Medical Sociology
Medical Sociology
Medical Sociology
Barker Source: Journal of Health and Social Behavior, Vol. 51, Extra Issue: What Do We Know? Key Findings from 50 Years of Medical Sociology (2010), pp. S67-S79 Published by: American Sociological Association Stable URL: http://www.jstor.org/stable/20798317 . Accessed: 04/08/2013 19:52
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AMERICAN SOCIOLOGICAL ASSOCIATION of Health and Social Behavior Journal 51 (S) S67-S79 ?American Sociological Association 2010 DOI: 10.1 177/0022146510383495 http://jhsb.sagepub.com
The
Social
Construction
of
(?)SAGE
Abstract The construction inmedical of illness is a major research perspective article traces sociology.This of this perspective and presents three overarching constructionist illnesses findings. First, some are particularly embedded is not directly derived with cultural meaning?which from the nature of the to those afflicted and influences the experience condition?that of that shapes how society responds social the roots illness. Second, come all illnesses and to understand are socially constructed livewith their illness.Third, and at the experiential medical knowledge level, based about on how individuals is not illness and disease
given by nature but is constructed necessarily We address central policy implications of each in a social constructionist relevant research to medicine's counterpoint broaden policy deliberations largely deterministic and decisions.
and interested parties. developed by claims-makers of these findings and discuss fruitful directions for policy an important constructionism tradition. Social provides approaches to disease and illness, and it can help us
In
the
last has
the social construction of years, a major area in the research of medical and it has made sociology, sig to our understanding contributions of the 50 become of illness. of a In social this article we the roots constructionist
contribute and
to producing social perceived and Luckman knowledge (Berger to illness social constructionist approach in the widely recognized conceptual dis
dimensions trace
present some of the key of social constructionism findings organized under three themes: the cultural meaning of illness, the as socially constructed, and med illness experience as socially constructed. In addition, ical knowledge we address central policy of these implications findings research Social work and fruitful directions in a social constructionist for policy-relevant tradition.
to illness, and we
tinction between disease (thebiological condition) and illness (the social meaning of the condition) (Eisenberg 1977). Although there are criticisms
and useful model, and limitations 2008),1 of this distinction and Haas it is nevertheless (Timmermans an exceedingly In contrast to the medical are universal
to time or place, social construction how the meaning and experience of ists emphasize illness is shaped by cultural and social systems. In invariant
constructionism is a conceptual frame that emphasizes the cultural and historical aspects of phenomena widely thought to be exclu is on how meanings sively natural. The emphasis of phenomena do not necessarily inhere in the
'Brandeis University 2Oregon State University Author: Corresponding Peter Conrad, Department of Sociology, Brandeis 10 University,Waltham, MA 02454-91 E-mail: [email protected]
themselves but develop phenomena through inter action in a social context. Put another way, social constructionism examines how individuals and
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S68
or physicians. As ing tobe discoveredby scientists Gusfield (1967) notes, "Illness is a social designa fact" (p. 180). There are, of course,biophysiologi cal bodily conditionsor naturallyoccurringevents, but these aren't ipso facto illnesses.Neither are they ipso facto diseases. The disease side of the disease/illness conceptual distinction is also ripe
for social constructionist tion, by no means given in the nature of medical
short, illness
in nature, wait
of patienthood, as distinctfrom any biological condition that may (or may not) launch such a individuals actively participate in interactionists, own socialworlds, includ of their theconstruction via ongoing social of the construction selfhood, ing interaction (Blumer 1969). The key tenetsof sym bolic interactionism effectivelylent themselvesto a detailed exploration of illness as experienced within the context of daily social interactions, which in turn alter the performance of self (Charmaz 1991; Glaser and Strauss 1965). In a related fashion,phenomenological tenets (Berger and Luckmann 1966; Schutz 1967)were appropri ated by medical sociologists to showcase how make sense of their illness,how they individuals and how with cope physical and social restrictions, in restric the face of those deflect self-erosion they tions (Bury 1982). Eliot Freidson's (1970) paradigm-shifting Medicine, also laid important book, Profession of of illness groundworkfor the social construction partof thebook, ina section approach. In the latter titled "The Social Construction of Illness," Freidson (1970) explains how illnesseshave con fromanybiological effects: sequences independent
[W]hen a physician diagnoses a human's condi tion as illness, he [sic] changes the man's [sic] behavior by diagnosis; a social state is added to a state by assigning themeaning biophysiological of illness to disease. It is in this sense that the phy sicians creates illness . . . and that illness is . . . analytically disease, and empirically distinct from mere career. According to Goffman and other symbolic
career,"
Goffman
spoke
experiences
analysis,
insofar as what
Some of thebasic building blocks are evident in the (e.g., writings of early sociological thinkers Emile Durkheim, Karl Mannheim, and W. I. Thomas), butwe will startthe story in the 1960s with themore direct predecessors of, and early
contributors to, the social construction of illness.
most important founda intellectual One of the of illness is social tionsof the social construction and research fromthe 1960s and problems theory
from positivist inter themselves 1970s. Distancing that in this tradition asserted scholars pretations, or what comes to be identified as deviant behavior a social
problem
is not "given,"
(Becker 1963; Gusfield 1967, 1975; Spector and Kitsuse 1977). These scholarsalso emphasized the
intentional of social use control for the purpose of these categories (i.e., defining and enforcing how
(p. 223)
particular people ought tobehave). The basic tenets of this framework have been readilyapplied to ill ness. Specifically, medical sociologistspoint to the processes by which certain behaviors contingent and experiencescome tobe definedasmedical con can function ditions,and the way thosedefinitions as a typeof social control (Conrad and Schneider 1992;Zola 1972). two popular and overlapping intellectualtrendsin contrib sociology in the 1960s?also significantly
uted to a social constructionist Symbolic interactionism and phenomenology?
Not only did Freidson (1970) explicitlyrecog nize the real and tangible social consequences of an illness label, but he also urged sociologists to address "how signs or symptoms get tobe labeled or diagnosed as an illness in the first place" (p. 212). By arguing that illness and disease, like
deviance, evaluative what are social constructions based on categories (i.e., they are social ideas about Freidson
is not "acceptable"
or "desirable"),
The writings ofMichel Foucault (1977) and albeit in a dif work in theFoucauldian tradition,
ferent vein, cal also knowledge, the scrutiny of medi emphasized in so doing, contributed and, to a social construction of illness regarded knowledge as a form
categories
and knowledge.
approach
to illness.
approach.
significantly Foucault
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S69
of power. Specifically, he argued that expert mality,"which is not objective or naturallygiven, modern societies: is theprincipal formof power in hence, his oft quoted expression, "knowledge/ constructsknowledge about the body, including disease.As Bryan Turner (1995) notes, "We can no longer regard diseases as natural events in the world which occur outside the language inwhich theyare described.A disease entityis theproduct medical of medical discourses" (p. 11). In turn,
discourse can influence power." Foucault stressed how medical discourse knowledge about human "normality" and "abnor
are common inour societyand significantly impact with the disease. Similarly,Barry those afflicted et al. (2009) examined how obesitymetaphors, affect indi such as "obesity as sinful" (gluttony), viduals' supportfordifferent public policies aimed at reducingobesity. While sociologists have rarelyfocused on the metaphorical connotations of illness, they have examined the impact of other cultural meanings all illnessesare embedded in illness. In thisregard,
not the same. For matized, instance, some illnesses are stig and others are not; some are contested, and disabilities,
their subjective experiences of embodiment, shape their identities, and legitimatemedical interventions (Foucault 1975, 1977).Accordingly, knowledge (i.e., provide a detailed analysis of medical discourse) to reveal its embeddedmean ings,normalizing tendencies,and relationship to embodiment and identity(Barker 1998; Lupton 1997;Rose 2006).
This Foucault-inspired scholars deconstruct medical
people's
behaviors,
impact
about these What is important while othersare not. distinctionsis thattheyexist for social ratherthan
purely
in examining thesedis gists are keenly interested because theybring into sharp relief the tinctions
cultural landscape that ordinarily eludes us; or, as
biological
reasons. As we will
see,
sociolo
is by no means
an exhaustive
account
of
the anthropologistRalph Linton (1936) once would notice is water." fish quipped, "The lastthing mere sociological curiosities,these But more than cultural meanings have an impacton theway the illness is experienced,how the illness is depicted, the social response to the illness,andwhat policies
are created
concerning
the illness.
mere
can be justified in thattheyall share an eschewal of a strictly positivist conception of illness as the
embodiment shared of disease. The
"stigmatized
foregrounds how
interactions, frameworks
approach
identified
of knowledge,
case of epilepsy, that it can be more difficultfor (Schneider and Conrad 1983; Scambler 1989). In the case ofHIV/AIDS, other researchhas shown and affects how stigma limitsaccess to treatment and identity(Epstein 1996;Weitz relationships from a constructioniststand The lesson 1990). is nothing inherentabout a that there is point makes it stigmatizing;rather,it is condition that the social response to the condition and some of make a condition stigmatized sufferfrom it, that (Conrad 1987).
its manifestations, or the type of individuals who
Cultural analystspoint out that illnesses also may (1978), for example, argued thatnegative meta
phorical meanings of cancer, as evil or repressive, metaphorical connotations. Susan Sontag
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S70
Contested These
illnesses are
are a category
of disorders
to have a specificdisease that many physiciansdo medical. not recognizeor acknowledge as distinctly Contested illnesses, includingchronic fatigue syn irritable bowel syn drome,fibromyalgiasyndrome, chemical and drome, sensitivity are multiple
suspect because the they are not associated between lay
medically nesses
cultural meanings thatare not reducible tobiology, burden the and these culturalmeanings further At a general level, insights from this line afflicted. of research suggest a shiftin emphasis away from an exclusive focus on biomedically fixing indi
viduals and toward
noted,
certain
illnesses
come
to have
medical knowledge with respect to the cultural legitimationof symptoms and suffering.In the
words of one
changing
the social
and
cul
have tofightto get" (Dumit 2006). Physicians, the of the symptomsand the question the authenticity In sum, contested of the sufferer. mental stability
illness sufferers are burdened public, and sometimes even sufferers themselves
researcher,
you
meaning.
matized
ingof a medically invisiblecondition in an era of biomedicine (Barker2005; Brown 2007; high-tech becomes Kroll-Smithand Floyd 1997). In fact,this one of the most important of these characteristics
illnesses, care, to a diagnosis and health affecting access and the response of others to one's problem, describing the social construction of
difficultto treatand manage. For example, if an illness such as epilepsy orHIV/AIDS has a power ful stigma, it can make people less likely to seek treatment for fear of being mistreated by health care providers and publicly associated with a taintedcondition.Obese women reportavoiding routine gynecological exams, despite having
than non of obesity cancers higher rates of gynecological obese women, because of the stigma
and thecorresponding negative attitudesof health careprofessionalstoward overweight people (Amy, effectivepolicy based on early cancer screening
overcome this barrier. are not associated Lyons, and Keranen 2006). Therefore, an
disabilityalso provides a powerful example of the of this approach are found inGoffman's (1963)
Stigma, physical social wherein the social meaning he highlights comes to acquire via social impairment of impairment does not emanate cultural meaning of certain conditions. The roots
Aalborg, must
with a discernable biomedicai abnormalityoften makes itdifficult for themto have theirsymptoms
or treated, and often raises suspicions acknowledged are "all in their heads." that their problems Some physicians contested will to treat patients diagnosed with illnesses, and some insurance companies refuse for such treatment. On the other
symptoms
readily
but from the fabricof fromthe impairment itself, everyday life. The social model of disability,
grounded on social constructionist
(i.e., the attribute) tuallydistinguishes impairment from disability (i.e., the social experience and
of
tenets, concep
not reimburse
hand,
meaning
impairment).
Because
the attributes
ability cannot be reduced to a mere biological problem located in an individual's body (Barnes, most basic Mercer, and Shakespeare 1999). In its form,thisdistinctionsuggests thatthebody has an impairment (e.g., loss of limb)while society cre ates the disability (Oliver 1996). Rather than a
"personal tragedy" that should be fixed to conform to medically determined standards of "normality" questions How then emerge. What obstacles
of being
costlydiagnosticprocedures.Faced with this situ ation, health organizationsmay find thatgiving patientsa contested illnessdiagnosis and providing them with inexpensive palliatives is the most
effective means of cost containment. Conse there are real concerns that these diag quently, noses are being overused to manage difficult and
as desires for a medical patients' diagnosis confirmation that their symptoms are "real" often lead to excessive for unnecessary demand and
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S71
contested
illnesses
meet the stated bility benefits, even when they criteria regarding the inability to do "usual and under find solutionsfortheputativeproblems that
lie contested illnesses are also scarce relative to the are customary work." Funds for medical research to
only
infrequently
receive
disa
practice
and
policy
the behavioral
discovered, but rather is created by individuals who act in and toward their world. Applied to ill with ness, people enact theirillness and endow it are to not entities merely passive meaning. They whom thingsare done (be it by a disease or by doctors and treatments). This is thegeneral starting a number of linesof sociologi for point important cal research, all highlighting the everyday and subjectiveexperienceof illness. In the 1960s, sociologists began to study the
patient's
Passed in 1990, theAmericans with Disabilities Act (ADA) affirms theessence of social construc
tionist
of disability
approach
are
myriad.
claims?namely,
an
individual's as
impair
allow wheelchair access into Although a buildings. individuals for civil living rightsvictory symbolic ADA of the with disabilities, the legal limitations arewell known (Acemoglu andAngrist 2001; Lee 2001). Moreover, theADA primarily addresses workplace discrimination and issues of public
access,
accommodations,
such
ramps
to
Strauss 1965;Goffman 1961). Strauss and his col leagues (Strauss and Glaser 1975), however,were among thefirstto recognize thatthepatientexperi ence isnot the same as the illnessexperience; after all, people with illnesses spend very littletime in thepatient role.This important step laid a founda tion fora more developed approach to the experi ence of illness.Building on this tradition, Conrad the elaborated (1987) approach:
[A] sociology of illness experience must consider everyday lives living with and in spite of
perspective
of
illness
(e.g.,
Glaser
and
people's
senta fundamental shiftin thecultural meaning of The social constructionist perspective disability. helps make sense of many other policy debates, includingthe opposition ofmany members of the
deaf
which,
although
important,
do not
repre
illness. It needs to be based on systematically col lected and analyzed data from a sufficient number and variety of people with an illness. Such a perspec tive necessarily focuses on themeaning strategies used in adaptation, (pp. 4-5) of illness, the social organization of the sufferer'sworld, and
hope the implant ple,while parentsof deaf children will make theirchildrenas normal as possible by giving themat least some ability to hear, thedeaf with itsown language defectbut a cultural identity undermine thatidentity and thatimplants (Dolnick explainwhy some disability rightsadvocates part
ways with 1993). Social constructionist tenets on policies also help community contends that deafness is not a medical
community
to cochlear
implants.
For
exam
inter This research isusually based on in-depth on the illness views, focusing experi subjective
ence and
creating
an
"insider's"
view.
Such
(1991) is a well-developed example. Charmaz describes how the worlds of some individuals
shrink when aspects become they are of managing immersed a chronic in the day-to-day illness. They
consequences.
research
of Charmaz
ingdeathwith dignityand prenatalgenetic screen movement ing and selection.The disability rights oftenopposes the cultural messages behind these
and procedures?namely, that it's better to
other progressives
concern
conventional
policies
ormove about with family,socialize with friends, Thus, the foundationon which a sense of freely. self is based can be lost, there is nothing to look forwardto,and nothing to do; time is experienced as unchanging (Charmaz 1991). There are also a numberof studies thatclosely
examine
cut off from the routines of increasingly to work, time life?unable spend
assertion is grounded in the strong pragmatist nomenology,which suggest that realitydoes not just exist out there in theworld waiting to be
innings of symbolic interactionism and phe
experience
is
socially
constructed.
This
as HIV/AIDS (Klitzman and Beyer 2003; Weitz McMurry, and Hedges 1990), diabetes (Peyrot, asthma (Snadden and Brown 1992), and 1987), fibromyalgia(Barker2005). Schneider andConrad (1983), forexample, provide a detailed account of
the experience
of specific
illnesses
such
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S72
the experiences of individuals with epilepsy, includingthe ins and outs ofwhen, and towhom, about theirill theyreveal or conceal information
ness. From
illness experience.Even in illness individualsare not passive: "the self ismore than its body and much more thanan illness" (Charmaz 1991:258).
ing intimate relationships, to going on a job or being on the lookoutfor"safe places" interview with epilepsy tryto to have seizures, individuals
maintain
getting
a driver's
license
and negotiat
crimination,and avoid becoming the object of a Whether focusing on chronic illness public crisis. are the types of rich details that emerge from research intothe illness experience. This researchalso describes how people strug gle tomake sense of their illness and reclaim a
in general, or on a specific chronic illness, these
self-control,
skirt embarrassment
ber of criticalpolicy implications.First, some of on clinical perspec thesefindingsshed a new light pliance" (Conrad 1985; Peyrot et al. 1987) and the impact of the subjective perspective on interac
tions with medical tives and policies toward issues such as "noncom
experience
sense of self.People endeavor to endow theirill ness withmeaning within the contextof their per
sonal health beliefs, and social relationships, coverage, employment and abate status, cultural an ero insurance and religious the like. Individuals may
(Waitzkin 1991). The focus on themeanings of medications in the contextof a patient's everyday orders, allows the clinical policy focus to shift ofmedi to improve the effectiveimplementation cal regimens.By giving voice to the sufferers' perspective,theexperienceof illnessapproach can Take thecase of clinical reforms. lead to important
its vast technical arse Despite pain management. to see or measure is simply unable nal, medicine have often trivial pain. For this reason, physicians from "compliance" to context-centered strategies life, rather than on compliance with doctors'
professionals
and
care-givers
reconstruction. sion of selfby engaging in identity Said differently, when illness becomes a "bio graphical disruption," individuals recast them selves in terms of new and unexpected plot developments (Bury 1982). Chronic illness can
a re-evaluation in some (e.g., of one's cases, cancer former life and of a new Finally, identity, and, illness the creation survivor).
prompt
medical sociologists have documented how lay people sometimes create and join illness-based
social movements, their own medical generate conditions,
identity
who lack a visible injury ized thepain of patients to account for their suffering. More aggressive
may management we take seriously sufferers. of evaluating The be mandated, however, appropriate of chronic in narrative the first develop the vivid accounts current interest were and
munities based on illness identities (Banks and Prior 2001; Brown et al. 2004; Kroll-Smith and Floyd 1997). Millions of American women, for
example,
activists in the fight against breast cancer. They events, options,participate innational fundraising and mobilize in supportof relevantpolicies and initiatives(Klawiter 2008; Radin 2006). In sum, individualsactively shape theparametersof their illnessand the meaning of selfhood in relationship This line of researchbrings to the fore aspects of illness thatthe tools ofmedicine are unable to
reveal. A constructionist and social to those parameters. exchange information about their treatment
identify as breast
cancer
survivors
and
among
are now
back into and for medicine, both as an end in itself chronic benefits. pain Again, potential therapeutic is illustrative: When it comes to affirmingthe and authenticatingthe humanity of the sufferer
existence
jective experience of illness seriously,examining exploring how illness is managed in the social
contexts that sufferers inhabit. This research has the personal meanings of illness, and
approach
takes
the sub
of high-tech medicine overcoming the limitations (Kleinman 1988). There are also policy and clinical implications
associated with the constructionist
of pain,
patient
narratives
more
With the ing lay knowledge and illness identities. expansion of the Internet, laypeople are becoming ingknowledge about theirown health conditions; they are also increasingly likely to create and
actively involved in producing and consum
findings
regard
view of thesuffer given us a detailed and intimate that illness often but it has also represents, ing
shown us that agency and resistance are key to the
embrace
new
illness
identities.
Some
medical
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S73
ways of knowing may sociologists suggest thatlay medical supplement knowledge and positively influencehealth outcomes (Brown 1992; Kroll Smith and Floyd 1997). Illness identities might also contributeto improved well-being insofaras a formof self-empowerment (Popay theyrepresent
and Williams
discourse
and
to naturalize gender inequality (Clarke 1998; Ehrenreich and English 1978; Lorber 1997). For example, embedded within medical knowledge about pregnancy,premenstrualsyndrome (PMS), and menopause, one finds clear ideas childbirth,
(i.e., subordinate) "proper" place as moral in society, as well about assumptions women's sexuality and femininity more generally. In the early twentieth century, pregnant women about women's
practice,
and,
in
turn, functions
sons to be concerned that lay knowledge and ill ness identities may negativelyimpact doctor-patient to theexpansion ofmedicalization (Fox, Ward, and O'Rourke 2005; Hardey 1999). For better or worse, layand experiential knowledgewill increas come with and challenge profes into conflict ingly sional knowledge. This is all themore assured medicine's mixed recordof thera given orthodox peutic efficacy in the face of many chronic ill
nesses. relationships and health outcomes and contribute
1996).
However,
rea
were advised against driving an automobile or dancing,on grounds thattheseactivities threatened unborn child. Today, pregnant thehealth of their women are endlesslywarned about the risks of 2003). In both peri drinkingalcohol (Armstrong marked cultural ods, themedical advice reflects
anxieties about women's sexual and social
conflicts and themovements they engenderwill create major policy challenges. Medical Knowledge as Socially Constructed medi Eliot Freidson (1970) was probably thefirst howmedical knowledge cal sociologist toarticulate tists have takenseveraldifferent paths in the study ofmedical knowledge. of the social construction
One major cal knowledge line of research sometimes some exposes and how medi reproduces reflects is socially constructed. Over the years, social scien
Coming
to terms with
these
lay-medical
freedoms; and, in both periods, when pregnant women follow theprescribed medical advice, they enact the dominant cultural ideals of femininity. Medical knowledge about PMS provides another
interesting symptoms case. Precisely of PMS (e.g., because frustration, some of the aggression,
anger) defy norms about how women ought to behave, theybecome prima facie evidence of a disorder (Markens 1996). Thus, not only canmed ical ideas result in the social control ofwomen's behavior, but theyalso contributeto our cultural beliefs concerningtheexistence of unalterabledif
ferences between men and women. These
existing forms of social inequality.Rather than or explicitly,shores up the interests of implicitly those groups in power. Upon close inspection,
value-neutral, medical knowledge,
being
beliefs,
society.
some medical shown to support ideas have been inequality. For the gender, class, and racial-ethnic some sake of illustration, we present important
construction
of
illnessapproach tobe a particularly potentanalytic of thestrong is likelytheresult device. This affinity constructionisttendencywithin feminist theory most (butnot more generally. The starting point for the is feminist conceptual distinction theory all)
between that our
cal knowledge is conditionedby the social context in which it is developed. Specifically, these schol ars explain that what qualifies as biological disease or biomedicai evidence is oftensociallynegotiated and interpreted (Joyce 2008; Timmermans 2007). Steven Epstein's work is exemplaryof this typeof research. In a recentbook Epstein (2007) analyzes the emergence,beginning in the mid-1980s, of a
new
gender
and
sex. Feminists
claim
that gen
paradigm groups
andmasculinity) arenot ards concerning femininity our by biological sex differences. predetermined our about ideas Therefore, gender and the social
that they institutionalize practices A number of feminist scholars are alterable. have shown how
gender
(i.e., norms
and
stand
with an eye toward minorities) in clinical studies, the between differences groupswith understanding
and treatment out to disease processes respect comes. Even as this new paradigm offers potential why do black women the consequence
gendermeaning is inscribedontowomen's bodies and minds through past and present medical
disparities?e.g.,
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S74 the categories of race and gender as biological realities. But, by showcasinghow a numberof dif ferent interestgroups and institutional players
(e.g., feminist activists, and advocates various for racial and minority groups, cadres of bureau
medicine, especially the pharmaceutical industry, are increasinglyimportant in the shaping and dis of medical knowledge topromote their seminating female sexual dysfunction(Hartley2006), meno pause (Bell 1990),mild depression (Horwitz and Wakefield 2007), sleep disorders (Williams 2005), and many other problems. The case of erectile dysfunctionis telling(Loe 2004). In the late 1990s
male products. There are now important case studies on
crats) pushed for this new research paradigm, Epstein explains how the knowledge it produces about race and gender are in part theoutcome of social and political conflictsand negotiations,as
opposed to essential truths found in nature. In an
underscored earlierbook, Epstein (1996) similarly how the politics of knowledge by demonstrating of the science regardingthe cause and treatment HIV/AIDS is best understood as an amalgam that
was constructed (e.g., and contested by different con stituencies scientists, doctors, drug compa rather than the outcome theme of the social con
tion" (ED), and in 1998 theFDA approvedViagra The drugwas intendedforolder for its treatment. men with chronic erectile problems and forED
associated medical with prostate conditions. cancer, diabetes, and other Pfizer, the drug manufacturer, commercials as
impotence
was
renamed
"erectile
dysfunc
Using
television
featuring
defined as medical problems, usually in termsof medicalization emphasize the ologistswho study a particulardiagnosis is devel which processes by becomes accepted as medically valid, and oped, types Sociologists have describedmany different have come tobe of problems and experiences that
defined focused medically. Early on the medicalization of deviance, drug and alcohol behavior (Conrad natural and treated studies includ gets used to define and treat patients' problems. illnesses, diseases, or syndromes. In general, soci
such as Cialis and Levitra came on the scene they were widely advertised as not only treating ED, but as useful for anyone who worried about or wanted to enhance their(or their partner's) sexual Both theboundaries of theED diagnosis and the markets for ED drugs expanded enormously (Conrad 2007). Policy Implications ofMedical Socially Constructed Knowledge as
experience (e.g., "Cialis is ready when you are").
medicalized (Barker 1998;Riessman 1983; Riska 2003). For example, Prempro,a widely prescribed hormone replacement drug, is just the latest in the
ongoing effort "symptoms," despite ated with menopause aspect of women's In recent years to medically "treat" menopausal the fact that changes associ are a common reproductive sociologists as lives. have focused on the and ordinary
A numberof policy implicationsare derived from thekey findingsconcerningthe social construction of medical knowledge. By acknowledging that medical knowledge about disease and illness is
other and by socially situated claims-makers interested parties, we can bring greater criti to the policy-making cal awareness process. After constructed
all, anypolicy response to a problem isdetermined by how the problem is defined or framed in the
first place. For
problem of health disparities between racial and ethnic groups?When the solution is tomandate thatfederallyfundedclinical studies include indi
viduals from inadvertently and underrepresented cast the problem as we subgroups, in bio rooted struc as a dis
example,
how
do we
approach
the
sexual
performance
turedinequalities(Epstein 2007).
Likewise, when we define the dominant alcoholic,
downplay
the role
of
socially
alcoholism
ease, vidual
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S75
to alcohol abuse or therole of factorscontributing the alcohol industryin alcohol promotion. When medical perspectives increasinglydefine obesity as an illness (ratherthana risk factorfordiseases
such as
more skepticalof quick,medicalized fixes for what Finally, medicalization itself raises concerns about the possibility of meaningful health care
reform. are really complex, multifaceted social problems.
policies focus on solutions such as gastricbypass or the availability promotionby the food industry with high rates of healthy foods inneighborhoods the of fetalalco about risks of obesity.2 Warnings women individual hol syndrome blame effectively
and deflect attention surgeries, rather than examining the role of product
diabetes,
cardiovascular
disease,
etc.),
Creating
an
ever
larger
jurisdiction
of
or public
reimbursement
may
be a seri
commercialization of cosmetic
lished linksamong class, race, and birthoutcomes (Armstrong2003). Framing anger inwomen as with evidence of the disease PMS, to be treated antidepressants,trivializes the impact of gender inequalityonwomen's daily lives.And when dif ficulties in children's attentionand behavior get disorder deficithyperactivity defined as attention school encourage (ADHD), policies increasingly
the use of medication fail to address of children's such as and
away
from
the well-estab
cine? Is itpossible to provide universal coverage given our cultural predisposition for "a pill for every ill," amplifiedby thepharmaceutical indus try'spromotionof an "ill for everypill" (Mintzes what can be 2002:909)? Are thereare any limitsto
medicalized, medical cal costs or are all human problems and varia
special
accommoda
cantly impede any effortto reformhealth care Mackie, andMehrotra, 2010). (Conrad,
agitation,
increasing
which human problemsbecome medicalized in the first policy toward ignoredincreating place is largely
these vides issues. A a means social constructionist how of understanding approach pro such problems
come to be defined in medical termsand how this into translates public policy (seeGusfield 1981).As
construc the above attest, medicalized examples tions can also be strongly evaluative (i.e., they sug that authorize social control.
to and that, in comparison experience, privatizing there were almost other forms of social deviance, no illness such subcultures. sites, bulletin of Web an The Internet?with and social interac network tiveWeb sites thousands boards,
to build on recentstudies thatexamine the impact on the illness experience (Barker of the Internet 2008; Conrad and Stults 2010; Pitts 2004). For decades sociologists have shown illness to be a
as Facebook?is
cal solutionswhile ignoringor downplaying the we Uchtenstein, and Pollack 2007). It seems that
social complicated problems
that. With changing sites and user groups dedicated public experience.
increasingly
This
predilection
toward
treating human
tion (Conrad and Stults 2010), new avenues for expanding influence of lay knowledge about of an illness illness.Thirtyyears ago few sufferers or disorder knew otherswith the same ailment; with the Internetthis is becoming increasingly
unlikely, and sharing information and experiences,
causes forcomplex social problemsand underlying We are quick to see individualized human suffering. medical interventions as logically consistent
responses to our troubles 1992). However, medicalization accounts. (see Conrad and Schneider research forces us In so doing, we can be
the consequences
of
this are
grist
positioned
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S76
participants'
construction
of illness
identities
and
CONCLUSIONS
we have touchedon severaldifferent In thisarticle ways medical sociologists have utilized a social constructionist approach for studyingillness over the last 50 years.We have highlighted the key findingsof three lines of research and pointed to some policy implicationsof each. First, some ill nesses are particularly embedded with cultural meaning?which is not directlyderived fromthe nature of the condition?that shapes how society and influencestheexpe responds to thoseafflicted rience of that illness. Second, all illnesses are at theexperiential level based socially constructed on how individuals come to understand their ill and livewith and in spite ness, forge theiridentity, of theirillness.Third, as feminist, science studies,
and medicalization medical knowledge have demonstrated, analysts about disease is not necessar
will need to track the rising influ ist researchers ence of laypeopleand layknowledge about illness, the institution ofmedicine, and thenatureof health
care. As
lective illness behavior, includinggenerating lay mean medical care,what will be the impacton the the and the role of of delivery services, ing illness, medical profession?Laypeo and influenceof the medical knowledge and,with orwithout the Inter
net, organize ple can use the Internet to promote to create and gather claims have new knowledge, and ever-more active consumers of
laypeople
become
more
involved
in col
their own
about
rienced a relativedecline inprofessionalauthority. and reinforcing this trend,laypeo Both reflecting ple with illnesshave a greatervoice, and there is also greater recognitionof thatvoice. The policy implicationsrelated to this shiftare an important
area of future research.
Compared
ily objectively given in nature; rather,it is con structed and developed by claims-makers and interested have a strong parties who frequently
evaluative
Medicalization studieswill continue to be an As the United States moves tionist tradition. toward health care reformand the potential of
universal important area of research in the social construc
agenda.
These
findings
do not
invali
how will medicalization impact what is covered, and how will what is covered impact medicaliza
tion? How will the rise of commercialized enhancements medi cine and biomedicai
health
insurance,
These findings,although sociologically signifi cant in theirown right, have a number of policy of Some these have already been implications. but others have way into yet tofind their adopted, gencies of illness at the individual, institutional,
and societal levels, a social constructionist conceptual wedge approach provides an invaluable the policy arena. By revealing the social contin
and drugs) impactourmedical costs, andwhat role will the forces toward medicalization play in this
area? For example, treatments, will health insurance cover interventions for genetic gastric bypass surgeries, and biomedi cai enhancements such as human growth hormone infertility "addictions," for short stature or so-called
(e.g.,
genetics
inaction) events. A
smart drugs
(stimulant
but health care reform may, in fact,be one of the few countervailing forces towhat otherwiseseems
to be
to achieve,
how a problem is defined affects how (or even if) to the society responds problem, and how the experiences of individuals are influencedby the
definition social and response constructionism provides to their problem. As such, a counter tomedi
approach
an ever-increasing
cine's deterministic ways thatcan broaden logic in and enrichpolicy deliberationsand decisions. To
that end, we must
importance
is thedefinitionof the problem upon which this policy is based, how was itdeveloped, and what are theconsequences of adopting thisdefinition?" Without these theoretically important questions to us we in will make guide decision-making, likely
serious health errors in the implementation reforms and health-related policy of future initiatives
routinely
ask ourselves,
"What
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S77
ACKNOWLEDGMENTS
Our thanks to Renee Anspach, Pavalko, also and feedback Paula Lantz, the JHSB for editor Eliza article. We editing. anonymous reviewers their constructive on earlier drafts of this for his careful copy
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