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Purpose – To explore the ideological effects and social control potential of diagnostic biopsychiatry and encourage the sociology of diagnosis to retain key insights of early medicalization scholarship.
Methodology – As the sociology of diagnosis emerges from medicalization, it is imperative that the new sub-specialty retains the critical edge of the early scholarship. With this in mind the paper reviews key aspects of the medicalization thesis, emphasizing the links between medical definitions and social control processes (e.g. Conrad, 1992; Conrad & Schneider, 1992; Zola, 1972). Based on this review scholars are urged to be mindful of the “diagnostic imaginary” -- a way of thinking that conceals the presence of the social in diagnoses, and which closes off critical analysis of the existential-connectedness and political nature of diagnoses.
Findings – The paradigm shift from dynamic to diagnostic psychiatry in DSM-III opened the door to a new biomedical model that has enhanced American psychiatry's scientific aura and prestige. With the increased presence and ordinariness of diagnoses in everyday life, an illusory view of diagnoses as scientific entities free of cultural ties has emerged, intensifying the dangers of medical social control.
Social implications – By illustrating that diagnoses are cultural objects imbued with political meaning, the ideological effects and social control potential of diagnostic biopsychiatry may be mitigated.
The United States has an uncomfortable relationship with pleasure. Cultural ambivalence is evident in discourses surrounding pleasure and the labeling and treatment of…
The United States has an uncomfortable relationship with pleasure. Cultural ambivalence is evident in discourses surrounding pleasure and the labeling and treatment of those who act on their desires. Pleasure seeking, generally understood in moral terms, is often medicalized and criminalized (as in the case of pregnancy prevention and drug use), placing questions of how to manage pleasure under the purview of medical and legal actors. At the macrolevel, institutions police pleasure via rules, patterns of action, and logics, while at the microlevel, frontline workers police pleasure via daily decisions about resource distribution. This chapter develops a sociolegal framework for understanding the social control of pleasure by analyzing how two institutions – medicine and criminal justice – police pleasure institutionally and interactionally. Conceptualizing medicine and criminal justice as paternalistic institutions acting as arbiters of morality, I demonstrate how these institutions address two cases of pleasure seeking – drug use and sex – by drawing examples from contemporary drug and reproductive health policy. Section one highlights shared institutional mechanisms of policing pleasure across medicine and criminal justice such as categorization, allocation of professional power, and the structuring of legitimate consequences for pleasure seeking. Section two demonstrates how frontline workers in each field act as moral gatekeepers as they interpret and construct institutional imperatives while exercising discretion about resource allocation in daily practice. The chapter concludes with a discussion of how understanding institutional and interactional policing of pleasure informs sociolegal scholarship about the relationships between medicine and criminal justice and the mechanisms by which institutions and frontline workers act as agents of social control.
Back in 2005 lawyers for the Milwaukee school board decided to exclude Viagra and similar erectile dysfunction (ED) drugs from health coverage for the teachers’ union because, well, they were simply too expensive.1 And besides, so the school board explained, such drugs are used primarily for recreational sex and are not a medical necessity.
This chapter explores processes of stratification in reproductive healthcare and considers the ways in which mechanisms of inclusion/exclusion shape reproductive…
This chapter explores processes of stratification in reproductive healthcare and considers the ways in which mechanisms of inclusion/exclusion shape reproductive opportunities and experiences. First, I consider the process of “selective inclusion” among sexual minority women. This examination questions the schisms that exist within the sexual minority population in regard to their visibility and legibility in medical, scientific, and public health discourses and constructions of reproductive health. The second process I examine is that of “exclusionary inclusion” among substance using pregnant women who have been collectively deemed “bad breeders” by medical and state authorities and whose reproduction is explicitly monitored, regulated, and criminalized. The final process I discuss is “side-stepping inclusion” which describes the healthcare and consumer decisions of women who circumvent medicalized childbirth experiences by employing the services of a midwife for their pregnancy and birth care. This chapter examines how medicalization, biomedicalization, and de-medicalization dynamically work together to expand and delimit inclusionary processes, emphasizing the spectral and interconnected quality of these processes. By exploring various processes of inclusion that shape reproductive experiences of these disparate and differentially marginalized populations, this chapter provides a conceptual and critical meditation on the ways in which “respectable reproduction” is deployed in reproductive care. In considering these processes of inclusion and the ways in which they are co-produced by medical discourses and practices, scholars may more clearly grasp some fundamental mechanisms of stratification in reproductive healthcare and knowledge production.
Health social movements address several issues: (a) access to, or provision of, health care services; (b) disease, illness experience, disability and contested illness;…
Health social movements address several issues: (a) access to, or provision of, health care services; (b) disease, illness experience, disability and contested illness; and/or (c) health inequality and inequity based on race, ethnicity, gender, class and/or sexuality. These movements have challenged a variety of authority structures in society, resulting in massive changes in the health care system. While many other social movements challenge medical authority, a rapidly growing type of health social movement, “embodied health movements” (EHMs), challenge both medical and scientific authority. Embodied health movements do this in three ways: (1) they make the body central to social movements, especially with regard to the embodied experience of people with the disease; (2) they typically include challenges to existing medical/scientific knowledge and practice; and (3) they often involve activists collaborating with scientists and health professionals in pursuing treatment, prevention, research, and expanded funding. We present a conceptual framework for understanding embodied health movements as simultaneously challenging authority structures and allying with them, and offer the environmental breast cancer movement as an exemplar case.
As biomedicine becomes increasingly enmeshed in modern life, biomedicalization processes have implications for reproductive policy, including abortion policy. Informed…
As biomedicine becomes increasingly enmeshed in modern life, biomedicalization processes have implications for reproductive policy, including abortion policy. Informed consent provisions have been a prominent trend in state-level abortion lawmaking in the United States in recent years. Modeled on the practice of securing informed consent for medical procedures, informed consent provisions stipulate the information a person must receive before they can consent to an abortion. Informed consent provisions purportedly require that this information be objective, scientifically accurate, and non-judgmental. Through an analysis of informed consent provisions in Texas abortion legislation from 1993 to 2015, this chapter explores how such provisions employ medical and biomedical tropes to frame regulations that restrict access to abortion care as ostensibly protecting women’s health and safety. I find that informed consent legislation in Texas selectively borrows from medical and biomedical lexicons, cites strategic empirical evidence, and co-opts medical techniques and experts in ways that encumber abortion access.
Purpose – To examine debates within the transgender rights movement over the GID diagnosis in order to demonstrate how diagnosis can be resisted as a source of stigma and…
Purpose – To examine debates within the transgender rights movement over the GID diagnosis in order to demonstrate how diagnosis can be resisted as a source of stigma and social control at the same time that it is embraced as a means of legitimating experience and gaining access to resources, including medical services.
Methodology/approach – This chapter draws on qualitative data from: in-depth interviews with transgender rights activists and advocates, participant observation in transgender health care and activism settings, and content analysis of print and web-based materials on transgender health.
Findings – Transgender rights activists and advocates overwhelmingly reject the pathologization of gender variance. However, some actors advocate complete demedicalization, while others advocate diagnostic reform. Actors' advocacy for each position is influenced by the perceived costs versus benefits of diagnosis.
Social implications – The findings of this research shed light on the multiple and often contradictory effects of diagnosis. Diagnoses can both normalize and stigmatize. They can function to allow or deny access to medical services and they can support or act as barriers to legal rights and protections. Understanding these contradictory effects is essential to understanding contests over diagnosis, including the contemporary debate over GID.
Originality/value of paper – Through examination of an intra-constituent contest over diagnosis, this research demonstrates the need to distinguish medicalization from pathologization and illustrates the importance of examining the multiple and contradictory effects of diagnosis, both in and outside of medical settings.
Purpose – This chapter presents a case for reframing medical sociology to focus on diagnosis as a pivotal category of analysis via an extended literature review of the…
Purpose – This chapter presents a case for reframing medical sociology to focus on diagnosis as a pivotal category of analysis via an extended literature review of the diagnosis as a tool of medicine.
Methodology/approach – Conceptual overview.
Practical implications – By reviewing the range of social functions served by diagnosis, and the similarly wide assortment of social forces that shape diagnostic categories, this chapter pushes social scientists and theorists to consider diagnosis as a cornerstone to the understanding of health, illness, and disease.
Originality/value of paper – Building on Brown's earlier call for a sociology of diagnosis, this chapter sets forth potential parameters for this field. It defines how the study of diagnosis is dissipated across myriad areas of scholarship, including medicalization, disease theory, ethics, classification theory, and history of medicine. Extirpating diagnosis and revealing it for specific discussion provides an opportunity to study topics such as illness experiences, health social movements, and disease recognition from a different and rich perspective.
To shed light on how gender norms are reproduced in medical training and practice through an exploration of representations of the problem of “work–life balance.” Women…
To shed light on how gender norms are reproduced in medical training and practice through an exploration of representations of the problem of “work–life balance.” Women physicians and women physician-researchers (WPs/WPRs) in Canada and in the United States experience social and health inequities when compared to their men colleagues. Despite current medical school acceptance parity, upon entering the medical workforce, women work harder than men to succeed within the historically male-dominated structures and value system of the medical profession.
We performed a critical discourse analysis of articles retrieved from academic databases and leading Anglo-American journals that discussed “work–life balance,” to investigate how the discourse contributed to, or challenged, the reproduction of gender norms in medicine.
While the medical literature acknowledges that the social and health inequities experienced by WP/WPR result from discriminatory norms and practices, it neglects to challenge built-in gendered inequities in benchmarks for success in the profession. Instead, proposed solutions require that WP/WPR themselves learn to cope and make better lifestyle choices, including downloading domestic responsibilities on socially disadvantaged – racialized and poor – women. Authors’ gender appears to make no difference.
Our search was limited to the Anglo-American literature, often retrieved articles inaccessible via our university library, excluded informal venues (e.g., blogs), and did not include cases of same-sex couples or interviews of WP/WPR. All these may have challenged components of our argument by revealing more nuanced debates, occurring under different political, cultural, and economic contexts.
While individual choices of WP/WPR are important to the protagonists, to successfully address the very real problem of work–life balance experienced by WP/WPR, patriarchal norms should be challenged, failure to comply with these norms should be rejected as explanations for work–life balance challenges, and norms themselves should become the focus of analysis and intervention.
The medical language used by physicians of both genders normalizes gendered inequities, favoring the success of medical men over women, and reproducing the professional and personal disadvantages experienced by the latter, further burdening socially disadvantaged women.
Turkish mothers’ interactions with medical authorities during pregnancy and childbirth have developed in a context of risk discourses produced by biomedical experts with…
Turkish mothers’ interactions with medical authorities during pregnancy and childbirth have developed in a context of risk discourses produced by biomedical experts with surveillance justified by these discourses. Giving meaning to pregnancy and childbirth through the search for the reduction of risks is a reflexive part of Turkish mothers’ everyday life.
This research paper aims to discuss a study examining how pregnancy and childbirth are socially constructed, how increased medicalization is experienced by Turkish mothers, and how they assign meaning to pregnancy and childbirth. A phenomenological research was designed using depth interviews with 10 Turkish mothers with children aged 0–6 years, living in Istanbul who had high education and welfare levels.
The findings shed light on Turkish mothers’ subjective experiences and how medicine as a profession shapes these experiences. With the medicalization of pregnancy and childbirth, how the trust toward the experts, the knowledge of preparation for maternity in an appropriate and responsible manner have become functional for Turkish mothers to create a sense of ontological security are examined.