SOC 162: The Expanding Medical Gaze? (10/12/2023) PDF

10/12/2023 THE EXPANDING MEDICAL GAZE? SOC 162 (10/12/2023) 1 About the First Midterm    Bring a scantron and a no. 2 pencil. Exam A and Exam B. Essay question – write directly on your exam.  ID and brief explanation; application;  You will be given a brief example in the test.  Possible t...

10/12/2023 THE EXPANDING MEDICAL GAZE? SOC 162 (10/12/2023) 1 About the First Midterm    Bring a scantron and a no. 2 pencil. Exam A and Exam B. Essay question – write directly on your exam.  ID and brief explanation; application;  You will be given a brief example in the test.  Possible topics for the essay question: social construction of medicine, medicalization, cultural brokerage. 2 1 10/12/2023 Social Processes of Medicalization  Last time:  Conceptualizing culture of biomedicine as “voice of medicine.” Today: “Voice of medicine” also extends far beyond the clinic.  Through processes of medicalization.  3 Lecture Outlines    What’s medicalization? Who is pushing for it? And why? So what? (What are the positive and negative consequences?) 4 2 10/12/2023 What’s medicalization?    A process by which a nonmedical problem becomes defined and/or treated as a medical problem. Initially driven by: Expansion of medical jurisdiction, into realms of social, cultural, & behavioral issues. E.g., ADHD, PTSD, PMS, baldness, shyness, etc. 5 The Case of ADHD  Emerged as a diagnostic category in 1950s: “Minimal brain damage”    Expansion of the medical category (1980s and beyond)     Expanding the definition from MBD to ADD and ADHD. Symptoms now include: “difficulty concentrating on schoolwork,” “acts before thinking,” “runs about excessively.” “Discovery” of ADHD adults. Public testimonies of famous individuals. Public awareness of ADHD (1990s and beyond)     Children’s behavioral issues (e.g., short attention span, distractibility, restlessness), now understood through a medical framework. Defined by symptoms rather than etiology. Widespread self-diagnoses. Key theme: “I finally find a medical reason/solution for my problem!” “A Ritalin culture:” Medicalizing underperformance; With a pill solution. Currently: more doctors suggest that ADHD has neurological roots, but the debate continues, and the diagnosis is still often made based on behaviors. 6 3 10/12/2023 Discussion  Why do various groups push for the medicalization of attention deficit or hyperactivity?       Doctors Parents Teachers Adult patients Pharmaceutical companies? Managed care (HMOs)? Professional jurisdiction; managing “difficult” children; permission to “fail” and/or support for struggles; profit.  Engines of medicalization: The medical profession, consumers, pharmaceutical companies, HMOs (Conrad 2005).  7 Is ADHD over-diagnosed?    Recent studies say: quite possibly. The number of children (3–17) diagnosed with ADHD: from 5.5% in 1997 to 9.8% in 2018. A 2021 study: ADHD is over-diagnosed in children and adolescents. For individuals with milder symptoms in particular, the harms associated with an ADHD diagnosis may outweigh the benefits. 8 4 10/12/2023 9 Why is ADHD over-diagnosed?   “Comparative immaturity.” Over-sensitivity to very mild cases of ADHD. 10 5 10/12/2023 Is ADHD Over-Treated?  Yes and no.  Yes: Kids with “comparative immaturity” or mild cases.  No: Kids with ADHD need both medication and behavior therapies, but most only get the former.  CDC study [Updated August 2022]:  About 23% of children with ADHD received no treatment.  About 30% received only medication.  About 15% received behavioral treatments.  About 32% received both medication and behavioral interventions. 11 So should we worry? Why?  Some parents:  What are the side effects of Ritalin?  Is the school the right one for my kids?  Some psychiatrists and doctors:  “A patient [finds] a biological cause, that is not always reasonable, for job failure, divorce, poor motivation, lack of success, and chronic depression.”  A “pill solution” may sometimes disguises other medical or issues. 12 6 10/12/2023 Over-Medicalized?  Clip from “Drugging our kids:”  https://www.youtube.com/watch?v=L7lHeosq-FY  Problems with how medications are used in this example? 13 “Can I opt out?” Obstacles Confronting Individuals who Resist Medicalization   Nicholas DuPerret To learn more:  Watch the rest of “Medicating Kids” on PBS. 14 7 10/12/2023 Updates   A letter from Nicholas’s parents: https://www.pbs.org/wgbh/pages/frontline/shows /medicating/four/nicolas_letter.html An update on Nicholas: https://www.pbs.org/wgbh/pages/frontline/shows /medicating/etc/kidsupdate.html#nicolas 15   What were some of the obstacles that Nicholas’s parents encountered as they chose to not medicalize his behavior issues? It worked out well for Nicholas at the end. However, some families may not be able to pursue similar paths. What are some examples that come to mind? 16 8 10/12/2023 Long-term Consequences  A 2017 U of Florida study finds that we may be overmedicating young kids with ADHD. A 40% chance that a 3-year-old diagnosed with ADHD would end up taking three kinds of mental health drugs by the age of 8.  A less than 10% chance that an 8-year-old diagnosed with ADHD would be on three types of mental health drugs.   A 2017 CDC study finds that most kids with ADHD have learning disabilities.  Alternative teaching styles and behavioral therapy may be more appropriate than medication for these kids. 17 “Life after Medication”?   Even for the most vulnerable kids in society, it is possible to avoid the danger of overmedicalization. What does it take? 18 9 10/12/2023 Dangers of Medicalization (1)  Foucault: Medicalization is a form of social control.  Doctors telling us what’s normal/abnormal (e.g., homosexuality, ADHD);  The claim appears scientific and objective;  We internalize the claim as truth when there should be more room for debate.  “Maybe it’s not ‘normal’ to expect 7-year-olds to sit still for an hour of math….”  E.g., Molano 2021: more than one normal? 19 Dangers of Medicalization (2)  Conrad: Medicalization leads to:  Individualizing and de-contextualizing behavioral problems.  “That kid acts out a lot more than his peers. It doesn’t seem normal. Perhaps he needs to be on XXX”  Context: “But his parents recently divorced.” “He is really afraid of his second-grade teacher.”  E.g., Will’s story (Hruska 2012): Being focused is good, but life contexts matter. 20 10 10/12/2023 Broader Examples (1): Addiction Medicalized   The body experiences withdrawal symptoms without the substance. Patient needs to go through rehab to manage the process. Understood in social contexts     Substance abuse is a coping strategy for some people living in chronic poverty. Patient needs to learn more productive coping strategies. We need structural solutions to address extreme poverty. Otherwise, patients are likely to relapse. 21 Broader Examples (2): Obesity Medicalized    Due to unhealthy eating habits and lack of exercise; Patient needs education about diet and exercise; They need to try harder. Understood in social context     When people live in unsafe neighborhoods, it’s difficult to exercise because…. When people work 3 part-time jobs, it’s difficult to exercise because…. Many low-income neighborhoods are “food deserts,” meaning…. So, addressing the larger context is also necessary, such as…. 22 11 10/12/2023 Revisit Foucault and Conrad: Two Potential Problems of Medicalization  Foucault: Medicalization is a form of social control.    Conrad: Medicalization leads to:   Doctors telling us what’s normal/abnormal (e.g., homosexuality, ADHD); The claim appears scientific and objective, but some of its claim is debatable. Individualizing and de-contextualizing behavioral problems, when the problem is caused by larger contexts or social environments. Medicalization    Can bring about powerful biomedical solutions; Can bring about cultural and material resources for patients (e.g., destigmatization; extra help at school, etc.); BUT: we need to watch out for these potential dangers. 23 12