It was a great pleasure today to attend and speak at a meeting in Senate House in London to celebrate the career and writings of Mike Bury. Not least of the day’s pleasures was reacquainting with numerous old friends and colleagues. Many of the old London medical school group: David Armstrong, Judy Green, Charlotte Humphrey, Myfanwy Morgan, Jon Gabe and Mary Ann Elston, other medical sociologists like Sara Arber, Jocelyn Cornwall, Hilary Thomas, Anne Rogers, Jane Sandall, Clive Seale, Sue Ziebland, Gillian Bendelow, Joan Busfield, Ulla Gustafson and Mile Kelly, as well as ex-UCL colleagues Paul Higgs and Fiona Stevenson. New acquaintances too. The intervals between talks allowed for time to catch up with and meet a number of them. So a good day conference organised by Jon and Mary Ann and a fitting tribute to Mike’s accomplishments.
This blog, another short effort, picks up on Mike Bury as an important catalyst for sociologists in health and illness. My abstract for my talk was as follows (in the event I improvised around it):
‘Mike was an eloquent innovator conceptually and theoretically as well as in terms of his research interests. But he
is probably best known for his writings on living with chronic illness. It was in 1982 that he introduced the notion of
‘biographical disruption’. This article prompted a flurry of kindred activity: Kathy Charmaz wrote on ‘loss of self’,
Gareth Williams on ‘narrative reconstruction’ and I contributed with Anthony Hopkins on ‘felt and enacted
stigma’. Mike went on: to (i) develop and contextualise the ideas in this early article by
deepening his analysis of coping and managing chronic illness in relation to a changing NHS,
and (ii) confront and critique theoretical challenges to orthodox sociology approaches to
chronic illness via postmodern thinking.
I offer here an analysis of the division that has opened up between the ‘personal tragedy’
approach to chronic illness and the objections raised to it on the part of some disability
theorists and activists who link biomedical approaches that emphasise individual coping
with socio-political oppression. Recalling Freidson’s classic ‘Profession of Medicine’
published in 1970, we need to study the labellers as well as the labelled. I shall contend that
there exists a credible middle ground between the individualist personal tragedy and socio-
political oppression orientations to the study of chronic or long term illness. I shall
commend a model based on the evolving interplay between structure, culture and agency,
or a ‘social dynamism model’.
Many of the papers focused on the notion of biographical disruption. Mine acknowledged both its salience and its limitations. I outlined the personal tragedy approach, of its time and very influential. I then whipped through the challenges mounted initially by the unrestrained ripostes from disability activists-cum-theorists like Mike Oliver, who commended a ‘social model of disability’ focused on the notion of external oppression. I recalled an incident when I invited Mike to talk to some American students. The accident that put me in a wheelchair, he said, was ‘the best thing that ever happened to me’. Sitting next to me was Terry Boswell, who had just been diagnosed with motor neurone disease. He lent towards me and whispered: ‘I don’t think so’. I guess that Mike’s ‘biographical disruption’ had left him with a challenge, a new academic and activist identity and an agenda. But …
Mike’s ‘political’ or ‘social oppression’ orientation to disability, pinpointing the overriding role of external oppression, took few prisoners. We needed to study the labellers as well as the labelled.
The contributions of disability theorists like Tom Shakespeare and Nick Watson offered an intermediate point between the personal tragedy and political oppression perspectives. Carol Thomas offered a statement to this effect:
‘once the term ‘disability’ is ring-fenced to mean forms of oppressive social action visited upon people with impairments, there is no need to deny that impairments and illness cause some restrictions of avtivity, or that in many situations both disability and impairment effects interact to place limits on activity’.
So it’s not either/or for personal tragedy versus socio-political oppression.
I mentioned the revisitation of the challenges facing medical sociology/disability theory by Sasha Scambler and I in a forthcoming new ‘version’ of our 2010 edited collection (to which Mike, along with Kathy Charmaz, Gareth William and Carol Thomas, also no longer with us, contributed a chapter).
I didn’t have time to directly address my plan in the abstract to sketch a replacement ‘social dynamism model’ (nor do I in my chapter with Alice Scavarda in the edited collection with Sasha, which focuses on stigma resistance). But I at least commended such a model. How might it be summarised?
The core components of such a model/approach might acknowledge the following:
- Chronic/long-term illness and disability can introduce, trigger or be accompanied by impairments which on their own account ‘disrupt’ individuals’ lives.
- Socio-political oppression remains a key causal/explanatory factor in explaining the circumstances of people with chronic/long-term illness and disability.
- Stigma and deviance are relevant here too. Stigma denotes attributions of shame, while deviance denotes attributions of blame. I have argued in numerous publications that ‘blame has been heaped upon shame’ as a calculated political project, rendering those impacted as ‘abject’. And the abject can be sanctioned/punished by a state intent on cutting health and welfare benefits (the out-of-control ‘welfare bill’ as it is now termed in mainstream cross-party politics in the UK).
- Mike Bury ‘allowed for/did not exclude the warranty for’ such an analysis in his writings, although he would/did express it differently. He was not informed/convinced by a (neo)Marxian analysis whereas I am.
- I was only able in the time available to hint at the usefulness of Maggie Archer’s theory (picking up on Simon Williams’ recommendations with which I agree). But I think what is required is an analysis of the causal linkages between long-term/chronic illness and disability and the ongoing dynamic interplay between structure, culture and agency. Archer’s theory allows for/enables this. I’ve written a book explicating her theory so will abbreviate here (‘The Sociological Theory of Margeret Archer: A Critical Appraisal’, London; Routledge. 2026).
- Archer conceptualises/theorises the ‘morphogenetic’ (leading to change)/’morphostatic’ (leading to stability) forces that have since the 1970s characterised the transition from modernity (‘welfare state capitalism’ in my more Marxian terminology) to late modernity (for me, ‘rentier capitalism’). She does this independently for structure and culture. She offers a theory-based methodological toolkit for addressing this which can and might profitably be deployed to study/explain the changing perception and structurally and culturally-informed governmental approach to long-term/chronic illness and disability. I would enthusiastically commend the study of her theory, most obviously around the notion of a ‘morphogenetic cycle’ and her account of reflexivity. In a nutshell she offers a way a way of exploring the interplay between (i) structure, culture and agency, and (ii) macro-, meso- and micro-social factors.
- One sensible hypothesis arising from Archer’s contributions would be that different personal modes of reflexivity (autonomous, meta-reflexive, communicative and fractured) – each with tap roots in particular structural and cultural conditions and circumstances – have different implications for people’s capacity to handle any biographical disruption that comes their way.
- It is worth emphasising that Archer’s notions of morphogenetic cycles and reflexivity can be deployed in multiple ways, not just, as is implicit in (vi), at the societal level. For example, they might be used to throw light on changing professional medical and lay attitudes and practices in relation to particular chronic illnesses and disabilities over time, and on any structural shifts that underlie those changes.
An Archer-motivated sociology of chronic illness and disability might well open the door to the kind of ‘social dynamic model’ I alluded to in my abstract.
In my view Mike Bury was not oblivious to all this – to the structural, cultural and agential context – and forces at play – when individual decisions around chronic illness are taken. But he didn’t get stuck into it. Nor, I suspect, would he have approved of my way of doing so, my theoretical ‘take’. In his various publications, several in books I edited, he displayed considerable elegance, subtlety and nuance. And he played a considerable role in the consolidation and growth of medical sociology in the UK, providing an important teaching and research linkage between Margot Jefferys, George Brown, Margaret Stacy, Raymond Illsley & Co, the seniors in my day, and present practitioners. It was a pleasure today to salute his contributions.