50 Ethnomethodology

In keeping with many other approaches to social action, ethnomethodology focuses on the way people practice or perform their everyday social roles and work through their daily lives, rather than focusing on the grand social institutions that other social theories concentrate on ^[1]. For ethnomethodologists, being a ‘patient’ requires a certain kind of labour to distinguish it from being a relative or a professional. Some of that work involves context-specific actions that all patients perform, other work is specific to that person’s particular situation. But ethnomethodology is ‘the study of how people do the work of sustaining commonly shared understandings and the institutions that depend on these understandings’ ^[2], or more simply, ‘the methods that people use’ ^[3].

As well as studying the work that people do to be themselves, ethnomethodologists are interested in what makes this work recognisable. For instance, what needs to be in place for people in society to recognise this person as a physiotherapist and not an osteopath? It asks how this person’s actions become ‘mutually recognisable and acceptably predictable’ (ibid). Because it concentrates on the ways we build up shared understandings about people’s actions, it centres on the everyday and mundane ways people make order and create stability out of what might otherwise be a chaotic existence. Ethnomethodologists believe that ‘the skilfulness and creativity involved in conducting everyday life has gone unnoticed’ ^[4], but that it could offer important insights into how things like education and healthcare function.

In a professional sense, ethnomethodology has been used to study the ways people come to understand practice through its common routines, rules and rituals. Some of these things are common to all aspects of society (expressing concern and asking questions, for instance), others less so (examining naked bodies, injecting). And some are specific to only one or two groups (dental extractions, arthroscopy, diagnosing someone as psychotic). Ethnomethodology drew inspiration from the work of phenomenologists like Alfred Schutz ^[5][6] and sociologist Michael Polanyi ^[7], shaping our understanding of what Weber called the ‘incommensurability’ of expert practice, and Polanyi called tacit knowledge.

Like other social action perspectives, Garfinkel believed that there were no social structures or concrete reality lying behind the workings of social actors, and the only thing we could say represented reality was that which was created through social interaction. Reality was whatever we perceived it to be. And it was one of our ‘interactional accomplishments’ ^[8], that we could, each day, make enough sense of the world, between each other, to function as a society. This, for Garfinkel, has particular resonance for our understanding of trust.

Trust relies on people sometimes going to extraordinary lengths to ‘conspire’ with each other to be convinced that they know what is going on. People act as if their perception of reality is objectively true, and that there is a world ‘beyond’ their actions and shared meaning-making. Garfinkel believed that this serves two important functions: firstly, it gave us comfort that our daily routines sit ‘above’ reality, which means that there must be some fundamental stability to the world; and secondly, that it engenders trust between us because the other person conspires with us in this fiction. This act of conspiring with others has created all of the shared customs and practices that make the world work as it does.

To test this idea, Garfinkel developed a series of what he called ‘breaching experiments’ to examine the ways people used common-sense knowledge to give meaning and order to everyday situations. He attempted to show his students how prevalent and taken-for-granted these practices were, and how dislocating it was when these everyday rules were broken. Garfinkel asked his students to stand too close to people in queues, speak too loudly, laugh out of context, or interpret what people said literally. In one example, a student met a friend in the street who greeted her by saying “What’s up?”. Garfinkel’s student replied, “Clouds, the sun, the sky.” Sometimes these actions caused people to become confused or irate, thinking they were being made fun of, but Garfinkel’s point was that there are social norms and ‘patterned regularities’ ^[9] implicit in social life that we often take for granted. By violating these common-sense norms, we can see more clearly the impersonal forces, like trust, that shape our lives.

Garfinkel believed trust was a particular problem in healthcare, where experts repaired, reconstructed, or tinkered with other people’s bodies ^[10]. Unlike car maintenance, the patient cannot leave the faulty part with the therapist. And so encounters between lay people and health experts become sites of ‘social drama’, in which the technical or ‘non-person treatment’ ^[11] has to be supplemented with rules and rituals that operate over-and-above fundamental caring and healing work ^[12]. Garfinkel’s work here coincided with interest in the voices of marginalised people, newfound interest in people’s personal health narratives, and growing criticism of the power of authority figures in society, to initiate a field of sociology interested in lay-professional interactions.