Navigating uncertainty: professional trajectories and recognition boundaries in integrative medicine in Spain.

Abstract

Integrative medicine should be understood not as an isolated entity but as a boundary field —a contested space where medical legitimacy, scientific authority, and professional jurisdiction are continuously negotiated. The Spanish case illustrates how regulation functions not merely as a technical or legal instrument but as a mechanism that structures professional practice while also defining what constitutes legitimate medical knowledge. In the absence of formal recognition, integrative medicine practitioners in Spain operate in a contested space where legal ambiguity, institutional constraints, and economic pressures shape their professional trajectories. Drawing on in-depth interviews with Spanish medical professionals engaged in integrative practices, this article explores how these practitioners navigate this terrain and makes two main contributions. First, at the empirical level, it provides one of the first in-depth qualitative analyses of the professional trajectories of integrative medicine practitioners in Spain, a context where CAM remains legally unregulated and politically contested. Second, at the theoretical level, it introduces the concept of “recognition boundaries” to capture how legitimacy is not only a matter of institutional inclusion but also of symbolic and cultural validation. By building on boundary theory and Lamont’s work on recognition, we argue that recognition boundaries operate as dynamic, contested markers that shape what is considered acceptable within medical institutions—and who is authorized to speak and act as a legitimate professional. This concept may be applicable to other health systems where professionals operate in liminal spaces, negotiating belonging in the absence of institutional support.