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An Ethnography
of a Chiropractic Clinic

Chapter 6: General Review,
Statement of Contributions, and
Suggestions for Future Research

© 1975
James B. Cowie, PhD
Julian B. Roebuck, PhD

Chiropractic is the largest and most influential of the competing health care practices in the United States. Labeled deviant by at least six formal, rulemaking, and sanctioning bodies, chiropractic, as a profession, has struggled for recognition by and approval from American society at large. A radically unique explanation of the origin and nature of disease, Coupled with an internal division or conflict within this occupational group [1], has hindered its professional image.

The present study has focused upon one chiropractic clinic in an attempt to examine the consequences of what has been referred to as the marginally deviant status of' the practitioner who ran it. Although no major assumptions were held prior to the research, it seemed obvious that what took place in this setting was different from what one would normally expect in an establishment medical doctor's office. Of central concern were the various points of view and social meanings held by the various actors within this behavior setting: the practitioner himself, his regular full-time assistant (his wife), and the numerous persons who came to the Clinic as patients.

Utilizing the symbolic interactionist stance, Coupled with the sensitizing concept of the behavior setting, and employing the methodology of participant observation, this study has sought to provide a body of empirical data not characterized by the bias often shown in the so-called objective approach which is normally employed in sociological studies of deviant behavior. By seeking out actors' definitions of the situation by a careful examination of their observable actions, including their interactions, and observing how they create and maintain rationalizations for those actions, the object has been to specify interactional patterns within that behavior setting.

Being an ethnographic account, this study has not had as its purpose the support or rejection of any theory or derived hypotheses put forth before or developed during the study. As a result, the most systematic means of evaluating the success of such an endeavor is to summarily review contributions to the sociological enterprise in the area of deviant behavior in general and to the study of the chiropractor in particular.

First, as indicated, although chiropractic as a profession has received some attention from sociologists [1-6], no work has been done on the everyday behavior of the chiropractor himself in the realities of a social situation. Being a representative of one of the most influential competing health care systems in the United States, the chiropractor, as a social actor, has deserved this type of attention.

Although the present work has focused upon one practitioner in one clinic, it has been shown that there is every reason to believe that this Clinic is not unlike others, especially if they are operated by straight chiropractors. For such reasons this study should shed further light on the profession as a whole.

Second, this study has added to the comparatively recent methodological efforts to supply data on social deviance, i.e., that methodology which demands the gathering of data within the actual ongoing situation. Traditional objective methods have recently been criticized for their tendency to gather and remove data from the realities of everyday social phenomena. Statistics and removed-from-the-scene reports do not reflect the natural context of deviance.

The methodology utilized in this study represents an attempt to convey the behavioral actualities of a chiropractic practitioner, his staff, and his patients as actors within all unconventional behavior setting, of the practitioner's own design.

A third contribution is the manner in which the task of presenting a history and general review of substantive literature was handled. Traditionally, this necessary task has been approached again, from an objective stance. This has been wen to have its limitations in that it does not reflect the perceptions and conceptions, which are inextricably bound together, of the actors in the world of their everyday lives.

A major assumption, based upon the premises of symbolic interactionism, is that the social actor relies upon past learned experiences (in this case, primarily the practitioner's formal and informal training and his experiences in the Clinic) in order to (1) perceive, evaluate, and modify his behavior in present situations, and (2) orient his behavior in Such a way as to prepare himself and others for imagined future events. (This statement, it should be noted, is an oversimplification of Mead's argument in which he asserts that even present behaviors are in actuality future-oriented. For an elaboration of this particular philosophical point, see Mead's Philosophy of the Present [7].

Thus, by presenting a general history, philosophy, and socio-legal status of chiropractic from the point of view of the central figure in the Clinic, it is seen to be directly applicable to the understanding of his actions, i.e., his explanations and rationalizations of his own actions, the actions of others, and the interactions which took place between them.

Fourth, the present study has attempted to define a set of delimiting and directional guidelines within which the notion of a behavior setting becomes operationally heuristic. Drawing upon an earlier work done in the field of ecological psychology, the chiropractic clinic in this study was defined in terms of' a total configuration delimited by spacial and temporal barriers. Also included were physical objects and standing patterns of behavior relative to those objects.

For the ecological psychologist, these spacial and temporal characteristics are, in a sense, given, in the present work, they are seen as being socially relative to the situation as it through time (as distinct from existing in time). An example of this last point, it will be recalled, was the practitioner's awareness of these situational qualities and his attempts to modify them as he problematically conceived of the necessity for doing so. In other words, the behavior setting was, at least, always potentially modifiable according to his situationally relative definition of that setting. From a symbolic interactionist view, the physical setting and the social setting are inseparable: one cannot be considered without the other.

A fifth contribution, closely related to the discussion above, is the empirical demonstration of methodographic activity on the part of the principal actor in the behavior setting. Buehler has stated that all persons engaged in professional activities before a public ("audience," in Goffman's dramaturgical terms), methodographically assess and modify their appearance and behavior ("presentation of self"), i.e., their methods of impression management. Clearly, this is consistent with the interactionist's position that social actors possess the capability of modifying their courses of action relative to their changing definitions of the situation. As seen in the previous chapter, the practitioner was clearly cognizant of differences among patients in terms of a variety of responses to him and to chiropractic in general. In light of these perceived differences among patients, he methodographically assessed and modified his methods of self-presentation.

Not only was this concept useful in the understanding of much of the practitioner's behavior in the Clinic, but the empirical evidence of this phenomenon in an actual situation provides at least partial support for Buehler's claim for trans-situational applicability. Thus, it appears to be a viable conceptualization.

A sixth contribution, and possibly the most significant finding of the entire study, necessitates a careful reexamination of what is seemingly an implicit assumption held by those researchers utilizing the labeling approach to deviant behavior: the labeled person is seen to be a relatively powerless individual, responding passively to the label as it is applied by other individuals who possess social power. (This point is well-documented by Schervish in the article mentioned in Chapter 5.)

It is obvious that the practitioner in this study did possess a considerable degree of social power. It was power not in the sense normally thought of when considered as a coercive force, but power in the sense that he was able to manipulate the composition of the audience directly confronting him. In other words, he had the ability to (1) eliminate certain patients who persisted in their definitions of him as a "quack" by labeling them, in turn, deviant in the sense that they failed to meet his standards of patient acceptability, and (2) having been trained in the techniques of salesmanship, he could present an acceptable front to other patients, thus assuring their return to the Clinic. By eliminating some and securing the allegiance of others, he could create for himself a fairly stable and satisfying standpoint from which to see himself as a competent professional (George Herbert Mead's role-taking process).

Although other attempts have been made to demonstrate the deviant's attempt to neutralize the deviant label (e.g., Sykes and Matza: Techniques of Neutralization [8]), the question of whether or not an individual labeled deviant could possess the ability to manipulate the audience (the labelers) has not been considered. Perhaps similar examples can be found in which the deviant possesses this power to control the make-up of the audience immediately confronting him (e.g., the ivory tower college professor). If so, a comparison of the techniques employed by these diverse marginally deviant persons would be valuable for future research.

Certainly, another area which demands closer attention than it has received in the limited research seen so far pertains to the socioeconomic characteristics of persons who seek out the services of marginally deviant health care practitioners (see Schmitt [6]). The question of why these persons deviate from the norm of seeing the establishment medical doctor when physical problems arise rernains to be answered. Furthermore, the psychology of conversion to a deviant health care service is even more of a mystery. Hopefully, the present work will add insight to questions dealing with chiropractic and/or similar forms of marginal deviance.

REFERENCES

1. Leis GL. The Professionalization of Chiropractic. Unpublished doctoral dissertation. State University of New York at Buffalo, 1971.
2. Wardwell WI. Social Strain and Social Adjustment in the Marginal Role of the Chiropractor. Doctoral dissertation, Harvard University, Department of Social Relations, 1951.
3. McCorkle T.. Chiropractic: A deviant theory of disease and treatment in contemporary Western culture. Human Organization 20(1):46-62, 1961.
4. Mills DL. Study of Chiropractors, Osteopaths and Naturopaths in Canada. Ottawa: Queen's Printer, 1966.
5. Sternberg David. Boys in Plight: A Case Study of Chiropractic Students Confronting a Medically-Oriented Society. Unpublished doctoral dissertation, New York University, 1969.
6. Schmitt MH Who Goes to Chiropractors: Descriptive Data on a Sample of Medicaid Chiropractic Utilizers in the Buffalo, New York Region. Working paper submitted to the American Sociological Association, Aug 27, 1974.Montreal, Canada, 1974.
7. Mead GH. Philosophy of the Present (Merritt H. Moore, ed.). Chicago: Open Court, 1932.
8. Sykes GM, Matza D. Techniques of neutralization: A theory of delinquency. American Sociological Review 22:664-670, 1957.

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