toys in the attic:
ideological furnishings for the
homeless mind
action
theory & the human condition
I - SOCIOLOGY OF HEALTH AND ILLNESS AND RELATED TOPICS - 11
Introduction to Part I
PART I Is CONCERNED with the first of the three more
empirical areas mentioned in the General Introduction,
namely, health and illness, higher education, and religion. As noted in the General Introduction, health and illness were for me
an object of substantial study in an examination of certain aspects of modern
medical practice in the period immediately following the completion of The Structure
of Social Action.1 A
number of publications appeared in this period, the most important of which was
Chapter 10 of The Social System,2 entitled “Social Structure
and Dynamic Process: The Case of Modern Medical Practice." A group of other papers, though not all on
this topic, were collected in the considerably later volume Social Structure
and Personality3 and in Family, Socialization, and Interaction
Process (with Robert F. Bales and others).4
Two themes were dominant in this phase of
concern with problems of health and illness.
The first of these was centered on the relevant role structure in
the social system; primary focus was placed on the roles of physician and
patient, the latter greatly overlapping with what I called the “sick
role." (The two are not
coterminous since many sick people are not patients and a few patients are not
sick.) This role complex was treated as
a salient example of the larger category of the profession
role complex, which above all was contrasted
with that of the business proprietor and his customer, which has been so
prominent in modern society and so important in debates over capitalism versus
socialism. This phenomenon clearly
belonged in the context of problems of the relation between economic and
sociological theory. One of my theses
has been that the heavily economic tradition of our social sciences has not
done justice to the importance of the professional complex in modern society.
1 Talcott Parsons, The Structure of Social Action
(1937; reprint ed., New York, Free Press, 1949).
2 Talcott Parsons, The
Social System (New York: Free Press, 1951).
3
Talcott Parsons, Social Structure and Personality (New York: Free Press,
1964).
4 Talcott Parsons and
Robert F. Bales, in collaboration with J. Olds, M. Zelditch, and P. F. Slater, Family,
Socialization, and Interaction Process (New York: Free Press 1955).
12 SOCIOLOGY
OF HEALTH AND ILLNESS
The second primary theme concerned the
relation of social structure to the personality of the individual, with special
reference to the health and illness of individuals. Not only was my first careful reading of Freud's works associated
with this area of inquiry but so was my emphasis, derived from my field
experience, on what many practitioners I observed stressed - the "psychic
factor in disease" - and in part by extension on the problem of the nature
of "mental" illness and of course health and the reasons for the
salience in modern (especially American) society of these problems.
The revisit to these two sets of themes in the essays
included in the present volume does not repudiate my previous positions but
puts them in a broader perspective, adding certain important insights to them.
The four essays in Part I may be characterized as follows. Chapter 1, "The Sick Role and the Role of the
Physician Reconsidered," is strictly a revisit, formulated in the light of
discussion subsequent to my earlier proposals about the roles of the physician
and patient and the sick role. It is a
summary, interpretive comment on problems presented to me in a session on the
sick role (organized by Andrew C. Twaddle) at the 1974 Toronto meeting of the
International Sociological Association.
My role was to comment on four papers that were made available to me in
advance. Chapter 1 was written after
the Toronto meeting at the request of the editors of the Milbank Memorial Fund
Quarterly; still, it was very much
oriented to that meeting
and, its discussions.
The three other papers explore some of the
peripheries - in sociological terms - of this central core. Chapter 2,
"Research with Human Subjects and the 'Professional Complex,'" was
written at a time (1968-69) when the ethical issue of such experimentation was
coming to occupy a leading position in the debate over public policy. In this situation, Daedalus, at the request
of the Surgeon General of the United States, convened a high level conference
of various medical people, a few social scientists, and others, chaired by Paul
A. Freund, a professor of law. Being
invited to present a paper, I chose to try to relate the topic of the
conference to the professional complex considered at the sociological
level. This approach drew very much on
my background of study of medical practice but also reflected my enhanced
awareness of the fact that since my earlier studies teaching in hospitals
attached to medical schools increased as a major focus for the medical world
and that there had been in addition an efflorescence of the research function,
especially in what are still called teaching hospitals. Patients, therefore, had become
"subjects" not only for the teaching of medical students but also for
"utilization" by research personnel, a large proportion of whom were
not physicians. What were the
implications of this new situation for the role in particular of the
patient? I tried to link this problem
to that of the structure of the intellectually prominent world in the
university and the place of research in it.
Indeed, by that time I had begun to be engaged in special study of the system
of higher education.5
Introduction
to Part I 13
This phenomenon in the medical world is one of the
most important examples of a much broader one, namely, the penetration of the professional complex beyond the
more academic parts of the university into many branches of the organization of
the society. Thus, biomedical research
is carried on in the teaching hospitals of medical schools, as well as in a
variety of government agencies, pharmaceutical firms, and elsewhere. Most of the large industrial firms in our
society have research agencies and so it goes.
The higher level staffs of these organizations almost uniformly include
considerable numbers of technically trained professional personnel many of whom
have or have had a choice between academic and non-academic careers and
sometimes have pursued both. I
deliberately include here not only natural scientists and engineers but also social scientists, especially economists and psychologists,
and lawyers.
The phenomenon of professional
penetration may be regarded as an important aspect of a principal
structural change in modern Society. It
seems to me at least that we have been in the midst of a major example of the
process of adaptive upgrading, which is discussed in the Introduction to Part
III of Social Systems and the Evolution of Action Theory.6 The central process has been the emergence
of what Gerald M. Platt and I have called the "cognitive complex" 7
into a new position of structural salience in Western societies, in part
superseding the previous position of the economy. For this reason (among others) a predominantly economic
interpretation of the course of development of modern societies is unacceptable
to me. This article also serves to link
Part I of the present collection with Part II, which deals with higher education.
Chapter 3,
"Health and Disease: A Sociological and Action Perspective," is one
of the most recent I have written. It
was requested by the editor of the new Encyclopedia of Bioethics
(1978). I was asked to treat the
sociological aspects of the problem, but at my request the word
"action" was included in the title.
I sought this rephrasing because I believed that the subject could not
be adequately covered without explicit consideration of the other parts of the
general system of action, especially the personality system.
This article constitutes a renewed probing into the
foundations of the health-disease complex, which must in my opinion be pursued
to the level of the human condition.
Moreover, this level must be linked with the sociological, cultural, and
psychological levels because among other things, of the involvement of the
phenomena of health and disease with the organic level of the human
condition. It seems that an adequate
articulation between these levels is essential to clarifying the meaning of
health and disease and that most attempts to do so fail to provide this
clarification.
5 See the Introduction to Part II of this volume.
6
Talcott Parsons, Social Systems and the Evolution of Action Theory (New
York: Free Press, 1977).
7 Talcott Parsons and
Gerald M. Platt, in collaboration with Neil J Smelser, The American
University (Cambridge, Mass.: Harvard University Press, 1973).
14 SOCIOLOGY
OF HEALTH AND ILLNESS
Chapter 4, "The
Interpretation of Dreams by Sigmund Freud," is a very brief and quite
recent paper. It is another invited
contribution – an interesting case in which I allowed myself to be influenced
by an editor and am glad to have accepted his advice. Stephen Graubard, the editor of Daedalus, was planning an
issue on key books of the twentieth century reconsidered and asked me to
discuss one of them. I proposed
Durkheim's The Division of Labor in Society,8 stretching a
point because it was first published in 1893.
Graubard, however, countered with, "Why not Freud?" leaving to
me which work to discuss. On
reflection, I accepted the suggestion and chose The Interpretation of Dreams,9
which barely falls within the limits because it was originally published in
1900. I completely reread the book in
German, which some perhaps tend to forget was Freud's native tongue and the
language in which he wrote.
I chose The Interpretation of Dreams because I
knew it was Freud's earliest major book-length publication, a rather late
effort since he was forty-four when it was published. Clearly, it is the first mature statement of the foundations of
psychoanalytic theory. My revisit of
this work many years after my initial reading left me enormously impressed with
its quality. Let me mention only two
major themes. The first is the clarity
with which Freud thought in terms of the conception of the human personality as
a system in the scientific sense of that word.
It was almost as if, which obviously could not have been the case, he
had been brought up on the writings of Lawrence J. Henderson 10 and
Alfred N. Whitebead,11 as I was.
The second impression is the clarity and consistency with which Freud
stuck to his last in insisting that he was dealing with, to use his own term, a
"psychic" system. Freud has
very generally been interpreted, especially because of the prominence of the
term "instinct" in English translations of his work, to be a
"biological reductionist." To
me this is an egregious misinterpretation.
8 Emile Durkbeim, The Division of Labor in Society,
trans. George Simpson (New York: Free Press, 1964); first published in French
in 1893).
9 Sigmund Freud, The
Interpretation of Dreams, in vols. 4 and 5 of The Standard Edition of
the Complete Psychological Works of Sigmund Freud (London: Hogarth Press
and the Institute of Psychoanalysis, 1953; first published in German in
1900).
10 Lawrence J.
Henderson, Pareto's General Sociology: A Physiologist's Interpretation
(Cambridge, Mass.: Harvard University Press, 1935); and idem, The Order of
Nature: An Essay (Cambridge, Mass.: Harvard University Press, 1917).
11 Alfred N.
Whitehead, Science and the Modern World (New York: Macmillan, 1935).
Introduction
to Part I 15
One of the most important corollaries, we may almost
call it, of Freud's strict adherence to the conception of the personality as a
psychic system is that a central theme of his analysis of dreams is that of the
role of symbols in the dream process. This of course is a theme on which Freud
concentrated much attention throughout the rest of his career. It is of particular significance to us
because its importance to Freud clearly points to the interpretation that his
theory of personality is basically a part of the theory
of action not a part of what has come to be known as physiological psychology.
To carry this point one step further. When Freud referred to
the human mouth ("orality"), anus, penis, and vagina as symbols,
he was of course referring, for the manifest content of the symbols, to
anatomical features of the human body.
The psychological meanings of these
symbols, however, are not organic but are phenomena in what Freud himself would
have called the "intrapsychic" realm. I call these meanings "motivational." They have to do with the directions and types of
commitment in which, in Freud's own term, the individual is brought, in
the course of his/her life history, to
"invest" the libidinal energy available. This level of psychological symbolization is
in turn articulated with that of cognitive-behaviorial systems and that of
social and cultural systems. [jjd 11/3/01:
notice we definitely are not talking gender-ish person-to-person
relations, ie who is doing what to whom according to (some) “preference:” we
are entirely in the “detachment” of action.]
In a later statement, Freud wrote about instincts as
the "psychical representations of an endosomatic, continuously flowing
source of stimulation." 12 They
are thus psychic entities that operate on the boundary of
what we call the personality system vis-a'-vis the organism. They are, then, indispensable, as factors in
the generation of libido, to the cathexis of objects through which the
structure of the personality of the individual comes to be built. In a still later statement,13
Freud asserted that verbal meanings also are
essential component's of libido.
It seems that a main source of the difficulty over reductionism in the interpretation of Freud's work
is the fact that although he was - as a medical man - exceedingly well versed
in the biology of his time there is not a comparably firm grounding in theory
of the action aspect of his work. Freud
was himself one of the few greatest builders of the theory of what he called
the psychic system of the human individual.
As we have seen, however, this human
individual must be regarded as intricately embedded in a larger action
matrix, to the cognitive aspects of which Freud made few contributions
and in regard to which he took available resources only partly into
account. More important, he had little theoretical understanding of the social system and
the cultural aspects of the action system even though, empirically, he was very
sensitive to these fields.
12 Sigmund Freud, Three Essays on the theory of Sexuality,
vol. 8 of Standard Edition, (1953; first published in German in 1905),
p. 168.
13 Sigmund Freud, Beyond
the Pleasure Principle, vol. 18 of Standard Edition sect. 4, (1955;
first published in German in 1920).
16 SOCIOLOGY
OF HEALTH AND ILLNESS
This lack is understandable since the disciplines
dealing with action were substantially less developed in Freud's formative days
than they have since become. A very
recent revisit to some of these themes in these discussions is reported on (as
the main part of Part IV of the present volume) in Chapter 15, "A Paradigm
of the Human Condition." I hope
the reader will agree that the advance over earlier considerations of these
problems is heavily dependent on further theoretical development of the theory
of action, which in turn has cleared the way for a better analysis of the
boundary relations between the action system and the system of human biology,
both as individual organism and as species.