DEVIANCE &
MEDICALIZATION:
FROM BADNESS TO
SICKNESS
Peter Conrad & Joseph W. Schneider
(Philadelphia:Temple University Press,
1992)
DEVIANCE, DEFINITIONS, AND
THE MEDICAL PROFESSION
2
1. DEVIANCE IS UNIVERSAL, BUT THERE
ARE NO UNIVERSAL FORMS OF DEVIANCE
 Acts like incest and murder come close, but even they are not
universally deviant
 And what counts as “murder” or “incest” varies
 What is deviant for a society is relative to that society: witchcraft
among the Puritans, hysteria and paranoia in American society
3
2. DEVIANCE IS A SOCIAL DEFINITION
 Deviance is not "given" in any behavior, act, or status
 It must be so defined intentionally by "significant" actors in the
society or social group
 Deviance may be seen as a label attached to an act or behavior or as a
category by which certain behaviors are defined
 Deviance is a socially attributed condition, and "deviant" is an ascribed
status
 It is not the act but the definition that makes something deviant
 Deviance is a system of social categories constructed for classifying behavior,
persons, situations, and things
4
3. SOCIAL GROUPS MAKE RULES AND ENFORCE
DEFINITIONS THROUGH JUDGMENT & SOCIAL SANCTION
 “Social groups create deviance by making the rules whose infraction
constitutes deviance, and applying those rules to particular people and
labeling them as [deviants]" (Becker, H. S. ,1963, p. 9)
 Collective rule making, social judgment, and the application of sanctions
(penalties) are central to all types of deviance.
 What is important to remember is that "societies" do not make
rules and define deviance; people acting collectively do
5
4. DEVIANCE IS CONTEXTUAL
 What is labeled as deviant varies by social context - especially
according to such conditions as
 Society
 Subculture
 Time
 Place
 Who is involved
 Who is offended
6
5. DEFINING AND SANCTIONING
DEVIANCE INVOLVES POWER
 Those belonging to the more powerful groups in society, in terms
of social class, age, race, ethnicity, profession, sex, etc., can enforce
their categories of deviance on less powerful groups
7
SOCIAL CONTROL IS CONTROL OF DEVIANCE
& PROMOTION OF CONFORMITY
 Social control operates on both informal and formal levels and
through "positive" and "negative" forms
 Informal controls include self-controls and relational controls
 Self-controls: internalized norms, beliefs, morals, self-concept, and "conscience"
 Relational controls: ridicule, praise, gossip, smiles, disapproving glances and "dirty
looks," mythmaking, group ostracism and support
 Formal social controls are institutionalized forms of social control,
including 'official' laws, regulations, and institutions and agents of social
control
 criminal justice system (police, courts, correctional facilities, etc.), education,
welfare, the mass media, and medicine
8
EMERGENCE OF THE MEDICAL
PROFESSION – UP TO 1850
 Humoral theory (Hippocrates) dominated European
medicine until well into 19th century
-diagnosis was impressionistic, often inaccurate, based on
patient reports of symptoms, physicians’ own observations of
signs of illness (appearance, behavior) but rarely on manual
exam of body
 Medicine not scientific
 In colonial America, physicians were p/t, also working as
clergymen, teachers, farmers, etc
 In early 19th c, medicine was low status, not an
important economic activity
9
PROFESSIONALIZATION
"the process by which producers of special services
sought to constitute and control the market for
their expertise" (Larson, qtd. on p. 195)
-Professions organize to create and control markets
In 1847 American Medical Association (AMA) is
formed
 The medical profession became functionally
autonomous, insulated from external evaluation and
largely free to regulate their own performance
10
CRUSADING, DEVIANCE, MEDICAL
MONOPOLY: THE CASE OF ABORTION
 Prior to the Civil War, abortion was a common and
largely legal medical procedure in America, free of
moral stigma
 Pregnancy was not considered confirmed until
"quickening" ("first perception of fetal movement,” p.
196)
-common law did not recognize the fetus before quickening, an
unquickened fetus deemed to have no living soul
 After 1840 abortion comes increasingly into public
view, services widely advertised in magazines and
newspapers
 By 1870, about 1 abortion per 5 live births
11
PHYSICIANS, NOT RELIGIOUS LEADERS, LED
ANTI-ABORTION CRUSADE IN LATE 1860S –
BUT WHY?
concern about dropping birthrates, esp. among native
born, "better classes"
to promote professionalization and create a monopoly
over medical services
-they did this by getting states to sanction their competitors
("irregular doctors," e.g., homeopaths, botanical doctors,
eclectic doctors, etc.)
By 1900, abortion was not only illegal in American
society, but also deviant and immoral
12
GROWTH OF MEDICAL EXPERTISE
AND PROFESSIONAL DOMINANCE
 last 3 decades of 19th c saw great strides in surgical medicine and
improvements in hospital care
 rise of germ theory of disease
 rise of “scientific” medicine
13
DOCTRINE OF SPECIFIC ETIOLOGY
 "each disease was caused by a specific germ or agent. Medicine focused
solely on the internal environment (the body), largely ignoring the
external environment (society)"….this paradigm is the essence of the
"medical model"
14
CHANGES IN MEDICAL PRACTICE
Doctors move from “solo practice” to large
corporate practices or employment in hospitals or
other bureaucratic organizations
Medicine more specialized & more dependent on
technology
Medicine expanded as a portion of American
economy
-projected to be over 1/6th in 2009 (Kaiser, 2009)
15
"FEE-FOR-SERVICE"
American medicine has long operated on a "fee-for-
service" basis, i.e., each service is charged and paid
for separately
 more services, more fees, possibly encouraging
unnecessary medical care
Medicine is one of the few services that can "create
its own demand," since patients go to
doctors to find out what procedures they medically need
16
Since the 1930s, a shift to "third party"
payments, mainly from health insurance
and the government
 availability of federal $ without cost controls, leading to “cost crisis”
This has also driven the medicalization
of more and more human problems
“It has won the almost exclusive
right to reign over the kingdom of
health and sickness, no matter where
it may extend.”
17