Week 6_1 Medicalization and The Sick Role

Question 1

Medicalization
Def.
Barker 2008

Answer 1

“processes by which an ever wider
range of human experiences come to be defined, experienced, and treated as medical conditions”

Question 2

Medicalization
Def.
Conrad 2007

Answer 2

“process of defining a problem in medical terms, using medical language to describe a problem, or using a medical intervention to treat it”

Question 3

medicalization, when?

Answer 3

the term is emplyoed when there’s a deviant starting point, when something is seen as abnormal and not as medical problem in the sense of the biomedical paradigm

Question 4

Examples of medicalization
THEN and NOW

Answer 4

Hyperactivity in
child –> Attention Deficit
Hyperactivity Disorder

Hysteria –> Mental Illness

Transexualism –> Gender Dysphoria

Senility –> Alzheimer’s Disease

Body size –> Obesity

Drug Abuse –> Addiction

Question 5

Examples of demedicalization?
THEN and NOW

Answer 5

Homosexuality
(as illness) –> Homosexuality (as
orientation)

Medical
treatment of
Disability –> Independent living
support for PLWD

Masturbatory
insanity –> Normal pubescent
behavior

Question 6

Degrees of Medicalization

Answer 6

Minimal
Medicalization
(e.g., domestic
violence, sex
addiction)

«<

Partial Medicalization
(e.g., opioid addiction,
menopause)

> > >

Full
Medicalization
(e.g., death,
childbirth)

Question 7

What socio-cultural changes
have led to increases in
medicalization?

Answer 7

• Secularization
  and the rise of
  science
• Expansion of
  professional
  domain
• Social
  movements and
  interest groups
• Creation of
  medical
  markets

Question 8

At what levels does medicalization occur?
see scheme as well

Answer 8

conceptional
institutional
interactional

Question 9

medicalization at the conceptional level

Answer 9

• Medical vocabulary or model used to
  define problem
• May-may not involve medical
  professionals or treatments

Question 10

medicalization at the institutional level

Answer 10

• Medical treatment approach
  conceptually incorporated
• Physicians as gatekeepers

Question 11

medicalization at the interactional level

Answer 11

• Medicalization through doctor-patient
  interactions
• Physician defines problem as
  medical/needing medical treatment

Question 12

Therapeutic Social Control
meaning

Answer 12

Control as definitional
* “The greatest social control power comes from having the
authority to define certain behaviours, persons and things”

Question 13

What does Therapeutic Social Control entail?

Answer 13

1) Medical Ideology
- Imposed medical model
because of accrued social
and ideological benefits

2) Medical Technology
- Social control through
technology (drugs, surgery,
genetic/other screening)

3) Medical Collaboration
- Physician as information
provider, gatekeeper, inst.
agents and technician

4) Medical Surveillance
- Imposition of a medical gaze;
disease and medical process
monitoring

Question 14

Impacts of Medicalization
THE GOOD

Answer 14

• “Humanization” of
  social problems
• Focus on helping
  afflicted individuals,
  lessening suffering,
  etc.
• Validation and route
  to addressing issue

Question 15

Impacts of Medicalization
THE BAD AND THE UGLY

Answer 15

• Misplaced assumption of neutrality
• Control by “experts”
• Individualizing of social problems
• Prevents seeing social/structural
  causes, dislocation of responsibility
• Therapeutic control may subvert
  prevention or reform
• Dominance of technology

Question 16

Parsons (1975) - The Sick Role

Answer 16

• Functionalist theory
  -Concerned with consensus and equilibrium
• Every part of society has a purpose that fits together to allow societies to endure
• Sickness is not solely a biological state
  of a human, but an institutionalized role
  with an assigned set of norms and
  values (pg. 261)

Question 17

Parsons (1975) – Sickness as Deviance

Answer 17

• Illness as deviance– the breakdown of the general
  ‘capacity for the effective performance of valued
  tasks’ (Parsons, 1964: 262)
• Losing this capacity disrupts ‘loyalty’ to
  commitments, such as the workplace and the family
• Cause of disloyalties is not disregard of norms but
  inability to conform to them
• (Key distinction between illness and immorality or crime)
• For the effect on the social system, however, it does not
  matter. In any case, it is dysfunctional

Question 18

Sick Role: Two Rights

Answer 18

1. A sick person is exempt from performing ‘normal social roles (exemption)
2. A sick person can seek help and be looked after, because they are not curable by simple willpower or motivation (responsibility/motivatedness)

Question 19

Sick Role: Two Obligations

Answer 19

1. A sick person must see being sick as
   undesirable, and to try and recover as quickly as possible
2. A sick person must seek “technically competent”
   help and follow all the advice of the doctor

Question 20

Therapeutic Agents

Answer 20

• Asymmetry in role relations between sick person
  and doctor
• Doctors must be competent and able, and do so with
  moral authority (sickness = bad), which exerts social
  control
• Must reinforce patients desire to get better

Question 21

Therapeutic Agents
RIGHTS

Answer 21

*to high status and prestige
*to autonomy in their professional practice
*to authority over the patient (gatekeeper of the social role of being sick)
*to examine the patient physically

Question 22

Therapeutic Agents
OBLIGATIONS

Answer 22

*to be highly trained and knowledgeable
*to be motivated for a concern
*to be objective and emotionally detached
*to be bound by the rules of professional
conduct

Question 23

Therapeutic Agents + Sick Persons

Answer 23

“For the inherent functions of effective care and for the amelioration of
conditions of illness, there must be a built-in institutionalized superiority of
the professional roles [over the sick person], grounded in responsibility,
competence, and occupational concern.” Parsons 1975, 271

• Despite asymmetry, relationship between TA + SP is
  reciprocal. Both have rights and obligations.
• Reciprocity and consensus, despite hierarchy, in a healthcare system of shared values (i.e., get better)
• Type of “medical paternalism”

Question 24

Feminist Critique of Sick Role Theory

Answer 24

• Rights of the sick role are not afforded to women as for men.
• When a woman is ill, she is rarely excused from the ‘normal social
  role’ of being the housekeeper / mother

Question 25

Marxist Critique of Sick Role Theory

Answer 25

• Medicalizing as much of human behaviour as possible in order to
  make profits for multi-national corporations
• Less about consensual institutions or the functioning of society

Question 26

Chronic Illness Critique of Sick Role Theory

Answer 26

• Exclude recovery since it is not attainable
• Doctor-Patient relationship exists in perpetuity
• (e.g., Barker)

Question 27

Interpretivist Critique of Sick Role Theory

Answer 27

• Access to the sick role is not always legitimized by a doctor
• Many people seek out information from friends, family, internet before they ever seek the formal advice of a doctor
• (e.g., Barker)