Surgical healing, power and social structure : an ethnographic and historical study
How the everyday activities of surgery mediate and reproduce surgical authority and privilege is studied by ethnographic study and interview material in and around the operating theatres of a large district general hospital, on surgical wards, and in a day surgery unit, using a case study approach. Routinised movements of staff, patients and instruments within the operating theatre suite (0T) order the activities by which patients pass through surgery. These movements are structured, and culturally designated, to ensure the safety of the patient during the dangerous transgression of boundaries in surgery. The history of surgical sterility indicates the symbolic significance of sterile garb, to mask the polluting bodies of the surgical staff and designate them purifiers of corrupting nature. Sterile techniques signify the superiority of cultural definitions over those based in 'nature'. While the surgeon is concerned with a patient's Illness, the anaesthetist is concerned with her/his Fitness. This interaction enables all operations other than those where both Fitness is reduced and Illness is not reduced, to be proclaimed 'successful'. Consequently, patients may be allocated a socially defined status of 'healed', despite no improvement in physiological status. Cross-cultural comparison suggests that surgical healing involves a social status passage from a negative status of victim to a positive one of survivor. Healing is socially reintegrative: it re-creates apparent congruence between the life-scales of the sick person and social structure, which is destroyed by illness. Case studies refine the hypothesis that this social recategorisation legitimates surgical authority and privilege. Both the operation's 'success' and patient discharge are found to be necessary for a full claim to have healed. The potential to generalise the model to all medical intervention, and the implications for surgery and the sociology of health and healing are discussed.