Medicine as an institution of social control

1. Medicine as an institution of social control • Introduction: • Frist conceptualized as an agent of social control by Talcot Parsons in 1951 • Boundaries of medicine are elastic and expansive • Medical social control- the way medicine specifically secures adherence to social norms by minimizing, eliminating or normalizing deviant behavior

2. Three major ideal types • 1) Acceptance of medical perspective • Example, a well balanced diet is healthy 2) Professional medical intervention - Example, medical treatment (sick to not sick) 3) Medicalizing deviant behavior - Example, underlying illnesses, symptom or disease

3. Medical Technology • Specialized medicine is growing • Medicines fro disorders is now more prevalent • Medicines are powerful, profitable potent and easily administered as well as the treatment of choice in most cases • Psychosurgery developed in 1930’s • Behavior modification (discussed in class) • Genetic explanations along with chromosome research and genetic counseling have also been delved into as the cause of some behaviors

4. Medical collaboration/ Ideology • Collaboration idea, Physician serves as gate keeper of knowledge regarding medical issues • Highlights how medicine is woven into society • Relieves patient of certain obligations demonstrating the power of the medical excuse • Ideology, A type of social control that involves defining behavior as an illness because of social and ideological benefits because it is conceptualized in medical terms • Can also benefit individual or the dominant interest in society

5. The Brighter Side • Humanitarian • Sick Role • Optimistic view for deviant • Prestige of the Medical Profession • Flexible and more efficient than legal controls

6. Responsibility • Medicalization diminishes responsibility from the individual • Separated from social action • Lowering of status • “not-completely-responsible” become dependent on the responsible “non-sick”

7. Power of Medical Profession • Medicine influenced by moral order of society • Deviant behavior is labeled as medical problem society deems it no longer deviant • Problem defined as medical it is removed from discussion among the public. Placed in a position where only medical experts can discuss the issue.

8. Trends in medicine and medicalization • Due to the increasingly technological nature of medicine, medical practice has become increasingly specialized. 80% of physicians considered themselves specialists in the early 1970s compared to only 20% in 1940. • Medicine is the fastest expanding part of the service sector with expenditures increasing more than 10% yearly while the rest of the economy has grown by 6% to 7%. • Rising costs of medical care has been attributed to the growth in third-party payments. Because of this, “third parties” are increasingly deciding what is appropriate medical care and what is not depending on what they help cover. • Hospitals are becoming the center for health care delivery rather than private offices. • Federal programs in the 1960s expanded medical schools increasing the amount of physicians. An increase in medical personnel could increase the number of problems that become defined as medical problems.

9. Trends in medicine and medicalization cont. • Countertrends: • Health is becoming defined as more of a personal responsibility and could potentially spur some demedicalization. • A “right to adequate health care” and the development of a National Health Insurance (NHI) program. • Possible scenarios resulting from enacting an NHI bill: • Fewer deviant behaviors are defined as medical problems due to the high cost of paying for treatment. • More deviant behaviors will become medical problems because anything defined as a medical problem is treated. • Individuals are not considered responsible for their illnesses; so activities leading to medical problems become defined as deviant and certain medical problems could be excluded from NHI coverage.

10. Punitive backlash • Since about 1970 there has been a “backlash” against the “liberalization” of the treatment of deviance. • In 1973, New York passed a “get tough” law with mandatory prison sentences for drug dealers. • Antiabortion are aiming to criminalize abortion and antihomosexuality crusades are tying to limit the rights of homosexuals. • Swell in pubic action may be a response to the therapeutic ideology and the perceived “coddling” of deviants and may cause a retreat from the medicalization of deviance.

11. Some social policy recommendations • The medicalization of deviance needs to be recognized as a de facto social policy. • Research is needed on the extent of medicalization, its benefits, and its costs. • Medicalization removes the constitutional safeguards of the judicial process. • Social policies toward deviance that hold people accountable for their actions but do not blame them need to be developed.

12. Medicalization ofDeviance: A Final Note • The increasing dominance of the medical professional, the discovery of subtle physiological correlates of human behavior, and the creation of medical technologies have advanced the potential for medicalizing deviance. • Medicalization has reduced societal condemnation of deviants but these benefits do not mean these conditions are in fact diseases or the same results could not be achieved in another manner. • The most difficult consequence of medicalization to discuss is the exclusion of evil. • Our own socialization and “liberal” assumptions make it difficult to view individuals as “evil.”

13. Medical Social Control • Defining behavior as a medical problem allows certain things to be done that could not other wise be considered. • Psychosurgery on an individual prone to violent outbursts requires a diagnosis that something is wrong with his brain or nervous system. • These net and increasingly popular forms of medical control could not be used without the prior medicalization of deviant behavior. • Not implying overt malevolence on the part of the medical profession, but rather it is a part of a larger process, of which the medical profession is only a part. • If a mechanism of medical social control seems useful, then the deviant behavior it modifies will be given a medical label or diagnosis.

14. Individualization of Social Problems • The medicalization of deviance is part of a larger phenomenon that is prevalent in our society; the individualization of social problems. • We tend to look for causes and solutions to complex social problems in the individual rather that in the social system. • “blaming the victim” • Rather than seeing certain deviant behaviors a symptomatic of social conditions, the medical perspective focuses on the individual, diagnosing and treating the illness itself and generally ignoring the social situation. • Hyperkeninesis is a good example of this. • By giving medications, we are essentially supporting the existing social and political arrangements in that it becomes a “symptom” of an individual disease rather than a possible “comment” on the nature of the present situration.

15. Depoliticization of Deviant Behavior • Result of both the process of medicalization and the individualization of social problems. • By defining the overactive, restless, and disruptive child as hyperkinetic, we ignore the meaning of the behavior in the context of the social system. • Medicalizing deviant behavior precludes us from recognizing it as a possible intentional repudiation of existing political arrangements. • The medical ideal of early intervention may lead to early labeling and secondary deviance. • “The medical rule,” which approximates “when in doubt, treat,” is nearly the converse of the legal dictum “innocent until proven guilty” and may unnecessarily enlarge the population of deviants.

16. Exclusion Of Evil • While it is not the sole cause of the exclusion of evil, medicalization contributes to the exclusion of concepts of evil in our society. • Medical definitions of deviance serve to further exclude evil from our view. • There are at least two different types of evil: evil intent and evil consequence. • In either case medicalization dilutes or obstructs us from seeing evil. • Susan Sontag has suggested that on a cultural level, we use the metaphor of illness to speak of various kinds of evil. • We suggest that the medicalization of social problems detracts from our capability to see and confront the evils that face our world. • The “darker” side of the medicalization of deviance has profound consequences for the putative or alleged deviant and society.

17. Medicalization of Deviance and Social Policy • “Social policy” may be characterized as an institutionalized definition of a problem and its solutions. • In a complex society, social policy is only rarely implemented as a direct and self conscious master plan. • It is far more common for social policies to evolve from the particular definitions and solutions that emerge from various political processes. • The medicalization of deviance never has been a formalized social policy. • It’s emerged from various combinations of turf battles, court decisions, scientific innovations, political expediences, medical entrepreneurship, and other influences.