2002 saw the publication of a single-authored effort, Health and Social Change, a contribution to Tim Mays’ excellent series on ‘issues in society’. I have it in front of me now. What do I think of it? I am a little embarrassed to say that I quite like it. Why embarrassed? Because I’m not sure many others feel similarly. This is not false modesty on my part; rather it’s an acknowledgement that I have a distinctive – expressed positively, succinct, expressed negatively, constipated – style of writing. I have variously tried to amend or shrug this style off, but not to any great effect (so far). If I am honest, I’ve grown attached to it.
I have mentioned before that what most drives me and my laptop is a wish to clearly communicate my grasp, understanding or explanation (such as it is) of/for whatever social phenomena I have been focusing on. I am not really bothered about style or other facets of presentation (even multiple parentheses, as will be apparent).
Health and Social Change comprised three parts and seven chapters. The first part was devoted to the merits and otherwise of different schools or paradigms within sociology. I considered structural-functionalism, interactionism, phenomenology and conflict theory by way of an opening, concluding that each was ‘grist to the sociological mill’ (a favourite phrase of mine). But synthesis trumps eclecticism: extant theories are for ‘using’. In the second chapter I tackled the pros and cons of postmodern thinking. My judgement on this flawed paradigm beyond paradigms, then and now? Its component ‘takes’ on the social world were and remain ‘disinhibiting’ (after the manner of alcohol), not emancipatory. Pick-and-mix petit narratives rather than a decisive choice between grand narratives (Lyotard). Habermas argued, rightly in my view, that postmodernisms/post-structuralisms are forms of neo-conservatism because they reinvent and espouse an epistemological relativism that rules out of court any rationally compelling narrative for change. I have to add that ALL arguments for relativism are – according to their own philosophical prescriptions – self-refuting. In the third chapter I set out my own frame, a composite of Habermas’ critical theory and Bhaskar’s critical realism with a pinch of added Scambler. It is a frame I remain generally content with.
Part two consisted of another trio of chapters, this time focusing on substantive areas of medical/health sociology, namely, health care reform, health inequalities and ‘lifeworld narratives and expert cultures’. It seems dated now but there is little I would want to revise. I now think the use of my ‘jigsaw model’ – of logics, relations and figurations – that I spoke about in my inaugural lecture at UCL is cumbersome. It works, but … What particularly pleases me 13 years after publication is that I drew on Allyson Pollock’s prescient, pioneering research to predict the medium-to long-term, hugely negative, financial impact of PFIs on the NHS as well as pinpointing US health care as a ‘satanic’ (ok, I didn’t actually use that word) institutional means for abandoning the working as well as the non-working poor. The US health care ‘non-system’ is a model to avoid at all costs, notwithstanding New Labour’s subsequent flirtation with it and Andrew Lansley’s loving embrace of it in his horrifying Health and Social Care Act. We are now beginning to live with the consequences of the Tory’s vested interest and ideologically driven privatization of the NHS (just check how many Tory – and not only Tory – MPs have shares in for-profit providers). Has the ‘greedy bastards hypothesis’ (GBH) ever been more convincing! The worrying thing is that we citizens will only truly grasp the effects of this assault on the NHS if and when we need it. Don’t be sick; and if sickness creeps up on or overcomes you, don’t be poor, or even in low-paid work.
If I might slip in another plug, I think there is some useful post-Freidson conceptual and theoretical under-labouring in the chapter on lifeworld narratives and expert cultures. But maybe I would say that!
The third section and its single chapter summarized what was then and largely remains my stance. I pushed for a critical sociology of health that had an elective affinity with deliberative democracy, civil society and the public sphere. Habermas again; and rehearsing an argument I originally made in my 1996 paper in Sociology. What is the point of sociology, I would now insist, if it is not purposively aimed – via the lifeworld’s enabling sector to its protest sector – AT AND THROUGH systemic opposition. Sociology is tied, logically and morally, to what Habermas terms ‘lifeworld rationalisation’. Otherwise …
So how would I appraise Health and Social Change now? I stand by it. Of course it has its limitations. I fully accept that: (a) my only-child, experiential and medical-school-induced propensity to work alone had/has reduced my capacity to learn from others; (b) my philosophical/theoretical inclinations are but one route to good sociology, (c) the propositions I commended are fallible and open to revision and rebuke (so they should be), and (d) my relentlessly challenging style may be off-putting (I was and am ‘hard work’).
I wrote what I wanted to write!
BUT, and this matters to me most, Health and Social Change represented my ‘best guess’ at the time. I continue to get frustrated when my fellow-sociologists cop out. So many books and, more so, academic papers, either just revisit extant philosophies, theories and arguments, or advise ways ahead without committing to anything bold and new. Playing safe maybe understandable, but it is an obstacle to good sociological practice oriented, as it surely must be, to lifeworld rationalisation!