Open Research Online The Open University’s repository of research publications and other research outputs Shiatsu Practitioners: Forging a Path Through a Landscape of Practice Thesis How to cite: Spurr, Susan Margaret (2015). Shiatsu Practitioners: Forging a Path Through a Landscape of Practice. PhD thesis The Open University. For guidance on citations see FAQs. c 2015 The Author https://creativecommons.org/licenses/by-nc-nd/4.0/ Version: Version of Record Link(s) to article on publisher’s website: http://dx.doi.org/doi:10.21954/ou.ro.0000efa2 Copyright and Moral Rights for the articles on this site are retained by the individual authors and/or other copyright owners. For more information on Open Research Online’s data policy on reuse of materials please consult the policies page. oro.open.ac.uk Shiatsu practitioners: forging a path through a landscape of practice Susan M Spurr BSc (Hons) Applied Biology (Lond), PGCE A thesis submitted for the award of Doctor of Philosophy The Open University Faculty of Health & Social Care March 2015 Oms. o? soe.mvSS.ion : 2”>’ i'APsRcv-t X O '.S Ds^re o f 1 o 2,.otS ProQuest Number: 13834802 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 13834802 Published by ProQuest LLC(2019). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 Abstract This thesis is an exploratory study of Shiatsu as a distinct type of healthcare practice. Situated within the sociology of the professions as the wider academic context, this study focuses on Shiatsu practitioners and the process of professionalisation in relation to complementary and alternative medicine (CAM). Neo-Weberian theory is used to examine the field of CAM, highlighting its marginalisation by the medical profession. What counts as legitimate knowledge is raised as an important question in relation to the process of professionalisation and CAM. Ethnography and narrative inquiry form the basis of the methodological approach. My experiences as a Shiatsu practitioner gave me ‘deep familiarity’ in the field of my research and I examine the challenges in this respect and discuss reflexivity as a methodological tool. The recruitment strategy led to a spectrum of participants’ experiences across a broad temporal dimension and I argue this is a particular strength of the study. Concepts of ‘social positioning’ and ‘turning points’ provide important theoretical considerations of the analytic framework. The data-led chapters collectively form a trajectory of participants’ pathways through a ‘landscape of practice’. These chapters highlight key tensions and turning points in relation to the trajectory of ‘Getting into Shiatsu’ and ‘Getting out there to practise Shiatsu’, particularly in respect of the status of knowledge and earning a living as a Shiatsu practitioner. These tensions are discussed in the context of professionalisation, and highlight some of the wider structural factors - for example the interface of Shiatsu with the NHS, other CAM practices as well as society in general. The issue of marginalisation provides a connection between Etienne Wenger-Trayner’s concept of landscapes of practice and neo- Weberian theory in relation to CAM practices. The experiences of participants this study are potentially relevant to other practitioners not only in other marginalised emerging professions but also practitioners in more established professions. Acknowledgments The wise guidance of my supervisors, Professor Jan Draper and Professor Rose Barbour, was invaluable. I also extend my gratitude to previous members of the supervision team, Dr Maxine Birch, Dr Terry Di Paolo and Professor Sheila Peace, for their support during the early years. The wonderful participants deserve a special mention as without their stories, this study could never have happened. I am very grateful to the Shiatsu Society (UK) for their generous help and support. I am indebted to the many friends and colleagues with whom I have walked and talked and shared my ideas and found inspiration. My family’s unending love and support have sustained me throughout my PhD journey. Table of contents Abstract ................................................................................................................................... i Acknowledgments ............................................................................................................... iii Table of contents ................................................................................................................ iv List of appendices .............................................................................................. x List of tables and figures ................................................................................................... xi Abbreviations ......................................................................................................................xii Use of authors’ first names .......................... xiii Nomenclature ....................................................................................................................xiv CHAPTER 1 Introduction ................................................................................................... 1 CHAPTER 2 Literature review ..........................................................................................5 Introduction ...................................................................................................................... 5 Part 1 Sociology of the professions .............................................................................6 Legitimation of knowledge and professionalisation ........................................... 10 Occupational socialisation .......................................................................................15 Professionalism .................................................................................................... 16 Rise of the medical profession .............................................................................. 17 Subordination and limitation of other health professional groups ................... 18 Part 2 Complementary and Alternative Medicine ................................................... 19 Defining C A M ............................................................................................................20 People who use C A M .............................................................................................. 23 CAM and bodywork ................................................................................................. 26 CAM and the medical profession ...........................................................................28 CAM and the evidence-based debate ...................................................................30 CAM and the state (U K ) ...........................................................................................31 CAM and professionalisation ..................................................................................32 CAM and the NHS ..................................................................................................... 38 Researching practitioners .......................................................................................40 Part 3 Shiatsu - a distinct healthcare practice ........................................................ 46 Shiatsu and Japan....................................................................................................47 Shiatsu and the U K ...................................................................................................49 Professional organisation ........................................................................................ 50 Concluding comments ..................................................................................................60 Aim of this study and the research questions ......................................................... 61 CHAPTER 3 Methodological and theoretical considerations...................................63 Introduction .....................................................................................................................63 Part 1 Taking an ethnographic approach ..................................................................63 Origins and differing perspectives ..........................................................................64 Generating the ethnographic enterprise - reflexivity ......................................... 66 Part 2 Narrative inquiry ................................................................................................ 72 Social positioning and identity in narratives ........................................................ 73 Turning points and trajectories in narrative inquiry .............................................74 Part 3 Putting the research process into practice ...................................................77 Ethical considerations .............................................................................................. 77 Approaching the field