The Sociology of the Caring Professions

Pamela Abbott University of Teesside, Liz Meerabeau University of Greenwich, Pamela Abbott University of Teesside, Liz Meerabeau University of Greenwich

• Editorial: Routledge
• Año: 2020
• ISBN:
  9781000159240
• Edición: 1
• Categoría: Medicina
• Categoría: Assistenza sanitaria

This text provides students with a comprehensive introduction to the sociology of professions. It covers social work, probation, nursing, midwifery and health visiting and looks at key topics such as control and legal relationships, the relationship of gender and care, and the 'new managerialism'.

Chapter 1

Professionals, Professionalization and the Caring Professions

Pamela Abbott and Liz Meerabeau

Introduction

The concept of ‘profession’ was largely taken for granted in sociology until the 1960s. Sociologists were concerned with defining what a profession was – what occupational groups could claim professional status – rather than with analyzing the role of professionals in society.

Subsequently, considerable debate has developed about professions’ role and status, and attention has shifted from attempting to define ‘profession’ to analyzing professionalizing strategies – the steps taken by occupational groups aspiring to be recognized as professions. Much of this more recent literature has taken a critical stance, challenging the motivation of professionals and suggesting that they control clients and are concerned primarily with their own status and economic rewards. However, the work that professionals do is, arguably, both necessary and desirable, and more recent contributions to the debate have suggested that emphasis needs to be placed on the service professionals provide for clients (Freidson, 1994), while Meg Stacey (1992) has suggested that it is necessary to distinguish professionalism (behaviour) from professionalization (status and monetary reward).

The terms ‘profession’ and ‘professional’ are confusing and are used in a number of different and potentially contradictory ways. In everyday language ‘professional’ is often used to mean the opposite of ‘amateur’: someone who is paid to do a job – for example, a professional footballer. It is also used to denote a job that is well or properly done, as opposed to badly done or done in a slipshod manner, regardless of whether the work was paid or not. ‘Professional behaviour’ is used as a term of approval for what is perceived as ethical/moral behaviour, and ‘a professional judgement’ is generally seen as a sound or expert one. However, the most frequent use of ‘profession’ is to define occupational groups – occupations that are recognized as being professions. These are generally of high status with high financial rewards, but there is some ambiguity and dispute as to which occupations are professions, in terms both of everyday recognition by members of society and of sociological definitions. However, many white-collar occupational groups lay claim to professional status or develop strategies for achieving it. Both social work and nursing, for example, have been concerned to establish their professional status, to develop professionalizing strategies, and both have been divided internally as to whether or not professional status is something desirable and to be strived for. Some commentators have suggested that a distinction can be made between ‘true’ professions – the paradigm case often cited being medicine – and semi-professions such as nursing and social work. (An alternative term is ‘bureau professionals’, taking cognizance of the bureaucratic organization of their work – see the chapters by Hugman and Clarke in this volume.)

The class position of professionals has also been debated. While Marxists have argued that they act on behalf of the ruling class as agents of social control, others have suggested that professionals are an emergent new class (Bell, 1973), that societies are professionalizing and that career hierarchies are replacing social classes. Knowledge and skill are becoming, it is argued, increasingly important in post-industrial society, and old class and sectional interests of diminishing importance. In contradiction to this it is suggested that middle-class occupations, including professions, are being proletarianized, that knowledge and skill are being routinized and that these occupational groups are increasingly using ‘trade union’ tactics to maintain their relatively privileged position vis-à-vis other occupational groups. More recently it has been suggested that managerialism is increasingly controlling professional autonomy and judgement (see Clarke, and May and Annison, in this volume).

Defining a Profession

The idea of a ‘profession’ emerged from the mediaeval university, but until the eighteenth century ‘profession’ and ‘occupation’ were not separate terms. The prefix ‘liberal’ or ‘learned’ was used to distinguish occupational groups such as doctors and lawyers – occupations which were free and self-regulating and/or required an elite education. In 1711 Addison referred to ‘the three great professions of divinity, law and physic’ (quoted by Carr-Saunders, 1928, p. 4). During the nineteenth century ‘professions’ came to be used to refer to superior occupations, requiring intellectual training, a body of expert knowledge, a degree of self-regulation by a professional body and, often, a royal charter or establishment by statute. The aim was to exclude the unskilled and the unqualified, to establish a monopoly of practice and to regulate the labour market.

Sociologists have attempted to develop definitions of ‘professions’. The earliest of these, generally referred to as ‘trait’ approaches, attempted to develop a set of criteria, an ideal type against which an occupation could be measured. A review of the literature indicates that a number of traits have been suggested by different commentators, but that the key ones are that the profession was based on a body of knowledge, that the members had specialized skills and competence in the application of this knowledge, and that professional conduct was guided by a code of ethics, the focus of which is service to the client (Goode, 1960). Carr-Saunders (1955), writing in this tradition, suggested that there were four types of profession:

1 the established professions – for example, law, medicine and the church – where practice is based on theoretical study and the members of the profession follow a certain moral code of behaviour;

2 the new professions, which are based on fundamental studies – for example, engineering, chemistry, and the natural and social sciences;

3 the semi-professions, which are based on the acquisition of technical skills – for example nursing, pharmacy and social work;

4 would-be professions – occupations which require neither theoretical study nor the acquisition of exact technical skills, but may require facility with modern practices in business administration – for example, hospital managers.

According to trait theories, then, professions are characterized by the monopolization of particular forms of expertise, the erection of social boundaries around themselves through entrance qualifications and extended training, and an ideology of public service and altruism – that is, they claim to serve higher goals than mere economic self-interest. This professional autonomy is justified by the self-policing mechanisms constructed through their own internal criteria of standards maintained by the profession itself. Thus, to enter medicine requires a lengthy period of study, a pledge to save life and adherence to standards of practice set by the teaching hospitals and by the professional associations of the medical profession itself. One consequence of these mechanisms is that they provide the basis for political power in the labour market, allowing the members of the profession to command higher status and high rewards for their services. However, critics have pointed out that the professions cannot necessarily be relied upon to police themselves effectively, nor to act in the public interest. Moreover, almost no occupation calling itself a ‘profession’ can meet all of these criteria.

On the whole, this approach of listing the characteristics of professions to measure how far different occupations meet them has been rejected as unhelpful. This is because the traits generally seen as delineating a profession are mostly based on an idealized conception of the characteristics of the archetypical professions – medicine and law. Trait theories thereby give tacit support to the view of themselves which these professions project to the public. They tend to obscure the middle-class nature of codes of ethics, and the ways in which the professions also act as agents of social control. Furthermore, they do not explain how and why an occupation became a profession, and they emphasize altruism rather than highlighting the economic and social rewards of being a professional (Ben-David, 1963). The approach is ultimately unhelpful because it tells us only what professionals claim to do. The German sociologist Max Weber pointed out that

When we hear from all sides the demand for an introduction of regular curricula and special examinations, the reason behind it is, of course, not a suddenly awakened thirst for education but the desire for restricting the supply of these positions and their monopolisation by the owners of educational certificates, (quoted in Parry et al., 1979, p. 73)

Freidson (1986) has suggested that it is more useful to consider the idea of ‘professionalism’ as used in practice. Becker (1971) suggested that ‘profession’ is a social symbol which people attach to some occupations but not to others, while Parry and Parry (1976) argue that the key question is how occupational groups achieve the status of profession and in the process gain ascendancy over other occupational groups.

Developing this analysis, feminists have argued that in the process of upward mobility the male-dominated professions gained control over and subordinated female-dominated occupations. This is most clearly illustrated in medicine, where the medical profession is male-dominated and where in the process of achieving its dominant professional status the female occupations of nursing, midwifery and health visiting were subordinated (Abbott and Wallace, Chapter 2 in this volume). Indeed, nurses are still fighting to gain recognition of the right to control their own work. Larson (1977) suggests that professions are occupations that by market strategies have gained dominance over areas of social concern, while Abbott (1988) suggests that there is a system of professions, with inter-professional contestation and the subordination of some occupational groups by others. He suggests that professions serve their own interests as much as those of others. Traditional professions have achieved high status and a high remuneration for their members. These professions have developed powerful councils which define the profession, control access to it and police its standards.

However, the problem of definition remains, even if it is recognized that it is problematic. Freidson (1994) has indicated that

I use the word ‘profession’ to refer to an occupation that controls its own work, organised by a special set of institutions sustained in part by a particular ideology of expertise and service. I use the word ‘professionalism’ to refer to that ideology and special set of institutions, (p. 10)

The Role of the Professions

Functionalist accounts of the professions emphasized the functions they played for society and for their own members. Carr-Saunders and Wilson (1933) stressed the stabilizing effect for society, Marshall (1963) the importance of altruism and Parsons (1954) the collective orientation. In the case of medicine, for example, Parsons pointed to the crucial role of medical doctors in defining who is legitimately sick and can therefore be excused normal role obligations. Hughes (1963) pointed out that professions provide a service for clients – they solve problems that clients cannot solve for themselves – but on a more critical note also highlighted the ways in which they exploit their monopolistic dominance. Larson (1977) has also deawn attention to the privileges that accrue to professionals. Johnson (1972) argues from a Marxist perspective that professions form a particular, institutionalized form of client control. Their professional status stems from the assumed ignorance of the client as against the claims of professional specialist knowledge, thereby rendering clients relatively helpless. Professionals are accepted as specialists, and they often have legal backing for this, making their clients socially and economically dependent. In addition, clients are often socially distanced from their advisers in other ways – by social class, ethnicity, educational background and gender, for example.

While the Marxist critique sees professionals as acting as the agents of the capitalist state, the Right and feminists have also been critical of the way in which professionals exercise power. Illich et al. (1977), for example, have argued that professions are disabling – that is, they take away individuals’ ability to care for themselves. While the New Right has attacked monopolistic practices and the political power of the professions, it has tended not to question their ability to provide a necessary service. However, the New Right has questioned the role of welfare professionals, especially social workers, arguing that individuals come to rely on them rather than solving their own problems (Minford, 1987). Feminists have been critical of the ways in which professionals use patriarchal ...