The Medicalization of Deviance

1. The Medicalization of Deviance

2. 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 Disease vs. Illness

3. Sociological model focuses on societal factors Medical model focuses on organic pathology in individual patients, rarely taking societal factors into account Approaches to illness: the sociological vs. medical model

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

5. 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

6. 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

7. 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?

8. 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

9. Social consequences of medicalization • The problem of expert control • Medical social control • individualization of social problems • depoliticizationof deviant behavior

10. Ch. 33: The Moral Career of the Mental Patient Erving Goffman

11. 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 • Goffmanstudies 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 hospitalized

12. 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

13. 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

14. 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 alienativecoalition

15. 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

16. 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.

17. 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