The Medicalization
of Deviance
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Disease vs. Illness
Disease: bio-physiological
phenomena that manifest
themselves 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
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Approaches to illness: the
sociological vs. medical model
• Sociological model
focuses on societal
factors
• Medical model focuses
on organic pathology in
individual patients,
rarely taking societal
factors into account
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Ch. 6: The Discovery of Hyperkinesis:
Notes on the Medicalization of Deviant
Behavior
Peter Conrad (1975)
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Medicalization of deviant behavior
• Medicalization means defining behavior as a medical
problem or illness and mandating or licensing the
medical profession to provide treatment, e.g.,
• Alcoholism, drug addiction, violence
• Medical institutions such as psychiatry and public health
have always been concerned with social behavior and
have functioned traditionally as agents of social control
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The Discovery of Hyperkinesis
• Clinical factors are directly related to diagnosis
and treatment
• Social factors set the context for the emergence
of the new diagnostic category
• Pharmaceutical revolution
• Government action
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Key questions
• How did children’s behavior become
conceptualized as a medical problem?
• Why did this occur when it did?
• What are some of the implications of the
medicalization of deviant behavior?
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Accounting for the medicalization of
attention fluctuation/hyperactivity
• Advances in pharmaceutical technology
• Prestige of medical profession, acceptance of its jurisdiction
over matters affecting the functioning of the body and
anything that can be labeled illness
• The humanitarian trend in the conception and control of
deviant behavior
• Medicalization is seen to take morality, right and wrong, out of
the equation, thus potentially removing stigma
• Moral entrepreneurs, who crusade for the creation and
enforcement of rules, played role, e.g.,:
• Pharmaceutical companies
• Association for Children with Learning Disabilities
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Social consequences of
medicalization
• The problem of expert control
• Medical social control
• individualization of social problems
• depoliticization of deviant behavior
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Ch. 33: The Moral Career of the
Mental Patient
Erving Goffman
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Moral career
• The moral career of a person of a given social
category involves a standard sequence of
changes in the way of conceiving self
• Self can be seen as something that resides in
the arrangements prevailing in a social system
• Goffman studies moral experiences within the
confines of an institutional system
• Goffman defines “mental patient”
sociologically, as a person who has been
hospitalized for mental illness
• this excludes those with symptoms who have not
been hospitalized
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Moral career of mental patient
has 3 phases
• Pre-patient phase: the period prior to
entering the hospital
• Inpatient phase: the period in the hospital
• Ex-patient phase: the period after
discharge from the hospital
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Pre-patient phase
• Patient begins with rights and relationships and ends up with hardly
any of either
• "The moral aspects of this career, then, typically begin with the
experience of abandonment, disloyalty, and embitterment."
• Patients enter willingly and, more often, unwillingly, e.g.,
• Implored or threatened by family
• Forced under police escort
• Tricked or deceived by others (pertains especially to underage
patients)
• Often, there is a complainant, some figure who makes a record of
some offense by the pre-patient that leads to his/her hospitalization
• But for every offense that leads to an effective complaint, there are
many psychiatrically similar ones that never do
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A circuit of agents --alienative coalition--participate
in passage from civilian to patient status
• Next of relation: person seen by patient as most available,
dependable in times of trouble (often, next of kin)
• Complainant
• Mediators: the sequence of agents/agencies to which prepatient is referred and through which he is relayed and
processed to the hospital, e.g.,
• Police, clergy, general medical practitioners, office psychiatrists,
personnel in public clinics, lawyers, social service workers, teachers,
etc.
• These agents may be experienced as a kind of alienative
coalition
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Betrayal
• Depth of feeling of betrayal increases when
another person, besides next of relation witnesses
his betrayal
• 3-party situation is significant b/c it makes the
betrayal “social”
• Sense of feeling “conned”
• Starts out with rights and liberties of civilian and
ends up in psych ward stripped of everything
• Betrayal funnel: how stripping of patient’s
rights, liberties, and satisfactions is managed
• Pre-patient’s moral career is retroactive
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Inpatient phase
• Upon entry there’s usually an attempt to maintain
anonymity, “not-hereness,” followed by “settling down”
• Settling down involves acceptance of patient status, of
membership in a total institution
• Total institution: place of residence and work, where a
large number of like-situated people live cut off from the
wider society for an appreciable period of time
• Characterized by walls around it, barriers
• An enclosed formally administered type of life
• Why is it total? Breakdown of barriers ordinarily
separating sleep, work, play, e.g.,
• Prisons, concentration camps, monasteries, work camps, etc.
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The ward system
• Assignment to a given ward is presented not as a reward
or punishment, but as an expression of his general level
of social functioning, his status as a person
• Ward system is an extreme example of how the physical
facts of an establishment can be used to frame one’s selfconcept
• The more “medical” and therapeutic (not merely
custodial) a mental hospital is, the more pressure to
reframe one’s concept of self
• Continual discrediting , by fellow patients and staff, is
common
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