ABSTRACT
While there are probably many sociologists who end up producing studies quite different from those they envisioned when they started, mine is more a story about stubbornly resisting the kind of study I eventually produced. The New Pediatrics: A Profession in Transition was published in 1996. The book, an extension of my Ph.D. dissertation, presented an account of the emergence and development of pediatrics as a primary care specialty in North America. Based mostly on a review of documentary materials, especially pediatricians’ own professional literature, I tracked the struggle of the first pediatricians to get children recognized as more than “miniature adults,” to get children’s health problems recognized as deserving of special attention, and to get those who studied and treated children recognized as legitimate specialists. I followed the development of pediatrics as it evolved into a primary care specialty-a point of first contact for children with health problems-and through a series of crises the specialty experienced during the 1960s and 1970s that led pediatricians eventually to expand their scope of practice to include not only children’s physical health, but their behavioral and social problems as well. The expansion changed the practice of pediatrics, but it also changed how children’s behavioral and social problems were viewed, framing them as medical issues. Clearly, in terms of its analytical focus, the New Pediatrics was a study
about a profession and processes of professional transformation. That is not, however, how the study began. In fact, in the initial conceptual stages of the research I deliberately tried to avoid a study of professions. I had just completed a master’s thesis on a profession-chiropractors in Quebec and their quest during the 1970s for legislative recognition and legitimacy. Forcing myself perhaps a bit too soon after the fraught completion of my M.A. to
make a decision about the topic of my dissertation, I resolved to do anything but another study on professions. I could say the decision was driven by a high-minded desire to expand my sociological horizons and explore bodies of theoretical literature beyond the literature on professions. I may actually have uttered something to this effect on occasion as a justification for my change in direction. In truth, it was more a matter of feeling burned out and quite sick at that point of the professions literature. Sitting with Malcolm Spector, my advisor, for a “what next” kind of discussion, I can recall saying: “Nothing to do with chiropractors or professions!” I expected an argument about the wisdom of building on what I had already done. Instead, Malcolm simply said: “OK, not chiropractors or professions. So what do you think you would find interesting?” I thought back over the courses I had taken and the readings I had done
over the course of my graduate training-in medical sociology, deviance and social problems, and symbolic interactionism, labeling theory and the social constructionist perspective. The ideas in much of that work seemed to converge in exciting ways, it struck me, in the case studies that were emerging during the late 1970s and 1980s on medicalization. Sociologists working in a diverse range of areas were writing about the extent to which so many aspects of life, including behaviors and social conditions defined as deviant, objectionable or problematic, were seen as medical concerns. Many of these case studies were published in Social Problems. Malcolm served as editor of Social Problems between 1979 and 1984, and through those years generously allowed me to help out with the journal. The experience gave me the opportunity to read many of the manuscripts that came in. The growing interest in medicalization was clear. That experience coincided with the publication in 1980 of Peter Conrad
and Joseph Schneider’s book Deviance and Medicalization: From Badness to Sickness. The book offered a collection of studies that Conrad and Schneider had conducted, some together, others individually, on the medicalization of such conditions as alcoholism, mental illness, hyperkinesis and opiate addiction. The book also presented a general framework for studying processes of medicalization. Influenced, as Conrad and Schneider themselves were, by Spector and Kitsuse’s writing on social constructionism, I imagined processes of medicalization to be essentially about claims-makers framing their claims about putative conditions in medical terms. I thought it would be useful to look at the process more explicitly in these terms. Searching for a case to examine, I was inspired by a series of papers on
medicalization that I found particularly fascinating, all of them involving children. The earliest of these studies, one that has since become a classic in the medicalization literature, was Peter Conrad’s account (1975; 1976) of how the hyperkinesis (hyperactivity) label was created and then promoted as a way of understanding children’s misbehaviors and poor school performance. Another study that had stayed with me was Stephen Pfohl’s (1977) “The
‘Discovery’ of Child Abuse,” which shows how through the claims-making efforts of pediatric radiologists, the neglect and maltreatment of children came to be understood as a manifestation of “child abuse syndrome.” A paper I worked on during my stint as editorial assistant for Social Problems was Johnson and Hufbauer’s (1982) analysis of how a group of parents agitated to get babies dying inexplicably in their sleep researched in a way that led ultimately to the construction of the “sudden infant death syndrome” label. Each of these papers made passing reference to the medical profession and
in some cases more explicitly suggested that pediatricians were implicated in these new medical understandings of old problems, but there was not much clarity in the literature on how pediatricians were involved. I wondered what role pediatricians were playing in the medicalization of so many childhood issues. If not the primary claims-makers themselves, I assumed that pediatricians at least endorsed these new understandings. As the medical specialty most closely connected to children, was the medicalization of any condition related to childhood even possible without pediatric endorsement and if so, what did that say about processes of medicalization and the role of the medical profession in these processes? I decided I would look more closely at where pediatricians fit into the picture. While I was studying pediatricians, I did not think of my project at that stage as a study in professions. Rather, since my questions were framed in terms of debates in the literature on social constructionism and medicalization, I envisioned a project that would contribute more centrally to a better understanding of the medicalization of childhood. I was persuaded that the questions I would be asking had the potential to
make both substantive and theoretical contributions. Above all, though, I found them intrinsically interesting. When Malcolm asked if I could see myself living with the topic I had chosen for the years that it would likely take me to finish the dissertation-warning me that there would be days where my interest in the subject and that alone would carry me forward-I did not hesitate to say yes. I sometimes hear colleagues, and especially graduate students, thinking more strategically these days about “hot” areas of sociology with which to connect themselves, wondering what potential employers and other audiences would find engaging or relevant and ruminating about what kinds of intellectual alignments would be most careerenhancing. Such considerations have probably always figured in some way in the decisions that sociologists make about what to study and how to study it. Or possibly the field and the world have changed in ways that make it sensible to take a pragmatic approach to the selection of topics and approaches. However, if I might be permitted a caution it would be this: Doing ethnography, like old age, is not for sissies. The task can be challenging enough without pushing oneself to study something that one does not find personally engaging or an approach that does not resonate on some level. There is wisdom in the advice that seasoned researchers often give-“study something
that grabs you.” If it grabs you powerfully enough, you will figure out how to make it interesting, relevant and engaging to others.
