ABSTRACT

This chapter will set out a sociological approach to complementary and alternative medicine (CAM) in Western societies in general and Britain in particular, with a focus on power and professionalisation in CAM. Too often, this latter concept is seen statically in terms of a group of specific therapies, which are frequently viewed as either traditionally or holistically based. Aside from the fact that only some CAM therapies have long historical roots or take a wholeperson approach philosophically and in their practical orientation to the client (see, for example, Coward 1989), developing a definition based on a fixed cluster of therapies does not capture the dynamic nature of CAM in the West. This is best conceptualised as fluidly related to orthodox medicine – the boundaries of both of which are interlinked and change over time (Saks 2003). CAM is therefore defined here in terms of its subordinated position in relation to orthodox health care, centred on the marginality of CAM practitioners in relation to power in the occupational division of labour. In this sense, orthodox medicine is viewed sociologically as health care underwritten by the state, which is at present based on biomedical dominance and focused heavily on drugs and surgery (as highlighted by Le Fanu 2011). CAM conversely is viewed as those therapies usually not supported by the state and currently largely subordinated to biomedicine (see, for example, Saks 1992a). As such, in Western societies, CAM covers a great range of approaches, from acupuncture and aromatherapy through herbalism and homoeopathy to naturopathy and reflexology. The diverse therapies contained under the umbrella of CAM, moreover, do not necessarily form in any sense a coherent set of practices, except in so far as they are marginalised; the line between medical orthodoxy and the nature of CAM may therefore vary not only historically (Saks 2005a), but also between specific societies and different parts of the world – from Western societies like Britain and the United States to Eastern countries such as China and India (see, for instance, Adams et al. 2012). The interpretation of CAM in this sense is inevitably shaped by theoretical perspectives. My own neo-Weberian approach is based on the concept of exclusionary social closure in the market giving rise to professionalisation (Saks 2010). On this approach, CAM is viewed as a marginal area in terms of the associated creation of bodies of insiders and outsiders through

legally enshrined social closure in which medicine and the allied health professions have generally captured the higher political ground. In this respect, CAM is defined in terms of its subordination in the politics of health – and is not simply held to be those therapies that lack available scientific evidence as regards efficacy and effectiveness compared to orthodox medicine (see, for example, Wallis and Morley 1976). This latter view is contentious and can be seen as a part of the dominant ideology of the medical profession in a fluid political game underpinned by group interests involving critical debates about what orthodox medicine has achieved in practice and what is to count as evidence in this discussion (Richardson and Saks 2013). The essence of the definition of CAM subscribed to in this sociological approach, therefore, is that its constituent therapies are not based on homogeneous intrinsic characteristics, but rather on their politically marginalised position (Saks 2008). Depending on the balance of power, therefore, the orthodoxy of one period can become the unorthodoxy of another, and vice versa. As the title suggests, while CAM can be used in a complementary, more politically acceptable way, to orthodox medicine, it can also be used in a more challenging manner in providing alternative patterns of health care to orthodoxy. This can be illustrated by the complementary use of osteopathy to treat the mechanical aspects of musculo-skeletal problems for which prescribed medicine like analgesics and anti-inflammatory drugs are being given. This contrasts with using alternative therapies like herbalism in place of orthodox medication for conditions such as allergies and asthma (Stone and Katz 2005). However, in all such guises, CAM represents different shades of marginal practice. Central to the process of marginalisation is the crucial notion of professionalisation based on legally bounded exclusionary social closure in the marketplace of occupations which – in elevating the standing of orthodox medicine – underwrites the lack of power of CAM practitioners and their position as outsiders (Saks 2002). This neo-Weberian view of professionalisation based on the operation of power and interests in the market provides a stronger framework for the analysis of CAM than many other theoretical perspectives since it is centred on a relatively non-assumptive model about the core differentiating characteristics of professional and non-professional groups in simply recognising the legally underpinned existence of professions linked to exclusionary social closure (Saks 2010). This contrasts with the longer standing trait and functionalist approaches to professions which, as part of their very definitions of these groups, reflexively see ‘top dog’ professions like medicine as rather flatteringly centred on their distinctiveness in terms of such features as high-level expertise, rationality and altruism (see, for instance, Greenwood 1957 and Goode 1960) – while those outside such professions, including semi-professions like nursing, are not thought to have such fully developed characteristics in these areas and this is held to account for their lower position in the pecking order (Etzioni 1969). More critical approaches to professionalisation linked to the 1960s/70s counter culture and beyond – such as interactionism, Marxism and Foucauldianism – also have their virtues in providing a challenge to the previously dominant orthodoxy. Nonetheless, unlike the neo-Weberian perspective based on seeing professions as a form of market control, they fall foul of the criticism of making rather too many constraining assumptions, albeit in a negative rather than a positive direction. The interactionists typically base their analysis at a micro-level on the largely nonsubstantiated premise that there is no real difference between professionals and non-professionals – and that being a member of a profession means little more than possessing an honorific symbol (see, for example, Becker 1962 and Hughes 1963). Marxists, meanwhile, tend reflexively and somewhat tautologically to see the operation and role of professions as serving the interests of the capitalist state (as illustrated by Esland 1980), while Foucauldians debunk the ideology of progress associated with professions by employing a concept of governmentality that is very difficult to operationalise (Johnson 1995) and playing fast and loose with the evidence (Foucault 1989).