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Sociology ofHealth Illness Vol. 18 No. 1 1996 ISSN 0141-9889 pp. 107-12

Irving Kenneth Zola , 1935-1994);An appreciation

Gareth Williams

Public Health Research and Resource Centre and Institute for SocialResearch University of Salford

The theme of this essay is that medicine is becoming a major institu-tion of social control, nudging aside, if not incorporating, the moretraditional institutions of religion and law. It is becoming the newrepository of truth, the place where absolute and final judgements aremade by supposedly morally neutral and objective experts. And thesejudgements are made, not in the name of virtue or legitimacy, but inthe name of health (Zola 1972:4871).

Introduction

When Irving Kenneth Zola, Mortimer Gryzmish Professor of HumaRelations at Brandeis University in Massachusetts, died of a heart attacat his home on December 1 1994, the sociology of health and illness losone of its most accomplished practitioners and the disability rights movement lost one of its most insistent voices.

Zola was born into a working class, Jewish household in Boston. Himother was Polish and his father Russian, and both were immigrants tAmerica when they were very young children. The details of his earlyears have been recorded by Zola himself engagingly and with considerable affection (Zola 1983). His childhood experience of polio and the consequences of a serious road traffic accident when he was nineteen years oage meant that Zola came to understand very early in his life the enormous significance of other people as sources of emotional, social anintellectual support. Some of these relationships were particularly trans

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One was a textbook in psychology (the name of which I can no longerecall) and the other was Gunnar Myrdal 's American Dilemma (Zola1983:12).

As well as helping Zola to understand the ways in which people can suport each other, this relationship awakened in Zola an interest in what came to understand were the 'social sciences'; an interest which he maaged to sustain through the rigidity of his education at the Boston LatSchool, and was later able to explore in the Department of SociRelations at Harvard University.

Although travelling widely, Zola spent his life in the Boston are

Obituaries in the Boston popular press, in academic journals, and in diability publications bear witness to Irving Zola's considerable impact academic and public life. The Boston Sunday Globe comm emorated a'Brandeis University professor and champion of the rights of the disableWriting in The Disability Rag and ReSource activist and academic colleagues acclaimed Zola's seminal influence on 'the consumer perspective health care, illness, and disability' (Scotch 1995: 30); his influential role the Boston Self-Help Center and as founder-member of the Society fDisability Studies; and his work as founder-editor of the unfailingly edifing Disability Studies Quarterly. His influence on the sociology of healtand illness has been considerable, and colleagues writing in Social Scienceand Medicine describe Zola as 'an innovative thinker in medical sociologand a pion eer in the sociology of disability' (Con rad et al 1995: v).

While these tributes quite rightly enumerate matters of public recormany people have been touched by Irving Zola ( 'Irv' to his friends) ways wh ich are difficult to ca ptu re in invento ries. H e is described as '. a scholar, teacher, creator of networks, builder of bridges and inveteraactivist' (Asch 1995:32), and as a '. . . friend, mentor, teacher, role modeleader, and supporter' (Scotch 1995:30). What underlies these accolades a recognition of Irving Zola as someone in whom there was no artificisegregation of personal, political, and academic hfe. He embodied, fact, a psychological and political resistance to segregation in all its manfestations, and the many human qualities to be found in his research anwriting flow from this. He was a serious man with a sense of humour, aanalytical thinker who enjoyed a good story, and a political activist wh

revelled in discussion with people who did not share his point of view.Much of Zola's political work in the self-help and disability movemen

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Irving Kenneth Zola: an appreciation 109

areas of inquiry, they also display qualities of intellectual depth whichmake them remarkably salient to the problems facing both medical soci-ology and health care systems in our own time.

During a visit to the USA in 1988 Irving Zola invited me to write apiece for Disability Studies Quarterly. I acquiesced uneasily. After all,Zola had been one of the inspirational influences on the development ofthe independent living movement, a movement of disabled people which Ihad criticised on a number of grounds, angering many disability activistsin the process (Williams 1983). 'What sort of piece do you want?', Iinquired, expecting a list of instructions about what not to say. 'Anythingyou want', came the unhesitating reply. After I had submitted my article

(Williams 1988), close to the deadline, I telephoned Irv to make sure ithad arrived. 'Is it OK?', I asked, expecting some expression of disap-proval. 'Yeah, it's great', he said, 'just perfect'. 'Are you sure?', I repliedsomewhat surprised. 'Yeah, Yeah, just perfect', he insisted.

I tell this story because I think it illustrates a quality which lies at theheart of Zola's sociology: his appreciation of dissent. Himself a dissenterwith strong political views, he accepted and encouraged opinions he didnot share. He exercised the sociological imagination through a commit-

ment to truth, reason, and freedom (Mills 1970), but this did not leadhim to assume that people who disagreed with him were dishonest, irra-tional, or intellectually confined. It is possible to regard Zola's work as alifelong attempt to grapple with certain paradoxes arising from his will-ingness to takes sides and see things from different points of view. Zolarecognised that where different points of view exist it is important to tryand build bridges between them. However, he had no truck with thesearch for some kind of facile consensus, and he clearly understood thatyou can only build bridges after you have torn down barriers in free andopen debate. A phrase which appears time and again in Zola's writing is'. . . my contention is . . .'; and his most enduring publications are aseries of contentions or arguments about subjects which concemed himdeeply.

Although I have started this paper with an unequivocal homage, myintention is to encourage a movement away from tributes to the mantowards an appreciation of his work. This is no easy task because, as Ihave indicated, the man is so much bound up in his work, and his acade-mic work is so intricately interwoven with the rest of his life.Nonetheless in what follows I have tried to summarise what I see as the

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Culture and Illness

Following some early work looking at crime and delinquency (McCord etal. 1959) Zola moved into the field of health and illness, spending perioas a research assistant collecting and collating data concerning menhealth and ageing. A significant move occurred when, in 1959, he begalong and fruitful intellectual association with John Stoeckle at Massachusetts General Hospital in Boston. The work they did withnumber of colleagues in the early 1960s on the processes involved in seing medical care, exerted an important influence on medical sociolog

in the USA and elsewhere. A number of the publications arising outthis collaboration have remained key references for studies in two ovlapping areas: the relationships between society, culture and illness athe reasons for people taking their symptoms to a doctor (Zola 196Stoeckle et al. 1963; Zola 1964; Stoeckle et al. 1964; Zola 1966; 1972b1972d; 1973a).

Research on illness behaviour in medical sociology has been dominaby the work of David Mechanic. However, while Mechanic's work alwseemed orientated to a psychological perspective on behaviour, the wZola undertook with John Stoeckle and others was unequivocally soclogical. Many of our key concepts started life there, or thereabouts, soof them emerging from Zola's doctoral work (Zola 1962). The sympticeberg, treatment delay, triggers to help seeking, and the link betweideas and actions in illness were all put on the map by Zola and his cleagues. Although Zola made use of socio-psychological concepts such'crisis', and happily drew upon epidemiological and routine health servdata, his work was richly contextualised in terms of an argument abthe material and cultural relations of society.

This contextualisation is characteristic of his work, and is refiectedthe kind of publications he produced. For example, one of the fipapers to emerge from the work he did at the Massachusetts GeneHospital was a 'selective review' of the literature on going to see the dtor (Stoeckle et al. 1963). In these days of information overload, and tnew fashion for 'systematic reviews', the selective review which Zola ahis colleagues produced is a fine model of scholarly work. Rather th

simply presenting the findings from the empirical work, they placed thin the context of an argument about the psychological and social for

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mality' of illness (a theme which emerges repeatedly in Zola's work) -and the comparatively low frequency of doctor-patient consultations, '. . .important factors besides the fact of medical disorder must intervene in

bringing the doctor or in keeping him away' (Stoeckle et al. 1963:976).With reference to the ground-breaking work of Zborowski (1952) and

Zola's own doctoral work, he and his colleagues began to explore whatfactors might determine the patient's reaction to and the meaning of hisor her disease. In this and subsequent papers which will be better knownto sociologists (Zola 1966; 1973a), Zola charted the general cultural fac-tors, such as ethnicity, which influenced what people thought and didabout symptoms. While Zborowski's study had been based on hospi-

talised patients, the work of Zola was based on interviews with people inthe process of seeking help at an out-patient's clinic, prior to their beingseen by the physician. From his comparison of prospective patients ofIrish, Italian, and Anglo-Saxon origin, Zola was able to demonstrate thatit would take different symptoms to bring these patients to the doctor,and that the same symptoms in these populations would lead to vastly dif-ferent courses of action.

Zola's work laid the foundations for the sociological study of both cul-

tural differences in responses to symptoms, and the factors which 'triggerdecisions to seek medical care. He recognised that in addition to thebroad social factors differentiating the actions of people from minorityethnic groups, individuals also had specific reasons - unrelated to anyclinical measures of severity - for consulting the doctor at a particularpoint in time, rather than earlier or later. Zola was one of the first torecognise that the question 'Why?' had many meanings within lay dis-courses in western societies. Drawing on some of the socio-psychological

work on life stress and crisis, Zola attempted to 'delineate some specificcircumstances under which the decision to seek medical aid was made -the trigger, the last straw, the patient's or his family's limit of tolerance'(Stoeckle et al. 1963:983).

What is striking about Zola's contribution to the study of the relation-ships between culture and illness is his recognition of the broader socialand cultural implications of his findings, and his willingness to theorisefrom his data:

Despite its limitations, our data seem sufficiently striking to providefurther reason for re-examining our traditional and often rigid concep-

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His papers on culture and symptoms and pathways to the doctor haexerted an enormous influence on tbe sociological study of illness, ahave been reprinted on numerous occasions. They are also rare exampof papers wbich demand an argument.

Tbese essays were, and still are, profoundly relevant to the day to dbusiness of public health and health care. In the context of the renewconcern in the National Health Service (NHS) and other western heacare systems with 'unmet need' on the one hand, and 'inappropriademand' on the other, this work remains, if anything, more relevant in implications for our present situation than it was when the research wfirst undertaken. However, in order to understand these implications it

necessary to recognise the flexibility and imagination required to translresearch into practice. As Zola himself argued with typical playfulness:

When speaking of implications, I ask your indulgence, for I refer notmerely to what leads in a direct line from the data but some of thedifferent thoughts and directions in which it leads me (Zola 1989:234[1973a]).

It was not the data but the thinking Zola did about the data that su

gested directions for future work. One of the implications of Zola's wowbich led in an interesting direction was how the universality of symtoms related to definitions of normality, and the way in which certadeviations from normality attract the labelling processes of agencies society. If we are all symptomatic much of the time, and if we will experience symptom-episodes with increasing frequency as we get older,we are all potential cases, who manages the continuum between heaand illness?

The dilenunas of expertise

Zola's early work appeared to point to the under-effectiveness of medcine in dealing with the routine, chronic health problems increasingprevalent in ageing populations. His emphasis was on the neglect of thowho needed health care and could not get it. During the late 1960s aearly 1970s a disturbing question occurred to Zola which fired the ne

phase of his work. If '. . . virtually every day of our lives we are subjeto a vast array of discomforts . . .', and we are all potentially medic

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tance to social control comes into existence and persists in almost everything he produced thereafter. The dilemma can be expressed like this: ill-health is ubiquitous and many health needs are unmet within health caresystems. However, entering the domain of medicine and its ancillaries isnot necessarily appropriate, nor are its effects always benign.

His ability to recognise this - as with many other things - stemmedpartly from deep reflections on his own personal experiences; although iwas only in his later work on disability that he brought these experienceup-front in his analysis. His post-polio, automobile accident-aggravatedimpairments had brought him into the embrace of the medical professionon many occasions. His classic examination of 'Medicine as an institution

of social control' is, therefore, partly a cri de coeur and notwithstandingthe upsurge of neo-Foucauldian analysis in recent years, it contains ananalysis of the nature of medical power that is at least as relevant todayas it was then.

The resounding sentences from Zola with which I opened this appreciation make plain his concem about the political implications of medicalinfluence. The establishment of this new repository of truth, he continued

. . . is not occurring through the political power physicians hold or caninfluence, but is largely an insidious and undramatic phenomenonaccomplished by "medicalizing" much of daily living, by makingmedicine and the labels "healthy' and "ill' relevant to an ever increas-ing part of human existence (Zola, 1972a:487).

Zola's thesis was not entirely new, but such was the force of his argumentthat we have been conscious of its reverberations ever since. Moreover, hiscritique of medicine was conspicuous for its ecumenicalism. Intellectua

assaults on psychiatry had become almost commonplace by this time; buZola argued that those who confined their concem about medicalisation topsychiatry were missing the mark: 'For psychiatry has by no means distorted the mandate of medicine, but indeed, though perhaps at a fasterpace than other medical specialties, is following instead some of the basicclaims and directions of that profession'. (1972a:487-88).

The dual concem with public health and civil rights led Zola to reflecon a number of apparent contradictions. He recognised, for example, thaone possible interpretation of the epidemiological transition to chronicdisease in westem societies was the 'dilution] of the exclusive control ofthe physician' (Zola and Miller 1973:165) In chronic diseases medica

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Moreover, he could see that medicine's greater involvement in sociestemmed from its combination of epistemological reductionism (the ngenetics) and therapeutic holism (psychiatry and health promotion). the one hand, there was the specialisation which focused medicine's atttion on biological minutiae inaccessible to ordinary vision and languaand on the other hand, we could observe the increasing emphasis treating the whole patient which involved consideration of an expandirange of non-medical factors - the ego, the stress of life, and the deprivtions of inner-city living. It seemed to him that these two trends togethhad placed medicine on almost ' . . .an inexorable path towards becomia major institution of social control' (Zola and Miller 1973:169), and

was this insight that provided the foundation for his essay on medicine an institution of social control (1972).

The main outlines of that essay are doubtless well-known. Like essays it has a number of threads, not all of which are perfectly wovinto the larger pattern. There are some loose ends which seem to be leing nowhere in particular, but nevertheless raise moral and political cocerns that were close to Zola's heart at that time. Many of theconcerns, such as drug safety and genetic counselling, remain salient.

the heart of the essay lies the argument contra Parsons and proFreidson - that medicine is a moral and political enterprise which is nwholly benevolent. As a counter to the idea that medicine was less judmental than religion or the law, and that calling something an illness wless blaming than labelling it a crime or a sin, Zola argued that medicwas playing an expanding role in the management of moral reputatioand the minutiae of everyday life.

This medicalisation of society involved what Freidson had identified

the medical profession's expanding jurisdiction over '. . . the label of iness and anything to which it may be attached, irrespective of its capacito deal with it effectively' (Freidson 1970:251). Zola identified four wain which the attaching process was taking place, leading to the medicasation of society: through the expansion to what in life is deemed relevato the good practice of medicine; through the retention of absolute cotrol over certain technical procedures; through the retention of neabsolute access to certain 'taboo' areas; and finally through the expansiof what in medicine is deemed relevant to the good practice of life. Tconsequence of these developments is that every aspect of our lives cotains risks to health - living itself is injurious to health

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tbe process masked as a technical, scientific, objective one, but one donefor our own good (Zola 1972a: 503). Even if medicine were able to add sixinches to our heights, thirty years to our lives, and generally expand our

potentialities, '. . . we should still be able to ask, what do six inches matter, in what kind of environment will the additional thirty years be spent,or wbo will decide what potentialities and potencies will be expanded andwhat curbed' (Zola 1972a:504).

In his essay on social control, and in one or two later papers (Zola1975a; 1975b), he was certainly raising profound concerns about tbe dilation of the medical gaze which has since come to be referred to as the'rise of surveillance medicine' (Armstrong 1995). However, Zola's distinc-

tion lies in the way in which he managed to sustain an analysis of powerthat was multidimensional and sensitive to the diffusion of technologiesand power relations, while also being committed to a strategy for sociachange that recognised the dilemmas and contradictions of expertise andthe difficulties involved in empowering consumers. In a comment fromthe mid-1970s about what should be done to counter the dominant experdiscourse on the new genetics he argued:

I have no ready alternative, but I do have a direction. Instead ofcalling for scholarly conferences, would call for public debates;instead of requesting physicians to share our information, I wouldencourage patients to demand it; instead of organizing commissions,I would organize patients, the last of the disenfranchised groups(Zola 1975a:561).

Fifteen years of restraint in public expenditure and vilification of the 'culture of dependency' casts a different light on Zola's critique. What is thepoint in worrying about medicalisation when many people (not least inthe USA) are unable to get access to the medicine they need? Why highlight the undramatic effects of the medical power of doctors when hospi-tals are being downsized with such enthusiasm by politicians? Zola wassensitive to these contradictions. However, he would certainly not haveallowed his concern to defend health services to deflect his critique ofmedical power and the marginalisation of the patient, or his warningsabout the disabling implications of healthism (Zola 1977).

Zola never extended his analysis of medical power into a more fullyworked out academic treatise. Instead he turned to bringing his growingpersonal academic and political interest in disempowerment of health

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about herself. The same could be said of Irving Zola (1982b; 1983). Tis particularly true of that period in his life and academic work donated by a concern with the problem of disability. Disability providedarena in which Zola was able to write politically about himself and aubiographically about politics and society, and his deepening contact wfeminism (he was married to one of the authors of Our Bodies Ourselveled him to recognise that writing about personal experiences could itbe a political act.

For someone whose politics had been fired in the civil rights and awar struggles of the 1960s, disability provided an arena in which his soology, his activism, and his own personal experiences could connect. Zdid not duck Howard Becker's famous question: 'Whose side are we oand his answer was never in doubt:

Through much of my professional academic career, I was perceived,and perceived myself as an analyst and articulator of the underdogand the oppressed. I wrote about the elderly, the sick, the young, themisunderstood, the alienated. . . . But though I drew on my personaexperience of hospitalisation to write and understand empathically,there was also a distancing. It was them, never myself of whom I wasreally speaking (Zola 1983b: 144).

In analysing the problems of people with disabilities Zola learned speak about himself. Much of his writing during this period is self-revetory, and he sometimes turned to the medium of the short story asmeans of handling issues which were particularly painful or sensit(Zola 1982c). However, Zola used autobiography and fiction not as escape from politics but as a means of displaying the full impact of soc

and economic forces on the everyday lives of individuals; and, to paphrase C. Wright Mills, Zola recognised that neither the life of a disabindividual nor the history of disabled people could be understood withunderstanding both.

Zola was concerned to represent the interests of people with disabties, and to explore new ways in which those interests could be repsented. He preferred to talk about 'people with disabilities', puttpeople first, but he emphasised that in choosing certain terms he was '.not arguing for any "politically correct" usage but rather examining political advantages and disadvantages of each' (Zola 1993c: 171). Voice iwhat social movements are all about (Zola 1993b) but there is no sing

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and welfare services. It might be difficult to understand exactly why andhow this shift in Zola's work occurred when it did. Fortunately he tells uin his account of Het Dorp, a 65-acre village in the Netherlandsspecifically designed to house four hundred severely disabled adults (Zola1982b). What started out as a sociological study became a characteristicblend of the personal and the political:

What I have produced might well be called a socio-autobiography, apersonal and social odyssey that chronicles not only my beginningacknowledgement of the impact of my physical differences on my lifebut also my growing awareness of the ways in which society invalidatespeople with a chronic disability (Zola 1982b:6-7).

Zola's writing on disability has a number of different aspects. His earlywork drew on his own personal experiences and his involvement in theself-help movement in order to develop a critique of the rehabilitationsystem and its models of adjustment and adaptation. Along with manyother activists Zola was becoming concerned with two interrelated problems: first that the rehabilitation process was not producing the kind of'adjustments' that actually enable disabled people to live independently in

society. Secondly, that even with good rehabilitation, the determinants ofindependence for disabled people were more to do with the organisationof the physical and social environment than with any professionally managed adaptation process.

The fundamental principles of the Independent Living Movement ofthe early 1970s were that disabled people had a right to live independently in society, and that this independence could only be achieved bypulling down the architectural and social barriers which prevented disabled people from gaining full participation in economic and civic lifeThrough his involvement with the Boston Self-Help Center, Zola was aprecursor rather than an instigator of the Independent Living MovementHe wrote about the principles of the self-help movement and its relationship to the movement for independent living and other social movement(Zola 1979a; 1986). He also wrote directly and analytically about independent living and its relationship to rehabilitation (Zola 1982d; Creweand Zola 1983), and about the deformative aspects of the rehabilitationprocess (Zola 1981a; 1982a).

During the early 1980s, Zola recognised that while his politics had tobe unwavering in the articulation of demands for independence and an

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contrast to much of the work in this field Zola recognised that toppression experienced by people with disabilities was a complex matte

Contrasting disability with race, for example, he argued that '. . . tsocial invisibility of people with a disability develops more insidiousChildren spontaneously express an interest in wheelchairs and leg bracbut as they grow older they are taught that: " . . . it 's not nice to ask suthings". . . . But why all this effort? Why this distancing of the chronicaill and handicapped? Why are we so threatening that we must be masocially invisible?' (Zola 1982b:200). The threat to be removed, Zola sugests, lies not just in society's failure but in the inevitability of one's own

When the 'able-bodied' confront the 'disabled', they often think with shud der, 'I 'm glad it 's not m e' . . . Th e thre at to be dispelled is theinevitability of one's own failure. The discomfort that many feel in thpresence of the aged, the suffering, and the dying is the reality that itcould just as well be them (Zola 1982b:202).

However imperative it may be politically to define people with disabilitas a minority group, it is a curious minority which will include us all not today, then tomorrow, or the day after:

It is clear that much has been achieved by recognising that people wita disability have long been treated as an oppressed minority and thatmuch has been gained by using a civil rights strategy to enhance andclarify the rights of people with disabihties. On the other hand . . . onwhen we acknowledge the near universality of disability and that all idimensions (including the biomedical) are part of the social process bwhich the meanings of disability are negotiated, will it be possible fulto appreciate how general public policy can affect this issue (Zola

1989:420).

Zola had a clear grasp of the relationship between his own life with a dability, his struggle to find a language in which to speak about it, and thistory of disabled people in the United States (Zola 1994). It was Zol'. . . conviction that it is impossible to create a society without diseaand disability' (Zola 1988a:380). There is no all-encompassing masteslave narrative, there is no simple schema ~ Marxist, Freudian, Foucauldian - which will illuminate the matrix of power and knowledwithin which disability exists, and there will be no simple revolutionachange in medicine or in politics which will deliver liberation. T

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have tried to state here and elsewhere, the numbers trying to speak ouare ever growing and tbe chorus of voices is increasingly diverse (Zola1994:65).

The disability movement in the USA has a history and a context differefrom tbat in Britain, and it would be dangerous to draw too literalfrom tbe former's successes and failures. Nonetheless, Zola's clear statment of the need for the disability rights movement to avoid exclusiviin its language and sectarianism in its politics seems to me to provide clear ethical and strategic direction for those engaged in struggle in thcountry and elsewhere.

In place of tbe monochrome languages of the 'medical model' on tbone hand and the 'social model' on the other, we find in Zola a willingness to examine disability from many points of view, and a desire tunderstand the contribution the different voices have to make to our dicussions about disability. Rather than merely castigating popular reprsentations of disability, he explored them (1985; 1987a; 1987c); instead ouncritically eulogising writing by disabled writers because they were diabled writers, he paid them the respect of questioning their claims tauthenticity (1988b; 1993b). He recognised the tension within thAmerican movement between the orientation to achievement and 'valiity' in the able-bodied world, and the creation of a disability culturpuffed up with disability pride. In some of his later work, in particulahe discussed tbe enormous implications of ageing societies peppered wichronic illnesses for the development of the disability movement (Zo1991b), pointing out that the processes of ageing were something thlinked tbe interests of 'the able-bodied' to those of 'the disabled'.

In the context of an occasionally intolerant debate over tbe correct language to use in talking about disability, Zola's work was a bold attempto hold firm to the politics of disability while remaining free to explore idarker phenomenological waters^. He wanted to place at the forefront oany discussion of disability the bleak realities of economic deprivatiodisenfranchisement, and marginalisation, while insisting on the continuinneed to find a place for research in clinical rehabilitation and an interprtive social psychology of the personal worlds of people with disability anchronic illness. He believed, in short, that you could not deal politicallwith disability without confronting it personally, and that confronting personally involved conflicts additional to the suffragism which ha

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whose self-proclaimed mission was the alleviation of the suffering of inviduals that '. . . whatever other essential work we do, we must not onlisten carefully to the voices of those we seek to help, but we must alwa

keep an eye cocked upstream toward some of those not easily viewforces . . .' (Zola 1992b:22).

His work on disability is multidimensional, both in its substance and its methods. It is both defiantly political and deeply personal. He wcommitted to a civil rights perspective on disability, but he recognisthat an understanding of disability also required an anthropology of tbody and the emotions. He wrote about it fictionally, factually, politicaland sociologically. He wrote hard-nosed pieces on statistics and pub

policy (1993a), along with the autobiographical explorations of his owexperience. He wrote for small publications produced by voluntary orgaisations and for medical textbooks, for government publications and fsociological joumals. He would alter his style and his approach depening on the audience he was addressing, but beneath his deconstructiondiscernment of the instability of texts lay a clear and unwavering moand political commitment to the necessity of dissent.

The value of Irving Zola

The evidence for and against Zola's likely long-term impact on the sociogy and social sciences of health and illness is ambiguous. WithAmerican medical sociology his work on culture and illness and on soccontrol remain staple fare for students (Brown 1989; Conrad and Ke1990; Cockerham 1995; Freund and McGuire 1995); and continuing reerence is made to his analysis of medicalisation in recent British publictions (Turner 1992; Nettleton 1995). However, the relevance of his woon disability, and his own writing on the body, for the sociologies of thbody and the emotions are not always given the recognition due to the(Nettleton 1995). In a keynote paper on the future of medical socioloZola (1991a) warned against the development of an oversocialised view illness and disability, and argued powerfully for bringing our bodies anourselves back in.

J would argue that Irving Zola's writings on disability from the ear1980s onwards continued and elaborated the two core themes from hearly work: the ubiquity of illness and the menace of medicalisatio

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and culture deserve other audiences, and recent reprints of his writingsuggest that some of his work on disability is now seen to have wider relevance (Schmitt and Moody 1994).

Within the historiography of medical sociology there is a danger thamuch of his work will be reduced to a prologue to the more extended theoretical and empirical analyses of power and knowledge with which we havbecome so familiar (Gerhardt 1989). In my view this would be to misunderstand the qualities of his contribution. What marked Zola out was hiwillingness to be pluralistic without losing sight of the need for taking position on issues of moral and political importance. He was a nonconformist who managed to avoid the vertigo of relativism and the arroganc

of sectarianism. He acknowledged the need for dialogue between lay anprofessional perspectives but he remained profoundly critical of medicadominance and sceptical of those who would try to persuade us to be leshostile to its growing terrain of expertise (Bell and Zola 1992).

It is not possible, in the end, to discuss what was distinctive about hisociology without talking about his political activism and his personal experiences of impairment and disability. There was in Zola a profound antidualism, originating perhaps in the Jewish culture in which he was broughup and of which he remained proud (Phil Brown, personal communication)Sociology was of no use unless it made connections with the world of policand politics on the one hand and the realm of personal experiences and narratives on the other. The 'voice' which was so important to Zola within thdisability movement, was the voice which told a story that connected witother peoples stories, providing the foundation for a collective identity, acommon agenda, and a shared strategy for social change.

Address for correspondence: Gareth Williams Institute for Social Research

University of Salford C rescent House Salford M5 4WT .

Acknowledgements

A number of people have told me of their sense of loss following the death oIrving Zola. Some have also sent useful material about him which has helpeinform this appreciation. I would like to thank Barbara Altman, Phil BrownPeter Conrad, David Pfeiffer and Al Wessen. Thanks also to Angela Greenall fohelp with the bibliography.

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references to later ve rsions of earlier pap ers by him w here 1 have quoted frthem having been unable to gain easy access to the original. The original datepublication is then included in parenthesis for purposes of cross-referencing w

the bibliography. In order to avoid unnecessary duplication I have not includedthe reference list citations that are contained in the bibliography.2 A recent semina r held at the University of Leeds, Accou nting for Illness and

Disability: Exploring the Divide April 1995, was a welcome attem pt to bridsome of the differences between medical sociologists and disability theoriststhe understanding of these issues.

References

Armstrong, D. (1995) The rise of surveillance medicine. Sociology of Health andIllness 17, 393-404.

Asch, A. (1995) Remembering Irv, The Disability Rag and ReSourceMarch/Apri l , 30-32.

Cockerham, W.C. (1995) Medical Sociology (Sixth Edition), Englewood-CliffNew Jersey: Prentice-Hall Inc.

Conrad, P. and Kern. R. (1990) The Sociology of Health and Illness: C riticaPerspectives New York: St. Martin's Press.

Conrad, P., Brown, P. and Bell, S. (1995) Irving Kenneth Zola, 1935-1994, SociaScience and Medicine 41, 2, v-vi.

Freidson, E. (1970) Profession of Medicine New York: Dodd-Mead.Freund, P.E.S. and McGuire, M.B. (1995) Hea lth Illness and the Social Body : A

C ritical Sociology (Second Edition), Englewood-Cliffs, New Jersey: PrenticHall Inc.

Mills, C W. (1970) The Sociological Imagination Harmondsworth: Penguin.McCord. W.. McCord, J. and Zola, I .K. (1959) O rigins of C rime: a New

Evaluation of the C ambridge-Somerville Youth Study New York: Columbia

University Press.Nettleton, S. (1995) The Sociology of Health and Illness. Cambridge: Polity

Press.Schmitt, R. and Moody, T.E. (eds) (1994) Alienation and Social C riticism

Atlantic Highlands, New Jersey: Humanities Press Intemational.Scotch, R. (1995) 'Remembering Irv' T he Disability Rag and ReSource

March/April , 30-32.Turner, B.S. Regulating Bodies: Essays in Medical Sociology London: Routledge.Williams, G.H. (1983) The movement for independent living: an evaluation a

critique. Social Science and Medicine 17, 1003-1010.Williams, G.H. (1988) Independent living: roiling back the frontiers of the Stat

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Irving Ke nneth Zola: an appreciation 12

Zola, I.K. (1983b) The evolution of the Boston Self Help Center. In Jones, and Tutt, N. (eds) A Way of Life for the Handicapped: N ew D evelopments Residential arui C ommunity C are London: Residential Care Association.

Zola, I .K. (1989) Pathways to the doctor - from person to patient. In Brown,(ed) Perspectives in Medical Sociology Belmont, Califomia: WadswortPublishing Company.

A selected bibliography(In chronological order)

Stoeckle, J.D., Zola, I .K. and Davidson, G.E. (1963) On going to see the doctthe contributions of the patient to the decision to seek medical aid: a selectreview. J ournal of C hronic Diseases 16, 975-989.

Zola, I.K. (1963a) Socio-cultural factors in the seeking of medical aid -progress report, Transcultural Psychiatric Research 14, 62-6 5.

Zola, I .K. (1963b) Problems of communication, diagnosis and patient care: interplay of patient, physician and clinic organization. Journal of MedicaEducation 38, 829-838.

Zola, I.K. (1964) Illness behaviour of the working class: implications and recomendations. In Shostak, A. and Gomberg, W. (eds) B lue-C ollar WorldEnglewood Cliffs, NJ: Prentice-Hall, 350-361.

Stoeckle, J.D. and Zola, I.K. (1964a) After everyone can pay for medical carsome perspectives on future treatment and practice. Medical Care 2, 36-41 .

Stoeckle, J.D. and Zola, I.K. (1964b) Views, problems and potentialities of clinic. Medicine 43, 413-422.

Stoeckle, J.D., Zola, I.K. and Davidson, G.E. (1964) The quantity and signcance of psychological distress in medical patients - some preliminary obsertions about the decision to seek medical aid. Journal of C hronic Diseases 17959-970.

Zola, I.K. (1966) Culture and symptoms - an analysis of patients' presentcomplaints , American Sociological Review 31, 615-630.Zola, I.K. and Croog, S.H. (1968) Work perceptions and their implications

professional identity: an exploratory analysis of public health nurses. SociaScience and Medicine 2 15-28.

Kosa, J., Antonovsky, A. and Zola, I.K. (eds) (1969) Poverty and Health - ASociological Analysis Cambridge, MA: Harvard University Press.

Zola, I.K. (1970) Whither medicine - three views. Social Science and Medicine 4687-690.

Zola, I.K. (1972a) Medicine as an institution of social control. SociologicaReview 20, 487-504.Z l I K (1972b) Th t f t bl d f di l i t

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Zola, I.K. (1973a) Pathways to the doctor - from person to patient, SocialScience and M edicine 1 677-689.

Zola, I.K. (1973b) On the problems of professing. Social Science and Medicine17, 80-82.

Zola, I.K. and Miller, S.J. (1973) The erosion of medicine from within. IFreidson, E. (ed) The Professions and Their Prospects 153-172, California:Sage.

Zola, I.K. (1974) Reflecting on directions in psychotropic drug research. ICooperstock, R. (ed) Social Aspects of the Medical Use of Psychotropic Drugs167-172, Ontario: Addiction Research Foundation of Ontario.

Zola, I.K. and McKinlay, J.B. (eds) (1974) Organizational Issues in the Delivery ofHealth Services P R O D I S T, N . Y.

Zola, I.K. (1975a) The fix we are in . . ., Social Science and M edicine 9 559-661.Zola, I.K. (1975b) In the name of health and illness: on some socio-political consequences of medical influence. Social Science and Medicine 9 83-87.

Zola, I.K. (1977) Healthism and disabling medicalization. In Illich, I., Zola, I.KMcKnight, J., Kaplan, J. and Shaiken, H. (eds) Disabling Professions 41-69,London: Marion Boyars.

Zola, I.K. (1978) A question of invalidity. Sante M edecine et Sociologie 256-276,Paris: Centre Nationale de la Recherche Scientifique.

Zola, I.K. (1979a) Helping one another: a speculative history of the self hel

movement, Archives of Physical Medicine and Rehabilitation 60, 452-456.Zola, I.K. (1979b) Oh where, oh where has ethnicity gone? In Gelfand, D.E. anKutzik, A.J. (eds). Ethnicity and Ageing 66-80, New York: Springer PublishingCompany.

Zola, I.K. (1979c) When getting into the field means getting into oneself. NewEngland Sociologist 1, 21-30.

Zola, I.K. (1981a) Communication barriers between the 'able-bodied' and 'thhandicapped' . Archives of Physical Medicine and Rehabilitation 62. 356-359.

Zola, I.K. (1981b) Structural constraints in the doctor-patient relationship: th

case of non-compliance. In Eisenberg, L. and Kleinman, A. (eds) The Relevanceof Social Science for M edicine 241-252, Dordrecht, Holland: D. ReidelPublishing Company.

Zola, I.K. (1982a) Denial of emotional needs to people with handicaps. Archivesof Physical Medicine and Rehabilitation 3, 63-67.

Zola, I.K. (1982b) Missing Pieces: A C hronicle of Living with a DisabilityPhiladelphia: Temple University Press.

Zola, I.K. (ed) (1982c) Ordinary Lives: Voices of Disease and Disability (includingoriginal short stories by Zola), Watertown, MA: Applewood Books.

Zola, I.K. (1982d) Social and cultural disincentives to independent living. Archivesof Physical Medicine and Rehabilitation 63, 394-397.

C N M d Z l I K ( d ) (1983) I d d Li i f Ph i ll

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Zola, I.K. (1985) Depictions of disability-metaphor, message and medium in thmedia: a research and political agenda. The Social Science Journal 22, 5-17.

Zola, I.K. (1986) Reasons for non-compliance and failure of the elderly to see

care. In Moskowitz, R.W. and Haug, M. (eds). Arthritis and the Elderly NewYork: Springer.Zola, I.K. (1987a) 'Any distinguishing features?' - The portayal of disability

the crime-mystery genre. Policy Studies Journal 15, 485-513 .Zola, I.K. (1987b) The politicization of the self help movement. Social Policy 18,

32-33.Zola, I.K. (1987c) The portrayal of disability in the crime mystery genre. Social

Policy 17, 34-3 9.Zola, I.K. (1988a) Ageing and disability: Toward a unifying agenda. Educational

Gerontology 14, 365-387.Zola, I.K. (1988b) Whose voice is this anyway? A commentary on recent colletions about the experience of disability. M edical Hum anities Review 2 6-15.

Zola, I.K. (1989) Toward the necessary universalizing of a disability policy. TheMilbank Memorial Fund Quarterly 67, Supplement 2, 401-428.

Zola, I.K. (1990) Ageing, disability and the home-care revolution. (The 39Annual, John S. Coulter Lecture), Archives of Physical Medicine andRehabiliation 71, 93-96.

Zola, I.K. (1991a) Bringing our bodies and ourselves back in - reflections o

past, present, and future 'Medical Sociology', Journal of Health and SocialBehaviour 32, 1-16.Zola, I.K. (1991b) The medicalization of ageing and disability. In Albrecht, G

and Levey, J.A. (eds) C hronic Illness and Disability Across the Life C ourseAdvances in Medical Sociology, 2, 299-315, JAI Press Inc. Greenwich, CT.

Bell, S.E. and Zola, I.K. (1992) Constructing a canon? - a review essay of UGerhardt 's Ideas About Illness: An Intellectual and Political History of MedicSociology, Social Science and Medicine 34, 581-583.

Zola, I.K. (1992a) Multiple sclerosis and the family: on the necessity of a larg

context. In Kalb, R. and Scheinberg, L. (eds) Multiple Sclerosis and the Family97-107, New York: Demos Publicat ions.

Zola, I.K. (1992b) The social construct of suffering. In Stark, P.L. anMcGovem, J .P. (eds) The Hidden Dimension of Illness: Human Suffering 11-23,New York: National League for Nursing Press.

Zola, I.K. (1993a) Disability statistics, what we count and what it tells us - a pesonal and political analysis, Jourrml of Disability Policy Studies 4, 9-39.

Zola, I.K. (1993b) In the active voice - a reflective review essay on three bookPolicy Studies Journal 21 , (Sym posium on Disability Policy - Pa rt one).

Zola, I.K. (1993c) Self identity and the naming question: reflections on the language of disability. Social Science and Medicine 36, 167-173.

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