Simon Johnson Williams - Medicine and the Body

Medicine and the Body

ISBN 0761956387 (hbk)

ISBN 0761956395 (pbk)

Simon J. Williams 2003

First published 2003

Reprinted 2005

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, this publication may be reproduced, stored or transmitted in any form, or by any means, only with the prior permission in writing of the publishers, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency. Inquiries concerning reproduction outside those terms should be sent to the publishers.

SAGE Publications Ltd
1 Olivers Yard
55 City Road
London EC1Y ISP

SAGE Publications Inc
2455 Teller Road
Thousand Oaks,
California 91320

SAGE Publications India Pvt. Ltd
B42, Panchsheel Enclave
PO Box 4109
New Delhi 110 017

A catalogue record for this book is available from the British Library

Typeset by M Rules, Southwark, London
Printed digitally and bound in Great Britain by
Lightning Source UK Ltd., Milton Keynes, Bedfordshire

is an update on arguments first published in Social Science and Medicine (Williams 1997). I am grateful for permission to reproduce this material from the above sources. Thanks also to Sharon Boden for typing and commenting on some of the chapters in the book, and to Bryan Turner for his constructive comments on the submitted manuscript. Thanks are also due to Chris Rojek and those at Sage for sticking with me and to Justin Dyer for some sharpeyed copy-editing! The book, I hope, does everyone justice, save the errors, which I dutifully bear.

Body is one great reason, a plurality with one sense, a war and a peace, a flock and a herdsman. (Nietzsche, Thus Spake Zarathustra)

This is a book about the body, medicine and health, and the sociological agendas these raise, with emotions at the heart of the matter: the animating principle, so to speak. What is the body? Where do its boundaries lie? How are bodies thought, lived, experienced and expressed, in sickness and in health? What of relations between the body and medicine, health and healing? Do emotions provide the missing link between nature and culture, biology and society, structure and agency, the public and the private? And what of ethics: what role bodies? Medical sociology, given the very nature of its subject matter, is well placed to address, if not (fully) answer, these embodied questions and emotion-laden issues, and it is to an exploration of these very matters that this book is devoted.

The origins, nature and status of medical sociology, to be sure, have been much debated over the years, with or without explicit reference to bodies. Medical sociology, for example, according to conventional accounts, one able to critically reflect upon matters of health and illness, within and beyond the formal health care arena, championing voices hitherto silenced by medicine (qua dominant profession) along the way. Others, however, challenge any such interpretation, tracing the roots of (medical) sociology much further back, thereby recovering its secret history of the body in the process. Turner (1992, 1995), for example, reminds us of Foucaults contention that sociology had its origins in nineteenth-century medical practices such as medical surveys. This in turn suggests not simply that sociology and medicine are inextricably bound together, but that modern medicine is in fact applied sociology, and sociology is applied medicine (Turner 1995: 6; see also Claus 1983 on the development of European medical sociology). The history of medical sociology, from this alternative viewpoint, is itself an outline of certain conceptual developments with respect to three key issues, namely nature, society and embodiment, raising a series of pertinent ontological and epistemological questions in doing so (Turner 1995: 6). To the extent, moreover, that medical sociology confronts the ontological question what is disease, which in its current form translates into the question what is the body?, these relations cannot be overstated (Turner 1995: 6).

Whatever its roots or points of origin, medical sociology, by all accounts, is now a thriving sub-field of inquiry, spanning a diverse array of themes and issues, from ongoing medicalization debates to the tracking and tackling of health inequalities, images, representations and experience of health and illness, to the dilemmas of high-technology medicine, challenges to professional power and dominance (including new social movements), to the changing (global) dynamics of health care in the new millennium. In many countries, Cockerham (1995) comments, medical sociology is either the largest or one of the largest specialty groups. The European Society for Medical Sociology, for instance, is a large and active professional society, as are the medical sociology sections of the American, British and German Sociological Associations (1995: xi). Australian medical sociology, likewise, has flourished in recent years, with signs of similarly healthy take-off in countries such as Japan. Medical sociology, then, appears to be in good shape, with a growing membership world-wide. It has also now secured a place in the interdisciplinary medical curriculum (see, for example, GMC 2002a).

Parsons, of course, theoretically speaking, stands out as a key figure here in all this, given his classic sociological formulation of illness as social deviance, channelled through the institutional mechanism of the sick role. Foucault too, as noted above, has been particularly influential in recent years, giving rise to a promising array of studies in health and beyond with the body at the very centre of discursive discussion and debate. Today, however, it is probably fair to say that the sociology of health and illness comprises a wide range or an eclectic mix of theoretical perspectives and positions, from interactionism to political economy, phenomenology to postmodernism and post-structuralism (see, for example, Gerhardt 1989). Feminisms too, it should be stressed, have contributed much to these agendas, shedding important light on issues of gender and patriarchy, health and healing, across the public/private divide challenging, along the way, claims to previous corporeal neglect.

Tensions remain, nonetheless, not simply concerning this eclectic theoretical mix, but also regarding various funding crises, institutional dilemmas and the push towards more evaluative health service research, including so-called evidence-based medicine (Sackett et al. 1997) and various quality assurance initiatives themselves linked to the changing nature and status, if not McDonaldization (cf. Ritzer, 1995), of contemporary medical practice, with changes of a similar kind currently sweeping through the academy (Turner 1992:13942, 1548). A sociology of the body, Turner ventures, is crucial in responding to these dilemmas. The sociology of the body, he argues, elaborating on the above points, provides an organizing principle in medical sociology and a much needed method for integrating existing approaches. This in turn creates promising new interdisciplinary linkages and fruitful avenues of future embodied inquiry, including renewed attention to such fundamental, existentially charged issues as pain and suffering, disability and death (1992: 16970). What this amounts to then, for Turner at least, is nothing short of a theoretical defence of medical sociology and its disciplinary integrity, given the tensions raised above and the broader relations between medicine and sociology of which they are a part (1992: 169).