Medicalization of Deviance
This article examines the medicalization of deviance through a sociological lens. A definition of deviance is offered in terms of behavioral conduct, and indicates potential reasons individuals behave in a deviant manner. Next, a description of the medicalization of deviance is offered that describes ways deviant behaviors have been re-categorized as medical conditions that can be treated through the use of pharmacological interventions. Accompanying applications are offered through the lens of alcohol and substance abuse. Issues are discussed that relate to treatment and conflicting philosophies. Subsequent areas of research for sociologists examining this phenomenon are suggested.
Keywords Deviance; Medicalization of Deviance; Social Constructionism Theory; Social Learning Theory; Socialization
The Medicalization of Deviance
From a historical perspective, the study of deviant behavior and social control began in the late 1960s. Interest emerged in ways categories of deviance are created, how the conflict among interest groups shapes the definition of what is considered deviant, and detailed ways that social policy about deviance develop and change over time (Horwitz, 1981, p. 750). From a reflective perspective, Higgins (1998) observes that "many of us take for granted" that those who engage in deviant behavior "are different kinds of people than we are" (p. 141). This belief is reinforced by stereotypical images of crime and deviance promulgated by the mass media, which often portray offenders as immoral, impulsive, insane, or otherwise unique (Donziger, 1996). From a definitional perspective, Brezina (2000) indicates that deviance and conformity can best be described as
"labels or definitions that are differentially applied to various individuals and their behaviors—not in terms of the personal attributes of the individuals, nor in terms of the intrinsic qualities of the behaviors individuals display… Second, sociological theories of deviant involvement are based on the implicit or explicit rejection of explanations focusing on unique personal characteristics, especially abnormal traits of a biological or psychological nature" (p. 72).
Akers (1994) indicates that sociological theorists tend to assume that biological and psychological variations are "more or less within the normal range" and that little or no deviance is directly caused by abnormal physiology or psychology (p. 69). Merton (1938) had previously indicated that strain theorists provide the most forceful argument in this regard by stating that participation in deviant behavior most often represents "the normal reaction, by normal persons, to abnormal conditions" (p. 672). Moreover, Orcutt (1978) indicates that deviance is socially constructed and exists in relation to "interactional processes through which acts and actors are socially defined as deviant" (p. 346). According to researchers, deviant behavior emerged in society after “component elements of the social and cultural structures existed in contradiction, thereby exerting pressure on individuals to engage in forms of illegitimate behaviors (Merton, 1957; Sumner, 1994).” Merton (1995) also indicates that deviant behavior is “more likely to emerge in societies where the emphasis on cultural goals was inconsistent with the available means to achieve them” (Parnaby & Sacco, 2004, p. 3).
Social Learning Theory
From a theoretical perspective, social learning theory (Akers, 1985; Burgess & Akers, 1966) posits that people hold definitions of deviance and prosocial behavior that vary according to how they are reinforced:
… the definitions themselves are learned through reinforcement contingencies operating in the socialization process, and they may function less as direct motivators than as facilitative or inhibitory "discriminative stimuli" or cues that signal that certain behavior is appropriate and likely to be rewarded or inappropriate and likely to be punished in a given situation. It is the anticipated reinforcement or punishment that provides motivation for the behavior independently of whatever motivation to engage in or refrain from an act comes from the fact that it conforms to or violates one's beliefs or definitions (Akers, 1996, p. 239).
Akers (1996) further states, "Deviant models are available outside the family and other conventional socializing institutions, in the media, and among peers" (p. 239).
Brezina (2000) indicates that the tendency of individuals to rationalize their deviant involvement can be observed across a wide spectrum of deviant behavior, from academic cheating to interpersonal violence. Moreover, while rationalizations employed by academic cheaters and violent offenders may differ in substance and form, they serve essentially the same function or goal: to justify deviant acts and to neutralize moral prohibitions (p. 77). Stanley Milgram's (1974) classic "obedience" experiments, as described by Higgins (1998), also suggest that ordinary people—not just deranged or disturbed people—have the capacity to deliver harm when circumstances make it doable or justifiable (p. 138–141).
Sykes and Matza (1957) point out that the prohibition of an act and definitions that justify the deviant act may be a product of an embedded general normative system. Patterson (1975) notes that, unaware of the system criteria, "parents and other socializers may make inefficient or inconsistent use of rewarding and punishing sanctions with the unintended outcome of reinforcing behavior that is contrary to their own normative standards" (cited in Akers, 1996, p. 239). Moreover, perceived behaviors and rewards play a role in whether individuals violate the general normative system. For example, an individual's "learned normative definitions may be violated because the rewards for the behavior outweigh the normative inhibitions. Individuals may refrain from law violation, despite having learned definitions favorable to violation, because individuals may anticipate more cost than reward attached to a given violation" (Akers, 1996, p. 239).
In attempts to better understand and reframe deviant behavior, theorists began to re-categorize deviance from a medicalized perspective, with one caveat: other trends were present in the study of deviance and societal reactions to deviance, and medicalization is only one way of looking at increased levels of deviance (Horwitz, 1981, p. 751). Many political and economic aspects affected the growth of medicalization within the context of the expanding US welfare state and are perhaps the most important unexplained aspects of the developments considered in the understanding of the medicalization of deviance (Horwitz, 1981).
The Medicalization of Deviance
According to Horwitz (1981), the medicalization of deviance "refers to the tendency to define deviance as a manifestation of an underlying sickness, to find the causes of deviance within the individual rather than in the social structure, and to treat deviance through the intervention of medical personnel" (p. 750). Types of deviance that have been viewed through the lens of medicalization include:
• Mental illness;
• Opiate addiction;
• Child abuse;
• Homosexuality; and
• The biological study of crime.
Societal reactions to deviance include deinstitutionalization, normalization, mainstreaming, and the expansion of due process rights, which seem opposed, or at least somewhat related, to medicalization (p. 750). Horwitz (1981) further indicates that "medicalization should not be regarded as the sole, or possibly, even the major trend in deviance definition but rather as one of a number of sometimes conflicting developments in the societal reaction to deviance" (p. 751). He continues,
Social policy toward deviants is undergoing dramatic changes. Medicalization requires a substantial resource base and funding for social services is undergoing a drastic decline. For students of social control this situation raises the question of whether medicalization as an explanation of deviant behavior will decline as resources for treatment are withdrawn (p. 752).
The medicalization of deviance can be viewed through the lens of social constructionism, which defines social problems as created by various political and ideological forces rather than being only a "part of the nature of things" (Berger & Luckman 1967, p. 52). Ajzenstadt and Cavaglion (2005) explain that social constructionism
assumes that the meaning of events and human behavior depends on dimensions of cultural and social practices. The construction of a social problem and its cultural categorization (Best, 1995) are a function of the interplay between various interest groups. This interplay subsequently impacts social actions in defining and attempting to resolve problems, while determining the extent of their social and political power, public image, access to the media, and influence on the state apparatus (Pfohl, 1977)—within a specific socio-historical context (Costin, Karger, & Stoesz, 1996; Nelson, 1984). Such individuals can be defined as "claimmakers" (Spector & Kitsuse, 1977), as they utilize a variety of techniques to organize public and official perceptions of the "problem." Claimmakers bring their issue to the public agenda through the influence of power relationships, cultural resources, and professional ideology (Bogard, 2001; Rafter 1992), as well as via a continuous dialogue with their audience, seeking public legitimization in an attempt to make their claims "believable" (Loseke, 1999) (Ajzenstadt & Cavaglion, 2005, p. 256).
More research into this arena is highly suggested, especially the impact of lobbyists on the political arena as a potential manifestation of the definitional process of the medicalization of deviance.
(The entire section is 4455 words.)