The Medicalization of Deviance

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Disease vs. Illness

Disease: bio-physiological phenomena that manifest themselves as changes in and malfunctions of the human body -a physiological state -objective

Illness: the experience of being sick or diseased

-a social psychological state, presumably caused by the disease -subjective

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Approaches to illness: the sociological vs. medical model • Sociological model focuses

on societal factors• Medical model focuses on

organic pathology in individual patients, rarely taking societal factors into account

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Ch. 6: The Discovery of Hyperkinesis: Notes on the Medicalization of Deviant BehaviorPeter Conrad (1975)

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Medicalization of deviant behavior

• Medicalization means defining behavior as a medical problem or illness and mandating or licensing the medical profession to provide treatment, e.g., • Alcoholism, drug addiction, violence

• Medical institutions such as psychiatry and public health have always been concerned with social behavior and have functioned traditionally as agents of social control

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The Discovery of Hyperkinesis

• Clinical factors are directly related to diagnosis and treatment

• Social factors set the context for the emergence of the new diagnostic category• Pharmaceutical revolution• Government action

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Key questions

• How did children’s behavior become conceptualized as a medical problem?•Why did this occur when it did?•What are some of the implications of the

medicalization of deviant behavior?

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Accounting for the medicalization of attention fluctuation/hyperactivity• Advances in pharmaceutical technology• Prestige of medical profession, acceptance of its jurisdiction

over matters affecting the functioning of the body and anything that can be labeled illness

• The humanitarian trend in the conception and control of deviant behavior• Medicalization is seen to take morality, right and wrong, out of

the equation, thus potentially removing stigma

• Moral entrepreneurs, who crusade for the creation and enforcement of rules, played role, e.g.,:• Pharmaceutical companies• Association for Children with Learning Disabilities 8

Social consequences of medicalization

• The problem of expert control•Medical social control• individualization of social problems•depoliticization of deviant behavior

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Ch. 33: The Moral Career of the Mental PatientErving Goffman

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Moral career

• The moral career of a person of a given social category involves a standard sequence of changes in the way of conceiving self • Self can be seen as something that resides in the

arrangements prevailing in a social system • Goffman studies moral experiences within the

confines of an institutional system• Goffman defines “mental patient” sociologically, as a

person who has been hospitalized for mental illness • this excludes those with symptoms who have not been

hospitalized11

Moral career of mental patient has 3 phases

• Pre-patient phase: the period prior to entering the hospital• Inpatient phase: the period in the hospital• Ex-patient phase: the period after

discharge from the hospital

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Pre-patient phase• Patient begins with rights and relationships and ends up with hardly

any of either• "The moral aspects of this career, then, typically begin with the

experience of abandonment, disloyalty, and embitterment."

• Patients enter willingly and, more often, unwillingly, e.g., • Implored or threatened by family • Forced under police escort• Tricked or deceived by others (pertains especially to underage patients)

• Often, there is a complainant, some figure who makes a record of some offense by the pre-patient that leads to his/her hospitalization• But for every offense that leads to an effective complaint, there are

many psychiatrically similar ones that never do 13

A circuit of agents --alienative coalition--participate in passage from civilian to patient status

• Next of relation: person seen by patient as most available, dependable in times of trouble (often, next of kin)• Complainant• Mediators: the sequence of agents/agencies to which pre-

patient is referred and through which he is relayed and processed to the hospital, e.g., • Police, clergy, general medical practitioners, office psychiatrists,

personnel in public clinics, lawyers, social service workers, teachers, etc.

• These agents may be experienced as a kind of alienative coalition 14

Betrayal• Depth of feeling of betrayal increases when

another person, besides next of relation witnesses his betrayal• 3-party situation is significant b/c it makes the

betrayal “social”• Sense of feeling “conned”• Starts out with rights and liberties of civilian and

ends up in psych ward stripped of everything• Betrayal funnel: how stripping of patient’s

rights, liberties, and satisfactions is managed• Pre-patient’s moral career is retroactive

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Inpatient phase

• Upon entry there’s usually an attempt to maintain anonymity, “not-hereness,” followed by “settling down”• Settling down involves acceptance of patient status, of

membership in a total institution• Total institution: place of residence and work, where a

large number of like-situated people live cut off from the wider society for an appreciable period of time• Characterized by walls around it, barriers• An enclosed formally administered type of life

• Why is it total? Breakdown of barriers ordinarily separating sleep, work, play, e.g.,• Prisons, concentration camps, monasteries, work camps, etc.

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The ward system

• Assignment to a given ward is presented not as a reward or punishment, but as an expression of his general level of social functioning, his status as a person• Ward system is an extreme example of how the physical

facts of an establishment can be used to frame one’s self-concept• The more “medical” and therapeutic (not merely

custodial) a mental hospital is, the more pressure to reframe one’s concept of self

• Continual discrediting , by fellow patients and staff, is common

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