DEVIANCE &
MEDICALIZATION:
FROM BADNESS TO
SICKNESS
Peter Conrad & Joseph W. Schneider
(Philadelphia:Temple University Press,
1992)
FROM BADNESS TO SICKNESS:
CHANGING DESIGNATIONS OF
DEVIANCE AND SOCIAL CONTROL
2
A HISTORICAL-SOCIAL CONSTRUCTIONIST
APPROACH TO DEVIANCE
 A dual perspective that views the attribution of deviance as a historical,
social construction of reality and the activities involved in constructing
new deviance definitions or designations for social control
 A sociology of deviance designations or categories is concerned with
the social processes through which certain forms of behavior are
defined collectively as one type of problem or another
 Focus: how certain categories of deviant behavior become defined as
medical rather than moral problems and how medicine, rather than
the family, church, or state, has become the dominant agent of
social control for those so identified
3
DEVIANCE AS COLLECTIVE ACTION: THE
LABELING-INTERACTION1ST TRADITION
 The labeling-interactionist approach turns analysis away from the individual
and the "causes" of his or her behavior to the "societal reaction"
 Deviance is "collective action" of all parties involved in any episode of
alleged deviance
 Who defines what as deviant?
 How does one group manage to have their definition of deviance legitimated?
 How do deviance designations change as political and economic conditions change?
Whose interests do deviance designations serve?
 This perspective leads to the study of the distribution of power in a
society, how those with power are able to effect the production of
deviance designations, and whose interests these designations support
4
SOCIAL CONSTRUCTION OF REALITY:
A SOCIOLOGY OF KNOWLEDGE
 The phenomenological perspective sensitizes us to the socially
constructed nature of deviance designations - that they emerge from
social interaction and that they are humanly constructed and
hence can be humanly changed
 The conflict perspective sensitizes us to the fact that not all people
are equal in their power to construct reality - that deviance
designations may serve political interests and that they are created
usually through some type of social conflict
5
POLITICS OF DEFINITION
 The decision to define certain behaviors, activities, or conditions as
deviant emerges from a political process that produces and legitimates
the imposition of the deviant categories
 The consequences of medical definitions, especially when they concern
human behavior, are also political
6
INTERESTS, STATUS, AND CLASS IN THE
POLITICS OF DEFINITION
 The politics of definitions is a process whereby definitions of
deviance are socially constructed
 Definitions are constructed through a political process and
legitimated in legal statutes, medical vocabulary, or religious doctrine
 Powerful interests in society are best able to implement their version
of reality by creating and legitimating deviance definitions that support
their interests
7
POLITICS OF DEVIANCE DESIGNATION
 Decisions concerning what is the proper deviance designation and who
is the proper agent of control are political questions decided frequently
through political contest
 Sociologists’ task: the examination of "claims-making" activities that
lead to the establishment of a deviance designation and the
appropriate agent of social control.
8
DEVIANCE DESIGNATIONS AND SOCIAL
CHANGE
 Deviance designations justify the suitable social control agent and may also
1.
2.
3.
4.
5.
6.
7.
8.
result in changes in:
the legitimate "authority" concerning a particular type of deviant
behavior
the meaning of behavior
the legal status of the deviance
the contents of a deviance category or the norm itself
the arena where identification and labeling of deviance takes place, and
the vocabulary used
the mode of intervention
the type of data collected and the focus of research
the attribution of responsibility
9
PARADIGMS & PARADIGM SHIFTS
 Three major paradigms have reigned over deviance
designations in various historical periods:
1. deviance as sin
2. deviance as crime
3. deviance as sickness
 scientific paradigm: "universally recognized scientific achievements
that, for a time, provide model problems and solutions for a
community of researchers" (Kuhn)
10
DEVIANCE, ILLNESS, AND MEDICALIZATION
 Medicalization of deviant behavior: the defining and labeling of deviant
behavior as a medical problem, usually an illness, and mandating the
medical profession to provide some type of treatment for it
 Medicine becomes an agent of social control, typically as medical intervention
 Medical intervention as social control seeks to limit, modify, regulate,
isolate, or eliminate deviant behavior with medical means and in the
name of health
11
THE SOCIAL CONSTRUCTION OF
ILLNESS: DISEASE VS. ILLNESS
Disease: biophysiological phenomena that manifest 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
Illness is a social construction based on human judgments of some
condition
12
ILLNESS AND DEVIANCE
 Deviance considered willful tends to be defined as crime; when it is
seen as unwillful it tends to be defined as illness
 Parsons conceptualized illness as deviance primarily because of its threat to
the stability of a social system through its impact on role performance
 The "sick role" serves to conditionally legitimate the deviance of illness:
1.
2.
3.
4.
the sick person is exempted from normal responsibilities, to the
extent necessary to "get well"
the individual is not held responsible for his or her condition and
cannot be expected to recover by an act of will
the person must recognize that being ill is an inherently undesirable
state and must want to recover
the sick person is obligated to seek and cooperate with a competent
treatment agent (usually a physician)
13
MEDICALIZATION OF DEVIANCE
 Historically there have been great transformations in the definition
of deviance: from religious to state-legal to medical-scientific
 Along with the change in sanctions and social control agent there is a corresponding
change in definition or conceptualization of deviant behavior
 Like all social change, they produced positive and negative effects that
were distributed differentially in the affected population
 For example, the medicalization of opiate addiction, deviant drinking,
obesity, hyperactivity, madness, etc. meant “progress” for some, but not
all
14
EXPANSION OF MEDICAL JURISDICTION
OVER DEVIANCE
 When treatment rather than punishment becomes the preferred
sanction for deviance, an increasing amount of behavior is
conceptualized in a medical framework as illness,
 e.g., alcoholism, drug addiction, hyperactive children, suicide, obesity, mental
retardation, crime, violence, child abuse, learning problems, and several types of
social deviance
 with badness the deviants were considered responsible for their behavior; with
sickness they are not, or at least responsibility is diminished
 The increasing acceptance and dominance of a scientific world view
and the increase in status and power of the medical profession
have contributed significantly to the adoption and public
acceptance of medical approaches to handling deviant behavior
15
THE MEDICAL MODEL AND
"MORAL NEUTRALITY"
 The medical model of deviance locates the source of deviant behavior
within the individual, postulating a physiological, constitutional, organic, or,
occasionally, psychogenic agent or condition that is assumed to cause the
behavioral deviance
 Adoption of the medical model generally legitimates and even mandates
medical intervention
 The medical model and associated medical designations are assumed to
have a scientific basis and thus are treated as if they were morally neutral
 However, medical designations of deviance are influenced significantly by
the moral order of society and thus cannot be considered morally neutral
16