Sources of Self-Help
Matthew E. Archibald
Health social movements bring about social change by challenging the authority of dominant interests in medicine and health care (Brown et al. 2004; Brown and Zavestoski 2004). To mobilize constituents, activists must demonstrate that their mission, its organizations, and its activities align with the sociopolitical and cultural (or identity) interests of constituents (Armstrong 2002). Challenger movements must demonstrate that they possess a moral justification for their program of change equivalent to that of their detractors and in doing so seek to acquire not only material support but legitimacy—sociopolitical and cultural recognition and acceptance (Scott 2003). Paradoxically, sources of legitimation, particularly for health movements, are controlled by actors with vested interests in mainstream health and health care. As Epstein (1996) and others in this volume, and elsewhere, have shown, health movements are dependent on their antagonists to a striking degree. How then do health social movements acquire legitimacy to foster social change from their adversaries who are invested in preserving the status quo?
Current research in health social movements sheds light on this question by theorizing a number of ways activists and institutional actors1 interpenetrate movements (Wolfson 2001) and create hybrids that blur the boundaries between lay and expert forms of knowledge, overcoming organizational and political divisions between them (Brown et al. 2004; McCormick, Brown, and Zavestoski 2003). The specific conditions under which these interpenetrated or boundary movements emerge and develop vary widely but one important precursor is elite discord—movements can and do take advantage of rifts among elites in order to win converts to their cause and secure formerly inaccessible institutional resources (Meyer 2004). Declining professional autonomy and authority has led to elite discord in the field of medicine and competition