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4_Medicalization and Social Control - Conrad

4_Medicalization and Social Control - Conrad -...

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Unformatted text preview: MEDICALIZATION AND SOCIAL CONTROL 211 The key to medicalization is the definitional issue. Medicalization consists of defining a problem in medical terms, using medical language to describe a problem, adopting a medical framework to understand a problem, or using a medical intervention to “treat” it. This is a sociocultural process that may or may not involve the medical profession, lead to medical social control or medical treatment, or be the result of intentional expansion by the medical profession. Medicalization occurs when a medical frame or definition has been applied to understand or manage a problem; this is as true for epilepsy as for “gender dysphoria” (transexualism). The interest in medicalization has predominantly focused on previously nonmedical problems that have been medicalized (and, often, thought to be inappropriately medicalized), but actually medicalization must include all problems that come to be defined in medical terms. While the definitional issue remains central, a broader conceptual frame helps clarify the meaning of medicalization (Conrad & Schneider 1980b). Medicalization can occur on at least three distinct levels: the conceptual, the institutional, and the interactional levels. On the conceptual level a medical vocabulary (or model) is used to “order” or define the problem at hand; few medical professionals need be involved, and medical treatments are not necessarily applied. On the institutional level, organizations may adopt a medical approach to treating a particular problem in which the organization specializes. Physicians may function as gatekeepers for benefits that are only legitimate in organizations that adopt a medical definition and approach to a problem, but where the everyday routine work is accomplished by nonmedi- cal personnel. On the interactional level, physicians are most directly in- volved. Medicalization occurs here as part of doctor-patient interaction, when a physician defines a problem as medical (i.e. gives a medical diagnosis) or treats a “social” problem with a medical form of treatment (e. g. prescribing tranquilizer drugs for an unhappy family life). Thus it becomes clearer that medicalization is a broad definitional process, which may or may not directly include physicians and their treatments (although it often does). Subcultures, groups, or individuals may vary in their readiness to apply, accept, or reject medicalized definitions (Cornwell 1984). There have been general and specific critiques of medicalization. The general critiques argue that the medicalization case has been overstated and that there are considerable constraints to medicalization (Fox 1977, Strong 1979). The specific critiques focus more directly on the conceptual validity of the case studies (Woolgar & Pawluch 1985, Bury 1986). The theoretical frame underlying these cases of medicalization is a type of social con- structionism (cf Spector & Kitsuse 1977, Schneider 1985), although this is not explicitly noted in all the writings. Put simply, this perspective presents reality and knowledge as “socially constructed,” shaped by its human con- structors, and brackets the assumption that there is any a priori reality “out ...
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