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The chapters PJ McGann and David J. Hutson have assembled for this volume are not only timely, coinciding with the appearance of DSM-V, but mark a defining moment in which a new subfield of medical sociology has emerged. Diagnosis, which refers both to diagnostic categories and the process of creating and applying them, is a central feature (Blaxter, 1978) – if not the central feature of medical work. Annemarie Jutel, who has done much to build the sociology of diagnosis, has described the wide array of “work” diagnosis performs in the medical world:Diagnosis is integral to medicine and the way it creates social order. It organizes illness: identifying treatment options, predicting outcomes, and providing an explanatory framework. Diagnosis also serves an administrative purpose as it enables access to services and status, from insurance reimbursement to restricted-access medication, sick leave and support group membership and so on… (Jutel, 2009, p. 278)
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.
Throughout the late 19th and early 20th centuries, one of the many techniques used by physicians and psychiatrists to diagnose patients involved external and highly public examination. Typically conducted as a lecture to other medical experts and students, the patient was placed in the center of a round room with onlookers arranged in tiered seating to guarantee an unobstructed view. As the lead physician detailed the list of symptoms, using the patient's body as an illustration, observers witnessed the behavioral signs for themselves and discussed the possible underlying conditions or pathologies. This process of consultation and naming worked to increase the relative reliability among experts and bolster the professional reputations of medicine and psychiatry alike (Conrad & Schneider, 1992; Gillis, 2006; Grob & Horwitz, 2010). As researchers have noted (Aronowitz, 2001; Foucault, 1973), this change from focusing on disparate, idiosyncratic symptoms as expressions of individual illness to a system that recognized disease states comprised of symptom clusters marks a historical turning point in the history of medicine. The shift toward a classification scheme that linked medicine with science and technology bolstered medical authority and the power of physicians. In addition to professional credentials, accumulated knowledge, and institutional legitimacy, the authority of modern medicine both rests on and is expressed by medicine's decisive power to name and categorize through diagnosis (Jutel, 2009). Even as medical prestige has eroded, ceding some of its power to other entities,1 physicians remain the final arbiter of official medical categories (Pescosolido, 2006), judges of what is, and what is not, a “real” diagnosis. In the diagnostic process, one looks within to reveal the nature of disease from without – empirical observation becomes immutable fact. Of course, as critical perspectives on medicine have long pointed out (Conrad & Schneider, 1992; Zola, 1972), the scientific “fact” of one time and place is the mythology or ignorance of another. Diagnosis, as both category and process (Blaxter, 1978), is infused with all manner of things social, historical, and cultural. This volume explores some of these infusions. In so doing, it aims to clarify and contribute to the emerging sociology of diagnosis – an endeavor first called for by Brown (1990), but more recently revived by Jutel (2009).
Purpose – The purpose of this chapter is to theorize the relationship between diagnosis and medicalization through an examination of the medicalization of childhood gender variance and the Gender Identity Disorder of Childhood diagnosis.
Methodology/approach – The chapter examines textual data (published clinical and research literatures, and critiques of the diagnosis appearing in a range of venues) to track how childhood gender variance is medicalized over time and the role of diagnosis in that medicalization.
Findings – While diagnosis certainly plays a role in shoring up medicalization, this case study reveals the many ways in which diagnoses may also become key tools in attempts to curtail medicalization.
Research limitations/implications – As a case study, the findings are not generalizable to all diagnoses. As a study of an instance of the medicalization of deviance, these findings may be particularly applicable to analogous cases.
Social implications – These findings show the sometimes tenuous nature of medicalization processes, and the social uses of diagnoses in those processes.
Originality/value of paper – This chapter sheds light on a relationship that is often assumed to be unidirectional (e.g., that the formation of diagnosis results in increased medicalization), and answers calls for a more nuanced sociology of diagnosis, including greater attention to the relationship between diagnosis and medicalization.