Femmes, sante et professions: histoire des dietetistes et des physiotherapeutes au Quebec et en Ontario, 1930-1980: l'affirmation d'un statut professionnel.
CAN A SOCIOLOGIST review the research of a historian? In Feminist Studies, the response to that question must be positive. We are, after all, part of a new "interdiscipline" whose results should be comprehensible across disciplinary boundaries. On the other hand, as feminist scholars know only too well, we carry with us a considerable baggage from our disciplines of origin to the point where comprehensibility might be present, but disciplinary biases may predominate. This may account for my perspective on the work in question. It is for the reader to decide whether feminism's interdisciplinary aims are betrayed by sheer disciplinary prejudices.
In brief, Nadia Fahmy-Eid and her colleagues provide us with a detailed history of the developing occupations of physiotherapy and dietetics over the period 1930-1980, in both Ontario and Quebec. It should be noted that they use the term "professions" in French which, of course, does not translate into the same word in English. Nevertheless, they treat both occupations as potential professions in the English sense, and their account basically focuses on attempts at professionalization. The research team relates this history to the development of the health professions in general, rooting these two female-dominated occupations within the context of their relations to connected professions, particularly Medicine. The role of the State in limiting the aspirations of these mainly female occupations is outlined, and a gender explanation advanced for their difficulties in attaining full professional status. The research involved is meticulous. Every possible source has been consulted; obviously, the documents of the relevant associations have been particularly helpful. Given that we previously had little information available on these two areas of women's work, this volume is a welcome addition.
Pauline Fahmy adds a substantial chapter at the end of the volume, analysing interviews with 13 physiotherapists and dieticians to add a dimension of "lived experience" to the historical account. Interestingly, she starts this chapter by saying that she is leaving the socalled "objective" and "scientifically reassuring" field of written sources to listen to those mainly involved in the two fields. (269) This statement is troubling, for it minimizes the very strong feminist emphasis on women's experiences; in addition, it diminishes some extremely interesting material which merits better treatment than to be tagged on at the very end of the work (after the Conclusion), instead of being integrated into the body of the work.
Why physiotherapy? Why dietetics? These are, of course, key questions. The authors grapple with them at an early stage of the study, saying that these two occupations are typical of the pattern of women's entry into the field of health professionals: a discrete entry to the field, taking an initial background position, but managing to improve professional status over time. (10) In effect, this becomes a historical case study of two similar occupations, relatively limited in size (fewer than 500 for each of Ontario and Quebec in 1961, up to around 2,500 for each province by 1981). (44) While appreciating the exemplary nature of these occupations, one is forced to wonder whether two contrasting occupations might not have provided more interesting material; in particular, social workers who constituted an even smaller group in 1961, multiplying to over 4,000 members, by 1981), might have been a good backdrop for the discussion of either physiotherapists or dieticians. (44) Or to put the matter briefly, the contrasting case study method might have revealed more explanatory material than a parallel method, where only small differences can be delineated.
The work is largely descriptive -- a good solid account of pressures for professional status on the part of two female-dominated occupations (they are finally accorded "titre reserve" by the State). The hypotheses that are put forward tend to be statements within an assumed research framework rather than possibilities that require exploration. For example, with respect to the knowledge base for both dietetics and physiotherapy, one "hypothesis" put forward is that theoretical knowledge has a higher status than practical knowledge. (88) But there is no way of proving or disproving this statement on the basis of the data presented; it is rather an assumption for examining the kind of knowledge that is transmitted to students in the two fields.
The theoretical framework comes from the standard literature on the professions, including Derber, Parkin, Sarfati-Larson, and Witz. This is a largely masculinist literature, relatively dormant over the past decade. But I wonder whether it was wise to employ such a framework for there is only one possible conclusion: these occupations did not gain full professional status (or what one might call the "failed profession" conclusion in parallel to the "missing persons" scenario which characterizes many discussions of women's entry into male arenas). As with most masculinist frameworks, women do not fit and do not "make the grade," and Witz's attempt to delineate how women's work can be "added on" to the professional literature only serves to reinforce such a negative conclusion.
Instead, I think it would have been more interesting to underline what women did achieve in these two occupations as they slowly and quietly made progress over the period in question. In fact, their achievements are remarkable -- from the status of "masseurs" and "home economists" early in this century, they progressed to specialists with university-level educational qualifications who managed to obtain both legal and professional acknowledgement of the importance of their expertise. The specificity of their contributions could then be highlighted and the pattern of women's contribution to the health field could begin to be formulated in its own right. In effect, instead of being measured against a male standard and found wanting, the experience of these women dietists and physiotherapists could serve to develop a new framework of analysis which, I suspect, could be enormously illuminating in our thinking about the health professions in general. It is the very excellence of the research contained in this volume which give rise to this possibility. All the data are there; we just have to get rid of the male standard.