English abstract and summary

Abstract

Carlhed, C. 2007. Medicinens lyskraft och skuggor. – om trosföreställningar och symbolisk makt i habiliteringen 1960–1980. (The glow and shadows of the Medicine. Doxa and symbolic power in the area of services to young children with disabilities 1960–1980). Acta Universitatis Upsaliensis. Uppsala Studies in Education 116. 400 pp. Uppsala. ISBN 978-91-554-7036-4.

 

The dissertation examines the formation of specific groups, their interests and positions related to children with disabilities and their education and care in Sweden developed during 1960-1980. The theoretical framework is based on Pierre Bourdieu’s sociological theory of social space, which assumes that social life is based on symbolic and cultural systems of beliefs with respectively specific doxas and symbolic economies. Consequently, the analysis has focused on the agents’ position-takings and their struggle for recognition and preferential rights of interpretations.

The reconstruction of a “habilitation sphere” was conducted through agents, their positions of interests and position-takings as analytical tools. The positions were mainly reconstructed on articles in journals of 10 professional organizations covering 6 occupations and 4 disability organizations. The occupational groups were paediatric doctors/child psychiatrists, physiotherapists, occupational therapists, social workers, psychologists and pre-school teachers. The other positions were related to the county council union, four disability organizations (DHR, FUB, RBU and HCK), two of which were parent organizations and in addition, the research field of social medicine. Other materials were e.g. reports of commissions of inquiry. In order to explore the social foundations of the occupational positions, materials from archives have been used.

The conclusion shows the significance of: a) historical structures related to the exceptional position of medicine in society, the development of the Swedish health care system in general and the organizations of “special” children, b) commissions of inquiry as consecration authorities and processes of social mobilization, both important contributions in shaping symbolic economies, c) myths and ideologies in the exercising of symbolic power, d) alliances between the state and medicine, and between occupational groups and clients. The analysis also shows the strengths of the doxas which could work as a shield for the agents but also as obstacles for external agents when entering the habilitation sphere.

 

Keywords: habilitation services, children, handicap, disability, medicine, social workers, counsellors, pre-school teachers, psychologists, occupational therapists, physiotherapists, parent organizations, disability organizations, symbolic power, sociology of culture

 © Carina Carlhed 2007

ISSN 0347-1314
ISBN 978-91-554-7036-4
urn:nbn:se:uu:diva-8327 (http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8327)  

 

Summary

 The glow and shadows of the Medicine. Doxa  and symbolic power in the area of services to young children with disabilities 1960―1980.

 The aim in the dissertation is to analyze beliefs and symbolic power in habilitation (the area of services to young children with disabilities) ― a field of symbolic forces, which were created by formation of specific groups, their interests and positions related to children with disabilities and their education and care in Sweden developed during the period 1960―1980.

 In chapter II the analytical frame is presented. In this section I have also positioned the dissertation in relation to studies of child- and youth habilitation in Sweden, other studies of relevant professions, organizations and social spaces related to boundaries between health care, social care and education. Pierre Bourdieu ’s sociological theory of social space works as the theoretical framework and is presented in this section. Central concepts are social space/field, agents, positions, position-takings, different forms of capital, symbolic economies, doxa  and symbolic power. In this chapter the methodological considerations are also presented with information about the material and how the reconstruction of the “habilitation sphere” was conducted through agents and their positions. The occupational groups were paediatric doctors/child psychiatrists, physiotherapists, occupational therapists, social workers (counsellors), psychologists and pre-school teachers. The other positions were related to the county council union (Landstingsförbundet), four disability organizations (DHR , FUB , RBU  and HCK ), two of which were parent organizations and in addition, the research field of social medicine.

These positions were reconstructed through journals of ten professional organizations covering six occupations and four disability organizations. One journal represents the position as researchers of social medicine (Socialmedicinsk tidskrift). The materials from journals were mainly articles, notes and announcements and book reviews. Other material used in the thesis are: an interview with a government official that were engaged in supervision of “The mental retardation care” (Sinnesslövården) at the time, reports of Government-appointed committees or commissions of inquiry (statens offentliga utredningar ) concerning the occupational groups and the specific areas and organizations where children with disabilities were attended to, (e.g. “The cerebral palsy care” and “The mental retardation care”)[1] or areas related to specific issues in social policy (e.g. disabilities). In order to explore the social foundations of the occupations, material from archives about the wages of the occupational groups has been used. Complementary statistics about wages and numbers of the occupations at different times come from official statistics.

 Chapter III is an historical overview of the development of the Swedish health care system, the discipline of medicine and its increased strong position within the welfare state from medieval times into the 20^th century. The historical overview also comprises organizations of “special” children. This chapter has a descriptive character and is based on secondary sources such as dissertations and other research by historians and sociologists. A conclusive discussion and reinterpretation by means of Bourdieu ’s conceptual framework ends this chapter, which also outlines a background for the main analysis in chapter VI.

 Chapter IV focuses on reports of commissions of inquiry (Statens offentliga utredningar ) concerning the occupational groups and the specific areas and organizations where children with disabilities were attended to at the time (e.g. “The cerebral palsy care” and “The mental retardation care”) or areas related to specific issues in social policy such as disability. These commission reports, the definitions that were used and produced, combined with their reception of political groups or occupational groups contribute to the shaping of an economy of symbolic values relevant to the specific “habilitation sphere”. In the context of Bourdieu ’s terminology, the commission reports are interpreted as consecration authorities, who sanctify certain agents and their actions based on recognition of their specific symbolic capital. Examples of symbolic goods produced within this classification process were social problems and categories, which the authorities should attend to. Consequently, the commissions of inquiry worked as an important assembling and determinative “qualifier” for citizens seeking welfare services as well as patients suitable for “habilitation services”. This is very important to recognize if one is to understand both the specificity of habilitation practices and the welfare organizations as well. The symbiotic relationships that characterize occupations, organizations and clients within the welfare system depend on the fact that they are all defined within the same system. Ultimately, all agents within the welfare system, including agents within ”the habilitation sphere”, have to orientate themselves and their actions in order position themselves in relation to the State – “The bureaucratic field”.

 In chapter V the social foundations of the occupational groups are explored by use of the concepts of cultural and educational capital. Material from three different county archives about the wages of the occupational groups has been used. Complementary statistics about the wages of, as well as the numbers employed in the occupations at different times stems from official statistics. A ranking order of economic capital between the occupational groups was constructed based on the archive material. The stable top ranking position over the twenty year period 1960―1980 was held by the doctors, they had the highest wages of all the groups. The psychologists held the second place, the social workers held the third position, the physiotherapists held the fourth ranking and the pre-school teachers and the occupational therapists took turns in the fifth and sixth ranking position during these years. This ranking order was stable and identical to the ranking of educational capital. A ranking order of social recruitment to the different educations was established, which revealed that students from high status families went preferably to medical and psychology studies. The students in physiotherapist education were predominantly women from high status families at least in the early years of the time period being researched. Students from middle and low status families went to social work studies, pre-school teacher studies and occupational therapist studies. Agents other than the occupational groups could not be compared by their amounts of educational and economic capital, because their positions in ”the habilitation sphere” depended on their parenthood or disability or being clients/patients.

Chapter VI is the presentation of the main analysis in the dissertation. It focuses on the social mobilization of both the occupational groups and the disability organizations, as a key to understanding the symbolic reproduction of the groups (and their leaders). These mobilization processes also contribute to shaping the symbolic economy, which rules the recognition of specific symbolic capital. “The habilitation sphere” was dominated by the medical doxa . All the agents were involved in defining and redefining “the Cause” ― in this particular case how to deal with children with disabilities and who should do it and how to do it in the best way. The processes of definition and redefinition took place in relation towards the dominant medical agents, i.e. the doctors and subsequently also to the bureaucratic field ― the State. The defining and redefining practices are interpreted as classification struggles in order to enhance the symbolic power, which promotes monopolizing of ways to systemize knowledge and to dominate the social space. The analysis of the classification struggles is structured by the groups’ orthodox and heterodox  position-takings. This analysis reveals the underlying doxic visions and the distance that existed from “the holy sphere” in the medical doxa (and in the medical field) and the other agents. It thereby exposes their amount of their specific symbolic capital.

 Chapter VII synthesizes the conclusions about the dominating doxa  and the other doxas, from the previous chapters. The early constitution of a ”habilitation sphere” was related to “the profane sphere” in the medical field and which was a boundary area between the dominant medical doxa, a dominated social bureaucratic doxa and a dominated pedagogical doxa. The cultural dimension (the sphere of position-takings) and the social dimension (the sphere of social positions) were amplified by the symbolic dimension (the rules of vision) within ”the habilitation sphere”. This specific structure is illustrated by three figures in chapter VII. For the same reasons as discussed earlier, the disability agents could not be fully compared with the others in these illustrations. However in relation to the dominant doxa, they were the furthest away from the medical positions.

Chapter VIII is the conclusion of the dissertation.
One finding was quite surprising and it is probably the most important conclusion. It was the strength and power of the social space and its opportunities to be a “shield” for its agents. If someone left that field to work in another, he or she was “out in the cold”. This “structural gap” means for example that if a pre-school teacher, who was raised within a pedagogic doxa  with its specific visions about her responsibility to ensure the best interests of children, should enter the medical field, she would thereby be accorded a low symbolic position in that receiving field. This would be due to her radically different way of acting and talking compared to the occupational groups within the medical field. Her strategies would not be recognized as valuable, because she had the wrong or less symbolic capital. Subsequently, a physiotherapist who entered a pedagogic sphere (the school) would meet a similar structural gap, as well as the psychologist who entered the school as a school psychologist and so forth. Consequently, the receiving field would not recognize their capital as valuable. This could be seen as a “shield function” for external influences. But the shield function worked even more strongly at the internal level when their former colleagues in the field they left, they swould not show no compassion for those who had gone. Therefore, the pioneers in “new areas” in other fields were treated by their former colleagues as renegades or as pariahs, who had themselves to blame if they experienced difficulties. But it is interesting to consider whether the same applied to medical doctors entering other fields than that field of medicine? Or is it a matter of the relation between “the holy sphere” and “the profane sphere”? Does leaving the “home-field” always mean losing a particular esteem from the eyes of the dominant positions in one’s own field, because one is viewed as a deserter? This is a challenging and an interesting phenomenon which could be further explored.

As a metaphoric conclusion, one could say that in the “glow” of Medicine there is a charismatic promise and tribute to successful development. Medicine has to conquer new areas, new riddles ― if something has been explored and explained, the interest fades. This powerful “glow” has been strengthed and fuelled with ideologies and myths for a long time. The messages have been that medicine is the most important human practice and doctors’ privileges and dominant visions are parts of a natural order. The silent medical doxa  embraces all this. If it is questioned ― it will defend itself through discourse.

At the same time, within the shadows of medicine symbolic power rules, dominating the vision of “the Cause”, of those who belong and who do not, of what is important and what is not. This dissertation has demonstrated the following: the constitution of a ”the habilitation sphere”; its agents who invested in the new “cause”; and their dependence on the medical doxa . That domination has its roots in the homologies of the symbolic and social order in Swedish welfare society. The dissertation has also presented an alternative view of habilitation practices during a certain period of time and a perhaps more pessimistic view of the resistance which could meet collaboration between different occupational and interest groups ― in the shape of doxas.

 

©-2007. SEC/UPPSALA UNIVERSITY, Box 2136, SE-750 02 Uppsala, SWEDEN
Updated: 2010-05-20 | Responsible for content: carina.carlhed@edu.uu.se
URL: <http://www.skeptron.uu.se/pers/carinac>