Locating Medical History: The Stories and Their Meanings

10 Social History of Medicine in Germany and France in the Late Twentieth Century: From the History of Medicine toward a History of Health

C H A P T E R T E N Social History of Medicine in Germany and France in the Late Twentieth Century From the History of Medicine toward a History of Health Martin Dinges What has distinguished the social history of medicine might be explained by contrasting it with other, earlier work. By and large, before 1970 medical history had been written by physicians, mainly for physicians, and about physicians and their world view. The social history of medicine, however, has tended to widen the focus to encompass all medical personnel, including, for example, nonacademically trained healers and nurses; to consider the economic aspects of medicine; and to give the patient—all but unknown in earlier medical history— his or her own place as an actor. A sufferer is interested in health matters long before any physician becomes interested; people experienced pain long before the emergence of a medical discipline like anesthesiology. At the core of my idea of the social history of medicine are questions of power and the inequality of chances. The inequality concerns the access to life chances and medical care, as well as the chance to become a historiographical subject: patients’ voices are weak in the bulk of sources used for medical history because this material originally was produced to allow physicians to work and health care administrations to function. No doubt one might also define the field by the object of research—medicine and society and their relations—or the specificity of theoretical or methodological 210 A Generation Reviewed approaches.1 Different combinations of these three have also been discussed. There is no doubt that medium-range theories—such as the patient’s role or professionalization —have helped to shape the field, and the same holds true for the use of larger concepts, ranging from historic materialism to theories of social differentiation, modernization, and the more recent theories of knowledge. Nevertheless , I prefer here not to restrict my focus to specific approaches to the exclusion of others but instead to concentrate on a field of research and, as a general approach, the social construction of illness.2 In this conception the different actors—patients, healers of all sorts, authorities (such as the state), and interested third parties—all have an influence on what is socially considered to be a disease.3 Their intellectual, symbolic, economic, and political resources varied from century to century. This ‘‘equipment’’ determines their chances to impose their view, but there is no need to presuppose that a specific—for example, the medical— vision of illness always and necessarily imposed itself over the other conceptions. In this chapter, I explore several interrelated shifts in historiographic attention over the past generation. I first look at the move toward a more differentiated view of actors, institutions, and experiences in the epidemiological transition and from general attitudes toward patients’ experiences with epidemics. I then turn to the shift from professionalization as a concentration of (monopolistic) power toward a better understanding of the variety of health care services offered in a pluralized medical marketplace, and from medicalization from above toward the power of demand. Finally, I examine the movement from ideas and ideologies toward discourses informing practices. My aim is to explain these shifts by limiting myself to some key examples, not to offer anything approaching an exhaustive literature review.4 Trained as a social historian of early modern Europe (with research in the 1980s on poverty and deviant behavior in France), I will concentrate on the modern era, chiefly up until World War I.5 Due to limited space, I will bypass the history of psychiatry, a large field that would merit a study of its own.6 I shall also emphasize the German-speaking countries, referring to France as a point of comparison. This focus might suggest that research in these two linguistic spaces interact strongly, which—aside two conferences in the 1980s and two recent monographs7—definitely is not the case. Because of linguistic competences on both sides of the Rhine, German and French research has been much more influenced by Englishlanguage publications. Nevertheless, I will concentrate on research conducted in Germany and in France, generally excluding research on Germany and on France by Anglophone historians such as Richard Evans, Colin Jones, Mary Lindemann, Social History of Medicine in Germany and France 211 Mathew Ramsey, and many others who were instrumental in...