Balance and social order

A brief introduction to functionalism — Trait theory — The sick role — Medicine as an ideal-type profession — The Flexner Report — Types of professions — The body-as-machine and physiotherapy’s reductionism — Taylorism, Fordism, and modern bureaucracy — Traits and the characteristics of professional physiotherapy — Neo-functionalism — Critiques of functionalism

The first concerted attempt to understand the professions sociologically began a century ago in the 1930s. Until then, the professions, as we know of them today, had not really existed. Medicine, for example, was considered one of the three ‘true’ professions, but medicine possessed ‘little of the autonomy and self-control so characteristic of the medical profession today’ until the enactment of the 1858 Medical Registration Bill in Britain ^[1]. At this point, medicine was still half a century away from discovering the placebo effect, and although germ theory had superseded belief in miasmas in the last decades of the previous century, insulin treatment had only just begun, sulphonamide drugs were entirely new, and antibiotic, widespread vaccinations, and mood-changing drugs would not become commonplace for another 20 years. So, these scientific and practice innovations cannot explain why medicine became so powerful, so quickly because medicine had achieved impressive social status long before it could demonstrate any therapeutic efficacy.

Sociologist Bryan Turner suggests that between 1875 and 1920 ‘the status of the general practitioner in the USA was transformed by a number of social developments’ ^[2]. He suggests that the market for medical services expanded because of economic growth, urbanisation, and the development of large-scale transport systems, ‘licensing laws with the legal backing of the state’ (ibid), and medicine’s opposition to alternative forms of practice. Turner suggests it was social factors, rather than features intrinsic to medicine, that shaped the direction the profession took.

As with medicine, early sociological studies showed that the emergence of all of the professions owed more to societal influences than had previously been thought. The first group of sociologists to take a particular interest in the professions came to be known as the functionalists, for their analysis of the ways professions functioned as a balancing force in society. This chapter explores the enduring legacy of functionalism and the ideas that shaped early thoughts about the sociology of the professions. We start with functionalism partly because it was the first established ‘school’ of sociology concerned with the professions, but also because the ideas it promoted are still heavily influential in healthcare today, particularly in professions allied to medicine.