Introduction

Long ago, professionals were seen as neutral experts who used their skills and knowledge for the betterment of society. This functionalist perspective on professionalism, embodied in e.g. the works of Emile Durkheim (1957), treats professionals as the bearers of important social values. Professionals are defined by the idealtypical traits of their profession, as described in the previous chapter, including a body of abstract and specialized knowledge and professional values. The idealtypical image of the impartial professional who uses his expert knowledge to the best interest of his clients is under attack since Ivan Illich's (1976) famous criticism of the medical profession. Illich argued that medicine is harmful to the individual. He spoke of ‘iatrogenesis’: harm caused by medical intervention. Illich did not only observe clinical iatrogenesis – harm caused by direct medical intervention – but also social and cultural iatrogenesis. This concerns the medicalization of everyday life and thinking. The medical profession extended its reach and medical intervention became more and more perceived as a solution for many individual and social problems.

In Illich's thesis that professional intervention creates the needs it responds to, is coupled with the idea of counterproductivity of professional intervention. This approach is applied to professionalism in general by, for example, the Dutch philosopher Achterhuis, who wrote a very influential critical review of social work in 1979, ‘The Market for Welfare and Happiness’. At that moment, social workers had experienced a long period of expansion, mainly because of the rapid growth of the welfare state in-between World War II and the 1970s. Achterhuis portrayed social workers as semi-professionals engaged in a process of professionalization. His conclusion was that these (semi-)professionals created their own expansive markets of well-being and happiness, which make people dependent on professionals and in the end fail to solve problems. This failure, however, is answered with more professional intervention, not less (Achterhuis 1980).

The critical analyses of professionalism by Illich, Achterhuis and many others undermined the high status and autonomy of professionals. This loss of status almost automatically contributed to the pressures experienced by professionals, especially the rule and societal pressures identified in the preceding chapter.