Selected Writings in Medical Sociological Research

Michael Bloor

• Publisher: Taylor & Francis
• Year: 2019
• Print ISBN: 9781138352049
• eBook ISBN: 9780429786440
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

First published in 1997, this self-selection of the writings of Michael Bloor, Reader at the University of Wales Cardiff, embraces papers on qualitative research findings, on qualitative methods, and on empirically-based theorising. It includes some material which is little known (for example, a rare observational study of illness behaviour) as well as some of Bloor's best regarded papers. This selection from an expert with more than twenty five years of research experience in the field of sociology of health and illness and nearly a hundred previous academic publications will be of interest to students of medical sociology, to methodologists, and to nurses, clinicians, and others interested in qualitative research in health and illness.

1. Introduction and acknowledgments

W.H. Auden, who knew a thing or two about writing, quoted approvingly an Icelandic proverb: ‘Every man likes the smell of his own farts’ (Auden 1971, p.278). This a (robust) warning to authors that they are not necessarily the best judges of the relative merits of their various works. So the opportunity to select one’s own ‘Greatest Hits’ volume (an opportunity which gives new meaning to the phrase ‘vanity publishing’) is also a difficulty. The difficulty would be the same whether it were John Lennon’s ‘Greatest Hits’ or Crispian St. Peters’s ‘Greatest Hits’: it’s a relative ranking problem. Accordingly, I have followed several principles (rather just than my nose) in selecting ten papers for reprinting from around a hundred candidate previous publications. I have ruled out some papers, most obviously review articles, which seem to me to be hopelessly out-of- date. I have chosen some papers which have been quite widely cited. I have chosen some others which I have been told have merit but which are rarely seen except via the good offices of the Inter-Library Loan Scheme. And finally, I have selected a few which the world has completely disregarded, but for which I retain a sneaking affection: here’s hoping that a turkey or two gets airborne. For obvious reasons, I’m not going to identify my turkeys.

The chosen papers, chronologically ordered, embrace reports of research findings, discussions of research methods and discussions of theory. But they nevertheless have a degree of thematic unity, insofar as all the research reports engage in ‘middle range’ theorizing and all the methods papers and theory papers draw extensively on empirical examples. The critical discussion of ethnomethodology (chapter 4) is perhaps an exception to this rule of unity. But as every ethnomethodologist knows, all rules are defeasible.

All the research reports (and all the empirical examples in the discussions of theory and methodology) are drawn from qualitative studies in medical sociology. ‘Qualitative studies’ for the obvious reason that this book appears in the series of Cardiff Papers in Qualitative Research. And ‘medical sociology’ because, since I graduated from the old M.Litt. course in Medical Sociology at Aberdeen more than 25 years ago, I have always worked as a medical sociologist - for most of that time, as a full-time researcher.

The days of the lone researcher are passing. Much of my own research work has been collaborative and the fact that half of these papers are coauthored is some reflection of the debt that I owe to many different coresearchers. For permission to reprint the co-authored papers, I am particularly grateful to my various co-authors: Marina Barnard and Neil McKeganey, both at the Scottish Centre for Drugs Misuse Research, University of Glasgow; Andrew Finlay, at Trinity College, Dublin; Jim McIntosh, at the Department of Social Policy and Social Work, University of Glasgow; and David Silverman, at Goldsmith’s College, University of London.

Thanks are also due to the editors of the Cardiff Papers series, Paul Atkinson, Amanda Coffey and Sara Delamont, to Anne Keirby, the editorial administrator at Avebury, and to Jackie Swift who prepared the camera-ready copy with great efficiency.

Turning to the individual papers, Chapter 2 (‘Bishop Berkeley and the Adeno-Tonsillectomy Enigma: an exploration of variation in the social construction of medical disposals’, Sociology, vol. 10, pp. 43-61, Bloor, M. (1976)) is a report of one of the first observational studies of doctor-patient encounters undertaken in the UK, an analysis of nearly 500 different cases of children referred to Ear, Nose and Throat (ENT) Out-Patient Clinics for specialist opinion on the need for adeno-tonsillectomy (removal of the tonsils and adenoids, separately or conjointly). It was my first major research project and was also written up, part-time, for my PhD. The analysis aims to provide a phenomenological description of routinized medical decision-making which could also apply to other types of routinized decision-making outside of medicine. There was a rather sniffy attitude among some sociologists twenty years ago that medical sociology was not quite kosher and it was thought to be rather difficult to publish it in mainstream sociology journals. So in order to try and make it more acceptable to Sociology, I gave it an arch title (rather than, say, ‘Variations in Assessments in ENT Out-Patient Clinics’) and a rather over-written introduction (consider the phrase ‘chestertonian whimsicality’, for instance?). For permission to reproduce it here, I am grateful to the editors of Sociology, to BSA Publications Ltd (who have the copyright) and to their publishers, Cambridge University Press.

Chapter 3 (On the Analysis of Observational Data: a discussion of the worth and uses of inductive techniques and respondent validation’, Sociology, Vol.12, pp.545-52, Bloor, M. (1978)) was an account of some aspects of the methodology of the same study. I have reproduced it here because the first part of the paper contains a discussion and extended illustration of the method of analysis known as ‘analytic induction’ or ‘deviant case analysis’. The paper has been discussed at length in various methods textbooks (e.g. Hammersley and Atkinson 1995, Silverman 1993). Analytic induction was hardly my invention (it had been briefly fashionable among American criminologists in the 1950’s) but my paper has helped to popularize the technique as a method for systematically analyzing qualitative data, a method which sits well with the modem computing packages for processing qualitative data. However, the discussion of analytic induction only covers the first half of the paper: the second half of the paper is taken up with a discussion of ‘respondent validation’ (aka ‘member validation’), the technique of feeding the results of one’s analysis back to research subjects for validation purposes. While I still believe, for several reasons, that discussing early findings with one’s research subjects is a valuable exercise and a source of important further data, I no longer think that such an exercise should be considered as validation. This is a matter I return to in the ‘Afterword’ at the end of the book. For permission to reproduce the original Sociology article here, I am grateful to the editors of Sociology, to BSA Publications Limited (who have the copyright) and to their publishers, Cambridge University Press.

Chapter 4 (‘An Alternative to the Ethnomethodological Approach to Rule Use?’ A comment on Zimmerman and Weider’s comment on Denzin’, Scottish Journal of Sociology (now entitled International Journal of Sociology and Social Policy), Vol.4, pp.249-63. Bloor, M. (1980)) was initially prepared as an internal staff seminar paper at the Institute of Medical Sociology, Aberdeen, in 1977. I had no original intention to publish it and only submitted it to a journal after I got a request for a copy from America. The seminar paper was a crystallization of some thoughts I’d had some five years earlier, an odd moment in the history of the discipline, when sociology appeared to be on the verge of a paradigm shift and even the most junior researcher (me) felt compelled to theorize in the grand manner. I have no conception of the nature of the paper’s fugitive appeal: I always thought it would be much the better with some original illustrative data (but what do I know?). It was originally published in the Scottish Journal of Sociology (now retitled the International Journal of Sociology and Social Policy); I am grateful to the publishers, Barmarick Publications, for permission to reproduce it.

Chapter 5 (Observations of Abortive Illness Behaviour’, Urban Life [now entitled Journal of Contemporary Ethnography], Vol. 14, pp.300-16, Bloor, M. (1985)) reported on what was meant to be a pilot work for a multi-setting ethnographic study of illness behaviour. The study setting was a Scottish ‘Common Lodging House’, a large Victorian institution originally set up to provide salubrious lodgings for apprentices and workmen, but whose 60-70 inmates in more recent years were largely problem drinkers, ex-psychiatric patients, ex-prisoners and the infirm elderly. Its advantage for the observer of illness behaviour was that a part- time General Practitioner held surgeries on the premises, so it was an easy enough manner to discover whether or not informal discussions of signs and symptoms led on to a medical consultation. For a variety of reasons, part intellectual and part organizational, the projected multi-setting study was never undertaken. But, apart from studies by sociologists who were also patients, this pilot study apparently remains one of the very few observational studies of illness behaviour conducted in a developed society. The paper is reprinted here with permission from Sage Publications Inc.

Chapter 6 (‘Conceptions of Therapeutic Work in Therapeutic Communities’, International Journal of Sociology and Social Policy, Vol.

6, pp.68-79, Bloor, M. and McKeganey, N. (1986)), co-authored with Neil McKeganey, grew out of a unique attempt to organize a comparative ethnography of the range of therapeutic community practice by stitching together a series of different ethnographies of different communities (seven in this paper, later eight in total) conducted by different individuals at different times but with similar foci. The comparative findings were eventually published as a book (Bloor et al. 1988). This paper draws on these inter-community comparisons to try and derive some broad principles of therapeutic work which Neil McKeganey and I felt had applications to therapeutic activity across a much greater range of health settings than just therapeutic communities. Immodestly, we felt that the six principles we elaborated of the ‘therapeutic gaze’ (reflexivity, interpretation, intervention, domination, habituation and selectivity) could provide an heuristic framework for the sociological description of a wide variety of medical work. The paper is reprinted with permission from Barmarick Publications.

Chapter 7 (‘Power, Surveillance and Resistance: a Comparison of Techniques of Client Resistance in Therapeutic Communities and Health Visiting’ in Cunningham Burley, S. and McKeganey, N. (eds) Readings in Medical Sociology, Tavistock: London, pp. 159-81, Bloor, M. and McIntosh, J. (1989)), co-authored with Jim McIntosh, was originally presented at a special conference held in Glasgow in 1987 to commemorate my mentor and former colleague, Gordon Horobin, who had died earlier that year. It is a pleasure to be able to re-iterate here the intellectual debt to Gordon owed by myself and many other medical sociologists who passed through the Institute of Medical Sociology in Aberdeen. The paper was subsequently published in Readings in Medical Sociology, edited by Sarah Cunningham Burley and Neil McKeganey (Tavistock: London, 1989). The paper draws on my own therapeutic communities work and on Jim McIntosh’s independent work on health visitors and their working class clients. In the paper we focus on client resistance as the inevitable response to professional power within a Foucauldian disciplinary relationship, showing how particular techniques of power call forth particular techniques of patient/client resistance, not least that of client concealment. I feel the paper remains a valuable empirical and theoretical demonstration of the importance and the rationality of concealment by patients/clients in professional-client relationships. I am grateful to the publishers for permission to reproduce it here.

Chapter 8 (‘Patient-Centred Medicine: Some Sociological Observations on its Constitution, Penetration and Cultural Assonance’, Advances in Medical Sociology [Albrecht, G. ed.], Vol 1, pp. 3-25, Silverman, D. and Bloor, M. (1990)), co-authored with David Silverman, is the third paper collected here which seeks to uncover a common theoretical pattern from a range of disparate empirical studies of medical sites. In this paper the sites were: cleft palate clinics, diabetic clinics, ENT clinics, forensic pathology, AZT treatment for HIV positive patients, oncology clinics, pediatric cardiology clinics and therapeutic communities. Our interest was in the spread and the practice of patient-centred medicine, or ‘holism’. Hand-in- hand with the snowballing popularity of ‘Let’s Talk about Me’ movements, with the Romantic linking of the revelation of inner feelings with revealed truth, patient-centred medicine has spread even to forensic medicine, a specialism without patients: some pathologists conceive of their work as being that of ‘physician to the bereaved’. However, this seemingly liberating vision of the consultation-as-confessional may also be viewed less positively, as where the dominating power of the professional is at its most effective, where the patient cannot remain silent, but is incited and required to speak, to confess. I am grateful to the publishers, JAI Press, for permission to reprint the paper here.

Chapter 9 (‘Spotting The Invisible Man: the Influence of Male Gender on Fieldwork Relations’, British Journal of Sociology, Vol. 42, pp. 195- 210, McKeganey, N. and Bloor, M. (1991)), co-authored with Neil McKeganey, also draws on a range of empirical studies, but this time with a methodological rather than a theoretical purpose. Our aim was to excavate archaeologically our past ethnographic fieldnotes, to lay bare the often unappreciated impact of male gender on fieldwork relations and on the data we had collected. There is an extensive literature on the influence of female gender on fieldwork relations. This paper seems to have been among the first to ‘spot’ the parallel but unremarked influence on data collection of cultural expectations about appropriate male gender roles. I am grateful to the British Journal of Sociology for permission to reprint the article here.

Chapter 10 (‘A Minor Office: the Variable and Socially Constructed Character of Death Certification in a Scottish City’, Journal of Health and Social Behaviour, Vol. 32, pp. 273-87, Bloor, M. (1991)) is concerned the problem of normative order in medical practice. Based on depth interviews with clinicians who write large numbers of death certificates (forensic pathologists, hospice doctors, police surgeons, junior hospital doctors working on certain wards, GPs with responsibility for residential homes, and so forth), it is argued there is very little normative control on certification practice: peer surveillance is largely absent and certification is a minor office, with no penalties for poor performance. Regularities in certification behaviour owe little to a normative order and everything to a routinized process of cognition: Chapter 10 takes me back to a theme first examined in Chapter 1. I am grateful to the American Sociological Association for permission to reprint the article here.

Chapter 11 (‘HIV-Related Risk Practices among Glasgow Male Prostitutes: Reframing Concepts of Risk Behaviour’, Medical

Anthropology Quarterly, Vol. 7, pp. 152-69, Bloor, M., Barnard, M., Finlay, A. and McKeganey, N. (1993)) is co-authored by Marina Barnard, Andrew Finlay and Neil McKeganey, who each at various times acted as my co-fieldworkers in an ethnographic study of male prostitution. The study was part of a programme of research on social aspects of HIV/AIDS conducted when I was a member of the MRC Medical Sociology Unit in Glasgow. I was keen to include one paper from that programme in this collection because it has been a matter of regret for me that there has been so little recognition within sociology of the important role that medical sociology has played in the scientific response to the HIV/AIDS epidemic. Sociologists worked alongside epidemiologists, virologists, biostatisticians and others documenting risk behaviours, mapping prevalences and evaluating interventions, such as needle exchanges and sexual health promotion programmes. Time was pressing and it should be no surprise that some of that effective and efficient sociological work was also ephemeral. But if some of that sociology was ephemeral, some of it was also work of lasting achievement (for example, the first UK national survey of sexual behaviour, Wellings et al. 1994). I make no megalomaniac claims of milestone status for the article reproduced here. But the article is of interest for two reasons. Firstly, because it highlights some aspects of HIV-related risk behaviour which are under-emphasized in much theorizing about risk behaviour and risk reduction, namely the way that risk behaviour often arises out of immediate social situations and social relationships, rather than being the outcome of individual attitudes and calculative individual decision-making. Secondly, there is some methodological interest in the conduct of research on an activity so covert that some service-providers to whom I spoke at the beginning of the research process were doubtful that male prostitution was an activity that existed on any significant scale in Glasgow (someone suggested that male prostitution was much more the kind of thing that went on in effete, middle-class Edinburgh than Red Clydeside). I am grateful to the American Anthropological Association for permission to reprint this article.

References

1. Auden, W.H. (1971), A Cer...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• 1. Introduction and acknowledgments
• 2. Bishop Berkeley and the Adeno-tonsillectomy enigma: an exploration of variation in the social construction of medical disposals
• 3. On the analysis of observational data: a discussion of the worth and uses of inductive techniques and respondent validation
• 4. An alternative to the ethnomethodological approach to rule-use? A comment on Zimmerman and Weider’s comment on Denzin
• 5. Observations of abortive illness behaviour
• 6. Conceptions of therapeutic work in therapeutic communities
• 7. Surveillance and concealment: a comparison of techniques of client resistance in therapeutic communities and health visiting
• 8. Patient-centred medicine: some sociological observations on its constitution, penetration, and cultural assonance
• 9. Spotting the invisible man: the influence of male gender on fieldwork relations
• 10. A minor office: the variable and socially constructed character of death certification in a Scottish city
• 11. HIV-related risk practices among Glasgow male prostitutes: reframing concepts of risk behaviour
• 12. Afterword