DEVIANCE & MEDICALIZATION: From Badness to Sickness

DEVIANCE & MEDICALIZATION: From Badness to Sickness Peter Conrad & Joseph W. Schneider (Philadelphia: Temple University Press, 1992)

FROM BADNESS to SICKNESS: CHANGING DESIGNATIONS of DEVIANCE and SOCIAL CONTROL

A HISTORICAL-SOCIAL CONSTRUCTIONIST APPROACH TO DEVIANCE • A dual perspective that views the attribution of deviance as a historical, social construction of reality and the activities involved in constructing new deviance definitions or designations for social control • Asociology of deviance designations or categories is concerned with the social processes through which certain forms of behavior are defined collectively as one type of problem or another • Focus: how certain categories of deviant behavior become defined as medical rather than moral problems and how medicine, rather than the family, church, or state, has become the dominant agent of social control for those so identified

Deviance as collective action: the labeling-Interaction1st tradition • The labeling-interactionistapproach turns analysis away from the individual and the "causes" of his or her behavior to the "societal reaction" • Deviance is "collective action" of all parties involved in any episode of alleged deviance • Who defines what as deviant? • How does one group manage to have their definition of deviance legitimated? • How do deviance designations change as political and economic conditions change? Whose interests do deviance designations serve? • This perspective leads to the study of the distribution of power in a society, how those with power are able to effect the production of deviance designations, and whose interests these designations support

SOCIAL CONSTRUCTION OF REALITY: A SOCIOLOGY OF KNOWLEDGE • The phenomenological perspective sensitizes us to the socially constructed nature of deviance designations - that they emerge from social interaction and that they are humanly constructed and hence can be humanly changed • The conflict perspective sensitizes us to the fact that not all people are equal in their power to construct reality - that deviance designations may serve political interests and that they are created usually through some type of social conflict

Politics of definition • The decision to define certain behaviors, activities, or conditions as deviant emerges from a political process that produces and legitimates the imposition of the deviant categories • The consequences of medical definitions, especially when they concern human behavior, are also political

Interests, status, and class In the politics of definition • The politics of definitions is a process whereby definitions of deviance are socially constructed • Definitions are constructed through a political process and legitimated in legal statutes, medical vocabulary, or religious doctrine • Powerful interests in society are best able to implement their version of reality by creating and legitimating deviance definitions that support their interests

Politics of deviance designation • Decisions concerning what is the proper deviance designation and who is the proper agent of control are political questions decided frequently through political contest • Sociologists’ task: the examination of "claims-making" activities that lead to the establishment of a deviance designation and the appropriate agent of social control.

Deviance designations and social change • Deviance designations justify the suitable social control agent and may also result in changes in: • the legitimate "authority" concerning a particular type of deviant behavior • the meaning of behavior • the legal status of the deviance • the contents of a deviance category or the norm itself • the arena where identification and labeling of deviance takes place, and the vocabulary used • the mode of intervention • the type of data collected and the focus of research • the attribution of responsibility

Paradigms & paradigm shifts • Three major paradigms have reigned over deviance designations in various historical periods: • deviance as sin • deviance as crime • deviance as sickness • scientific paradigm: "universally recognized scientific achievements that, for a time, provide model problems and solutions for a community of researchers" (Kuhn)

DEVIANCE, ILLNESS, AND MEDICALIZATION • Medicalization of deviant behavior: the defining and labeling of deviant behavior as a medical problem, usually an illness, and mandating the medical profession to provide some type of treatment for it • Medicine becomes an agent of social control, typically as medical intervention • Medical intervention as social control seeks to limit, modify, regulate, isolate, or eliminate deviant behavior with medical means and in the name of health

Disease: biophysiological phenomena that manifest 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 Illness is a social construction based on human judgments of some condition The social construction of Illness: Disease vs. Illness

Illness and deviance • Deviance considered willful tends to be defined as crime; when it is seen as unwillful it tends to be defined as illness • Parsons conceptualized illness as deviance primarily because of its threat to the stability of a social system through its impact on role performance • The "sick role" serves to conditionally legitimate the deviance of illness: • the sick person is exempted from normal responsibilities, to the extent necessary to "get well" • the individual is not held responsible for his or her condition and cannot be expected to recover by an act of will • the person must recognize that being ill is an inherently undesirable state and must want to recover • the sick person is obligated to seek and cooperate with a competent treatment agent (usually a physician)

MEDICALIZATION OF DEVIANCE • Historically there have been great transformations in the definition of deviance: from religious to state-legal to medical-scientific • Along with the change in sanctions and social control agent there is a corresponding change in definition or conceptualization of deviant behavior • Like all social change, they produced positive and negative effects that were distributed differentially in the affected population • For example, the medicalization of opiate addiction, deviant drinking, obesity, hyperactivity, madness, etc. meant “progress” for some, but not all

Expansion of medical Jurisdiction over deviance • When treatment rather than punishment becomes the preferred sanction for deviance, an increasing amount of behavior is conceptualized in a medical framework as illness, • e.g., alcoholism, drug addiction, hyperactive children, suicide, obesity, mental retardation, crime, violence, child abuse, learning problems, and several types of social deviance • with badness the deviants were considered responsible for their behavior; with sickness they are not, or at least responsibility is diminished • The increasing acceptance and dominance of a scientific world view and the increase in status and power of the medical profession have contributed significantly to the adoption and public acceptance of medical approaches to handling deviant behavior

The medical model of deviance locates the source of deviant behavior within the individual, postulating a physiological, constitutional, organic, or, occasionally, psychogenic agent or condition that is assumed to cause the behavioral deviance Adoption of the medical model generally legitimates and even mandates medical intervention The medical model and associated medical designations are assumed to have a scientific basis and thus are treated as if they were morally neutral However, medical designations of deviance are influenced significantly by the moral order of society and thus cannot be considered morally neutral The medical model and "moral neutrality"

DEVIANCE & MEDICALIZATION: From Badness to Sickness