fashion, expressed in terms of external controls, discipline, and such refinements as a hierarchical division of labour and mechanization. This, in turn, caused a lowering of status and autonomy for the worker and a corresponding reduction in work satisfaction (Durkheim, 1933; Marx in Fromm, 1964). It appears that our service occupations currently are industrializing in the face of similar societal pressures. The vast knowledge explosion in nearly all fields, advances in technology, and an increasing demand for services have created a need for access to complex items of equipment and increased specialization, leading to a greater division of labour and teams of hierarchically organized work groups functioning within and across occupational lines. These changes are reminiscent of the restructuring which previously occurred in the roles of production workers. Past experience suggests that limitations in autonomy and status might again result in dissatisfaction, particularly for such members of personal service occupations as are created to assist already established professionals such as doctors, psychologists and clergymen (Halmos, 1970 *)1. One factor spurring the industrialization of medicine in the United States is the increased demand for health care services evidenced in the past decade. In spite of the rising demand, productivity has lagged behind (Hughbanas and Freeborn, 1971).