Selling slumber: American neoliberalism and the medicalization of sleeplessness

Sleeplessness is an ancient and cross‐cultural phenomenon that is socially structured and restructured against a backdrop of ideology and inequality. In an effort to make sense of sleeplessness, some scholars have invoked the medicalization framework, which highlights consumerism, managed care, biotechnology, and physicians as key “engines” that foster the transformation of this formerly “normal” condition to one that people view as a medical problem. However, this burgeoning literature has not answered the call of medical sociologists to situate the medicalization process in a political economic context. In this article, we employ the case study of sleeplessness and the creation of the “Sleep Industrial Complex” to expand the medicalization framework and illustrate how American neoliberalism creates an ideal environment for the primary engines of medicalization. We identify three critical features of American neoliberalism—enhancement culture, commodification of health, and a “productivity imperative”—that act in concert with the driving engines to foster an environment wherein medicalization not only survives but also thrives.     

The shifting engines of medicalization

Social scientists and other analysts have written about medicalization since at least the 1970s. Most of these studies depict the medical profession, interprofessional or organizational contests, or social movements and interest groups as the prime movers toward medicalization. This article contends that changes in medicine in the past two decades are altering the medicalization process. Using several case examples, I argue that three major changes in medical knowledge and organization have engendered an important shift in the engines that drive medicalization: biotechnology (especially the pharmaceutical industry and genetics), consumers, and managed care. Doctors are still gatekeepers for medical treatment, but their role has become more subordinate in the expansion or contraction of medicalization. Medicalization is now more driven by commercial and market interests than by professional claims-makers. The definitional center of medicalization remains constant, but the availability of new pharmaceutical and potential genetic treatments are increasingly drivers for new medical categories. This requires a shift in the sociological focus examining medicalization for the twenty-first century.     

Attention Deficit‐Hyperactivity Disorder as the Medicalization of Childhood: Challenges from and for Sociology

Sociology has problematized the expanding province of medicine for several decades, and it is important to clarify some of the central questions regarding the medicalization question for those new to this subset of the discipline. With a primary focus on the diagnosis of attention deficit‐hyperactivity disorder (ADHD), this paper seeks to accomplish four goals. First, this paper will summarize the general concept of medicalization, including the way that medical practitioners attribute children’s behavioral problems to disease entities. Second, this paper argues that the medicalization of childhood and the rise of the disease entity of ADHD stems from the transformation of children and childhood into objects of scientific study. Third, using the example of ADHD, this paper will attempt to demystify the premise that medicalization emanates from the “monolith” of medicine, but is instead, a process rife with internal contradiction and epistemological disagreement. Fourth, following the uncertainty of etiological positions toward childhood behavior problems, this paper will discuss some of the external critiques of medicalization, including the way that lay actors push back against the medicalization process, and concerns about the effectiveness of technologies used to diagnose and treat ADHD.     

The institution of medicine and transgender identity construction: Between a doc and a hard place

Research shows that when transgender young people are well-supported throughout their gender transition they have similar levels of depression to their cisgender counterparts. For transgender young people who wish to transition medically, these support systems may include parents as advocates and healthcare professionals who specialize in transgender services. Decisions about steps throughout transition are made by transgender children, their parents, and their physicians. An examination of gender structure theory and medicalization literature helps to assess how medicine-on institutional, interactional, and individual levels-contributes to cisnormativity and enables us to reflect on the relationships among sex, gender, and science. This literature review aims to analyze how cultural ideologies influence medical processes that shape the identity construction of transgender children and it sheds light on parental involvement throughout transitions.     

Troubled hearts,care pathways and hospital restructuring: Exploring health services research as active knowledge

This paper explores the socially active character of contemporary forms of expertise through an institutional ethnographic analysis of health services research. The paper draws primarily on interview research to investigate how health services research helps shape text-mediated relations linking government health-care policy with local reform initiatives. In the paper, I focus on the use of a particular research report by managers, physicians, and others at a community hospital in Toronto, Canada as part of their efforts to standardize and reduce the duration of care provided to heart attack patients. I discuss how, through its intertextual presence, health services research helps to co-ordinate medical and managerial practices and rationalities into medico-administrative relations. I offer two examples of this process. The first focuses on the relations co-ordinated through the textual observance of inefficiency. The second addresses how the report helped resolve the problem of physicians’ resistance to reforming cardiac care. My analysis contributes to current perspectives on the relationship between discourse and action.     

Perceived Cultural Distance in Healthcare in Immigrant Intercultural Medical Encounters

This article responds to the paucity of empirical research on the impact of patient-provider ethno-cultural distance and providers' cultural competence on the quality of healthcare service in migrant intercultural medical encounters in Australia. A cross-sectional study was conducted with 447 patients, consisting of 195 Caucasian and 252 non-Caucasian patients from six outpatient clinics in New South Wales, Australia. Structural equation modelling was used for data analysis. The findings demonstrated that cultural distance is an influential factor in perceived quality of outpatient care. Caucasian and non-Caucasian patients' perception of cultural distance between their physicians and themselves affected their service quality ratings of their physicians' professionalism, empathy and expertise. This is the first study on healthcare service quality in outpatient clinics in Australia for Caucasian and non-Caucasian patients. Policy implications suggest intervention strategies and the need for cultural competence education in medical and health curricula in medical schools and clinical practices.     

The Medicalization of Deviance as an Interactive Achievement: The Construction of Compulsive Gambling

This article joins two lines of research from distinct areas in sociology to illuminate the mechanisms through which the meaning of “compulsive gambling” and what it means to be “a compulsive gambler” are cooperatively constructed in interaction at meetings of the fellowship group Gamblers Anonymous (GA). Combining Conrad's work on the medicalization of deviance with a social psychological focus on support group interaction, I demonstrate how individuals' experiences and identities come to be imbued with a medical vocabulary through the homogenization of the initial diversity among members. This analysis contributes to conceptualizations of the medicalization of deviance as well as to interactionist interests in the social construction of reality.     

Medicalization, Natural Childbirth and Birthing Experiences

Although much of the early sociological and feminist analysis of medicalization focused on reproductive issues and childbirth, attention has moved away from this topic over time as new conditions have become subject to the medicalization process. At the same time, one of the major concepts within this analytical framework, the dichotomy of 'natural' versus 'medical', has not been sufficiently problematized. In this article, we call for a renewed examination of the medicalization of childbirth from a critical perspective that neither takes for granted the meaning of this dichotomy, nor presupposes feminist perspectives or those of privileged groups of women. We revisit sociological frameworks and feminist critiques of medicalization, specifically around childbirth, and review scholarship that addresses their limitations. We propose a research agenda that goes beyond the traditional assumptions about 'natural' and 'medical' childbirth and examines more closely how medicalization processes both shape and conflict with women's subjective experiences of childbirth.     

Recapturing Control: Robotics and the Shift from Medicalized to Biomedicalized Surgery

ABSTRACT

Biomedicalization theory has proven itself a generative theoretical lens for examining the commodification of health and the associated constitution of new medical practices. A shift from the control over bodies to the technoscientific transformation of bodies is a major difference between the medicalization and biomedicalization eras. The case of robotic surgery provides an example of how the bodies of health care providers are being transformed while offering an opportunity to expand our understanding of the differences between these two eras. While new medical technologies can transform bodies and identities, they sometimes do so with an eye toward achieving the professional goals of the medicalization era. Ethnographic data regarding the da Vinci® Surgical System are used to elaborate these concepts. These were gathered through content analysis of marketing materials, interviews with surgical professionals, and participant-observation at a recruitment event for prospective da Vinci® surgeons. While patient-facing marketing materials alternately conflate and separate robotic surgery from the traditional, minimally invasive surgery (MIS) it is meant to replace, the participation of surgeons is obtained through the technology’s transformation of their bodily capabilities. The benefits for surgeons include increased control over laparoscopy and a reification of their place at the top of the surgical hierarchy.     

From desire to disease: human papillomavirus (HPV) and the medicalization of nascent female sexuality

This article critically examines the proliferation of information on the human papillomavirus (HPV) vaccination as integral to contemporary processes of medicalization that take the young female body and her nascent sexuality as its primary object and target. We suggest that the recent introduction of voluntary HPV vaccination for girls, in North America and elsewhere, constitutes a form of neomedicalization (Batt & Lippman, 2010 ) that links risks for future disease (cervical cancer) with the transmission of a common, sexually transmitted infection (HPV). Informed by findings from a critical discourse analysis of Canadian English newspapers, magazines, and public information about HPV vaccination, our interest is on how the emergence of sexual relationships becomes constructed as a time fraught with risks to future health, and that must be managed through biotechnological intervention (vaccination). We suggest that this configuration of medicalization, rather than demarcate a new category of abnormality that can be treated with pharmaceutical or medical intervention, positions the emergence of sexuality itself as the basis of risk and pathologization. The article concludes by considering the implications of this form of medicalization for constructions of female sexuality and sexual health education.     

The sexualization of the medical

The medicalization of sex is part of an already-in-place discursive problem that can be illuminated by looking at efforts to sexualize the medical. "Erectile dysfunction," "female sexual dysfunction," and their real and imagined pharmacopia, do not constitute the medicalization of sex; they are effects of sex already having been-to borrow a term from Peter Conrad ( 1992 )-healthicized. The equation of sex and health, as cultural common sense, has made health seem like the natural discourse for thinking about sex in the first place. Reversing the terms of this special issue, and using the methodology of rhetorical analysis, this article looks at the person with cancer as a sexualized subject-someone whose health is represented as intimately tied to his or her sex life. It suggests that, in public discourse-and notably in movies and on television-sex is the comic ending of the illness narrative. In light of this narrative move, the ability to have good sex joins the ability to be positive and cheerful as a (Western) cultural imperative of illness experience, in general, and cancer experience, in particular. Public representations of illness virtues often fail, then, to answer realistically the compelling question, "How shall I be ill?"     

Settlement has many faces: physicians, attorneys and medical malpractice

We conduct an analysis of the jurisdictional dispute over the management of medical malpractice lawsuits, focusing on the process through which liability is defined. We utilize a North Carolina sample of physicians who have been sued, their defense counsel, and counsel for the plaintiff in the case. A comparison of the perspectives of these three parties reveals that over half of the physicians who settle perceive themselves as not liable. Defense counsel are more adept at predicting both negotiated resolutions and whether or not money will be paid than either plaintiffs' counsel or physicians. Almost two-thirds of physicians who thought they were not liable expressed a desire for vindication. Almost half the time when the physicians denied liability money was nonetheless paid to resolve the claim. Physician responses to the outcome of their cases focus on the need for reform, especially in terms of a call for peer or expert review. We identify and discuss culture conflict between law and medicine. For lawyers "settlement" is not a negative thing, but for physicians it implies fault. We challenge existing literature which analyzes the settlement of medical malpractice claims solely in terms of rational economic models, and we argue that social psychological variables are equally important.     

Public attitudes toward the use of psychiatric medications for children

Psychiatric medication use for children has increased dramatically over the past three decades. Despite substantial media attention to the issue, little is known about how the lay public feels about the use of psychiatric medications for children. Drawing on theories of medicalization, we describe and analyze Americans' attitudes towards the use of psychiatric medications generally and Prozac specifically for children described as having three types of behavioral problems. Using data from the 1998 General Social Survey's Pressing Issues in Health and Medical Care Module, we find that more Americans (57%) are willing to use psychiatric medications for children who have expressed suicidal statements than for "oppositional" behaviors (34.2%) or for hyperactivity (29.5%). Across the board, respondents are less willing to give Prozac than the general class of psychiatric medications. While socio-demographics do little to identify Americans with differing positions, the strongest and most consistent correlates of willingness to give psychiatric medications to children are trust in personal physicians, general attitudes towards psychiatric medications, and the respondent's expressed willingness to take psychiatric medications herself or himself.     

Medicalizations and demedicalizations of sexuality therapies

This article complicates recent discussions about the expanding zones and influences of medicalization and biomedicalization on sexuality and sex therapy by contextualizing them with competing nonmedicalizing trends. These latter developments include an escalating nonexpert commercial sexuality sector on the Internet, as well as a long history of anarchic and democratizing social politics, such as "the counterculture" and "free love movements." What these nonmedicalizing trends have in common is the view of sexual problems and solutions as far broader than sexual dysfunctions and sex therapies, a belief in the social determinants of individuals' sexual experiences, and a deep concern regarding the socially harmful consequences of medicalization. With the quantity of sexuality information and advice available to the public through the Internet only likely to expand, a long era of clashing claims about relations between sexuality and health and about the role of expertise in sexual life can be foreseen.     

Medicalization of Social Problems: Rising Depression-related Absenteeism in Japan

Increasing numbers of people are absent from work with a diagnosis of depression, and this has become a social problem in Japan. This study examines the hypothesis that this rise of depression-related absenteeism in Japan is influenced by social factors that contribute to the medicalization of social problems. Here, “social factors” are corporate systems that affect workers' psychology and mental health, media coverage and disease awareness campaigns by pharmaceutical companies, the intentions of patients' physicians, as well as psychopathological factors such as increased workplace stress. Data were obtained from semi-structured interviews conducted with 50 workers who had a history of taking depression-related leaves of absence, and a re-diagnosis by six physicians of 10 representative cases derived from categorizations based on data from the interviews. The data were analyzed to identify social factors underlying the rise in depression-related absenteeism and the mechanisms of medicalization of social problems. Social factors found to affect the rise of depression-related absenteeism include mentalities whereby patients, seeking to escape from harsh work environments, may wish to receive a diagnosis of depression to take a leave of absence; and the intention of participants' physicians to provide the diagnosis out of sympathy even when official diagnostic criteria are not met. Thus, it would seem that work-related social problems that should normally be addressed by public policy measures are in fact being medicalized. Moreover, this study considers how “self-medicalization” by patients renders the solution to social problems more complex by contributing to the further medicalization of social problems.     

How discrimination in adoptive,foster, and medical systems harms LGBTQ+ families: Research on the experiences of prospective parents

Abstract

LGBTQ+?people face multiple challenges to parenthood because of barriers such as discriminatory legislation and policies influencing foster parenting, adoption, and reproductive health services. This study documents these obstacles and examines their impact through a grounded theory analysis of interviews of LGBTQ+?prospective parents. Stressors included social isolation, unnecessary medicalization, prohibitive financial costs related to accessing social and medical services (sometimes across state lines), and being denied services, parental leave, and insurance coverage. Findings indicate that heteronormative attitudes and discrimination can lead to debilitating and enduring harm upon the economic, emotional, and relational well-being of growing LGBTQ+?families.     

Medicalized mothering: experiences with breastfeeding in Canada and Norway

This paper explores infant feeding practices and experiences of mothers in Canada and Norway, two countries where breastfeeding rates are relatively high. Based on interviews with 33 Canadian mothers and 27 Norwegian mothers, we also examine how mothers feel, think and talk about their infant feeding decisions and experiences, and examine similarities and divergences across their stories. Our findings reveal that infant feeding is very much organized according to the logic of the broader medical discourse, a finding which lends support to arguments that contemporary parenthood is characterized by a process of increasing medicalization. Our findings also reveal the existence of a broader culture of pressure, competition, judgement and surveillance regarding breastfeeding, suggesting that the high breastfeeding rates in these two countries are not merely a result of favourable structural conditions, but also of strong cultural expectations towards breastfeeding. We discuss our findings in connection with the broader argument that medical discourses and health professionals are becoming the primary authorities and moral gatekeepers of contemporary parenthood.     

Misdiagnosing medicalization: penal psychopathy and psychiatric practice

Theory and Society - This article offers a critique and reconstruction of the concept of medicalization. Most researchers describe medicalization as the redefinition of social problems as medical...     

Normative Accountability: How the Medical Model Influences Transgender Identities and Experiences

The medicalization of gender variance is a key force in transgender people's experiences of embodiment, identity, and community. While most directly dictating experiences of diagnosis and medical classification, it is important to acknowledge that the effects of medicalization are widespread across social contexts and institutions. I explore the medical model of transgender identity, with special attention to its current diagnostic classification, in order to highlight how transgender people's interactional experiences of gender are shaped by medical authority. I review literature that highlights the operation of the medical model as a normative accountability structure in its influence across multiple institutions of social life including health and healthcare, transgender community groups, and legal classification.