Relief, risk and renewal: mixed therapy regimens in an Australian suburb
Introduction
In the sociology of health, the “medicalisation” thesis, ultimately deriving from the sociology of Max Weber, has long been an important concern (Illich, 1976; Waitzkin, 1983; Navarro, 1986). Is biomedicine extending its powerful reach ever deeper into more spheres of life? What are the interest groups that benefit from such developments? What forms of control are exercised, and over which social groups? What are the effects on patient care? These and related questions are characteristic of research informed by the concept of medicalisation and remain important questions for many medical sociologists (who have also accommodated the many critiques of medicalisation). Foucauldian analyses focusing on the idea of biopower and state technologies for the normalisation of citizens have added a new dimension to these debates but, in the broad emphasis on social control, are not necessarily discontinuous with them.
The subject of study has been transformed in recent decades by the rise of what might be termed “post-institutional health care”. I am referring here to the proliferation of non-biomedical therapies that are mostly unsupported by government-authorised systems of medicine, such as hospitals, medical training schools and health insurance schemes (Taylor, 1984; MacLennan & Wilson, 2002; Ernst, 2000). These therapies, some of which are more formally organised than others, are generally characterised by terms such as “complementary” or “alternative” medicine, or the acronym “CAM”.
Sociologists have gone about studying these post-institutional forms of health care largely through analysis of political struggles between orthodox and alternative medicine and between different types of alternative medicine (e.g., Baer, 1987; Easthope, 1993; O’Neill, 1995). There have also been surveys of users and healers (e.g., Furnham & Smith, 1988; Murray & Shepherd, 1993; Yates, Beadle, & Clavarino, 1993; Sawyer, Gannoni, Toogood, Antoniou, & Rice, 1994; Wardwell, 1994; Kermode, Myers, & Ramsay, 1998; Sherwood, 2000; Wilkinson & Simpson, 2002) and some attempts to deconstruct the concept of “holism” as it is used by alternative practitioners and their patients (Weil, 1983; Armstrong, 1995). Ethnographic studies of patients and alternative healers are relatively rare (Sharma, 1992). The medical anthropologist Ursula Sharma (1993), who has carried out research among CAM users in both India and Britain, has argued that the ethnographic methodologies of anthropologists can be well turned to the study of alternative medicine in Western societies. She argues that medical anthropologists can provide the more interpretive cultural analysis, focusing on the agency of patients, which is lacking in sociological studies.
This paper draws on data collected as part of a community-based study of health and illness in an Australian suburb, in which post-institutional medicine emerged as a significant therapeutic option for some residents. The ethnography of what I have termed “mixed therapy regimens” can inform sociological theorising about the nature of illness, the cultural authority of professional knowledge, constructs of the self and the body, and relations of power in contemporary Western society.
Section snippets
The Oceanpoint study
During the 1994–1996, the author was part of a multidisciplinary team (general practitioners (GPs) and anthropologists) that carried out an ethnographic study of health and illness, in a regional city in New South Wales, in a suburb that we have named “Oceanpoint”. The research collaboration was initiated by the GPs who wished to extend their understanding of health knowledge and practices in local communities beyond that provided by survey-based research, which is the most commonly used
Mixed therapy regimens in oceanpoint: an overview
In Oceanpoint, it is not uncommon for people to seek treatment from more than one kind of practitioner for the same symptoms, and to visit several kinds of alternative practitioners. In 27 of the 111 interviews (24%), respondents provided information that they or another household member had used non-biomedical therapies, often preceded by or in combination with some form of biomedical therapy. In total, the 27 respondents reported detailed information for a total of 34 people (themselves or
Lay constructions of therapeutic pluralism
The members of the research team, both GPs and anthropologists, started out with a rough working concept of “alternative” or “complementary” medicine. By this we meant those healing modalities that are not part of state-authorised biomedical services, but which are offered on a fee-for-service basis by other practitioners with varying types of training and certification, such as chiropractors, naturopaths, masseurs, iridologists, and acupuncturists. These practitioners have varying degrees of
Issues of legitimacy and effectiveness
How did residents view the legitimacy of alternative therapists? Evaluations of legitimate practice made from within any particular professional knowledge system may not correspond to those of client or patient groups. As Willis has pointed out, scientific legitimacy of a health profession such as biomedicine, and the associated politico-legal legitimacy of practitioners, must contend with the clinical legitimacy of other modalities: the fact that patients experience an improvement in their
The symbolic value of “natural therapies”
Non-biomedical therapies are frequently described as “natural”, and indeed the term “natural therapy” in some contexts is used as a synonym for “alternative medicine”. The term “natural” seems to imply something about the way in which these therapies work on the body and yet precise mechanisms of action are rarely specified by residents. Rather, “natural” is often associated with those treatments and medicines that can be used at the discretion of the sufferer. Sometimes it implies therapies
The symbolic value of pharmaceuticals: toxic therapies
While vitamins are viewed as natural and benign in their action on the body, respondents assert that the medicines prescribed by biomedical health professionals can have quite opposite effects. Some people voiced a strong critique of drugs and the pharmaceutical industry, as well as the competency and training of biomedical practitioners. Implicated in this critique were questions about physicians’ own capacity to evaluate the promotion of the drug industry, and the use of prescriptions as a
The moral universe of healing
Healing is a moral relationship as well as a technical or social one, invoking judgements of honesty, kindness and integrity. Moral evaluations pervade the accounts of biomedical and non-biomedical ministrations in the previous section. Likewise, residents’ descriptions of their encounters with non-biomedical practitioners are sometimes suffused with moral judgements. Ben and Lucy are a case in point, interesting enough to pursue in some detail here, although it should be noted that the
Conclusion
In Australia, biomedicine still has a firm position of economic and institutional dominance of health care, through massive state support at all levels. We can only speculate as to how much more prevalent the use of alternative medicine would be if similar support were available. The growth of therapeutic alternatives in Australia has increased markedly in the past few decades, in keeping with a general diversification and expansion of the capitalist economy in which increasing areas of life,
Acknowledgements
The research on which this paper is based was funded by a General Practice Evaluation Program Grant no. 275 from the Australian Commonwealth Government. The author wishes to thank the residents of Oceanpoint for their generous participation in the study, and the other members of the research team: A. Whittaker, A. Reid, K. Robinson, A. Sprogis, S. Freeman, and B. Missingham.
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