Boundary work
Weber, the Protestant work ethic, and social closure — Boundary work and social closure — Encroachment — Symbolic interactionism — Socialisation, or becoming a health professional — Ethnomethodology — Lay-professional interactions and social distance — Social action and physiotherapy — Critiques of social action
Beginning in the 1960s, somewhat in the shadow of the bellicose identity politics of critical theory, a new and very different way of understanding society began to emerge that would transform our understanding of the way health professions worked. At the same time as second wave feminists and the civil rights activists were threatening upheaval, social action perspectives were inciting a quieter, but no less influential, revolution. Like critical theory, social action perspectives also represented a cluster of sometimes quite diverse philosophical approaches, but they all share one important thing in common: a belief in the importance of human agency.
All of the approaches we have looked at so far have been fundamentally structural. Functionalism, Marxism, and critical theory, all share in common a belief that society is made up of structures that precede us as individuals, and that these structures shape what is possible for us to do in the world. Physiotherapy looks the way it does, for instance because specific conventions of language, power, gender relations, capitalism, and so on, exist, and operate invisibly in the background, making certain ways of thinking and practicing possible, whilst denying others. Medicine has power in society, functionalists argued, because it helps to bring order and balance to the world, and society has rewarded it accordingly. Women, racialised people, and disabled people are constantly marginalised, critical theorists argue because every level of society has been subtly designed to favour patriarchy and the Global North.
Social action argues instead that while social structures are certainly present, and have a powerful influence on who we are and what we do, they have tended to neglect the individual and the way that human relations shape the world. It is people’s individual and collective actions, advocates argue, that defines social reality. As these approaches gained popularity in the 1980s and 90s, they began to open up entirely new ways of understanding people and the society, including healthcare.
The importance of the ‘turn to agency’ that social action instigated cannot be understated. Amongst other things, it gave birth to what we now think of as qualitative research; it shaped our understanding of professional boundaries, professional socialisation, and professional prestige; it developed our understanding of lay-professional relationships, and the idea of professionalism as performativity; it turned health professionals’ attention towards patient narratives and subjective explanations for health and wellbeing; and it provided new insights into the sociology of identity and the self that had previously been dominated by psychology. Perhaps the person most responsible for initiating this turn was the sociologist Max Weber, so we will begin the chapter with him.
