Redefining Medicine: Boundary Work and Legitimating Claims Among Acupuncturists and Physicians Open Access

Crabtree, Charity (2009)

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In this study I interview physicians, licensed acupuncturists, and medical
acupuncturists (physicians who are licensed to practice acupuncture as well) in
order to clarify the types of boundary work and legitimating claims used to
maintain distinctions between acupuncture and conventional medicine in an
increasingly "diverse" medical field. All practitioners use social and symbolic
boundary work to some extent; where social boundaries are weak, often
symbolic boundaries become increasingly important to physicians trying to
maintain professional dominance. They are also important to acupuncturists
concerned with highlighting their distinctiveness from this institutionalized (and
seemingly flawed or inadequate) healing modality. The fluid nature of these
types of boundaries hints at the legitimation process undergone by exotic or
unusual cultural elements in our society. Moral and cognitive legitimacy are
valuable tools for overcoming social boundaries, and claims of such are
vehemently made (and challenged) by advocates (and adversaries). As more
patients are seeking out alternative treatments, results indicate that physicians
tolerate and even welcome alternative perspectives but use symbolic means of
distinguishing between good medicine and false hopes. Evidence also indicates
that acupuncturists have adapted explanations of acupuncture to fit the current
medical landscape, as a result contributing to an understanding of acupuncture
as a type of medicine that has the potential for filling in the "gaps" left by
conventional forms. Results suggest that the success of other types of healing in
entering the medical field depends on collecting a body of scientific research
supporting the claims of the alternative healers and developing explanations of
their medicines that make sense in the current medical landscape, as well as
making an argument that they are able to do things conventional medicines

Table of Contents

Table of Contents:

Chapter One: Introduction 1

Chapter Two: The Science and Culture of

Biomedicine and Acupuncture 12

Chapter Three: Theoretical Background/Complementary

and Alternative Medicine as a Social Movement 42

Chapter Four: Research Design/

Question, Methods, and Data 57

Chapter Five: Social and Symbolic Boundaries/

Working Together, Working Apart 93

Chapter Six: Legitimating Claims/

Cognitive, Moral, and Pragmatic 120

Chapter Seven: Conclusion/

Redefining "Medicine" 147

Epilogue: Machine or Garden?

Enchantment and Integrative Medicine 159

Bibliography 164

Appendices 1-8 173

Tables and Diagrams:

Table One: Types of Practitioners 57

Diagram One: General Model 58

Diagram Two: Training, Interactions, and Practice 59

Table Two: Hypotheses: Boundary Work 63

Table Three: Hypotheses: Legitimating Claims 71

Diagram Three: General Model 72

Diagram Four: Training, Interactions, and Practice 73

Diagram Five: Boundary Work/Integrative Practitioners 74

Diagram Six: Boundary Work/Non-Integrative Practitioners 74

Diagram Seven: Legitimating Claims 75

Table Four: Respondents 84

Table Five: Hypotheses: Boundary Work 94

Table Six: Hypotheses: Legitimating Claims 121

Diagram Eight: Legitimating Claims 145

Diagram Nine: Boundary Work/Integrative Practitioners 149

Diagram Ten: Boundary Work/Non-Integrative Practitioners 149

Diagram Eleven: Legitimating Claims 151

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