The Global Sociology Blog

I know this is Todd Krohn‘s turf but the topic of the ways more and more conditions and behavior come to be defined or redefined as medical conditions to be treated through pharmacology is both sociologically a perfect case study in social construction and labeling but a scary display of the intersection of socially-induced pathologies then treated through powerful social institutions who get to command the discourse on such deviant behaviors.

What is especially interesting to me is, in the medicalization process, the elimination of the social, economic and political as the background against which behaviors and conditions come to be defined as forms of deviance to be treated medically. In other words, medicalization becomes a discourse of legitimation that preserves power dynamics within the social system intact. In this sense, medicalization serves as a cover discourse (with the trappings of science) to evacuate the social aspects whose proper treatment would be better social and public policy. A very obvious example of this was the recent news of the large numbers of suicides among veterans (among other social pathologies widespread in the military, as mentioned in the article).

It is actually quite “funny” that the article lists a whole bunch of social reasons why servicemen and women commit suicide but keeps coming back to “but we don’t know why people commit suicide):

“The numbers reflect a military burdened with wartime demands from Iraq and Afghanistan that have taken a greater toll than foreseen a decade ago. The military also is struggling with increased sexual assaults, alcohol abuse, domestic violence and other misbehavior.

Because suicides had leveled off in 2010 and 2011, this year’s upswing has caught some officials by surprise.

The reasons for the increase are not fully understood. Among explanations, studies have pointed to combat exposure, post-traumatic stress, misuse of prescription medications and personal financial problems. Army data suggest soldiers with multiple combat tours are at greater risk of committing suicide, although a substantial proportion of Army suicides are committed by soldiers who never deployed. [Note: but the probability of being deployed might play a part]“

Or later in the article,

“The numbers are rising among the 1.4 million active-duty military personnel despite years of effort to encourage troops to seek help with mental health problems. Many in the military believe that going for help is seen as a sign of weakness and thus a potential threat to advancement.

Kim Ruocco, widow of Marine Maj. John Ruocco, a helicopter pilot who hanged himself in 2005 between Iraq deployments, said he was unable to bring himself to go for help.

(…)

“It’s a sign in general of the stress the Army has been under over the 10 years of war,” he said in an interview. “We’ve seen before that these signs show up even more dramatically when the fighting seems to go down and the Army is returning to garrison.”

But Xenakis said he worries that many senior military officers do not grasp the nature of the suicide problem.

A glaring example of that became public when a senior Army general recently told soldiers considering suicide to “act like an adult.”

In other words, the article keeps providing perfectly good social, institutional / organizational, and cultural explanations for the suicide rates but keeps returning to the “we just don’t know” as if these could not possibly be sufficient.

I think part of this skepticism is because the pattern does not hold in 100% of cases. It is a kind of skepticism that plagues the social sciences and that, I am sure, many of us have faced in the classroom as we describe statistical patterns of behavior, showing that, under certain conditions, X% of people tend to do A, then, some dude raises his hand to tell us that his brother-in-law (sister, cousin…) actually met the conditions and did B, so, the pattern is not true.

Social explanations are never good enough in the context of individualism and, especially in the case of behavior defined as deviant, the puritan moralism (David Brooks, take a bow) that passes for sociological explanation and that is so much more satisfying to the moral entrepreneurs.

Anyhoo, back to the medicalization of everything especially social ills as cover up to keep systems of power and stratification intact, evidence 1:

“One in four men, and one in three women, has endured recent bouts of depression. As the grinding economic crisis continues to batter people’s nerves, suicides and psychosomatic illness are both on the increase.

In April, a 77-year-old retiree, explaining in a note that he could no longer scrape by, went to a public square in the middle of Athensand put a bullet into his brain, a shot that echoed throughout the country.

While politicians and economists argue about how to pull Greece out of the quagmire of debt that has kneecapped its economy, there can be no doubt that the crisis — once again threatening to eject the country from the eurozone towards an unknown fate — is taking a devastating toil on the mental health of its people.

Compounding the emerging health care emergency is the fact that the state’s ability to cope with it has been deeply eroded by theausterity measures and slashed budgets prescribed to cure the patient.

If you’re going to have a nervous breakdown, in other words, Greece is not the best place to be.”

LOL… don’t you love that last line and how it erases the causality: it is because people ARE in Greece that they are having nervous breakdowns, not a bunch of depressed people who shouldn’t go to Greece because the mental health system sucks. The mental health system is over capacity because the Masters of the World have decided that Greeks should suffer… and so they do. And guess what, widespread systemic collapse hurts.

It hurts in Greece, but it also hurts in Italy:

“Dozens of Italian women widowed when their husbands killed themselves because of the recession will march on Friday to bring attention to their plight.

The grieving wives and family members of more than 25 businessmen who have committed suicide because of financial woes linked to Italy‘s economic crisis – dubbed the “white widows” by the Italian media – will be led by Tiziana Marrone, the unemployed wife of a craftsman who set fire to himself outside the tax office in Bologna last month, dying nine days later.”

And one cannot help but notice that when social causes are accepted as sufficient to explain these suicides, then, no specific help or policy is really forthcoming. There is no medication that the pharmaceutical industry could provide and cuts to health benefits, as required by austerity, are the first be implemented. Easing social pain can only be done socially and systemically. So, it is not happening.

I would also note that no one expands on the role of masculine socialization in these, mostly male,  suicides. If women committed suicide in large numbers, you can bet that there would be loads of experts on gender telling us that departures from “traditional” gender roles (whatever the hell that means) are leading to this mental health disaster.

And it goes on and on:

“Mental health advocates say that stress and anxiety caused by job insecurity is threatening to become a major public health problem in Australia.

Beyond Blue, one of the nation’s most prominent mental health organisations, says job insecurity is one of the leading risk factors for depression and even heart disease.

Beyond Blue CEO Kate Carnell says research indicates that the casualisation of the Australian workforce has resulted in an increase in mental health disorders and heart disease amongst workers.

With 40 per cent of the Australian workforce in insecure work arrangements, Ms Carnell says it has become a serious public health problem.

“Heart health is affected by exercise levels, stress levels, dietary approaches and so on, so bad lifestyle outcomes can cause definite heart problems and mental health is very much part of that whole mix,” she said.

“There is no doubt that job insecurity is a major major cause of job strain and job strain is a major risk factor for depression.

“So we’re seeing more depression in the workplace, we’re seeing more absenteeism and almost more importantly more presenteeism – people who are coming to work when they are depressed without the capacity to concentrate enough, and that can be an issue with other people in the workplace.

“They’re coming to work simply because they’re scared of losing their jobs.”

One could never have guessed that living in the precariat could lead to mental illness (and I suspect that presenteeism is very much akin to Merton’s strain theory’s ritualism). And here again, read the whole article and you will find that once social causes are accepted, no solution is forthcoming. Every expert shakes hir head at what precarization does to people but no one suggests, maybe, just maybe, some structural change might be needed. Nope.

At the same time that socializing deviance leads to a relative shrug as to what should be done, the reverse happens when behaviors and conditions are medicalized, diagnosed and treated:

“In what could prove to be one of their most far-reaching decisions, psychiatrists and other specialists who are rewriting the manual that serves as the nation’s arbiter of mental illness have agreed to revise the definition of addiction, which could result in millions more people being diagnosed as addicts and pose huge consequences for health insurers and taxpayers.

(…)

In addition, the manual for the first time would include gambling as an addiction, and it might introduce a catchall category — “behavioral addiction — not otherwise specified” — that some public health experts warn would be too readily used by doctors, despite a dearth of research, to diagnose addictions to shopping, sex, using the Internet or playing video games.”

This is because the DSM is not just the profession’s standard. It is a reflection of the power of the mental health medical establishment in staking new territory for itself, as under its expert jurisdiction produced as an scientific and objective updating of the field. And for those behaviors and conditions now listed in the manual, there are treatments and professional to administer them. Foucault would have a field day with this. And note that the controversial nature of these new guidelines is not that some “not otherwise specified addiction” is not, well, an addiction, but that it’s going to cost money to treat. One of the key concepts for the profession to stake a new claim is the concept of “spectrum”, constructed as grabbing a whole bunch of conditions and behaviors, now redefined as related as part of the spectrum.

The result, of course, is something that has been known for a few years now: the medicalization of younger and younger children with psychotropic drugs (thanks to The Sociological Imagination for the initial posting on this report):

Part 1

Part 2:

Part 3:

Part 4:

If Louis Theroux annoys you (he does me), there is an older PBS Frontline documentary on a similar subject, albeit a bit older. The whole video is here, broken up into chapters.

This documentary does a great job of showing how a medical condition, such as ADHD, is socially constructed. See chapter 3 especially on that.

But beyond that, as medicalization spreads, it also becomes part of the larger culture so that when one thinks about specific issues one faces, such as cramming for school exams, then, it feels “natural” to turn to medical and chemical substances (via Todd Krohn):

“At high schools across the United States, pressure over grades and competition for college admissions are encouraging students to abuse prescription stimulants, according to interviews with students, parents and doctors. Pills that have been a staple in some college and graduate school circles are going from rare to routine in many academically competitive high schools, where teenagers say they get them from friends, buy them from student dealers or fake symptoms to their parents and doctors to get prescriptions.

“It’s throughout all the private schools here,” said DeAnsin Parker, a New York psychologist who treats many adolescents from affluent neighborhoods like the Upper East Side. “It’s not as if there is one school where this is the culture. This is the culture.”

Observed Gary Boggs, a special agent for the Drug Enforcement Administration, “We’re seeing it all across the United States.”

The D.E.A. lists prescription stimulants like Adderall and Vyvanse (amphetamines) and Ritalin and Focalin (methylphenidates) as Class 2 controlled substances — the same as cocaine and morphine — because they rank among the most addictive substances that have a medical use. (By comparison, the long-abused anti-anxiety drug Valium is in the lower Class 4.) So they carry high legal risks, too, as few teenagers appreciate that merely giving a friend an Adderall or Vyvanse pill is the same as selling it and can be prosecuted as a felony.

While these medicines tend to calm people with A.D.H.D., those without the disorder find that just one pill can jolt them with the energy and focus to push through all-night homework binges and stay awake during exams afterward. “It’s like it does your work for you,” said William, a recent graduate of the Birch Wathen Lenox School on the Upper East Side of Manhattan.”

And here again, the problem, as the article writers see it, is that this might lead to more mental health issues and deviance (the strategies to get a prescription), not the very fact of using these substances for school work, not the whole system that creates that need for chemical support, not the fact that this is the way the upper classes get their edge in the academic race, not the organization of the academic system itself. Again, behind the substance discussion, the central social aspects are pushed to the background.

This reminds me that, a couple of years ago, a well-known company selling energy drinks came to my campus during final exams week to give out free samples of their products. No one can come and distribute stuff to campus without administrative approval. Apparently, someone thought this was a good idea. Let’s pump them full of the thing and it won’t matter that they have to work two jobs to pay for college.

On the other end of the social spectrum, medication can be used a naked social control (here again, via Todd Krohn):

“Georgia’s foster children are being over-medicated, often to sedate them or control their behavior rather than treat a medical condition, a new study confirms.

The question is: What should Georgia do about it?

(…)

Giovan Bazan, now 21, said he almost died at 16 when a combination of medications caused him to convulse and vomit. A sedative made it difficult for him to sit up in bed, Bazan said, and he would have suffocated if the staff at his group home hadn’t recognized the danger and come to his aid.

Bazan told the state House Health and Human Services Committee that foster parents had used more medications and stronger doses to control his behavior. He said juvenile justice officials also warned that they would not end his probation unless he kept taking his medication.

“Obviously as a youth we have a bit of rebellious spirit,” he said, “but that doesn’t mean that we are mentally ill.”

Mason McFalls, 24, said nearly every child he met in 14 years in foster care was taking psychotropic medications.

“I’ve seen kids literally shaking from being so wound up on the medication,” McFalls said.

Frequently, foster children are treated by a different doctor every time they’re moved to a new foster home, authorities say. Those doctors generally do not have access to a child’s medical history, so they may diagnose different disorders and prescribe different drugs and treatment.”

Well, at least, they don’t have to come up with strategies to get prescriptions, like the upper-class kids.

So where am I going with all this? Simply with the fact that how we define, diagnose, treat (or not treat) mental illness involve a whole bunch of variable such as masculine (in the case of the military) or competitive subcultures, organizational and institutional structures, the structure of professional organizations competing for power and various forms of capital, as well as the social status of affected populations and general socio-economic conditions. And all these variables, put together also point to the fact that labeling of conditions or behavior as “mentally ill” they either leave people to fend for themselves when the source of their mental health problems is unavoidably social, or hides the social nature of mental disorders.