Doing Feminist Research

H. Roberts

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136102448
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

By now it must be clear to even the most traditional of male scholars that in doing sociological research we can no longer follow Evans-Pritchard's advice to behave like a gentleman, keep off the women, take quinine daily and play it by ear. This volume presents accounts of research work undertaken by sociologists who have been influenced by feminism or the feminist critique of sociology, or both. It proceeds from the basis that problems raised in personal accounts of research are themselves of sociological importance and that such accounts can offer the student a lively insight into research of a kind that is often denied by conventional methods textbooks. That there are sexual as well as social divisions in society cannot be ignored by sociologists, but much of the work that has appeared up to now has been concerned with making women visible within sociology. There has been little basic theoretical work, and still less work on the ways in which either taking a feminist perspective, or even merely taking account of women in research, affects the research process. This volume presents discussion on practical, methodological. theoretical and ethical issues raised where the sociologist adopts, or is aware of, a feminist perspective. 'There are very few methods books like this one that sociologists would pick up and read from cover to cover - and cause a queue of colleagues to form eagerly awaiting to get their hands on it. Compelling reading'. Colin Bell New Society

1

Women and their doctors:

power and powerlessness in the research process¹

Helen Roberts

This chapter, although drawing on a particular research project, attempts to raise in a preliminary way issues which are developed in more detail in subsequent chapters, and to look at general problems concerning the development of particular ways of doing research which can be related to a wider feminist perspective in sociology.

In recent years some sociologists (mostly feminists) have been tackling the problem of the ‘invisibility’ of women in sociological enquiry. During this time, although some attention has been paid at the level of informal discussion (for instance within the British Sociological Association Womens Caucus) to problematic methodological issues for those working within a feminist framework, little has been written on the subject.

In 1977, Helen Roberts and Michèle Barrett, working together on a sociological analysis of womens’ consulting rates at their general practitioner, were asked to contribute to a workshop on qualitative methodology where the organisers suggested that papers should focus on the ‘intellectual rather than the practical or “political” problems of qualitative research’. It seemed at the time that it was not only in this particular piece of research that a separation of the intellectual from the practical and the political was problematic, but this research, by adopting a framework in which the women studied were subjects rather than objects, may have rendered the ‘political’ problems more evident. In what follows, Helen Roberts looks at some of the issues raised by the use of a feminist perspective in theory and practice as well as in methodological issues.

Grace: They call me Grace.

Yesterday I went

to the grocery store.

I had filled up

the cart

and was halfway through

the check stand

before I realised

I had shopped for the whole family.

The last child left

two years ago.

I don’t know what

got into

me.

I was too embarrassed

to take things back

so I spent the week cooking

casseroles.

I feel like one of those

eternal motion machines

designed for an

obsolete task

that just keeps on

running

I certainly don’t want them

back either.

When the

last baby stopped getting

up at

night, I didn’t stop …

… And William never

understood. To him

if you are tired, you sleep.

I have never been able to

penetrate the

simplicity of his logic

which is

after all

the logic

of most of the world. (Griffin, 1975, p.35)²

This extract from Susan Griffin’s poetry play Voices (1975) serves as an illustration of some of the central concerns in looking at the consulting rates of middle-aged women at the doctor’s surgery. The first part of the quotation points in a very acute way to the feelings of some middle-aged women after their children have left home and they perceive themselves (and are frequently, if implicitly, perceived by others to be) socially obsolete. The second section, which refers to

‘the logic
of most of the world’

provides a starting point for some of the methodological issues I should like to discuss.

Our research on women and their doctors was begun in the light of the well documented fact that women have higher consultation rates with their GPs than do men, that middle-aged women have a particularly high discrepancy with men in this respect once consultations for childbirth and contraception in the younger age group of women are taken into account,³ and from the widely held view that a good deal of the complaints of high consulters in this age group are seen as ‘psychosomatic’ in origin. We held the view that the label ‘psychosomatic’ as applied to the complaints presented by certain groups of women was less apposite than the parallel term ‘sociosomatic’⁴ since the latter acknowledged the social basis of such psychological phenomena. We held that the social and economic structure of modern industrial society systematically causes women to be disadvantaged educationally, occupationally, and in other ways. This disadvantaged position, as Friedan (1973) and others have suggested, may have as its result vague feelings of dissatisfaction and minor worries and complaints. We wanted to explore the possibility that women in this position, particularly women with little interest outside their families (and therefore most vulnerable at middle age as their children leave home) use their doctor as a source of attention and sympathy as well as a source of compensation for the frustrations and inadequacies of their daily lives. (In fact, we found that their visits to the doctor were more than this, and that the doctor played a more active part in reconciling women to their traditionally prescribed role.)

Preliminary research we had done indicated that an analysis of ideological factors in general practice consultations was essential, and we were inevitably led in formulating our work into a discussion of the general practitioner’s attitudes towards his or her patients. These attitudes were, we found, particularly relevant in relation to the gender of patients, which the doctor perceived as an important influence in determining their priorities in life. We also found that it would be necessary to look at the patient’s attitudes towards her doctor, and the congruence between these attitudes, those of the doctor, and those of ancillary staff and specialists. Hence, as well as approaching the study in such a way as to secure qualitative and quantitative data, we wanted to approach it from the doctor’s view as well as from the patient’s. It seemed to us at the stage when we were setting up the research, that the doctor’s perception of a patient’s sex (and what he or she takes to be the consequences of it) would affect diagnosis and treatment in much the same way as his or her perception of other socially significant variables such as class and occupation. This perception and its consequences, we hypothesised, would vary in relation to the doctor’s age, sex and medical training as well as in relation to his or her social class background and practice experience.

We hypothesised that women patients’ perception and use of medical services would be influenced by age, employment, position in the family life cycle and so on. For these reasons, we chose to work within a sample which, at the same time as supplying us with the qualitative data, would allow us to compare consulting behaviour in terms of a range of variables. Eight study practices were used, constituted in the following manner: 4 surburban, 2 inner city, 2 rural. The sample was weighted towards surburban residential areas because of the high proportion of full-time housewives there. We worked with both male and female doctors and covered such variables as age, social class background, training and single-handed and group practices in the sample. While the sample of practices was too small to allow for a statistically significant comparison on the basis of these variables, we felt at least that we could guard against such variables potentially vitiating our research. (‘Ah, but you haven’t looked at women/young/old/group/health centre/single-handed doctors.’)

Within each of the practices a sample of thirty women was selected on the following basis to be studied in detail:

(a) From the age/sex register, a list of women born between 1921 and 1931 was compiled.

(b) For these women records were consulted and the frequency of consultations over the past five years noted.

(c) From these rates, a list was drawn up of the fifteen highest and fifteen lowest consulters in a given practice, and these women constituted the sample for the practice. These women were then approached by letter for an interview, and, with their permission, their records and any correspondence passing between the GP and specialists, analysed in more detail.

Each of the respondents took part in a long semi-structured interview in her own home conducted by one of the two investigators. In response to a request from the SSRC who funded the research, two samples of male patients were also interviewed, an issue which will be discussed below.

Although an interview schedule was used, this provided only the basis for the questions to be asked. The interview included basic demographic information, the woman’s working history, her health history over the past year and the past five years, her attitudes towards her health and towards her doctor, and her marital history. These interviews lasted anything from three-quarters of an hour in the case of some low consulters to several hours for some of the high consulters. The length of the interview frequently indicated the degree of isolation of the respondent, but also indicated in many cases a very real interest in the research similar to that described by Oakley below.

In addition to this, at least one doctor from each of the practices involved was interviewed. Naturally, one would like to see some evidence that the attitudes and ideological stances expressed by doctors during an interview are consistent with their behaviour during the consultation. One way of approaching this problem would have been to use validation procedures based on actual or simulated consultations, but this was rejected at an early stage for technical and ethical reasons. Since a certain amount of time was spent in each practice, however, giving opportunities for conversation with the doctor as well as the ‘interview’, and since both patients and doctors were interviewed, the problem of validation was not such an important issue as was originally envisaged.

An additional source of validation, although of a rather more indirect kind, is through a content analysis of professional literature and medical journals dealing with illness among middle-aged women. This analysis served to supplement the discussion of the ideological aspects of the relationship between doctor and patients.

Access to data was less of a problem than might have been supposed. Some of the practices were obtained through the Royal College of General Practitioners Working Party on the Social Components of Disease; others we approached directly. A high response rate was obtained from patients, particularly the high consulters, and this may well be due to the original letter requesting an interview normally coming from the patient’s doctor; an indication of the influence of the GP. Before deciding to conduct the research in this way, the possibility of recycling existing data was explored, and of the data resources available, the General Household Survey proved the most relevant. However, no information could be obtained from this survey about the woman’s general health, and second, of course, the use of this type of survey would have precluded any in depth interviewing on our part. Although some relevant references may be made from the material provided by the survey, the questions asked were not sufficiently specific to our needs for this to be an appropriate way of obtaining data. In addition, since the survey is based on social class position in terms of the husband’s occupation, a question raised again below, it poses particular problems in dealing with our hypotheses. The possibility of a large-scale prospective survey was also considered but it was felt that this would be inappropriate given that the qualitative character of the proposed interviewing demanded in our opinion that only the two named investigators carry it out.

The objective of the research, begun in September 1976, was to establish a category of illness, and of demand for medical attention, which would properly be defined as ‘sociosomatic’. The concept of psychosomatic illness is known to the general public, has found currency in women’s magazines, and is used as a basis for diagnosis and treatment by the medical profession. It was felt, in beginning this research, that the well-documented higher consulting rates at their general practitioner for women,^5,6 and the high incidence among women of ‘psychosomatic’ complaints and associated disorders could profitably be viewed from a sociological perspective. In doing so, and in setting up the project, it was argued that:

(a) Women are systematically disadvantaged by educational and occupational structures, and are encouraged to see their social role as synonymous with their familial roles as wife and mother; as a consequence of this, the ‘dual career’ woman often suffers stressful role conflict, and the housewife (particularly at the point of her family cycle at which the children leave home) is vulnerable to feelings of social uselessness, frustration and dissatisfaction. One of the aims of the study was to see how far this distress, so often seen as a manifestation of individual inadequacy, could be viewed in terms of a social structural origin.

(b) Illness of various kinds, and especially the consequent demand for, and gratification obtained by attention from the medical profession, is seen by certain groups of women as a source of compensation for the inadequacies of their daily lives. In this respect, medical attention is parallel to the support traditionally received by women from religious institutions.

(c) The groups of women to whom this hypothesis most directly relates will be sociologically distinct from other groups of women. Those with no employment outside the home, recent experience of children leaving home, feelings of dissatisfaction with their work, and a lower level of educational and occupational status before marriage are likely to be the most frequent consulters.

(d) The ideological function of the consultation between such a woman and her general practitioner is normally to help her adjust to the limitations of her structurally determined role, rather than to question these limitations. In this respect, the institution of medicine legitimates and endorses the status quo, and therefore acts as an agency of disguised social control.

The first point made above relating to social structure has been well documented in recent sociological literature. In this context, Oakley’s Sociology of Housework (1974) has been an important work, showing as it does in its introductory discussion the way in which sociology itself has traditionally operated within a patriarchal paradigm, and aspects of this will be raised in the discussion below.

An initial problem for those attempting to employ feminist insights concerns accusations of bias and triviality, both of which are rightly seen as being of methodological concern. It was therefore of no real surprise to the investigators to find that the research was subject to at least two streams of criticism. Both of these raised issues concerning ‘gatekeeping’ and the construction of knowledge discussed in more detail in Dale Spender’s chapter.

The first type of criticism was along the lines of: ‘SSRC funds another piece of research telling us what we have always known. Any doctor can tell you’ (though none in fact did, in this context) ‘why middle-aged women spend so much time at the surgery. It’s all c...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Acknowledgements
• Notes on contributors
• Ten Years On
• Introduction
• 1 Women and their doctors: power and powerlessness in the research process
• 2 Interviewing women: a contradiction in terms
• 3 Reminiscences of fieldwork among the Sikhs
• 4 Men, masculinity and the process of sociological enquiry
• 5 Women in stratification studies
• 6 Occupational mobility and the use of the comparative method
• 7 The expert’s view? The sociological analysis of graduates’ occupational and domestic roles
• 8 The gatekeepers: a feminist critique of academic publishing
• Index