The Reformist Triad and Institutional Forgetting of Culture: A Field Study into Twentieth-Century Swedish Social Medicine

Abstract

Social medicine deals with the interplay between medicine and society. An awareness of how analytical categories have emerged historically can strengthen the role the discipline can play in the societal reinventions of health care now under way around the world. This study examines the categories that informed social medicine in Sweden during the 20th century. An anthropological field study was conducted over a 12-year period in a Swedish academic clinical setting. Historical documents were used to link local-level issues with macro-level (here, national and European) contexts. Social medicine, modernity, and social democracy were found to share a common history and a common vision of what society should be. As a result, concepts from politics, ideology, economy, and science tended to be conflated. As a clinician at the study site explained, "samhälle [community] is both society and state". The consequence for social medicine is that culture has become neglected as an analytical category. This institutional amnesia has strongly influenced how 21st century social medicine, in this region of the world, has defined itself and its interests. To return a cultural perspective to social medicine, a critical distance must be kept between the analyses the discipline undertakes and the prevailing societal ideologies.