The Biographical Turn and the 'Sociolization' of Medicine

I should perhaps begin by apologizing for the proof-reading problems engendered by my use of the term ‘sociolization’ and to attempt to define what I mean by this. It refers to what I wish to argue is the process through which sociology has come to shape the profession of medicine, partly, but not exclusively, through what I’ve called ‘the biographical turn’. I’m using the licence afforded by this plenary to take a biographical turn of my own and to revisit the thinking that informed my own PhD, carried out in the late 1970s. This was concerned with charting the professional socialization of social work students and drew on the literature relating to the sociology of the professions – particularly the work of Eliot Freidson (1970a), who published his influential book Medical Dominance: The Social Structure of Medical Care in 1970 (b) which, of course, built on the work of Everett Hughes (1958). Freidson – and, indeed, other commentators - viewed medicine as the quintessential profession, deriving its authority through its claims to possession of a distinctive and complex body of knowledge; its control over selectivity with regard to admission; and the requirement of a lengthy training period – in other words, via its ‘attributes’. Freidson’s analysis introduced a conflict view of the acquisition and maintenance of professional power and acknowledged the power struggles both within medicine as the ‘prototype’ profession (Conrad, 2007) and with close contenders. Medicine was seen also as occupying a superior power position vis-avis other occupational groups concerned with providing health care. In the spirit of that time I, too, viewed social work as one of the semi-professions (Etzioni, 1969) and speculated as to whether it would ever become a fully fledged profession. At this point in time social workers on the ground – if not their senior managers and associations - remained largely ambivalent with regard to attaining full professional status and sought to resist the all-pervasive drive to professionalization identified by theorists such as Wilensky (1964). I concluded in my PhD thesis that social work claimed legitimacy through appeals to a somewhat different cluster of attributes, which privileged the possession of ‘people skills’ and emphasized its value base. In a similar vein, Kleinman (1981) differentiated between professions which relied on an established skills set and those concerned with “making professionals into ‘persons’”. The arena of ‘people skills’, I argued, was not the terrain on which medicine deigned to wage battles for professional dominance, contenting itself with its manifest success in relation to fulfilling ‘harder’ and more easily observable claims as outlined earlier. However, since that time both society and the medical profession itself have changed and, alongside a more generalized ‘humanization’ of society, medicine has, I would argue, sought to cultivate recognition in respect of these ‘softer’ skills, whilst retaining its traditional power base underpinned by its unchanging attributes. Rather than social work and other so-called semi-professions seeking to emulate medicine, it would appear that the movement has, at least some of the time and in some quarters, been in the opposite direction. Sociology – and, in particular, medical sociology – has also had a significant influence on the ways in which the medical profession, at least in some of its incarnations, has responded and sought to