Legitimating outcast practices: Professional contestation over introduction of traditional and complementary medicine into the Turkish healthcare system, 2014-2018

In this dissertation, I examine legitimation as a multidimensional process, which involves interactions between entities (such as practices or organizational forms), legitimacy criteria by which these entities are evaluated (such as regulative or normative), and legitimators (such as professionals or the state). Specifically, I examine legitimation of a bundle of outcast practices as driven by a heterogenous community of professionals mobilizing diverse legitimacy criteria and the ensuing contestation. My empiricial context is integration of traditional and complementary medicine (TCM) into the Turkish healthcare system (THCS), which was initiated in 2014 by the Turkish Ministry of Health through a bylaw that regulated 15 different TCM practices, allowing them to be performed by medical doctors (MDs). In order to examine how legitimation process unfolded within this context, I designed a qualitative research encompassing the period 2014-2018 during when I collected interview data from medical professionals. I also used other data sources to collect background information. Results from qualitative analyses revealed that legitimacy of TCM practices is not resolved once and for all but instead the process unfolds in a multidimensional space made up professionals with divergent ideologies, their varied legitimacy criteria, and a variety of practices. The outcome is contestation characterized by an emergent schism within the profession as to legitimacy of TCM practices, establishment of new criteria according to which adequacy of medical practices can be evaluated, and divergence in the extent to which individual TCM practices are considered as legitimate. As I conclude this dissertation, I argue that studying legitimation as a multidimensional process may help capture overall complexity and critical dynamics of this process and avoid biases that emenate from a unidimensional conception.