54 Critiques of social action

One of the most useful methods used by sociologists to critique different schools of thought, is to compare their respective strengths. This makes it easier to see what a theory does well and what it lacks. By knowing more about gender theory, for instance, you can see that functionalism and Marxism both fall short when it comes to gender. By the same token, one of the main limitations of social action comes from critical theory, being that it takes our attention away from structured power.

Social action is very much focused on individual or group agency: the things people do to shape their world. The world we know is ‘the result of our perceptions of the world’ ^[1]. There is nothing lying ‘behind’ people’s actions. No pre-existing social structures, and so no real acknowledgement of class, gender, and race. There is little about gendered social relations in the work of Weber, Blumer, Mead, and Garfinkel (although people like Anne Witz and Magali Larson have combined social action and critical theory to talk about gender). And there is little consideration given to colonial power, normalisation, othering, or disability, beyond thoughts about the way we stigmatise others for their otherness. The world is only what we perceive it to be, and the only world that exists is that which is created by our ‘interactional accomplishments’ ^[2]. As a result, social action has been criticised for focusing too much on micro-narratives and small-scale interactions, and ignoring the grand social structures talked about in Chapter 4.

Much of the socialisation literature has also been criticised for focusing on single professional disciplines in ‘effective monocultures’ ^[3], with the professions operating in isolation to one another. In doing so, Shân Wareing argues, ‘we underestimate the complexity of other disciplines’ and the relationships between them that shape the way healthcare operates. Because social action emphasises the work that professionals do to shape their worlds, it promotes the belief that professions are very powerful social actors. But Keith Macdonald argued that ‘Although there is no doubt that professions have pursued social closure, or broad-based attempts to secure market dominance, we should be careful not to read too much into this’ ^[4].

Just because we can see boundary closure, encroachment, labelling, and other social action concepts in practice, does not mean that they are necessarily powerful or significant. Martin Lipscomb has asked, for instance, ‘what would happen if boundaries (between professions, and between the professions and the public) were overtly rejected? Sadly, he argues, the answer would be ‘not a lot’ because ‘entrenched (‘structural’) blocks upon wider participation and openness would remain’ ^[5]. This has become an important issue in the discussions about inter-, multi-, and trans-professional practice, with critics arguing that the professions have been too concerned with their own inculturation, and have forgotten that their primary purpose is patient care ^[6][7][8][9].

Structural criticisms aside, social action perspectives have also been critiqued for being anchored in the Global North, particularly North America. Daniel Johnson has suggested that social action relates closely to neoliberal and bourgeois beliefs ^[10], emphasising people’s individuality, their power to change, the importance of self-help, reflective practice, and self-actualisation, combined with a general disregard for the social and historical conditions that shape people’s choices and underpin oppression. It implies that the reasons why we might feel bad or ill, or experience discrimination and unjust treatment, is because we have internalised a particular way of seeing the world, and that it is possible just to think and act differently and, through this, transform ourselves into better people. It is perhaps easy to see, then, why social action theories have been popular in the self-help movement, in health promotion, and personal psychology, but offer little when it comes to addressing the social determinants of health.

Notwithstanding these limitations, however, the works of people like Weber, Larson, Garfinkel, Witz, Blumer, and Goffman offer important insights into the way healthcare operates. It is a shame, then, that their work has been almost entirely ignored within the physiotherapy literature; a situation Martin Lipscomb argued was also true of nursing. To take just one example, Max Weber’s work ‘is rarely mentioned by name and this is perplexing for, if we grant that he spoke to (a host of issues relevant to nursing) in a sophisticated and nuanced manner, if his writings still stimulate fresh thinking regarding these topics, then his near-invisibility from our literature is disquieting’ ^[11].

Lipscomb goes on to suggest that;

‘[O]ne does not have to accept or even agree with Weber to realise that his thinking continues to resonate with present-day concerns and, just as ethicists do not need to be Aristotelians to read and take inspiration from Aristotle, nurses (and other health professionals, like physiotherapists presumably) interested in the themes addressed by Weber can gain much from his work while recognising and perhaps preferring modern theorists’ (ibid).

In the next chapter, we will look closely at some of these modern social theorists, and explore what they have to offer the sociology of physiotherapy.