The salutogenic gaze : Theorising the practitioner role in complementary and alternative medicine consultations

Research on why people use complementary and alternative medicine (CAM) shows clients value the CAM consultation, where they feel listened to and empowered to control their own health. Such ‘empowerment’ through CAM use is often theorised as reflecting wider neoliberal imperatives of self-responsibility. CAM users' perspectives are well studied, but there has been little sociological analysis of interactions within the CAM consultation. Specifically, it is unclear how user empowerment/self-knowledge relates to the CAM practitioner's power and expert knowledge. We address this using audio-recorded consultations and interviews with CAM practitioners to explore knowledge use in client-practitioner interactions and its meaning for practitioners. Based on our analysis and drawing on Foucault (1973), The Birth of the Clinic: an archaeology of medical perception and Antonovsky (1979), Health, Stress and Coping, we theorise the operation of power/knowledge in the CAM practitioner-client dyad by introducing the concept of the ‘salutogenic gaze’. This gaze operates in the CAM consultation with disciplining and productive effects that are oriented towards health promotion. Practitioners listen to and value clients' stories, but their gaze also incorporates surveillance and normalisation, aided by technologies that may or may not be shared with clients. Because the salutogenic gaze is ultimately transferred from practitioner to client, it empowers CAM users while simultaneously reinforcing the practitioner's power as a health expert.publishedVersionPeer reviewe

The sociology of neuroethics: expectational discourses and the rise of a new discipline

The sudden emergence of the discipline ‘neuroethics’ is an intriguing event from the perspective of the sociologies of medicine, science and bioethics. Despite calls for greater social science engagement with neuroethics, it has so far received little attention. So that sociologists might consider how to engage with the field, and in order to simultaneously contribute towards a sociology of neuroethics, this paper explores neuroethics’ disciplinary identity via a critical analysis of literature defining neuroethics’ scope and role. Drawing on the sociologies of bioethics and expectations, I argue that in setting the neuroethical agenda, neuroethicists construct expectations about the future of neuroscience. In doing so, they align themselves with neuroscience, rather than maintaining a critical distance. Similar critiques have been made of bioethics, but in its efforts to distinguish itself from bioethics, neuroethics appears to exacerbate many of the attributes which sociologists have found problematic. This reinforces the need for critical social science perspectives to inform neuroethics, and also shows how neuroethics is potentially an interesting area of empirical study for sociology. However, the paper concludes by calling for critical reflexivity in sociology’s engagement with neuroethics, in light of recent debates surrounding the relationship between social science, bioethics, bioscience and expectations

Introduction: the struggle over medical knowledge

From the first emergence of medical sociology in the 1950s, medical education enjoyed a central place on its research agenda (Rafferty 2000: 239), beginning with the publication of Robert Merton et al. 's (1957) The Student-Physician: introductory studies in the sociology of medical education. The sociology of medical education had emerged, Merton explained, owing to a number of developments within medical education itself: the need to incorporate the expansion of scientific knowledge within limited curricular time; the renewed focus on treating 'the patient as a person' and the sense that sociology, though not well understood within the medical profession, could play a role in developing this aspect of practice; the development of systematic research into medical education; and innovations in medical curricula. Simultaneously, sociology was beginning to focus on the professions, organizations and adult socialization processes, and was developing social-scientific research methods (Merton et al. 1957). The Student-Physician aimed to showcase some early work applying sociological methods to the study of medical education

Pierre Bordieu and the theory of medical education: thinking 'relationally' about medical students and the medical curricula

Sociologists have been studying medical education for more than 50 years. Rich empirical studies of life in medical schools and hospitals have been conducted by some of the most influential sociologists of the twentieth century. Nevertheless, sociology has yet to put forth a coherent and comprehensive theory of medical education. Fred Rafferty has highlighted an analytical schism within the sociology of medical education between the majority of studies which focus on student socialization, and a less developed strand centering on organizational structure. In general, students' experiences have received ample scrutiny, while medical curricula, medical schools and the complex web of healthcare and higher-education institutions and policies impacting on medical education have received comparatively little attention. This divide is reflected in the use of theory within the sociology of medical education, which has tended to privilege agency over structure, and, less often, the reverse. As a consequence, sociology lacks a comprehensive theory accounting for both institutional arrangements and student practice in medical education, and the relationships between them. This chapter offers one way of bridging this divide by drawing upon Pierre Bourdieu's theoretical framework in medical education. Bourdieu (1930-2002) was one of the most influential sociologists of his generation. Although relatively recently applied within the sociology of health and illness, Bourdieu's work has been profoundly influential in many other areas, particularly in the sociology of education, where his theories and empirical work have elucidated how the social order is reproduced through the educational choices and practices of individuals and institutions. Bourdieu seeks to overcome the theoretical opposition between structure and agency, urging us instead to 'think relationally' about social practices. This framework can potentially enrich a part of sociology which has tended to overemphasize either individual experience or institutional politics, thereby neglecting their interrelation

The sociology of medical education : the struggle for legitimate knowledge in two English medical schools

This thesis is not available on this repository until the author agrees to make it public. If you are the author of this thesis and would like to make your work openly available, please contact us: [email protected] Library can supply a digital copy for private research purposes; interested parties should submit the request form here: http://www.lib.cam.ac.uk/collections/departments/digital-content-unit/ordering-imagesPlease note that print copies of theses may be available for consultation in the Cambridge University Library's Manuscript reading room. Admission details are at http://www.lib.cam.ac.uk/collections/departments/manuscripts-university-archivesThe epistemological basis of medical education has been highly contested since the turn of the twentieth century, with 'traditional', science-based curricula gradually being replaced by 'innovative' curricula, purporting to be more holistic. Both curricular types are currently employed in the United Kingdom, amid calls for both fu11her reform and a return to traditional teaching. This thesis explores the sociological meaning and consequences of debates over knowledge in medical education by examining the construction of legitimate knowledge in two English medical schools, one 'traditional' and one ' innovative'. Part I includes a literature review and theoretical discussion. Research on medical students ' experiences shows that they learn to value scientific and clinical 'competence' rather than 'caring'. Furthermore, sociologists argue that curricular reform serves symbolic purposes in medical schools but does not effect meaningful change. However, the relationship between students and medical schools is not well understood. Pierre Bourdieu's theoretical framework is proposed as a way of reconciling the analytical schism between research focusing on either student socialisation or organisational factors. Part II presents the research findings. Data were collected via six months' paiticipant observation at the two schools, semi-structured interviews with thirty-six medical students and fifteen faculty members, and analysis of institutional documents. By analysing the schools' marketing strategies, histories and relationships to external bodies, I show that medical education operates as a field in which medical knowledge is a form of symbolic capital: medical schools compete for scientific capital on the one hand, sustained by mechanisms within the higher education field, and, on the other, for clinical capital, fostered by the healthcare field. The two schools I studied were positioned unequally and oriented towards different sides of the medical education field. Faculty members participated in the dualistic competition for knowledge-based capital, largely reproducing their own institution's construction of legitimate knowledge. Drawing on their habitus, students also perpetuated the field struggle through their choice of medical school and their perceptions of legitimate knowledge. In turn, students' practices and dispositions were shaped by their school's position in the field. Ultimately, the struggle for scientific and clinic.al knowledge precluded holistic medical education: humanistic and social knowledge were marginalised in both the 'traditional' and the 'innovative' school, having little value within the field. Educational reform is thereby limited by this competition over knowledge, which is a 'game' played to gain institutional and individual power, rather than to produce good doctors

Authentic early experience in Medical Education: A socio-cultural analysis identifying important variables in learning interactions within workplaces

This paper addresses the question 'what are the variables influencing social interactions and learning during Authentic Early Experience (AEE)?' AEE is a complex educational intervention for new medical students. Following critique of the existing literature, multiple qualitative methods were used to create a study framework conceptually orientated to a socio-cultural perspective. Study participants were recruited from three groups at one UK medical school: students, workplace supervisors, and medical school faculty. A series of intersecting spectra identified in the data describe dyadic variables that make explicit the parameters within which social interactions are conducted in this setting. Four of the spectra describe social processes related to being in workplaces and developing the ability to manage interactions during authentic early experiences. These are: (1) legitimacy expressed through invited participation or exclusion; (2) finding a role-a spectrum from student identity to doctor mindset; (3) personal perspectives and discomfort in transition from lay to medical; and, (4) taking responsibility for 'risk'-moving from aversion to management through graded progression of responsibility. Four further spectra describe educational consequences of social interactions. These spectra identify how the reality of learning is shaped through social interactions and are (1) generic-specific objectives, (2) parallel-integrated-learning, (3) context specific-transferable learning and (4) performing or simulating-reality. Attention to these variables is important if educators are to maximise constructive learning from AEE. Application of each of the spectra could assist workplace supervisors to maximise the positive learning potential of specific workplaces.</p