Credit where credit is due

As a PhD student at the back end of the 1980s I came to be suspicious of ‘grounded theory’ studies and carried on feeling that way even though the constant comparative method that underpins grounded theory building has been my main methodological commitment for my whole career. I saw Grounded Theory (1) as a step backwards. Although I don’t necessarily hold with all of the technical procedures that drive GT, increasingly I think it is a really good model for work that integrates empirical investigation and theory-building research, and I approach GT much more sympathetically. I’ve looked again at how Barney Glaser and Anselm Strauss were able to draw from their ethnographic studies of medicine and health care a set of substantive theoretical constructs about trajectories and then they worked these into a formal theory of Status Passage. Although it’s nearly 50 years old, it’s elegant, parsimonious and interesting. It’s hugely relevant to some of the problems we investigate today in medical sociology, especially around the experience and management of chronic illness.

I stayed suspicious of GT because so many of they studies that have claimed grounded theory, actually deliver nothing of the kind. Instead they offer a set of empirical generalizations – regularities in the data that call for theoretical explanation – rather than theoretical explanations in themselves. In this context, it’s scale that is important. Empirical generalizations may be all that it is possible to achieve, inductively, in the kind of small scale qualitative study that are the most common examples of the species in medical sociology. But GT, as set out by Glaser and Strauss did not come about through such studies. Instead, they drew on, and drew together, comparative analyses on a large scale. Status Passage, for example, draws on three large studies in which Strauss was a senior investigator – Boys in White (2), Psychiatric Ideologies and Institutions, (3) and Awareness of Dying (4) – to develop a theory of personal trajectories. These were large programmatic studies, consisting of many field researchers conducting hundreds of interviews and observations in a very intensive process of data gathering and interpretation-in-action. Individually and together, these studies made major theoretical contributions to the development of medical sociology as a field and they did so by cumulative and comparative theoretically informed analysis. When I started drawing together my own studies to build up a theoretical model (5) I ended up doing something close to Grounded Theory-building as it was described by Glaser and Strauss. Close enough, in fact, to need to call it that and give credit where credit is due.

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(1) Glaser BG, Strauss A. The discovery of grounded theory. (Chicago: Aldine, 1967)

(2) Becker H, Geer B, Hughes EC, Strauss A. Boys in white: student culture in medical school. (Chicago: University of Chicago Press, 1961)

(3) Strauss A, Schatzman L, Bucher R, Ehrlichman D, Sabshin M. Psychiatric Ideologies and Institutions. (New York: Free Press, 1964)

(4) Glaser BG, Strauss A. Awareness of dying. (Chicago: Aldine, 1965)

(5) May C. A rational model for assessing and evaluating complex interventions in health care. BMC Health Services Research 2006; 6: 1-11