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8_Medicalization and Social Control - Conrad

8_Medicalization and Social Control - Conrad -...

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Unformatted text preview: MEDICALIZATION AND SOCIAL CONTROL 215 pediatricians to treat. Pawluch argues that pediatricians weathered this pro- fessional crisis by changing the focus of their practices, first by becoming “baby feeders,” and recently by including children’s troublesome behavior in their domain. The new “behavioral pediatrics” enabled pediatricians to main- tain and enhance their medical dominance by expanding their medical terri- tory. This led to the medicalization of a variety of psychosocial problems of children. Halpern (1990), in an important article, contests some of Pawluch’s in— terpretation. She argues that routinization of work, rather than market decline, preceded behavioral pediatrics. To the recently trained academic specialists, general outpatient care seemed “unappealingly routine” (Halpern 1990:30). The “new pediatrics” was a vehicle for academic generalists to secure a place in medical schools dominated by subspecialists and to make their own training and routine clinical work more stimulating. She argues that understimulated specialists in search of professional standing rather than underused clinical practitioners took the lead in medicalization. While the data cannot be conclu— sive, based on a review of studies, Halpren suggests that pediatricians do not seem to have increased their treatment of psychosocial disorders in recent decades. She further suggests that physicians need not treat the medicalized disorders themselves, but can become the managers of medical care, while auxiliaries and extenders provide treatments in a medical frame. Put another way, Halpern suggests that medicalization in pediatrics occurred more on the conceptual and institutional levels than on the interactional level of patient treatment (cf Conrad & Schneider 1980b). Whether Halpern’s “routinization hypothesis” or Pawluch’s “market hy- pothesis” is more nearly correct, or some combination of both as Halpern (1990:35) seems to indicate, it is clear that medicalization is in part a by-product of intraprofessi‘onal issues that underlie the growth of behavioral pediatrics. The cases of hyperactivity (Conrad 1975, 1976) and learning disabilities (Carrier 1983, Erchak & Rosenfeld 1989) are examples of the increased medicalization of childhood behavioral problems. MEDICAL SOCIAL CONTROL Social control is a central and important concept in sociology. Most societies develop therapeutic styles of social control (Horwitz 1991), especially when individualism is highly valued. Durkheim (1893/ 1933) differentiated between repressive and restitutive controls, seeing the latter as more characteristic of complex societies. The social control aspect of medicine was conceptualized initially by Parsons (1951), when he depicted illness as deviance and medi- cine and the “sick role” as the appropriate mechanism of social control. Early analysts (Pitts 1968, Zola 1972) indicated that medical social control would ...
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