Doctors and dirty work—the case of alcoholism*

Doctors’treatment of certain classes of patient as dirty work is often ascribed to irrational reasons such as ignorance and prejudice. This is certainly true of the research tradition which seeks to explain why doctors avoid or dislike alcoholics. However, based on informal interviews with a group of Scottish general practitioners, I argue that, although all may be ignorant in some ways and a few are perhaps prejudiced, there are nevertheless other and quite rational grounds for their general avoidance of alcoholics. For alcoholics break three broad principles which shape conventional medical practice: the assumption of medical expertise, the belief that medical matters fall largely within the‘natural’sphere of things; and the assumption that, despite the doctors’inability to intervene or order, patients are normally motivated to comply with medical instructions. To break one principle would make matters difficult enough, to break all three renders normal consultations highly problematic. I conclude by noting that, although alcoholism has some unique features, the difficulties which its treatment entails are common to much of psychiatric practice also.