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On Use and Purpose in the Sociology of CAM
Guest Editorial ON USE AND PURPOSE IN THE SOCIOLOGY OF CAM I have to admit that I do not generally find sociologists’ theories very sexy. I cannot usually understand the concepts, and sometimes not even the words they use to describe them [or] . . . how sociological theories might help anything.1 Adrian White Editor, CTiM
What is the sociological study of CAM all about? What are its driving forces? Is it appropriate for Adrian White, CTiM’s editor, and author of the above comments, to expect it to ‘help’? In short what is the use of the sociology of CAM and what is its purpose? It is perhaps helpful to distinguish between two ways in which such questions might be answered. To some extent these are pure forms; the approaches will at times overlap. The first, and I suspect the one with which Adrian would most readily identify, is that sociology is all about affecting change. Its research agenda is political and inspired by the need to address inequalities, injustice, inappropriate professional practice and so on. This is an active traditional seen currently, for instance, in the inter-relationship between academic disability studies and the disability movement more broadly. Within such a conceptualization we can, and should, be looking to address the issue of how sociology can help. We can highlight the ways in which existing findings, concepts and theories, and the discipline’s methodologies, can be of direct relevance to research issues that transcend disciplinary boundaries. For example, we might draw on the wealth of work conducted on similarities and differences between lay and professional perspectives on health to explore what is going on in the CAM therapeutic encounter. At an immediately practical level, we already regularly see how some of the methods of sociology are not only employed by sociologists but also by others to explore (sometimes more successfully than others) issues such as ‘user perspectives’ on CAM. In the longer term we can anticipate moving beyond what can sometimes be a tiring (and trivializing) reliance on focus groups and interviews to make use of other techniques like ethnography, and narrative based approaches such as life histories and diaries. These are ideally suited to an exploration of a range of issues such as individuals’ decision making and negotiation about the use of CAM in the context of their lives, their personal and professional networks etc. The list could go on and on. It is through an appreciation of the tools and knowledge base of sociology that the inherent sexuality of the discipline might become clearer for those it has thus far eluded. C 2001 Harcourt Publishers Ltd Complementary Therapies in Medicine (2001) 9, 134–135 °
doi:10.1054/ctim.2001.0462, available online http://www.idealibrary.com on
But there is a second way in which the opening questions can be answered. From this perspective the purpose of what can be termed the sociology of CAM may be seen rather differently. Here the sociological enterprise is geared – as its primary objective – towards the elucidation of a social process or series of inter-related social processes as an end in itself; an element of a broader pursuit of an understanding of ongoing social change. It is not that knowledge generated may not be of use; rather it is that production of it is not inevitably driven by that goal. With this different conceptual starting point can come a somewhat different research agenda, and with that different agenda so emerges the need for a rather differently oriented interpretation of purpose (and a questioning of the appropriateness of assessments of use or help, at least in the manner that they may be interpreted by practitioners). For instance, it is instructive to compare the research agenda set out in the House of Lords report2 with the priorities that are emerging within the discrete sub-discipline of the sociology of CAM. The priorities of the House of Lords report come as no surprise. Questions of efficacy, safety and the like dominate. In the context of pursuing public funding and with a direct focus on improving patient care this makes a good deal of sense. And as detailed above there is a real contribution to be made by sociologists in rounding out what can sometimes be quite narrow means of assessing effects, outcomes and experience. However, if we turn to the developing agenda of those contributing to the emerging sociology of CAM we find an array of issues that are fascinating sociologists at the moment that are never likely to appear on the mainstream agenda. Again it is not that these may not yield insights which inform practice, but rather it is that by following an ‘interest driven’ agenda questions are not formulated to necessarily achieve that end. The purpose is to work towards sociological understanding. The distinctiveness of the sociology of CAM agenda can be seen when looking at some of the topics to be covered in a forthcoming book on the subject.3 Issues such as whether, and in what way, CAM constitutes a social movement; the extent to which existing theoretical understanding of the nature of professions is robust enough to explain developments in CAM; why the apparent inter-connectedness of nursing and CAM should have emerged, and how it is perpetuated and developed are just some examples of current priorities. All are purely sociological issues being researched as ends in themselves. An example of such work is presented in this issue.4 It is drawn from research I am conducting with a fellow sociologist. In this paper, we explore (through an analysis of texts) how advocates of CAM within nursing set up an opposition between nursing and medicine as
134
Sociology of CAM
a means of strengthening their claims over CAM. As part of a multi-method, theoretically informed study, or set of studies, the intention is to achieve a rounded, fully contextualized understanding of the affinity between CAM and nursing – ‘knowledge’ of which currently owes more to assumption than rigorous research. In time, this work may well produce the kind of detailed understanding of (professional/orthodox) participants in the CAM process that will yield practical implications, and indeed may add to an understanding of how greater integration might be achieved or hindered. But it may not. So if we return to our opening questions, we can see that they need to be answered via an appreciation of different types of sociological enquiry. Only when an understanding of the purpose of those different forms has been achieved does it make sense to consider whether the search for immediate practical utility is relevant. Different forms of work need to be encountered in their own
135
terms. At times a failure to find a practical use may be less an indication of a flaw in the work as a failure to recognise the purpose of it. Philip Tovey School of Healthcare Studies University of Leeds
REFERENCES 1. White A. Review of P Tovey [eds.]. Contemporary Primary Care. Buckingham: Open University Press. Complement Ther Med 2000: 9, 52–53. 2. House of Lords. 6th Report of the Science and Technology Committee 2000. London: House of Lords. 3. Tovey P, Easthope G, Adams, J. [eds.]. The Mainstreaming of Complementary and Alternative Medicine: Studies in Social Context, In press. London and New York: Routledge. 4. Adams J, Tovey P. Nurses use of professional distancing in the appropriation of CAM: A text analysis. Complement Ther Med 2001: 9, 136–140.
What is the sociological study of CAM all about? What are its driving forces? Is it appropriate for Adrian White, CTiM’s editor, and author of the above comments, to expect it to ‘help’? In short what is the use of the sociology of CAM and what is its purpose? It is perhaps helpful to distinguish between two ways in which such questions might be answered. To some extent these are pure forms; the approaches will at times overlap. The first, and I suspect the one with which Adrian would most readily identify, is that sociology is all about affecting change. Its research agenda is political and inspired by the need to address inequalities, injustice, inappropriate professional practice and so on. This is an active traditional seen currently, for instance, in the inter-relationship between academic disability studies and the disability movement more broadly. Within such a conceptualization we can, and should, be looking to address the issue of how sociology can help. We can highlight the ways in which existing findings, concepts and theories, and the discipline’s methodologies, can be of direct relevance to research issues that transcend disciplinary boundaries. For example, we might draw on the wealth of work conducted on similarities and differences between lay and professional perspectives on health to explore what is going on in the CAM therapeutic encounter. At an immediately practical level, we already regularly see how some of the methods of sociology are not only employed by sociologists but also by others to explore (sometimes more successfully than others) issues such as ‘user perspectives’ on CAM. In the longer term we can anticipate moving beyond what can sometimes be a tiring (and trivializing) reliance on focus groups and interviews to make use of other techniques like ethnography, and narrative based approaches such as life histories and diaries. These are ideally suited to an exploration of a range of issues such as individuals’ decision making and negotiation about the use of CAM in the context of their lives, their personal and professional networks etc. The list could go on and on. It is through an appreciation of the tools and knowledge base of sociology that the inherent sexuality of the discipline might become clearer for those it has thus far eluded. C 2001 Harcourt Publishers Ltd Complementary Therapies in Medicine (2001) 9, 134–135 °
doi:10.1054/ctim.2001.0462, available online http://www.idealibrary.com on
But there is a second way in which the opening questions can be answered. From this perspective the purpose of what can be termed the sociology of CAM may be seen rather differently. Here the sociological enterprise is geared – as its primary objective – towards the elucidation of a social process or series of inter-related social processes as an end in itself; an element of a broader pursuit of an understanding of ongoing social change. It is not that knowledge generated may not be of use; rather it is that production of it is not inevitably driven by that goal. With this different conceptual starting point can come a somewhat different research agenda, and with that different agenda so emerges the need for a rather differently oriented interpretation of purpose (and a questioning of the appropriateness of assessments of use or help, at least in the manner that they may be interpreted by practitioners). For instance, it is instructive to compare the research agenda set out in the House of Lords report2 with the priorities that are emerging within the discrete sub-discipline of the sociology of CAM. The priorities of the House of Lords report come as no surprise. Questions of efficacy, safety and the like dominate. In the context of pursuing public funding and with a direct focus on improving patient care this makes a good deal of sense. And as detailed above there is a real contribution to be made by sociologists in rounding out what can sometimes be quite narrow means of assessing effects, outcomes and experience. However, if we turn to the developing agenda of those contributing to the emerging sociology of CAM we find an array of issues that are fascinating sociologists at the moment that are never likely to appear on the mainstream agenda. Again it is not that these may not yield insights which inform practice, but rather it is that by following an ‘interest driven’ agenda questions are not formulated to necessarily achieve that end. The purpose is to work towards sociological understanding. The distinctiveness of the sociology of CAM agenda can be seen when looking at some of the topics to be covered in a forthcoming book on the subject.3 Issues such as whether, and in what way, CAM constitutes a social movement; the extent to which existing theoretical understanding of the nature of professions is robust enough to explain developments in CAM; why the apparent inter-connectedness of nursing and CAM should have emerged, and how it is perpetuated and developed are just some examples of current priorities. All are purely sociological issues being researched as ends in themselves. An example of such work is presented in this issue.4 It is drawn from research I am conducting with a fellow sociologist. In this paper, we explore (through an analysis of texts) how advocates of CAM within nursing set up an opposition between nursing and medicine as
134
Sociology of CAM
a means of strengthening their claims over CAM. As part of a multi-method, theoretically informed study, or set of studies, the intention is to achieve a rounded, fully contextualized understanding of the affinity between CAM and nursing – ‘knowledge’ of which currently owes more to assumption than rigorous research. In time, this work may well produce the kind of detailed understanding of (professional/orthodox) participants in the CAM process that will yield practical implications, and indeed may add to an understanding of how greater integration might be achieved or hindered. But it may not. So if we return to our opening questions, we can see that they need to be answered via an appreciation of different types of sociological enquiry. Only when an understanding of the purpose of those different forms has been achieved does it make sense to consider whether the search for immediate practical utility is relevant. Different forms of work need to be encountered in their own
135
terms. At times a failure to find a practical use may be less an indication of a flaw in the work as a failure to recognise the purpose of it. Philip Tovey School of Healthcare Studies University of Leeds
REFERENCES 1. White A. Review of P Tovey [eds.]. Contemporary Primary Care. Buckingham: Open University Press. Complement Ther Med 2000: 9, 52–53. 2. House of Lords. 6th Report of the Science and Technology Committee 2000. London: House of Lords. 3. Tovey P, Easthope G, Adams, J. [eds.]. The Mainstreaming of Complementary and Alternative Medicine: Studies in Social Context, In press. London and New York: Routledge. 4. Adams J, Tovey P. Nurses use of professional distancing in the appropriation of CAM: A text analysis. Complement Ther Med 2001: 9, 136–140.