Introduction to Sociology: Medicine

 

We shall discuss the social constructionist approach to medicine, using Michel Foucault's ideas, contrasting it with other approaches, such as

- feminist (e.g., Witz's patriarchy in the labour market);

- interpretivist (say, Goffman's career of a mental patient);

- liberal (a consumerist welfare state and patient's choice); and

- Marxist (labour socially reproduced - mentally, physically, emotionally and economically - for capitalist exploitation).

 

Social Constructionist Approach

a) gives an historical account of medicine and medical knowledge (e.g., medieval bedside medicine, late C19th hospital medicine and late C20th laboratory medicine);

- there is no evaluation of good or bad medicine - only different forms of medicine.

b) usually, we regard science/medical knowledge as a single march of scientific progress, of enlightenment, of truth;

- but, Foucault argues that science is not about discovering knowledge, but ‘producing’ it:

- social reality is not fixed but changeable according to different knowledges (bedside medicine to laboratory medicine); and

- truth is not a collection of insights waiting to be discovered or revealed; rather it is ‘produced through discourse’, and its production is involved within relations of power (e.g., in the birth of asylum, knowledge to assist mental patients is linked to power and authority).

c) Foucault challenges the notion that knowledge is discovered. For him, it is produced through the language and practitioners in the field (e.g., doctors at asylums assert their 'way of seeing' (gaze) mental patients and how to treat them, using their analytical categories and medical instruments).

d) There are several aspects of Foucault's ideas:

i) 'discourse'

- a set of ideas, statements and practices that provide a way of representing a particular kind of knowledge;

- a way of thinking about, knowing about, classifying and speaking about a subject that takes priority in being used to control and observe people involved in different parts of social life (e.g., ‘race’ categories in the US census);

- discourses are sets of specialist or technical language that define, control and observe; i.e., 'gaze';

- e.g., when asking for a sickness note, we must be defined as ill by a doctor, and not by a neighbour; and

- e.g., conventional Western medicine classifies and controls how we diagnose mental illness, not alternative Eastern or spiritual medicine.

- different discourses present different truths and different ways of thinking about, speaking about and knowing the truth;

- powerful groups can define a particular set of ideas and ways of thinking that come to be seen as the truth; e.g., Freudian psychoanalysts (not bio-genetic medics) define mental illness; during the mediaeval times, religious dogma was significant in shaping how and why people became ill, and what kind of treatment was required - usually prayer!

ii) the body is invented or created

- the body becomes a political field of state intervention of the private sphere for public and political surveillance, for monitoring and regulating appropriate sexual behaviour, mothering, parenting and deviant behaviour (e.g., legislation on sexuality, abortion and marriage);

- the body is disciplined through surveillance, encouraging self-discipline so that people become accustomed to regulating and controlling their own actions:

- i.e., 'govern-mentality';

- e.g., the government encourages us to have 'healthy' bodies, and to become responsible for own health care through taking regular physical exercises, having private health insurance, and buying medicine over the counter.

- the body is ‘normalised’ (or becomes ‘docile’) through discourses, as specialists use their expertise to define sick/normal bodies, healthy/ill-healthy bodies;

- e.g., doctors define a healthy body, and observe how far patients deviate from it using Body Mass Index, measuring overweight and obesity, and underweight and wafer-thin bodies.

iii) power/knowledge

- through discourse, power is produced by knowledge, and knowledge is shaped by power relationships in society;

- power is not only allocated in economic structures and relations (a Marxist position) nor is always in the hands of the state (a Weberian position), but is also dispersed throughout society in everyday encounters, interactions and practices defined by discourses;

- e.g., in everyday life, we make assumptions about how people will behave and how they will interact with us - we are using some sort of framework of knowledge to make these judgements.

- power is not only negative, but positive since it allows things to be done and performed;

- without power/knowledge, nothing can be achieved;

- e.g., just think of what social behaviour and relation can be undertaken without some form of knowledge - very little!

- power can be resisted and challenged within the discourse by understanding its terms and not obeying it:

- so alternative groups and social movements become 'empowered' through knowledge of existing and creating alternative knowledges;

- e.g., resisting the practice of hospital births, and having 'natural' home births.

- there is no evaluation of different regimes of power as practised within society;

- e.g., the new regime of mental health care from 19th was not a humanitarian medical advance from the barbarism of physical constraints towards a liberal restorative application of new treatment (reflecting liberal-scientific interpretation of psychiatric development) - Foucault rejects claims of liberators or enlightened thinkers - only different form of exercising power:

- asylums, clinics and hospitals are sites of control by doctors using technical and specialist knowledge.